Mental health professionals’ perspectives on quality of life and organisational conditions in severe and persistent mental illness in Germany

Abstract Background Severe and persistent mental illness (SPMI) is associated with long-term impairment in functioning, social participation, and subjective quality of life (QoL). Although QoL has become a central outcome in psychiatric research, little is known about how mental health professionals (MHPs) conceptualise QoL and translate quality-of-life–oriented care into everyday clinical practice. Professional perspectives are essential for understanding how person-centred and palliative-informed approaches are negotiated within the organisational realities of psychiatric care. This study explored how MHPs in Germany conceptualise QoL in people living with SPMI and how organisational conditions shape these perspectives. Methods Seven mental health professionals working across different psychiatric care settings participated in semi-structured interviews. Interviews were audio-recorded, transcribed verbatim, and analysed using qualitative content analysis according to Mayring, supported by MAXQDA 24. A proxy-adapted version of the Schedule for the Evaluation of Individual Quality of Life – Direct Weighting (SEIQoL-DW) was used as a complementary elicitation tool to document professionals' prioritisation of QoL domains. SEIQoL-DW data were analysed descriptively and interpreted alongside the qualitative findings. Results Mental health professionals conceptualised QoL in SPMI as a multidimensional construct grounded in social relationships, daily structure, emotional stability, and situationally achievable autonomy and participation. At the same time, they identified organisational and structural constraints that limited the implementation of these priorities in everyday practice. Communication and information deficits, staff shortages, and gaps within the mental health care system emerged as prominent barriers to QoL-oriented care. While the SEIQoL-DW documented professionals’ explicit prioritisation of QoL domains, organisational and systemic barriers emerged primarily through the qualitative interviews. Conclusion This study demonstrates that, from the perspective of mental health professionals, QoL in SPMI is understood less as an outcome of symptom reduction than as something that emerges from the interaction between everyday stability, social relationships, and the organisational conditions of psychiatric care. By combining qualitative interviews with a proxy-adapted SEIQoL-DW, the study highlights the complementary value of individualised QoL assessment and qualitative inquiry for understanding professional perspectives. The findings support the development of psychiatric care models that strengthen continuity, participation, and everyday QoL alongside clinical treatment.