Title: Joining up primary and specialist care for people with complex mental health difficulties: a mixed methods study to produce an implementation toolkit
Funder: Department of Health and Social Care

Abstract: Background This work aims to narrow the gaps between people with complex mental health difficulties, their GPs and specialist services. Complex mental health difficulties include (but are not limited to) personality disorders, neurodevelopmental co-morbidities and the consequences of trauma. Complex mental health difficulties are increasingly recognised in NHS policy as important. Research Questions: The overarching research question is &ldquo;How can general practices better identify people with complex mental health difficulties, and provide care in a way which integrates primary care and specialist services?&rdquo;. Four sub-questions address GP s perceptions, patient experience, using electronic health data and improving practice. Methods Mixed methods study with four workstreams: 1) qualitative interview study of GPs to understand how they recognise and provide care for people with complex mental health difficulties; 2) qualitative interview study of people with complex mental health difficulties about their experience of primary care and its integration (or not) with specialist services; 3) analysis of electronic health data to identify patterns of diagnoses, attendance and treatment in order to improve recognition of complex mental health difficulties; 4) integration of workstreams 1-3 and development of an implementation toolkit suitable for use as new services are developed. Implementation plan This research will be conducted with implementation in mind from the start. We will produce an implementation toolkit combining clinical knowledge, practice database searches, and examples of good practice. Health equity This research will take place in communities with low income, low home ownership and high ethnic diversity. Patient Public Involvement and Engagement People with complex mental health difficulties have influenced the design of this research. We are currently recruiting two lay members to the project team. We will invite a lay person to our steering committee and hold at least two stakeholder events to which patients and the public will be invited to contribute.

Lay abstract: We want to improve the way GPs work with specialist services to help people with complex mental health difficulties. By complex mental health difficulties, we mean repeated episodes of anxiety and depression, with long-term unpredictable changes in mood and difficulties in relationships. Many people with complex mental health difficulties have had difficult childhoods. Some have had difficulties with drugs and alcohol, and some repeatedly experience thoughts of harming themselves. Complex mental health difficulties increase the risk of suicide and accidental harm. People with complex mental health difficulties are often missed by NHS services that focus on either the most severe mental disorders (e.g., psychosis) or simpler ones (uncomplicated anxiety or depression). Recently new services have been launched for people with complex mental health difficulties. In this research we will find out how people with complex mental health difficulties are recognised by GPs and how general practices should work with new services to provide them with joined-up care. Our research will do four things. First, we will interview GPs about how they recognise complex mental health difficulties and how they try to help. Second, we will interview people with complex mental health difficulties about their experiences of using general practice for their mental health issues. Third, we will analyse anonymised GP records to find patterns of diagnosis, attendance and prescription which can help with recognising complex mental health difficulties. Finally we will bring the three pieces of work together to make recommendations and a toolkit to help practices and new services work together. People with complex mental health difficulties have helped and will continue to help in designing, running, and reporting this research so that it focuses on their needs. We will focus on recruiting participants from communities which have low income, low home ownership and high ethnic diversity.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: MENTAL HEALTH