Clinician views on best practice community care for people with complex emotional needs and how it can be achieved: a qualitative study

Background Service provision for people with complex emotional needs (CEN) is recurrently identified as needing to be transformed: there are serious concerns about quality, accessibility, fragmentation of the service system and the stigma and therapeutic pessimism service users say they encounter. We use the term CEN as a working description to refer to the needs experienced by people who may have been diagnosed with a "personality disorder". Understanding clinician perspectives is vital for service transformation, as their views and experiences shed light on potential barriers to achieving good care, and how these might be overcome. In this study, we aimed to explore these views. Methods We used a qualitative interview design. A total of fifty participants from a range of professions across specialist and generic community mental health services across England who provide care to people with CEN took part in six focus groups and sixteen one-to-one interviews. We analysed the data using a thematic approach. Findings Main themes were: 1) Defining Best Practice, 2) Facilitators of Best Care, 3) Barriers to Best Care, 4) Systemic Challenges. Across these themes, staff highlighted in particular the need for care that was person-centred, relational, empathic, and trauma informed. However, major barriers to achieving this are stigmatising attitudes and behaviour towards people with CEN, especially in generic mental health services, lack of development of coherent service systems offering clear long-term pathways and ready access to high quality treatment, and lack of well-developed structures for staff training and support. Discussion Overall, the findings point towards clinician views as generally congruent with those of service users, reinforcing the need for priorities towards systemwide change to ensure that we can provide the best practice care for these individuals. Particularly prominent is the need to put in place system-wide training and support for clinicians working with CEN, encompassing generic as well as specialist services, and to challenge the stigma still experienced throughout the system. Conclusions Staff working with this service user group report that delivering best practice care services to be flexible, integrated, and sustainably funded, and for staff to be supported through ongoing training and supervision.