Electronic supplementary material
Interview type (Number)
Participant type (Number)
Total number of participants
Focus group (6)
SU (12), SU/C (2), C (9), MHP (5), MHP/SU (2)
SU/C (1), MHP (3)
Themes confirming general care planning requirements
Tailoring a collaborative working relationship
“I think that one of the best things that users and carers can bring is experts by experience, and they can really help to shape the whole, kind of, how our health and social care system works, to make it more integrated” [5641, telephone, service user and carer].
“It’s a two-way process… it’s something that they’re involved with and taking part in and contributing to, rather than something that’s being done to them… they [professionals] might learn the reasons why people do things in certain ways and be able to manipulate something around that. And having that full picture of that patient” [6225, telephone, mental health professional].
“I think a lot of patients are quite passive in themselves about some important health priorities, and if they are passive about those and there are some other difficulties such as time constraints, resources in the health and social care system, that passivity combined with lack of resources does conspire to neglect kind of assertive physical health care plans” [6372, telephone, mental health professional].
“…there’s a huge assumption that the cared for will be able to take up that offer of physical health, and I think that’s a huge assumption for that person who’s not well to be able to suddenly skip to the gym or do whatever. And I think without the role of the carer it’s just not going to happen… I’m sure there’s many people out there that might be given social prescribing, and it does nothing for them because they’re not able to actually make that step to actually do it. I’d make sure the cared for actually goes to the gym or whatever, which is actually quite a challenging task in itself sometimes” [5277, FG3, carer].
Maintaining a trusting relationship with the care planning professional
“I think, for a start, it’s the sense of knowing that nothing is physically wrong with me, or when it is, knowing that I’m getting the right treatment or I’m not being misunderstood by a GP or other form of professional, that it’s just the mental health that’s making you think like that” [5641, telephone, service user and carer].
“It’s having somebody visible that can go and access and to take that information on board and having somebody there for when they need that information. But it’s building up that baseline first that people know that there’s people there that they can access. It’s knowing what resources they can tap into” [6225, telephone interview, mental health professional].
“I think trust is a big issue... You know, you get a number of therapists that make people feel like freaks, you know, and there’s not going to be any positive remark... especially if you talk about things like smoking that people enjoy, or anything that’s hard to change, you’re not going to do that with someone you don’t trust” [5276, FG2, service user and carer].
Having access to and being able to contribute to a living document
“I don’t even want to call it physical or mental, I’d rather just call it a wellbeing health plan or a wellbeing plan, because both parties shouldn’t ignore the other part of your life, you know, they are both equally important. If I go to see a physical health practitioner, I would like that physical health practitioner to ask me questions around how am I feeling, what is my mental state like, what impact is this physical health condition having on me? And I would like the same for a nursing staff to do in a mental health setting, to ask me about my physical health. So I think that for me there should be something that people should see you as a whole person” [5641, telephone, service user and carer].
“I don’t have one [care plan]… if one was written it would be written for them [mental health professionals’], by them without anything to do with me. So I mean I wouldn’t see it anyway. So I mean the things I want, or if I had an imaginary care plan, is a discussion about what affects me, you know, like a sort of level of… what’s having the biggest impact on me and maybe where I can get support with these things, that would be the kind of thing I’d want” [5276, FG2, carer].
“I haven’t seen a care plan for eighteen month, maybe two years. It must be approaching two years that my social worker said ‘oh, I’ve done your care plan, will you have a look at it for me’. These things need updating every three to six month at the very least” [5275, FG1, service user and carer].
Novel themes with specific relevance to physical health discussions
Valuing physical health equally with mental health
“So it is important that it is connected, the mind and body, because what you think and that, it affects what you eat and everything. But it’s important to treat them both as equal and the same” [5277, FG3, carer].
“I think fundamentally commissioning is where we’re going wrong with physical health, getting it together with mental health and we look at parity of esteem and I think mental health services are working towards parity of esteem, we are starting to look at physical health as something we do, we’ve got to get it right, it’s really important, it doesn’t work the other way, the acute trust do not, when you’re having your appendix out, consider your schizophrenia or your medicines” [5427, FG5, mental health professional].
“I’ve had a personal experience where you explain a condition to a doctor and he just doesn’t actually realise that what you’re saying is physically happening, he just thinks it’s just part of your mental illness and they kind of fob it off” [5641, telephone, service user and carer].
“I think staff will often say, well, you need to go to the GP. And so a lot of them redirect them to the GP really, if there’s a physical health problem. Because they don’t have the knowledge, primary care’s the best one, the GP has the knowledge” [6390, Telephone, mental health professional].
“I think in relation to having a mental health diagnosis, for me physical needs to be part of the equation, because most people get put on medication where the side effects aren’t explained fully, so you’re experiencing different physical things that you’ve probably never encountered before. So the physical aspect needs to be included to include them side effects” [5275, FG1, service user and carer].
Experiencing coordination of care between physical-mental health professionals
“What I would like more of, is that there’s more coordination in my mum’s care plan around physical practitioners, healthcare practitioners working along with mental health practitioners” [5641, telephone, carer].
“I think we need the resources ourselves really. The Community Mental Health Trust needs to provide that. When people come to an outpatient appointment… the consultant sends a letter to the GP and says, can you do the bloods and the ECG. Now that doesn’t always happen. And we don’t know if it happens, nobody… we just have to ask the patient. So if you had somewhere there like they do at [name]… I know they’ve got a physical health clinic there and people go to an outpatient appointment, maybe they could just pop in and have their bloods done, and they can have an ECG or they can have an appointment to come back and have a physical health check. I think we need something like that” [6390, telephone, mental health professional].
Having a physical health care discussion within care planning that is personalised
“They are discussed. There’s no doubt about that, I wouldn’t say that they don’t get discussed because, you know, part of my care plan when I used to get a lot of services was input around my mental wellbeing. They used to cover, you know, all the physical aspects of it, but it was a tick box exercise. It was very much a tick box exercise: ‘okay, let’s da-da-da-da’, it would only… But, actually, when you have something, no thorough detail no thorough interest is taken by mental health practitioners” [5641, telephone, service user and carer].
“I think the care planning, the patients themselves need to understand why it’s done, it’s not just a tick-box exercise [using the rethink tool], that it has actually got outcomes, and it’s for their health. But it’s them perceiving that… care planning takes a bit longer. When you involve the patients and you take them on board, there are things that will be raised up and how you actually signpost that person to the more appropriate place, will they take up more time in the extra help that they potentially might need to support them through this” [6225, telephone, mental health professional].