User Involvement in the Handover between Mental Health Hospitals and Community Mental Health: A Critical Discourse Analysis

Health professionals' perceptions of user involvement in a mental health centre: A critical discourse analysis

The objective of this study was to investigate the engagement between healthcare professionals and users of mental healthcare at the individual level in a mental health hospital. A qualitative research design with purposive sampling was adopted. Five audio-recorded focus group interviews were conducted with nurses and other health professionals at a mental health hospital in Copenhagen and were explored using Fairclough's discourse analysis framework. This study shows how users can be subject to paternalistic control despite the official aim that user involvement be an integral part of the care and treatment offered. As evidenced in discussions by health professionals, the users were involved in plans based on conditions determined by the health professionals who were predominantly focused on treating diseases and enabling the users to live a life independent of professional help. Our results can contribute to dealing with the challenges of incorporating user involvement as an ideology in mental health hospitals.

Patient Participation in Mental Health Care - Perspectives of Healthcare Professionals and Patients: A Scoping Review

AIM

This scoping review aims to synthesize findings from fourteen selected articles to provide a comprehensive understanding of patient participation in mental healthcare.

METHOD

The review analyzed articles employing various qualitative methodologies, including interviews and observations, to explore patient and healthcare professional perspectives. Articles were selected based on their relevance to the topic of patient participation in mental health care.

RESULTS

The analysis revealed diverse perspectives on patient participation. Patients' preferences varied, with some preferring shared decision-making while others preferred minimal involvement. Barriers to shared decision-making included fear of judgment and substance misuse concerns. Strategies to manage disagreements and foster trusting relationships were identified. Challenges in implementing patient and public involvement in mental health services were noted, including stigma and inadequate professional training. Interprofessional collaboration was deemed fundamental, although fragmented care pathways and communication breakdowns persisted. Structural conditions and professional expectations significantly influenced patient participation, with a paternalistic approach perpetuating power imbalances.

CONCLUSION

Despite challenges, the findings underscored the importance of empowering patients in treatment decision-making, promoting collaborative relationships, and addressing barriers to enhance patient-centered care in mental health settings. Insights from this review contribute to the discourse on patient-centered care, emphasizing the need for holistic approaches prioritizing patient dignity and well-being.

Healthcare Professionals' Experiences of Recovery-Oriented Collaboration Between Mental Health Centres and Municipalities: A Qualitative Study

Collaboration within mental health centres and with municipalities in Western European healthcare has presented challenges due to structural and cultural disparities. The Danish healthcare system faces obstacles that impact mental healthcare services, particularly in cross-sectorial cooperation. Our aim was to investigate healthcare professionals' experiences of recovery-oriented collaboration within a mental healthcare setting across hospitals and municipalities to gather a deeper understanding of this issue. Twenty-four employees were purposively sampled from mental health centres in Copenhagen and focus group interviews were conducted to explore their perceptions of working together. Inductive content analysis was used to analyse the data and identify themes and categories. The participants emphasised challenges in communication and coordination to improve collaboration within across the two sectors. This study can contribute to a greater understanding of collaboration between mental health centres and municipalities. It aims to inspire improvements in communication, coordination, and the optimisation of mental health service delivery across sectors.

Perspectives on Recovery-Oriented Care in Mental Health Practices: Health Professionals Experiences

In several Western countries, mental health professionals work in accordance with the principles of recovery-oriented practices, but there is little research into what opportunities there are for fostering recovery-oriented practices in mental health settings. To investigate how central elements of recovery-oriented practices are reflected in health professionals experiences of care and treatment in mental health. Four focus group interviews with nurses and other health professionals are conducted and analysed using manifest content analysis to carry out a low-level analysis of the participants' experiences in mental healthcare. The study was designed in accordance with the ethical principles of the Helsinki Declaration (1) and Danish law (2). The participants gave informed consent after verbal and written information. The main theme, 'recovery-oriented practices framed within institutional structural conditions', was based on three subthemes: 1) users need help to find meaning during hospitalisation and find hope, 2) health professionals experience it as an obligation that users achieve personal recovery, and 3) user perspectives versus the mental health practices' structural logic. This study sheds light on health professionals experiences with a recovery-oriented practice. The health professionals believe in this as a positive approach and see it as an important obligation to help the user find their own aims and hopes. On the other hand, it can be difficult to work in recovery-oriented practices. It requires an active commitment from users; for many, this can be difficult to live up to.

Healthcare Professionals' Experiences with Patient Participation in a Mental Healthcare Centre: A Qualitative Study

INTRODUCTION

Patient participation is a cornerstone of the debate concerning healthcare professionals and patients of mental health centres. It constitutes an objective in government health policy in Scandinavia and other Western countries. However, little is known about the experiences of healthcare professionals in mental healthcare practices involving patients under their treatment and care.

OBJECTIVE

This study aimed to explore the experiences of healthcare professionals with patient participation in the context of a mental health centre.

METHODOLOGICAL DESIGN

Four focus group interviews with healthcare professionals reflected differing experiences with unfolding patient participation in clinical practices in four wards of a mental health centre. A content analysis developed and framed themes.

RESULTS

Patient participation was based on structural conditions, which shows that predetermined structural methods predominantly control involvement. The structural methods are seen as promoting participation from the patient's perspective. At the same time, the methods also enable taking account of the individual patient's wishes and needs for involvement.

DISCUSSION AND CONCLUSION

This study illuminates the meaning of patient participation in a mental health centre based on the social interactions among nurses and other healthcare professionals. The approach can contribute to dealing with the challenges of incorporating patient participation as an ideology for all patients in a psychiatric context, which is important knowledge for healthcare professionals.

Recovery-Oriented Practices in a Mental Health Centre for Citizens Experiencing Serious Mental Issues and Substance Use: As Perceived by Healthcare Professionals

INTRODUCTION

Recovery-oriented practices have become a means of promoting user recovery during hospitalisation, but we do not know much about the concrete means of practicing recovery-orientation for the most vulnerable users with serious mental difficulty and substance use.

AIMS

We investigated the concrete means of practicing recovery-orientation in care work and the elements, dimensions, outcomes, or steps of it in a special department of mental health centres.

METHOD

Focus group interviews were conducted with 16 health professionals with experience with users with serious mental difficulty and substance use. Qualitative content analysis was undertaken.

RESULTS

The main theme was "holistic recovery on structural terms" based on two themes and four subthemes. The first theme was "recovery based on an individual approach" with subthemes "detective-find hope" and "how to do recovery-oriented practice". The next theme was "recovery subject to structural framework" with subthemes "tension between different interests" and "symptoms as a barrier".

CONCLUSIONS

recovery-oriented practice is understood as an approach where health professionals emphasise forming relationships based on trust, being hopeful for the users' future, spending time with users, and respecting users' experiences and knowledge from their own life. There are cross-pressures between different interests. The desire to meet the users' perspectives and respect these perspectives but at the same time live up to mental health centre purposes to stabilise the users' health and achieve self-care.

Measuring judiciarization of people with mental illnesses

The judiciarization of the psychiatric subject is a two-sided process. It could anti-discriminate people with mental illnesses but, at the same time, it could potentially provoke pathologization of mental illnesses. Current methodologies proposed to measure this important and complicated process for people with mental illnesses do not allow analysis on multiple levels (the macro, meso, and micro). In this article, to fill this gap we propose a methodological strategy that helps to investigate judiciarization of people with mental illnesses on multiple levels at once. This approach is based on critical discourse analysis of legal documents and court decisions that feature people with the poor mental health. Namely, we suggest how to measure the level or degree of judiciarization, its geographical evenness, actors in the legal process, its dimensions (the law branches of its occurrence), and linguistic content. We applied this methodology in examining 1,243 legal documents and 327,311 court decisions that were issued by agents of the Russian law system. The research findings show that judiciarization levels in Russia have been rising over the years, moving away from stigmatizing those with mental illnesses and towards anti-discrimination. Our paper could be of interest to socio-legal researchers and social policy practitioners.