Primary mental health care for adults with mild intellectual disabilities: a focus group study of care professionals’ perspectives

Background
GPs and mental health nurse practitioners (MHNPs) often feel ill equipped to provide mental health (MH) care to people with mild intellectual disabilities (MID). This is worrying, as insufficient primary MH care may lead to more severe or chronic problems. To improve primary MH care for this patient group, account must be taken of the experiences and needs of GPs and MHNPs providing the care.

Aim
To explore GPs’ and MHNPs’ experiences, needs, and recommendations for improvement regarding primary MH care for adults with MID.

Design & setting
A qualitative study was undertaken using focus groups with GPs and MHNPs in the Netherlands.

Method
The focus groups were guided by topics based on an interview study with adults with MID receiving primary MH care. Transcripts were analysed by thematic analysis.

Results
Four focus groups, with 19 GPs and nine MHNPs, revealed four themes describing the needs and perceived complexity involved in providing MH care to patients with both MID and MH problems: (1) GPs’ and MHNPs’ struggles with adapting to challenging patient characteristics; (2) importance and difficulties of establishing a good doctor–patient relationship; (3) facilitating and hampering roles of the patient’s network; and (4) GPs’ and MHNPs’ challenges to provide care in the healthcare chain.

Conclusion
GPs and MHNPs often experience providing care and support to this patient group as burdensome. It is important to consider the MID throughout the MH trajectory, to invest in a strong doctor–patient relationship, and to establish a stable, sustainable network and coordinated collaborative care around the patient.