Exploring the implications of genetic testing in mental health care
Thesis or dissertation
University of Exeter
Now is a time of dramatic change in mental health care as the world is witnessing a proliferation of research into the genetics of mental disorders. Despite several genetic test developments there is a paucity of qualitative research exploring the issues concerning its potential future introduction. This inspired my primary research question: What are the main implications regarding the developments being made in genetic testing for mental disorders in terms of their proposed introduction in a clinical setting? This was investigated through 33 semi-structured interviews with a range of psychiatric professionals from a single NHS trust location in the South West of England. As research has demonstrated that different medical professionals consider issues in mental health care in different ways (Colombo, et al. 2003 ; Fulford and Colombo, 2004) participants’ personal constructs of mental disorder were examined to see if their accounts of the tests differed on the basis of their unique conceptualisations of mental distress. An additional component feature in this research relates to what these developments may ultimately represent or provide psychiatry and mental health care as a result of being able to consider mental disorders in terms of underlying biology. Historically there has been a persistent attempt to determine the underlying genetic components of mental distress, however, this always seems to fail or the next big development is always ‘just around the corner’ - this observation is considered when the major developments in psychiatric genetics are examined in light of the sociological field of the ‘promissory nature of science’ (Borup, et al. 2006) - I suggest that the developments in genetic testing for mental distress represent an iconic continuation of this process. Interview transcripts were subjected to thematic analysis and five themes were developed that cover aspects such as how the tests’ introduction will alter perceptions in mental health care, issues concerning the tests’ practical impact, their possible shortcomings, and how they may alter clinical practice. My findings indicate that, in the majority of themes, personal approaches to mental disorder do appear to influence participants’ accounts of the tests. The overall trend is that if an interviewee personally endorsed a biological approach to understanding mental disorder they would be willing to see the tests used in clinical practice. There were two areas of thematic agreement between all psychiatric professionals regardless of their conceptualisations of mental disorder. These concerned the impacts genetic testing could have on different aspects of the legitimacy of mental disorders and the significance of using the tests to aid in treatment rather than diagnosis. Implications of my thematic findings for patient groups, mental health services, and policy makers are discussed.
Doctor of Philosophy in Genomics in Society