Practitioner relationships and quality of care for low-income persons with serious mental illness.
OBJECTIVE
Though central to experiences of mental health care for persons with serious mental illness, relationships with practitioners have been underemphasized in recent quality-of-care research. This qualitative study described concepts of good care in relationships with psychiatrists, therapists, and case managers from the perspectives of low-income persons with psychiatric disabilities.


METHODS
In-person, semistructured interviews were conducted with 51 adult Medicaid enrollees with psychiatric disabilities and diagnoses of schizophrenia. Grounded theory techniques were used to analyze the data.


RESULTS
Eight categories representing service users' priorities for care in practitioner relationships resulted from the analysis: getting "extra things," looking for common ground, feeling known, the importance of talk, feeling like "somebody," practitioner availability, practitioner flexibility, and opportunities for input into treatment.


CONCLUSIONS
Quantitative and illness-centered formulations may miss much of what low-income service users with serious mental illness value in their relationships with practitioners. The opportunity to counter feelings of vulnerability and alienation with a sense of connection that is based on shared humanness may be a high priority for services for this group. Practitioner relationships that help service users feel cared about and connected to the social world address suffering in mental illness and are thus essential to the meaning of good care.
Ware
Norma C
NC
Harvard Medical School, 641 Huntington Avenue, Second Floor, Boston, Massachusetts 02115, USA. norma_ware@hms.harvard.edu
Tugenberg
Toni
T
Dickey
Barbara
B
D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008484:Medicaid; D008605:Mental Health Services / Q000592:standards*; D028642:Persons with Psychiatric Disorders / Q000523:psychology; D008875:Middle Aged; D010817:Physician-Patient Relations; D011787:Quality of Health Care; D012559:Schizophrenia / Q000175:diagnosis / Q000628:therapy*; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014481:United States; D035862:Vulnerable Populations / Q000523:psychology