GPs’ views and experiences of patients with an at-risk mental state (ARMS) for psychosis
Psychotic illnesses are one of the leading causes of disability worldwide. Early intervention in people with an at high risk mental state (ARMS) for psychosis can decrease the rates of transition to psychosis. GPs play a key role in the identification of ARMS, as they are usually the first point of contact with health services. However, very few studies have explored GPs’ awareness of ARMS. This study aims to explore GPs’ views and experiences of identifying patients with ARMS, and the barriers and facilitators to identification in primary care.
In-depth interviews were held with 20 GPs working in the South West of England. A topic guide was used to ensure consistency across the interview. It covered the following areas: recognition, identification, management of ARMS patients, and facilitators and barriers to early identification. All the interviews were audio recorded, transcribed verbatim and analysed thematically.
Some GPs were unsure what was meant by ‘ARMS’. They asked if we were referring to people who had certain risk factors for psychosis (i.e. illicit drug use), people at risk of a psychotic relapse, or people with mild psychotic symptoms. When providing GPs with a definition, some GPs still struggled to recognise who might be patients with ARMS, as most of the patients they had seen were either in a florid state or had recurrent psychosis. Other GPs mentioned that in most cases, mild psychotic symptoms occurred in the context of other mental health illnesses, and these patients would not be placed in a separate diagnostic category. There were also GPs, however, who said that they were familiar with the term ARMS, but that they rarely saw these patients. The facilitators and barriers to ARMS identification related to patients (i.e. patients not consulting or disclosing psychotic symptoms), GPs’ knowledge of ARMS, and working in the NHS (i.e. a lack of continuity of care).
Most GPs are unfamiliar with the term ARMS and would not identify patients as being at risk of developing psychosis. GPs’ ability to identify patients with ARMS was hindered by patients not disclosing symptoms, and GPs’ knowledge of this condition and specific patients.