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Primary mental healthcare: care professionals’ perspectives135Table 6.1. continuedNo Focus groupaAge(years)Sexb GP/MHNPc Work experience (years)Experience with patients with MIDd4 58 F GP 28 +4 34 F GP 5 +4 29 M GP 1 +a Focus groups 1, 2, 4 were held live, focus group 3 online;.b F: Female, M: Male; c GP: General practitioner, MHNP: Mental health nurse practitioner; d - None, + low, ++ average, +++ above average of experience with patients with mild intellectual disabilities.Box 6.1. Themes reflecting the complexity of primary mental health (MH) care provision to adults with mild intellectual disabilities (MID) from the perspective of general practitioners (GPs) and mental health nurse practitioners (MHNPs)aTheme 1: GPs’ and MHNPs’ struggles with adapting to challenging patient characteristics y Patients’ reason for encounter is often unclear or difficult to discerny Multiple simultaneous problems, medical and non-medicaly Patients are easily disoriented when facing problems y Standard guidelines for diagnosis and treatment are often not applicable to patients with MIDy Patients struggle with practical implementation of practitioners’ advices and organisation of care y The MID often goes unrecognised or is not addressedTheme 2: Importance and difficulties of establishing a good doctor–patient relationshipy May be complicated by the vast difference between the lived experiences of practitioners and patient y May be influenced by patient’s previous negative experiences in care or supporty A paternalistic stance on decision making is often adopted in the doctor–patient relationship Theme 3: Facilitating and hampering roles of the patient’s networky A supporting formal or informal network can assist both practitioners and patients; however, it is not always available or lacks of continuity y The network can contribute to the complexity of MH problems y The network may often not provide the patient with the necessary emotional and practical support Theme 4: GPs’ and MHNPs’ challenges to provide care in the healthcare chainFinding appropriate care and support y The practitioners’ regular network is inadequate, and there is a lack of specific networks for patients with MIDy There are regional differences in the organisation of care and support for patients with MIDy It is often unclear for practitioners how additional care and support is reimbursed y It is often unclear for GPs where to request a formal IQ test and how it is reimbursed y MID is often an exclusion criterion for secondary MH care y Support and treatment in secondary care lack alignment with the MID y Long waiting times for additional support and care6Katrien Pouls sHL.indd 135 24-06-2024 16:26