Community physician perceptions of managing complex child and adolescent psychiatric patients: a self-determination theory perspective.

Children and adolescents with complex mental health needs often require a level of care that is unsustainable in tertiary settings. Yet, the psychological impact of this on community physicians, who are tasked with providing quality care to this population, is not well understood. Grounded in Self-Determination Theory (SDT), the present study explores how the challenges of caring for these patients is affecting community physicians' basic psychological needs (autonomy, competence, and relatedness) and intrinsic motivation. Participants from Calgary, Alberta, Canada, were invited to complete an anonymous online survey containing questions about managing complex child and adolescent psychiatric patients. We used SDT's needs-based framework and 22-item Intrinsic Motivation Inventory as a component of our pilot study, to explore and understand their ideas. Community physicians reported moderate-high interest/enjoyment and moderate perceived competence in managing complex child and adolescent patients, but little perceived choice and high tension/pressure in carrying out this task. Physician remarks provided meaningful insights into how these clinical experiences are impacting them, psychologically, and where opportunities may exist for interventions to support them and their patients. Findings from this study suggest that the participating community physicians feel interested and adequately skilled to manage complex child and adolescent psychiatric patients, but that systemic barriers are hindering their basic psychological needs and intrinsic motivation to do so. Potential explanations and implications for these findings are discussed.