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Table 3 Secondary care screening model: Advantages and disadvantages

From: Prevention of coronary heart disease in people with severe mental illnesses: a qualitative study of patient and professionals' preferences for care

  View expressed by *
Perceived advantages of delivering screening in secondary care CMHT GP SU N
• CMHT staff have a better rapport and understanding of people with SMI 12
• CMHT has better access to and knowledge of people with SMI   8
• The CMHT setting and workers are less threatening for patients than the GP environment and easier to trust – this might reduce the non-attendance rates   6
• CMHT staff can access patients in a greater variety of settings, thus enhancing the uptake of screening    6
• It promotes a more holistic model of care – 'not just a prescription'    4
• It is better to unite clients' physical and mental health care in one place   3
• CMHT staff are more experienced than GPs in working assertively with people with SMI   3
• If the CHD risk factors are linked to having SMI, then the CMHT should take responsibility for screening   3
• Psychiatrists prescribe the antipsychotics which require risk factor screening   2
• CMHT workers have more time and can offer longer appointments    2
• It would allow CMHT staff to develop new skills    1
• There are shorter waiting times at CMHT compared to the GP    1
Perceived disadvantages     
• The CMHT workload is already high – they lack the time for extra responsibilities 19
• Lack of skills and knowledge required for screening amongst care coordinators, especially those without nursing or medical training   12
• Lack of appropriate facilities – e.g. equipment, clinical rooms, access to blood results in community settings   9
• Unwillingness of CMHT staff to take on extra roles   8
• Lack of medical expertise in the CMHT regarding appropriate interventions if screening results are positive – care will either be inferior or simply result in re-referral to primary care.   5
• It blurs the role of the CMHT    5
• Some service users mistrust psychiatric services and don't want their involvement   4
• CMHTs only see the most severely mentally ill people, so some patients will be overlooked    3
• It would be stigmatising (not normalising) to have separate services for people with SMI    3
• Patients like to keep their mental health and physical health separate   3
• Mental health meetings such as Care Programme Approach meetings are inappropriate settings for screening    2
• It would cause stress for CMHT staff who might feel to blame if CHD morbidity was undetected    2
• Lack of continuity with CMHT staff – they tend to come and go more often than GP staff   2
• CMHT bases are less accessible than GPs geographically    1
  1. * Note: Tick-boxes indicate which group(s) of participants expressed the view: CMHT = staff from community mental health team; GP = staff from general practice; SU = service users. Numbers (N) indicate the prevalence of each view within the total sample.