Perspectives of people with enduring mental ill health from a community-based qualitative study.

BACKGROUND The views of people with enduring mental ill health have received limited exploration. Existing work has largely focused on patients in specialist mental health settings, rather than on a wider range of patients in the community. AIM To explore experiences and perceptions of health care of people with enduring mental ill health. DESIGN OF STUDY A community-based qualitative study using theoretical sampling, in-depth interviews, and grounded methodology. SETTING A total of 34 responders registered with four general practices, serving five wards with a mean Townsend Deprivation Score of 7.75. METHOD Subjects were chosen using a theoretical sampling framework and they participated in one-to-one interviews which were audiotaped. Themes were identified and developed by reading transcripts, then they were further refined and classified manually by open coding into key categories using a grounded approach. RESULTS The primary goal of the responders was to enhance, sustain, and take control of their mental health. The building of positive therapeutic relationships with professionals based upon effective communication, trust, and continuity were important to achieving this aim. However, the settings in which their health care took place could affect responders' attempts to deal with social stigma. Experiences of social isolation, socioeconomic privation, and stigmatisation were often pervasive. These compromised responders' opportunities and their capacity to enhance their mental health, compounding their illness and marginalisation. CONCLUSIONS This study shows the potential of health professionals to empower people with enduring mental ill health, by attending to the quality of communication and continuity of care they provide and to where this takes place. It further underlines a need to address the social stigma and exclusion this group experiences.