Conceptualising and Working with ‘Psychosis’ in Assertive Outreach Teams: A Grounded Theory Study

Part One: Literature Review - Purpose: To determine current opinions amongst mental health professionals regarding the aetiology of ‘schizophrenia’ Method: Literature searches were conducted using online databases. Search terms included: schizophrenia, psychosis, cause, etiology, aetiology, beliefs, causal, explanatory models, conceptual models, causal beliefs, psychologists, nurses, psychiatrists, staff, professionals, workers. Results: Thirteen relevant studies were identified: 11 cross-sectional surveys, 1 quasi-experimental design, 1 peer-professional autobiographical account. Conclusions: The majority of health professionals favoured biological aetiology. Aetiological beliefs are related to preferred management strategies. Biological aetiological beliefs are amenable to change through the use of a training programme. Part Two: Research Report - Objectives: To explore 1) What understanding staff members have of possible causes of clients’ unusual experiences and distress? 2) What approach do staff members take in promoting recovery and how is this related to their construction of ‘psychosis’? 3) How are differences in opinions about treatment and recovery negotiated between clients and staff or between the individual staff member and the team? Method: Semi-structured interviews were conducted with eight mental health professionals working in four separate Assertive Outreach teams, spanning two regions of the East Midlands. Interview data was analysed using grounded theory methodology. Results: A model was developed based on two continuums between the core categories of ‘expert position’, ‘being with’ and ‘dependence’, ‘independence’. Four contributory categories ‘conceptualisation of mental health difficulties’, ‘focus of recovery’, ‘risk and responsibility’ and ‘team/organizational factors’ influence the position that professionals. Conclusions: Professionals’ approaches to understanding and working with people experiencing mental distress are context-dependent. Biomedical conceptualisation tends to be associated more frequently with the ‘Expert Position’, but other factors such as risk and resource limitations can also move professionals towards this way of working. Part Three: Critical Appraisal - This is a reflective account of the research process and some of the challenges encountered.