Introduction and aim: Severe mental illness (SMI) patients’ needs in psychiatric day hospitals have not received enough research attention. There is a lack of in-depth knowledge about the nature and context of their needs. This research aims to assess the needs of this population in Slovenian psychiatric day hospitals, to analyse their organizational and cultural characteristics, and to determine the range of needs that can be met in this setting.
Methods: A mixed-methods approach was used with a multiphase design combining sequential and concurrent sets. A smaller quantitative part was placed in the dominant qualitative methodology. To collect data, triangulation was conducted, namely individual interviews (n=15) and focus groups (n=18), as well as a standardized questionnaire. A purposive sample was used in the qualitative part, while in the quantitative part, the entire population of patients attending the day hospital in the three psychiatric hospitals was researched. In total, 85 participants participated in the qualitative part - experts, patients and relatives from health and social services. In the quantitative part, 75 patients filled out the questionnaires. For the qualitative data, content and thematic analyses were carried out. The quantitative data were analysed by using descriptive statistics with methods of determining association. Standardized needs self-assessment supplemented the data set.
Results: The qualitative analysis in the first phase reveals a diverse spectrum of needs patients in psychiatric with SMI in day hospitals. The analysis yielded six themes (19 categories): optimal daily functioning, work and educational activities, social network inclusion, continuous treatment, support and guidance, and long-term care. The second phase reveals paths how to address identified needs in the day hospital setting (21 categories, six themes): help in planning and performance of daily activities, help with employment and independence, help with creating and strengthening a safe social network, supporting accepting treatment, establishing an appropriate therapeutic relationship and providing the accessibility of other services. On average, five unmet needs (standard deviation 3.158) were identified per patient by standardized self-assessments, which represents a serious problem. More than 50% of patients revealed their needs to address psychological distress and lack of companionship, followed by physical health, sexual needs, needs to reduce psychotic symptoms, help with daytime activities and intimate relationships. The whole range of needs identified as unmet needs was more than 40%. The needs assessment mostly did not differ between patients, relatives and experts, except for medication treatment and the cooperation of relatives. A qualitative needs assessment enabled an in-depth assessment of needs. It enabled understanding of the background of the need, obstacles and other circumstances, as well as the possibility of determining about unmet needs satisfaction.
Conclusion: This study is the first research in Slovenia and one of the few in Europe and globally that used triangulation to assess the needs of patients with severe mental illness. Due to the complexity and systematic nature of data collection and analysis, it represents an important contribution to science. The research contributes to a better understanding of the needs of patients with severe mental illness and provides an improved and in-depth description of their needs with insights into how to address them better. Besides the clinical treatment, needs regarding continuous treatment, psychological and social needs should be considered routinely in day hospitals settings.
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