#MHNR2020

Experiences of care continuity and recovery for people at the interface of primary and secondary mental health care in Wales: a thematic discourse analytic approach

This PhD thesis is about experiences of care continuity and recovery for people with serious mental health issues who have been discharged from secondary services in Wales. Recent service structure transformation, surrounding the Mental Health (Wales) Measure 2010, has aimed at implementing recovery-based services, where there is an expectation of self-management after discharge to primary care. This has led to greater movement across the interface of primary and secondary care, which may cause disruptions to care trajectories and hinder recovery

Aim - The study aims to investigate experiences of care continuity and recovery for people at the interface of primary and secondary mental healthcare in Wales.

Method - A qualitative methodology employed in-depth, semi-structured interviews.

Analytical approach - Interview transcripts were subjected to thematic analysis incorporating discourse analysis.

Findings - First, participants’ expectations were misaligned with transforming service structures and interfaces. Second, participants constructed competing versions of recovery in their talk. Third, analysis revealed multiple experiences of care discontinuities concentrated at the primary care level.

Discussion - A proliferation of bottom-up competing recovery versions and misaligned expectations of transforming services are closely allied with escalating service system complexity and fragmentation. This has detrimental implications for care continuity and coordination. Top-down policy-based recovery implementations, such as the Measure, are seen as neoliberalist colonisations of the recovery concept. The Habermasian social theory of system versus lifeworld is employed to provide a theoretical context for understanding recovery colonisation. Systematic distortion of an emancipatory recovery concept rooted in the lived experience of the service user is a further factor for escalating complexity.

Conclusion: Service complexity and fragmentation result from a polarisation towards either a proliferation of bottom-up, emancipatory recovery versions, or hegemony of top-down, colonised recovery implementations. Policy aimed at promoting recovery-based services should strike a balance between top-down and bottom-up recovery versions to avoid such polarisation and contain escalating service complexity.