Severe mental illness (SMI) inhibits individuals from accessing fair and effective healthcare for their physical health; as a result, individuals with SMI are more likely to develop physical health problems. The below-par standard of healthcare delivered to these individuals has been attributed to confusion between primary or secondary healthcare in who should monitor the patients’ physical health (Happell et al., 2012), and negative stigmatising attitudes in clinicians towards SMI (Stone et al., 2019). Ultimately, this inequality is matched with a significantly reduced life expectancy compared to the general population (De Mooij et al., 2019); training aiming to reduce this inequality is necessary.
After the development and implementation of a simulation-based training programme, Maudsley Learning in collaboration with King’s College London has had the opportunity to evaluate the outcomes of the training for primary care professionals through funding awarded by the Closing the Gap UKRI Network. Previous qualitative evaluation of a motivational interviewing simulation programme at Maudsley Learning used post-course focus groups to gain an insight into the efficacy of the training. Thematic analysis indicated that participants had increased confidence in their communication abilities, including beginning difficult conversations with patients, use of open questions and verbal and non-verbal listening (Parish et al., 2019)
About the training
The programme specifically targeted the improvement of participants’ motivational interviewing skills, an evidence-based technique that has proven effective in primary care at improving patient outcomes in their physical health (VanBuskirk & Wetherell, 2014).
The two-day programme included 1 day of didactic teaching, and 1 day of simulation training, delivered via Zoom. Didactic teaching introduced participants to the core principles and application of motivational interviewing; simulated scenarios in day 2 allowed participants to put this teaching into practice, where they gained feedback through thorough debriefing.
Pre and post assessment
Before participating in the training, trainees did a pre-course assessment, where they met with an actor patient who played a middle-aged man, struggling with weight loss and long-term mixed anxiety and depression. A ten-minute ‘consultation’ was undertaken, designed to simulate a normal GP phone consultation – participants were asked to treat it as they would in their clinical practice. After completing the two-day course, participants undertook their post-course assessment, where they met again with an actor playing a patient with the same concerns. These calls were recorded, with participants being informed of this, and their anonymity and confidentiality maintained.
As part of general evaluation, participants also voluntarily completed the pre and post-course evaluation questionnaires. These included the Mental Illness Clinicians’ Attitudes (MICA-4) scale, where measurement of stigmatising attitudes towards mental illness and psychiatry was taken.
Analysis
The recordings of the pre and post assessments were used in analysis; the Motivational Interviewing Assessment Scale (MIAS) was used by three researchers to score the participants in their motivational interviewing skills. These data (which included 15 participants), as well as the MICA-4 data from the questionnaires (including 19 participants), were taken in their quantitative form and analysed using paired-samples t-tests in SPSS statistics.
Results and conclusion
Statistical analysis found that there was a significant reduction in MICA-4 scores post-course, compared to pre-course. This is indicative that the participants’ attitudes towards mental illness and psychiatry were more positive and less stigmatising after having completed the training. Additionally, participants’ scores based on the MIAS increased significantly after their training; encouragingly, on average, they performed much better in their post-course video assessments.
Conclusively, the training undertaken by participants was successful in multiple dimensions. Not only has this research enriched what we know to be true about the efficacy of simulation-based education in improving patient care, but its findings emphasise the importance implementing motivational interview training in primary care. An improvement of patient-centred skills, including in attitudes towards mental illness, is critical in the reduction of health inequalities, which falls closely in line with the NHS Long Term Plan. With the pivotal role that GPs and other primary care professionals play in everyone’s lives, it is hoped that, once longitudinal impacts of this type of training are assessed, programmes of this type will be weighted with more importance in training curriculums.
Acknowledgements
We would like to send our thanks and appreciation to all 24 participants of the Closing the Gap training for their engagement with the programme and evaluation. We’d also like to send appreciation to Closing the Gap for supporting this project and to the Mind and Body Programme for their support in recruitment and the development of the original course.
References
- Happell, B., Scott, D., & Platania-Phung, C. (2012). Perceptions of barriers to physical health care for people with serious mental illness: a review of the international literature. Issues in Mental Health Nursing, 33(11), 752-761.
- Stone, E. M., Chen, L. N., Daumit, G. L., Linden, S., & McGinty, E. E. (2019). General medical clinicians’ attitudes toward people with serious mental illness: a scoping review. The journal of behavioral health services & research, 46(4), 656-679.
- De Mooij, L. D., Kikkert, M., Theunissen, J., Beekman, A. T., De Haan, L., Duurkoop, P. W., ... & Dekker, J. J. (2019). Dying too soon: excess mortality in severe mental illness. Frontiers in Psychiatry, 855.
- Parish, S., Williams, L., Attoe, C., & Iannelli, H. (2019). Using simulation-based training to improve health conversations by developing motivational interviewing in clinical support workers. BMJ Simulation and Technology Enhanced Learning, 6(5).
- VanBuskirk, K. A., & Wetherell, J. L. (2014). Motivational interviewing with primary care populations: a systematic review and meta-analysis. Journal of behavioral medicine, 37(4), 768-780.