In psychiatric practice, effective communication is important for fostering patient understanding, engagement, and adherence to treatment. One increasingly recognised method of enhancing this communication is through writing personalised correspondence to patients about their psychiatric care. Some correspondence may focus on treatment plans or care plans. The activity is not only about outpatient care. For in-patients psychiatrists may wish to share treatment plans, risk-assessments or provide information about medications
This seemingly straightforward task involves a range of challenges and considerations. From the time constraints faced by busy practitioners to the need for clear, layperson-friendly language that does not oversimplify complex medical information, the decision to generate correspondence requires careful prioritisation based on clinical needs. This article explores the pros and cons of writing to psychiatric patients and offers a structured approach to deciding when and how to prioritise this form of communication.
The AOMRC gave general guidance to all. There is more at the GMC’s WordPress blog about what patients have said.
| Pros | Cons |
|---|---|
| Enhanced communication: Writing correspondence can improve understanding of treatment plans, diagnoses, and progress, promoting patient engagement. | Time-consuming: Finding administrative time to write these correspondence can be challenging, especially given other clinical responsibilities. |
| Patient empowerment: Patients may feel more involved in their care, which can improve adherence to treatment and outcomes. | Language simplification: Writing in layperson’s language requires additional effort to ensure clarity without compromising clinical accuracy. |
| Record for patients: The correspondence serves as a reference for patients, helping them remember and reflect on their care. | Risk of misinterpretation: Patients might misinterpret or misunderstand clinical information, leading to confusion or anxiety. |
| Strengthened therapeutic relationship: Personalised communication can enhance trust and rapport between the psychiatrist and patient. | Confidentiality concerns: There is a risk of sensitive information being accessed by others if the correspondence is not properly handled. |
| Improved continuity of care: Written communication can assist in ensuring consistent understanding between the patient and other healthcare providers. | Legal implications: Written records may be scrutinised in legal contexts, potentially exposing the psychiatrist to liability if the content is misinterpreted. |
| Increased transparency: Providing written summaries promotes transparency, which can be important for ethical practice. | Potential emotional impact: Reading about their condition in detail might cause distress or trigger negative reactions in some patients. |
| Documentation: Correspondence can serve as documentation of the communication provided, which might be useful for both parties. | Cultural sensitivity: Language and tone must be carefully considered to avoid misunderstandings, especially in a diverse patient population. |
The challenge of finding time to draft these correspondence is indeed significant, but as the table illustrates, there are additional factors to consider. These pros and cons need to be balanced based on the individual needs of each patient and the specific context of their care.
Challenges and Impacts
Writing documents that are clear, accurate, and sensitive to the needs of psychiatric patients and their loved ones is a complex task. It requires careful consideration of language, tone, cultural factors, and the emotional impact of the communication. Balancing these elements while ensuring that the correspondence is informative and supportive is a significant challenge in psychiatric practice.
| Aspect | Challenge | Impact |
|---|---|---|
| Language simplification | Psychiatric concepts often involve complex medical terminology and abstract ideas that may not be easily understood by those without a clinical background. Simplifying these concepts into layperson’s terms without losing the essence or accuracy of the information can be difficult. | If not done carefully, simplification can lead to oversimplification, which might distort the meaning or leave out important details, leading to misunderstandings about the diagnosis, treatment, or prognosis. |
| Balancing clarity with sensitivity | Mental health issues can be deeply personal and sensitive, making it essential to communicate information in a way that is clear but also empathetic. For example, explaining a serious diagnosis or discussing the potential side effects of medication requires a tone that is both honest and supportive. | An overly clinical tone might come across as cold or uncaring, while an overly simplified approach might fail to convey the seriousness of the condition. Striking the right balance is crucial to avoid causing unnecessary distress or anxiety. |
| Avoiding jargon and technical terms | Medical jargon and technical terms are second nature to psychiatrists but can be confusing or intimidating to patients and their families. Finding alternative ways to express these ideas without relying on jargon is essential but requires additional time and effort. | Misunderstanding or misinterpreting jargon can lead to incorrect assumptions about the patient’s condition or treatment, potentially impacting their adherence to the prescribed plan or causing unnecessary worry. |
| Addressing diverse literacy levels | Patients and their loved ones come from diverse educational backgrounds, and not all will have the same level of literacy or familiarity with medical concepts. Writing in a way that is accessible to a broad audience, while still being respectful and informative, adds another layer of complexity. | A document that is too complex might alienate some readers, making them feel overwhelmed or excluded, while an overly simplified letter might come across as patronising to those with higher literacy levels. |
| Cultural and linguistic considerations | Cultural beliefs and values can significantly influence how mental health information is perceived. Additionally, for patients whose first language is not English, there may be language barriers that complicate communication. | Cultural missteps or language barriers can lead to misunderstandings, non-compliance with treatment, or a breakdown in the therapeutic relationship. Ensuring that communication is culturally sensitive and, if necessary, translated accurately, is critical. |
| Conveying emotional and psychological nuances | Mental health correspondence often needs to convey not just factual information but also the emotional and psychological nuances of a patient’s condition. This might include discussing the patient’s mood, behaviour, or interpersonal dynamics, which can be difficult to express in a way that is both clear and respectful | Miscommunication in this area can lead to patients or their loved ones feeling misunderstood or stigmatised, which can undermine trust in the therapeutic relationship. |
| Ensuring consistency with verbal communication | Letters should be consistent with what has been communicated verbally during consultations. If there are discrepancies, patients may become confused or doubt the reliability of the information they receive. | Inconsistencies can erode trust and lead to confusion about the treatment plan, potentially resulting in non-compliance or a breakdown in the therapeutic relationship. |
| Addressing emotional impact | Receiving written information about a psychiatric condition can be confronting for patients and their families. The emotional impact of seeing a diagnosis or treatment plan in writing can be more significant than hearing it verbally. | A document that is not carefully crafted may trigger anxiety, depression, or other emotional responses. It is essential to consider how the patient might react to the content and to provide the information in a way that is supportive and encouraging. |
| Providing actionable information | Patients and their loved ones need to understand not only the diagnosis and treatment but also what steps they need to take next. Providing clear, actionable information in writing is crucial but can be challenging to communicate effectively. | If the next steps are not clearly outlined, patients may feel lost or uncertain about how to proceed, which can delay treatment or hinder progress. |
Prioritising correspondence
Prioritising which patients to write to based primarily on clinical needs involves considering several key factors related to the severity of their condition, the complexity of their treatment, and their ability to manage their care independently. The table below are some strategies to help prioritise patients.
| Clinical Factor | Higher Priority (Write Soon) | Lower Priority (Can Delay Writing) |
|---|---|---|
| Severity of the condition | Severe mental health conditions (e.g., schizophrenia, bipolar disorder, major depressive disorder). | Milder conditions (e.g., mild anxiety, mild depression). |
| Complexity of treatment plans | Complex regimens with multiple medications or therapeutic interventions. | Simple treatment plans (e.g., single medication with regular follow-up). |
| Risk of non-compliance | History of poor adherence or risk of non-compliance due to ambivalence or side effects. | Demonstrated good adherence and engagement with treatment. |
| Recent changes in treatment/diagnosis | Recent changes in diagnosis, medication, or therapy. | Stable treatment and diagnosis over an extended period. |
| Frequency of contact | Infrequent contact with mental health services or less frequent appointments. | Regular appointments or frequent check-ins. |
| Crisis management | Recent mental health crisis (e.g., suicide attempt, psychotic episode) or high risk of crisis. | Currently stable, with no recent crises. |
| Need for patient empowerment | Patients who struggle with self-management or have limited insight into their condition. | Already actively engaged and empowered in their care. |
| Support system dynamics | Limited support system or highly involved loved ones needing clarity on treatment. | Strong, well-informed support system that understands the treatment plan. |
| End-of-care summary | Patients nearing the end of their treatment or being transferred to another provider. | Patients in the middle of long-term treatment not nearing transition. |
Sample correspondence
The following sample is not a one-size fits all thing. It can help. Different patients may need individualised correspondence with different contents.
Conclusion
Writing personalised correspondence to psychiatric patients can be a powerful tool for enhancing communication and patient engagement. However, this practice comes with significant challenges, particularly in terms of the time required and the need to convey complex clinical information in a clear, accessible manner. The decision to create correspondence should be carefully prioritised, focusing on patients with the most pressing clinical needs.
Patients with severe mental health conditions, complex treatment plans, or a history of non-compliance should be at the top of the list for receiving written communication. Those who have recently experienced changes in their diagnosis or treatment, are at high risk of crisis, or have limited contact with mental health services may also greatly benefit from receiving letters. Additionally, patients nearing the end of their care or being transferred to another provider should receive detailed summaries to ensure continuity of care.
Ultimately, while writing correspondence can be time-consuming, the benefits in terms of patient empowerment, clarity, and continuity of care make it a valuable practice when applied thoughtfully and selectively. Prioritising based on clinical needs allows psychiatrists to provide targeted, meaningful support to those patients who need it most.
