Table 1 Further evidence to outline inductive findings
Differences in professional background
Reliance on clinician for the ATT (AMHP)‘I would have spoken with the doctor that made the first medical recommendation’. (Gen Adult 1, 39M, AMHP)
‘The doctor had the treatment plan’. (LD 2, 18M, AMHP)
‘I can’t remember if he [the patient] was on any medication…I’m not personally bothered as a social work professional’. (GenAdult2, 42M, AMHP) ‘On the treatability side, I think I’ve got a knowledge in that, I could say from a laypersons point of view, but no, I usually steer clear of therapy labels’. (Forensic 1, 32M, AMHP)
‘It [the appropriate treatment] wasn’t at the forefront of my mind’. (Forensic 3, 35M, AMHP)
Reliance on clinician for the ATT (Dr)‘Intensive nursing was available to manage risk, to other young people and herself [the patient]…psychopharmacological intervention was for the longer period of time, so availability of SSRI’s for ruminations and depressive symptoms including high anxiety…and smaller dose of antipsychotic to control her high agitation……availability of psychological input including CBT, OT and ward based activities’. (CAMHS1, 15F, Dr)
‘Structured environment from nursing and MDT input and available education at his level’. (Forensic 4, 17M, Dr)
‘He [patient] was going to need antipsychotics to try and resolve the paranoid thoughts of persecution he was displaying’. (GenAdult5, 35M, Dr)
‘But also just the structure of the hospital, the whole nursing care, consistent boundaries’. (PD3, 20F, Dr)
Therapeutic pessimism‘It’s a shame there wasn’t anything more suitable. I think she [the patient] could have been managed somewhere, probably at her aunts or somewhere’. (CAMHS4, 17F, AMHP)
‘It’s not an ideal thing for a young person who was 18, and, you know, to have been in for years’. (LD4, 18M, AMHP)
‘They [the patient] needed clear behavioural boundaries…attempt to modify behaviour, by rewarding appropriate behaviour’.
(LD4, 18M, Dr)
Age and diagnosis of personality disorder‘There were definitely personality difficulties and traits of personality disorder’. (LD4, 18M, AMHP)
‘I feel that, personally I feel a bit uncomfortable about the label ‘personality difficulties’ in young patients’. (LD4, 18M, Dr)
Differences in mental health subspecialties
General adult‘It was mainly about, the reintroduction of, of, antipsychotic medication’. (GenAdult2, 42M, Dr)
‘So that we could further assess her mental state and at the same time, give her medication’. (GenAdult4, 38F, Dr)
‘He was going to need antipsychotic treatment to try and reduce some of these paranoid thoughts’. (GenAdult5, 35M, Dr)
PD‘I think that case does reflect some of the dilemmas particularly around assessing when you admit patients with opersonality disorders to hospital…because I think you are often reliant on making a clinical judgement on treatability’. (PD1, 31F, Dr)
‘we prescribe medication…we do think they benefit from medication’ ‘I felt medication would help reduce some of her emotional lability’. (PD3, 20F, Dr)
‘The treatment plan, as I remember it, was to commence her on an antipsychotic and an antidepressant’. (PD1, 31F, Dr)
‘Medication is not always a solution and I do find that she’s been pumped up with a lot of medication’. (PD1, 31F, AMHP)
‘You bring in someone who’s got a personality disorder which isn’t going to benefit from treatment [medication], and they, I suppose, become stuck in the system’. (PD3, 20F, AMHP)
‘What was appropriate medical treatment for her at that stage was really kind of containment and management of risk’ ‘they would have been able to enforce boundaries’. (PD2, 26F, Dr)
CAMHS‘we were not able to manage the behaviour within our unit’. (CAMHS1, 15F, AMHP)
‘She [the patient] was on one-to-one and also two-to-one nursing care to reduce risks’. (CAMHS1, 15F, Dr)
‘So being on the MHA actually was helped itself [sic] to get her security’. (CAMHS4, 17F, Dr)
LD‘It was more about putting boundaries in place for her, than anything else’. (LD1, 16F, Dr)
‘He mainly needed, you know, containment’. (LD4, 18M, AMHP)
Forensic‘I work in a [secure unit], and I knew we had beds available’. ‘They get practitioners that don’t work within these hospitals to do these detentions because of the possible conflicts of interest in terms of pecuniary advantage’. (Forensic4, 17M, Dr)
Effects of the ATT on service provision‘She was on section two, so she definitely would have a bed’. (PD4, 38F, AMHP)
‘sort of anything goes with sort of [sic] appropriate treatment’. (GenAdult3, 34F, Dr)
‘treatment didn’t change as a consequence of the mental health act, it didn’t change’. (CAMHS2, 17F, Dr)
  • ATT, Appropriate Treatment Test; AMHP, approved mental health professional; Dr, Doctor; F, female; M, male; LD, learning disability; PD, personality disorder.