Towards understanding the self-perception of people with a psychotic illness who use illicit substances and have a history of disengagement from mental health services: qualitative research.

OBJECTIVE: This research study aimed to provide insights into the self-perceptions of six people diagnosed with severe and enduring mental health problems and a history of substance misuse. It was anticipated that exploration of people's understanding and individual explanations of their conditions could help inform health professionals' interactions with this group of people and contribute towards building therapeutic relationships.

METHODS: All participants were under the care of an inner city Assertive Outreach Team, implicit in that they had a history of disengagement from mental health services. In this qualitative study, through thematic analysis of the transcripts from semi-structured research interviews of the research interview common themes became apparent. The semi-structured interviews were based upon case formulation and the Health Belief Model.

RESULTS: Analysis revealed that much of the information was of a deeply personal and idiosyncratic nature, however eight themes of relevance were highlighted; the beneficial nature of substance use, absence of polysubstance use, negative attitudes towards hard drugs, refutation of diagnosis, issues around physical health, lack of social networks, immigration, positive self image. Although eight themes of relevance were highlighted, only the three main ones are discussed in detail in this paper.

CONCLUSIONS: The three main themes of beneficial substance use, refutation of the diagnosis and lack of social networks are discussed in detail and the implications for practitioners drawn out.