Unmet needs and treatment seeking in high users of mental health services: role of illness perceptions.
OBJECTIVE
A small number of patients tend to use a disproportionately high amount of mental health services. Understanding the needs and behaviours of this group is important in order to improve patient management. Few studies have investigated the role that patients' perceptions about their mental illness play in guiding coping responses and treatment seeking. The aim of the present study was to investigate how illness perceptions in high users of mental health services were related to unmet needs and treatment-seeking behaviours.


METHODS
A total of 203 high users of mental health services were interviewed using the Brief Illness Perception Questionnaire, the Camberwell Assessment of Need and the Drug Attitude Inventory, and were also asked to report the number of visits they had made to the general practitioner in the past year. District Health Board clinical staff completed the Camberwell Assessment of Need and the Global Assessment of Functioning for each user.


RESULTS
More negative perceptions about mental illness were associated with higher ratings of unmet needs by both patients and staff. Negative perceptions were also related to poorer attitudes towards medication, and lower functioning. Perceptions about the personal ability to control the illness were consistently associated with better outcomes. Patients' causal attributions could be categorized as social, psychological, biological and behavioural. More frequent visits to the general practitioner were associated with perceptions of more severe symptoms, greater concern and higher emotional responses to the illness, and psychosocial causal attributions.


CONCLUSIONS
Illness perceptions provide a framework to assess patients' ideas about severe mental illness and a means by which to identify maladaptive beliefs. Interventions targeted at changing these beliefs may encourage better self-management.
Broadbent
Elizabeth
E
Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand. ebroadbent@auckland.ac.nz
Kydd
Robert
R
Sanders
Deanna
D
Vanderpyl
Jane
J
D000223:Adaptation, Psychological; D000328:Adult; D001294:Attitude to Health; D015984:Causality; D003430:Cross-Sectional Studies; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D008605:Mental Health Services / Q000706:statistics & numerical data*; D020380:Needs Assessment / Q000706:statistics & numerical data*; D009520:New Zealand / Q000453:epidemiology; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires