Strategies to improve adherence have often focused on simplifying regimens and strengthening therapeutic alliances, while the emotional and relational aspects of medication use have remained under-investigated. The study was conducted within one NHS mental health trust and used a critical realist epistemological position. Twelve psychologists and psychotherapists were recruited through purposive sampling and completed semi-structured interviews.

Their accounts were analysed with reflexive thematic analysis following Braun and Clarke’s six-phase approach. As a qualitative investigation based on professional perspectives, the study explored how participants understood medication non-adherence rather than measuring adherence rates, evaluating a treatment programme or establishing causal effects. Five themes emerged from the interviews: identity and sense of self, internalised negative beliefs, patient autonomy and control, dynamics and decision-making within multidisciplinary teams, and facilitating patient-centred care.

Together, these themes describe non-adherence as the outcome of an interaction between a patient’s experiences of medication and the service context in which treatment is discussed and managed. Participants’ accounts indicate that acknowledging the meanings patients attach to medication is an important part of understanding why medication is not taken as prescribed. The findings also show that non-adherence was discussed in relation to decision-making across multidisciplinary teams and to efforts to facilitate patient-centred care.

The authors conclude that reflective, multidisciplinary work and attention to patients’ meanings may support more patient-centred approaches to adherence, but the interviews do not demonstrate that a specific intervention improves medication-taking. The sample was limited to 12 psychologists and psychotherapists from a single NHS trust, and the study did not include patient perspectives. Further research involving patients is therefore needed to examine how the reported factors relate to the experiences of people prescribed psychotropic medication.

Subject of Research: Psychological and service-level factors influencing psychotropic medication non-adherence in NHS mental health care

Article Title: Psychological factors influencing psychotropic medication non-adherence: a qualitative investigation into the perspectives of psychologists and psychotherapists in an NHS mental health trust

Article References: Din, M., McDowall, A., & Sonigra, K. (2026). Psychological factors influencing psychotropic medication non-adherence: a qualitative investigation into the perspectives of psychologists and psychotherapists in an NHS mental health trust. BMC Psychology. https://doi.org/10.1186/s40359-026-05637-5

Image Credits: AI Generated

DOI: 10.1186/s40359-026-05637-5

Keywords: psychotropic medication, medication non-adherence, qualitative research, NHS mental health care, patient-centred care, multidisciplinary teams, psychologists, psychotherapists, reflexive thematic analysis, Psychological, factors, influencing

The survey’s most striking finding is not the length of the waits themselves but how clinicians judge them. Most of the GPs surveyed considered delays of this magnitude unacceptable, saying that young people should ideally begin receiving care within weeks rather than months. That professional consensus matters because it comes from the very doctors who manage the consequences of the delay. More than 90 percent of respondents said long waits increased the risk that young people would disengage from treatment, experience worsening symptoms, feel abandoned by the health system, and become less likely to seek help in the future. In other words, the waiting list is not a neutral queue in which patients simply hold their place. It is an active clinical risk factor, one that can erode the motivation that brought a teenager through the clinic door in the first place.

The study arrives amid mounting national concern about access to timely mental healthcare for children and young people in Australia. Recent data from the Australian Institute of Health and Welfare have highlighted a substantial mental health burden among young Australians, while the Royal Australian and New Zealand College of Psychiatrists has warned of a growing shortage of child and adolescent psychiatrists. That workforce shortfall carries a specific danger flagged by the college: children and adolescents may only reach specialist services once their needs have become complex, meaning the system encounters them later, when treatment is more demanding and outcomes are harder to secure. The Flinders and Black Dog Institute findings give that warning a primary care dimension, showing how the shortage cascades downward into everyday general practice.

The scale of the demand shock is evident in the survey’s own numbers. Eighty percent of the GPs reported having seen an increase in adolescents presenting with depression or anxiety over the previous year. Faced with that rising tide and with specialist appointments months away, most doctors did not simply refer and wait. More than 80 percent reported increasing the number of appointments they offered and expanding the support they provided to young patients during the waiting period. General practitioners, in effect, improvised an interim mental health service, scheduling extra consultations, monitoring risk, supporting parents, and trying to keep adolescents connected to care until a specialist became available.

Professor Bridianne O’Dea, Little Heroes Professor in Child and Adolescent Mental Health at the Flinders University Institute for Mental Health and Wellbeing, framed the human stakes of the delay in blunt terms. Young people are reaching out for support, she said, but many are left waiting too long for the care they need. For a teenager experiencing anxiety or depression, a delay of several months can feel like a lifetime, with parents worried, young people struggling, and GPs doing everything they can to support them while they wait. That description captures a triad of strain, the patient, the family, and the family doctor, all carrying the burden of a gap in the service system that none of them created.

Yet the survey also exposed a capability gap at the heart of this improvised safety net. Although GPs were overwhelmingly willing to step up their care, most rated their knowledge of the most effective strategies for supporting adolescents during the waiting period as only basic or adequate. This is a crucial technical distinction. Managing a young person’s mental health while they wait for specialist treatment is not the same as routine general practice; it involves monitoring clinical risk, maintaining engagement, and applying evidence-based interim support strategies that many GPs have had little formal training in. The researchers argue this is precisely where the system can intervene, by better equipping and supporting GPs during the waiting window rather than leaving them to improvise under pressure.

O’Dea described GPs as having become a vital safety net for young people caught in a stretched mental health system, providing ongoing mental healthcare while adolescents wait for specialist services. They are managing clinical risk, supporting families, and helping adolescents stay engaged with care, she said, often under significant pressure and without enough resources. The framing is important because it reframes the waiting period as a clinical phase in its own right, one with its own evidence base, its own best practices, and its own support needs, rather than as dead time between referral and treatment. Treating it that way, the researchers suggest, is an opportunity to reduce harm even before specialist capacity expands.

The findings add to growing calls from Australia’s mental health sector for earlier and more accessible support for children and young people, and O’Dea argues the challenge must be tackled on two fronts simultaneously. The first is structural: improving timely access to specialist services and reducing the wait times themselves. The second is interim: asking what can be done during the weeks and months between referral and treatment. Until specialist access improves, she said, providing safe, effective and accessible support during that period may help reduce distress and keep young people connected to treatment, rather than leaving families and GPs to navigate the wait alone. The distinction matters for policy, because investments in interim support and investments in workforce expansion are complementary, not competing, responses.

The research, a cross-sectional survey of general practitioners’ perspectives on wait times for adolescent mental health specialists and services in Australia, was led by O’Dea with colleagues from Flinders University and the Black Dog Institute and published in the Australian Journal of Primary Health. Its methodological approach, capturing the frontline view of 190 GPs nationwide, offers a ground-level measure of a problem that is usually discussed in workforce statistics and funding announcements. What the survey reveals is a system in which the first and often only point of contact for struggling teenagers is a general practitioner with limited specialist backup, limited interim-care training, and a waiting list measured in months. The researchers are now calling on GPs to take part in a new service pilot designed to support young people while they wait, a direct attempt to convert the survey’s central finding, that the waiting period is a clinical risk window, into a structured, evidence-based response. Whether that pilot can ease the pressure on families and doctors will depend on how quickly the sector acts on what its own frontline clinicians have made unmistakably clear.

Subject of Research: General practitioners' perspectives on wait times for adolescent mental health specialist services in Australia

Article Title: Teens wait months for mental healthcare as GPs step in to bridge the gap

Article References: Teens wait months for mental healthcare as GPs step in to bridge the gap. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: adolescent mental health, general practitioners, wait times, Australia, Flinders University, Black Dog Institute, psychologists, psychiatrists, primary care, anxiety, depression, health workforce shortage

The study employed an exploratory qualitative design grounded in collective case methodology. Between three and nine participants from each of eleven teams, three Assertive Community Treatment teams, four acute teams, three follow-up teams, and one rehabilitation team, took part in semi-structured focus group interviews lasting approximately 75 minutes each, conducted over a four-month period. Managers were deliberately excluded to encourage open dialogue and minimize hierarchical influence, and all groups were gender-balanced. Using Braun and Clarke’s reflexive thematic analysis, the researchers identified four interrelated themes that structure the findings: Anchoring Amid Chaos, Bearing Ethical Strain, Reinventing in Motion, and Sustaining Care Through Strong Relationships. What began as site-specific complaints, the authors note, emerged through the analytic process as shared dilemmas cutting across team types and service formats.

The first theme, Anchoring Amid Chaos, describes how professionals compensate for fragmented systems, unclear responsibilities, and organizational discontinuities. Participants described unclear handovers, split documentation systems, and persistent ambiguity about who holds responsibility at different stages of a user’s care journey. One ACT team member captured the structural absurdity plainly: the team works for both municipal and specialist services but cannot see each other’s records. Tasks such as following up on referrals or reconnecting users with support structures were taken on not because they were assigned, but because no one else would do them. As one participant put it, the system collapses when they let go, and they do not know who is supposed to catch the users. Another reflected that sometimes the system itself creates the instability the teams are trying to manage, comparing the work to building on sand.

The second theme, Bearing Ethical Strain, exposes the moral weight of practicing without protocols. Unlike institutional settings with formal decision hierarchies, ambulatory professionals confront dilemmas in real time, often during understaffed shifts or legally fraught situations. Examples ranged from the seemingly mundane, such as accompanying a patient to buy alcohol to maintain engagement, to the legally complex, including an ACT team’s decision to contact a patient’s father without consent for safety reasons. One acute team member noted there is no place to talk about the ethical judgments made daily, while another described making tough calls alone, trusting instinct in the moment. Some teams developed informal debriefing routines, often over coffee or in the car on the way back from difficult shifts, but these improvised supports rarely addressed the deeper systemic issues. The researchers frame this not merely as moral distress but as moral endurance, the capacity to keep practicing in ethically uncertain conditions day after day.

The third theme, Reinventing in Motion, documents continuous, improvised adaptation of formal service models. ACT protocols shift to accommodate rural contexts, acute interventions blend standardized tools like the Health of the Nation Outcome Scales with improvisation, and follow-up teams combine therapy with practical activities such as hiking. One rehabilitation team member described having to build the road while walking it, since no clear plan existed. This reinvention was not preference but necessity, unfolding in response to unpredictable conditions and loosely coordinated systems. Yet the researchers found a troubling duality: professionals expressed pride in their flexibility while also feeling vulnerable, expected to be creative but left on their own when something went wrong. This improvisational labor remains structurally invisible, unrecognized in official metrics, even though, as one participant concluded, without it things fall apart.

The fourth theme, Sustaining Care Through Strong Relationships, positions relational continuity as the core infrastructure of care in fragmented environments. Professionals built trust through persistence and presence, meeting users in homes, public spaces, or cars, sometimes showing up fifteen times before receiving a response. ACT teams maintained contact through cycles of rejection and re-engagement, occasionally visiting without appointments just to keep a thread of connection alive. One participant reflected that sometimes the walk was the intervention, capturing how blurred the line between professional duty and human companionship had become. These bonds were not only therapeutic but practical, enabling early crisis detection and re-engagement of users who had dropped out. A five-minute call, one acute team member observed, can mean the difference between stability and breakdown. Yet visits for coffee, impromptu walks, and regular check-ins were rarely logged as treatment, despite being fundamental to stability.

Theoretically, the study weaves together five complementary frameworks. Jarrett Zigon’s concept of moral breakdown illuminates how routine ethical comportment gives way to conscious deliberation under ambiguous conditions, a state the researchers found to be a persistent feature of ambulatory work rather than a rare event. Niklas Luhmann’s social systems theory explains why integration is structurally impossible: healthcare, municipal governance, and legal institutions each operate according to autonomous codes, forcing professionals to become de facto translators between self-referential subsystems. Donald Schön’s reflective practitioner model reframes the teams’ improvisation not as drift or inconsistency but as professional artistry, a form of reflection-in-action grounded in contextual competence. Carl Rogers’ person-centered theory underpins the relational findings, with empathy, congruence, and unconditional positive regard functioning as foundational conditions for recovery rather than mere techniques.

To synthesize these dynamics, the authors applied Ødegård’s Perception of Interprofessional Collaboration Model, or PINCOM, which analyzes collaboration across individual, group, and organizational levels. Viewed through this lens, collaboration in ambulatory mental health care emerges not as the result of seamless coordination or rational planning, but as what occurs in their absence. At the individual level, professionals respond to moral ambiguity with discretionary judgment; at the group level, teams co-produce collaboration through trust-based improvisation rather than standardized fidelity; and at the organizational level, practitioners perform integrative labor across institutional gaps, bridging disconnected services and translating between incompatible documentation systems. The researchers identify three recurring cross-level tensions: collaborative intent versus infrastructural friction, personal ethics versus institutional mandates, and team-level improvisation versus vertical expectations. Ambulatory teams, they conclude, are not extensions of the system but the glue binding its fragments.

The findings carry concrete implications for training, evaluation, and policy. The authors call for structured opportunities for ethical reflection, including dialogical training, team debriefs, and peer consultations to mitigate moral distress. They urge regional health authorities to build joint documentation systems, shared care plans, and cross-sector case conferences that connect municipal and specialist domains. Evaluation frameworks, they argue, must evolve beyond hospitalization rates and throughput metrics to include indicators of relational quality such as continuity, user trust, and emotional safety. National policymakers should allow local adaptations that preserve fidelity to recovery principles while endorsing reflective judgment over rigid adherence, and organizational leaders must formally recognize the mediating role professionals play at the intersection of systems, with clear expectations and shared accountability across sectors.

The study’s limitations warrant attention. It draws on teams within a single Norwegian region and focuses exclusively on specialist health services, so findings may not transfer to municipally organized teams or different structural configurations. The focus group format may have amplified dominant perspectives, and the secondary analysis prioritized thematic content over interactional dynamics within groups. The cross-sectional design offers only a temporal snapshot of evolving practices. Still, the researchers caution that professional resilience, however pronounced, cannot indefinitely compensate for systemic fragility. For recovery-oriented mental health care to endure, system-level change must recognize and support the invisible labor currently borne by frontline professionals, the ethical improvisation, relational stamina, and situational intelligence that make care possible despite, not because of, existing frameworks.

Subject of Research: Professional experiences and adaptive anchoring work in Norwegian specialized ambulatory mental health care teams

Article Title: Anchoring practice in flux: Experiences among professionals in Norwegian specialized ambulatory mental health care teams

Article References: Dale, K. Y., & Ødegård, A. (2026). Anchoring practice in flux: Experiences among professionals in Norwegian specialized ambulatory mental health care teams. Current Psychology, 45(18), Article 1526. https://doi.org/10.1007/s12144-026-10096-7

Image Credits: AI Generated

DOI: 10.1007/s12144-026-10096-7

Keywords: ambulatory mental health care, Assertive Community Treatment, crisis resolution teams, ethical dilemmas, interprofessional collaboration, relational care, systemic fragmentation, qualitative research, thematic analysis, recovery-oriented care, Norway, mental health services