Whose decision is it anyway? A qualitative study of user participation and how clinicians deal with the patient perspective in mental healthcare

DOIhttps://doi.org/10.1108/MHRJ-01-2016-0003
Publication Date12 December 2016
Pages249-260
AuthorVår Mathisen,Geir Fagerheim Lorem,Aud Obstfelder,Per Måseide
SubjectHealth & social care,Mental health
Whose decision is it anyway? A
qualitative study of user participation and
how clinicians deal with the patient
perspective in mental healthcare
Vår Mathisen, Geir Fagerheim Lorem, Aud Obstfelder and Per Måseide
Vår Mathisen is an
Assistant Professor and
Geir Fagerheim Lorem is a
Professor and an Associate
Dean for Education, both at the
Department of Health and Care
Sciences, UiT The Arctic
University of Norway,
Tromsø, Norway.
Aud Obstfelder is based at the
Center for Care Research,
Gjøvik University College,
Gjøvik, Norway and
Department of Health and Care
Sciences, UiT The Arctic
University of Norway, Tromsø,
Norway.
Per Måseide is a Professor
Emeritus at the Faculty of Social
Sciences, Universitetet i
Nordland, Bodo, Norway.
Abstract
Purpose The concept ofuser participation is wellaccepted internationally. Nevertheless, studies show that
both patients and health professionals find it challenging to maintain patient-centred ideals in the context of
severe mentalillness. The purpose of this paper is to explore how professionals dealwith the ideals in light of
patientsrightto participatein planning anddecision makingregarding milieutherapeuticmeasures and activities.
Design/methodology/approach This is a qualitative study with an interactionist approach based on
fieldwork at three district psychiatric centres in Norway during 2011-2012. The observations focused on
patient-staff interaction in milieu therapeutic activities. Interviews were based on observed situations.
Findings Adherence to treatment, rules and routines restricted patient autonomy. The professionals
practical orientation towards routines overrode the ideals of patientsrights. The staff regarded user
participation primarily as participation in organised and mandatory activities. Refusal to comply was met with
different sanctions, e.g. the prospect of being discharged.
Originality/value Although user participation calls for patient-centred approaches, there is some debate
about the challenges and premises for cooperation with persons suffering from severe mental conditions.
This study adds insight into the everyday organisational context that facilitates or impedes user participation.
It helps to explain why the user perspective can be overlooked, thus providing important information to both
clinicians and policy makers who aim to fulfil the patients right to participate in planning and decision making
regarding treatment and care.
Keywords Qualitative research, Communication, User participation, Decision-making process,
Mental healthcare
Paper type Research paper
Introduction
User participation is a central tenet of guidelines for mental healthcare in most of the western
world, with the aim of enabling patients to play a greater role in their own healthcare (Rush, 2004;
Petersen et al., 2008). In theory, professionals should include users in everyday psychiatric and
medical healthcare. Users are entitled to be respected and recognised as competent to make
choices and participate in treatment planning and important decisions (Rush, 2004; Szmukler
and Appelbaum, 2008). International research emphasises that dialogue and the establishment
of mutual understanding between patients and clinicians are essential to achieve the dual
objective of user participation: involvement in treatment choices and enhancement of recovery
(Szmukler and Holloway, 2000; Davidson et al., 2006; Kartalova-ODoherty and Doherty, 2010;
Received 27 January 2016
Revised 30 May 2016
8 September 2016
Accepted 11 October 2016
DOI 10.1108/MHRJ-01-2016-0003 VOL. 21 NO. 4 2016, pp. 249-260, © Emerald Group Publishing Limited, ISSN 1361-9322
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MENTALHEALTH REVIEW JOURNAL
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PAG E 24 9

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