Shared Decision-Making: An Autoethnography About Service User Perspectives in Making Choices About Mental Health Care and Treatment

Autoethnographic Reflections on Mental Distress and Medication Management: Conceptualising Biomedical and Recovery Models of Mental Health

This article uses autoethnography to explore the author's lived experiences of mental distress and how she has conceptualised and explained these symptoms to herself using both the biomedical and recovery models of care. Autoethnography is a process of personal reflection that enables connection between the personal and the political. Experiences of mental distress are recounted alongside the decision to reduce medication. This personal experience is then explored in the context of limited evidence base on the effectiveness of reducing medication and the situation in which prescribers often feel reluctant to recommend and support service users in these choices. Shared decision-making in medication management is introduced which is an approach which draws on the models of recovery and co-production challenging traditional biomedical approaches which locate the prescriber as expert. Moreover, the radical service user led model is highlighted, within which, the Hearing Voices Network and Open Dialogue offer alternative approaches which promote co-production and empowerment. The author connects the personal to the political and reflects on her dual identity as an expert-by-experience and social work academic. She details how she has drawn on biomedical explanations to describe her distress yet has been challenged by the recovery model throughout her journey of recovery. She concludes that her own position, in identifying herself as an academic and expert-by-experience is an important step in challenging notions of expertise and approaches to mental health care.

Shifting Perspectives on the Challenges of Shared Decision Making in Mental Health Care

Although shared decision making (SDM) has become the most preferable way in doctor-patient communication, it is not fully implemented in mental health care likely due to the complex nature of psychiatric syndromes and treatments. In this review we provide a systematic overview of all perceived and reported barriers to SDM in the literature, acknowledging field-specific challenges, and offering perspectives to promote its wider use. We conducted a systematic search of the wider literature in different databases and included all publications mentioning specified barriers to SDM in psychiatric care. Relevant data and opinions were categorised into micro-, meso- and macro-level themes and put into clinical perspective. We derived 20 barriers to SDM from 100 studies and reports. Eight were on micro-level care delivery, seven involved meso-level issues, five concerned macro-level themes. The multitude of perceived and actual barriers to SDM underline the challenges its implementation poses in mental health care, some of which can be resolved while others are inherent to the nature of the care, with its long-term relationships, complex dynamics, and social consequences, all requiring a flexible approach. We present four perspectives to help change views on the potential of SDM in mental health care.

Promotion of research culture among radiographers in one UK NHS trust through journal club activities - An autoethnographic study

INTRODUCTION

The poor research culture within the radiography profession can be addressed through initiatives such journal club activities. The role of a research radiographer is best suited to drive achievement of journal club outcomes for research culture improvement; however, the cultural environment of healthcare providers presents challenges. This is an autoethnographic account of a research radiographer in promoting research culture among diagnostic radiographers in a single UK NHS trust through journal club activities.

METHODS

The study adopts an analytical autoethnography methodology to critically analyse reflective accounts of the research radiographer's experiences and the interplay with the cultural environment in which the experiences occurred. The reflective accounts are supported by locally collected data during a 10-month period of the journal club and published literature.

RESULTS

The establishment of the journal club received encouraging support from the senior management, university academics, library services and radiography professionals. There are initial signs of research culture improvement among participants of the journal club as observed through engagement in research related activities. However, cultural challenges including lack of time to explore gaps in research evidence, and prioritisation of clinical duties over research related activities, may have affected the achievement of expected outcomes of the club.

CONCLUSION

The research radiographer is well placed to encourage research culture within the clinical imaging department through targeted initiatives such as journal clubs. The long-term contributions of such initiative to departmental efficiency and quality service delivery should encourage optimum support to actualize expected outcomes.

IMPLICATIONS FOR PRACTICE

Encouragement of journal clubs as a means of improving research culture within clinical radiography teams, driven by research radiographers. Encouragement of management support for the achievement of set outcomes of journal clubs.