Ambivalent connections. Improving community mental health care for non-psychotic chronic patients perceived as 'difficult'

Depression is a widespread psychiatric disorder, which becomes chronic in 25-30% of cases. When psychiatric and psychological treatments are ineffective, chronic depressive patients are often assigned to long-term care which is mostly provided by mental health nurses. Due to factors strongly associated with chronicity (like dependency, demoralization and hopelessness) long-term care is a difficult undertaking both for patients and mental health nurses. Areas in which major problems occur are interpersonal functioning, treatment compliance and crisis management. In this research proposal, the development and testing of a best practice program for mental health nurses is presented. This program will support mental health nurses in recognizing, analyzing and acting upon problems in the care of chronic depressive patients. Interventions that are effective for these problems are systematically laid out in this best practice program. Both professionals and patients will benefit from this program as it aims to improve long-term care which may subsequently result in reduced costs of this form of care. Depressive disorders are among the most common of all psychiatric diseases (Kessler et al. 2003), resulting in high direct (health care) and indirect (work-related) costs (Stewart et al., 2003). Most depression incidents can be treated effectively with medication, psychotherapy or a combination of both. Unfortunately, in a considerable amount of cases (25-35%) the disease becomes chronic (Spijker Goal: The development and testing of a nursing best practice program consisting of evidence-based mental health nursing interventions for patients with a chronic depression. This project will result in a best practice program that enables mental health nurses to provide evidence-based care for patients with chronic depression. With reference to the problems mentioned above, it will help mental health nurses in recognizing, analyzing and acting upon: 1) patients interpersonal problems This project consists of four distinct phases: 1) inventory, analysis and prioritization of problems in current practice (12 months