Rethinking interactions with mental health patients

New research overturns the belief that people with severe mental illness are incapable of effective communication with their psychiatrist, and are able to work together with them to achieve better outcomes for themselves.

“Interviews are a critical part of assessing people suffering from thought disorder (TD), and deciding what the best therapy is for them,” says Professor Cherrie Galletly from the Adelaide Medical School, University of Adelaide.

“Clinical interactions with people suffering with severe mental illness can be challenging, especially if the patient has disordered communication.”

Published in the journal Australian Psychiatry the study analysed 24 routine clinical interviews between psychiatrists and inpatients, with a mean age of just under 30 years, who were suffering from TD.

“The study, the first of its kind, examined the expertise with which psychiatrists conducted clinical interviews of people suffering from TD, and the shared goals that were accomplished,” says Professor Galletly.

“When interviewing people with TD psychiatrists need to adopt a mindset that the information the patient provides in that particular moment is, for them, meaningful, truthful, relevant and clear.

“They have to piece together snippets of information in order to create and interpret meaning and build respectful relationships by inviting patients to share their perspectives no matter how disordered or delusional their responses appear.”

Thought disorder is common in psychotic disorders. The thoughts and conversation of people suffering from TD appear illogical and lacking in sequence and may be delusional or bizarre in content.

In 2010, 0.3% of Australians aged 18-64 years, had a psychotic illness with men aged 25-34 experiencing the highest rates (0.5%) of illness.

“Patients are positioned as active participants by psychiatrists who adopt a non-confrontational, non-judgemental approach, conveying support and safety, and ask open ended questions which allows the patient to engage, feel listened to, and work with the psychiatrist to achieve a shared understanding,” says Professor Galletly.

“Findings from this study of sample interviews between psychiatrists and their patients highlight the need to rethink the notion that patients experiencing TD are incapable of communicating productively with the people trying to help them.

“Psychiatrists use transactional, relational and interactional techniques when they are talking to patients with thought disorder, which go beyond techniques normally employed in clinical interviews.

“Experienced psychiatrists undertake meaningful interviews with these patients, who in turn respond in ways that belie the notion that effective communication is not possible.

“The findings from this research can be used to develop training resources for clinicians who work with people with psychotic disorders.”