Supported Decision-Making: The Expectations Held by People With Experience of Mental Illness

Supported decision-making (SDM) is a principle guiding mental health service provision, which aims to improve people’s ability to make informed decisions about their care. Understanding diverse individual needs is vital to its success. Based on 29 narrative interviews with people diagnosed with mental illness in Australia, we examine how participants reflected on their own experiences of SDM. We find that participants’ conceptualization of mental health expertise, their own lived experiences and sense of agency, and their varying needs for dependence and independence influenced their relations with mental health practitioners. These factors in turn shaped their expectations about SDM. Four narrative positions emerged: the ‘Inward Expert’, the ‘Outward Entrustor’, the ‘Self-Aware Observer’ and the ‘Social Integrator’. These positionings influenced the type or style of support that participants expected and considered most useful. Our findings are relevant to developing effective approaches to SDM that take into account service users’ needs and preferences

Reflecting on the Past: The Role of Biographical, Familial and Social Memory in New Mothers Interpretations of Emotional Experiences in Early Parenthood

Becoming a mother occasions multiple, intersecting changes in a womans life: bodily, biographical, relational and social. Many women in contemporary Australia find the adjustment to motherhood more challenging than anticipated, contributing to feelings of ambivalence or distress. Based on interview data, this chapter explores womens tendency to look towards the pastrevisiting personal and family histories and reflecting on sociocultural changes they felt had affected motheringto make sense of complex affective experiences during the transition to motherhood and construct a desired maternal self. Drawing on insights from feminist psychoanalysis, sociology and oral history, the chapters findings reveal the significance of memory (personal and collective) as a resource for the reflexive reworking of identity in times of personal transition and an impetus to social critique

Space and the navigation of intimacy in intergenerational Tongan-European Australian relationships during partnering and early parenthood

Drawing on a larger study of a diverse group of eight Tongan-European Australian intercultural couples' experiences of partnering and becoming parents, this article explores participants' accounts of relationships with parents and parents-in-law over the course of these key family life cycle transitions. In particular, the article seeks to understand the role of geographical space in couples' experiences of navigating intimacy in intercultural, intergenerational relationships, understood as sites for cosmopolitanization, and what this reveals about intercultural partnering and parenting in the context of wider social and economic changes impacting family life. The analysis shows that participants placed importance on both intimate relationships with their parents and parents-in-law, and on autonomy as a couple, but that balancing these objectives was challenging. The article also illustrates how the occupation and sharing of space can enhance or disrupt intimacy between adult children in intercultural relationships and their parents/-in-law. Alternatively, space can be used to remedy uncomfortable cosmopolitanized encounters and reinscribe preferred degrees of physical proximity and distance. These findings highlight the importance of attending to the 'doing' and undoing of intimacy, including non-verbal gestures and responses. The article contributes to our understanding of emotional experiences of cosmopolitanization, and of intimacy in intercultural, intergenerational relationships

'One of the Most Vulnerable Times in Your Life': Expectations and Emotional Experiences of Support in the Early Postnatal Period

Childbearing has cross-culturally and historically been considered a time of vulnerability and transition for new mothers and their babies, as reflected in the existence of ritual postpartum practices. The decline of 'lying-in' or confinement practices in Australia has, together with large-scale socio-cultural and demographic changes, led to many new parents, particularly mothers, finding themselves isolated and unsupported in the early postnatal period. This chapter explores how a diverse group of new parents in Australia felt and thought about social support in early parenthood, and the support they experienced. Based on an in-depth engagement with parents' narratives, it argues that understanding emotional responses to experiences of support in early parenthood is impossible without an appreciation of both expectations of support, and the factors influencing such expectations

Supported decision-making: The expectations held by people with mental illness

Supported decision-making (SDM) is a principle guiding mental health service provision, which aims to improve people’s ability to make informed decisions about their care. Understanding diverse individual needs is vital to its success. Based on 29 narrative interviews with people diagnosed with mental illness in Australia, we examine how participants reflected on their own experiences of SDM. We find that participants’ conceptualization of mental health expertise, their own experiences and sense of agency, and their varying needs for dependence and independence influenced their relationships with mental health practitioners. These factors in turn shaped their expectations about SDM. Four narrative positions emerged: the “Inward Expert,” the “Outward Entrustor,” the “Self-Aware Observer,” and the “Social Integrator.” These positionings influenced the type or style of support that participants expected and considered most useful. Our findings are relevant to developing effective approaches to SDM that take into account service users’ needs and preferences

Options for Supported Decision-Making to Enhance the Recovery of People Experiencing Severe Mental Health Problems

People experiencing severe mental health problems may experience a loss of autonomy in decision-making under laws that enable others to make decisions for them or because of pre-conceived notions about their decision-making abilities. The United Nations Convention on the Rights of Persons with Disabilities (CRPD, 2008), which Australia has ratified, is driving changes to ensure the integration of a human rights perspective into mental health and community services. Mental health laws, policies and practice are moving towards a stronger focus on personal recovery and human rights. The personal recovery model values autonomy and the right of people experiencing severe mental health problems to have choice and control over important decisions. Ensuring people's views and preferences in decision-making are respected on an equal basis with others is a cornerstone of these developments. Supported decision-making means that those assisted retain legal authority to make decisions. It involves individuals receiving support from others to consider alternatives and make specific decisions. This report summarises the findings of an Australian Research Council Linkage project which sought to document the experiences, views and preferences of people experiencing severe mental health problems, family members and other informal supporters, and mental health practitioners about supported decision-making, treatment and recovery in Australia. The research team interviewed 90 people across Victoria. This report documents the analysis of those experiences and the project's findings. It also includes an international comparative analysis of supported decision-making laws, policies and programs. The project findings have informed recommendations for improvements to mental health service delivery

Supported decision-making: The expectations held by people with mental illness

Supported decision-making (SDM) is a principle guiding mental health service provision, which aims to improve people’s ability to make informed decisions about their care. Understanding diverse individual needs is vital to its success. Based on 29 narrative interviews with people diagnosed with mental illness in Australia, we examine how participants reflected on their own experiences of SDM. We find that participants’ conceptualization of mental health expertise, their own experiences and sense of agency, and their varying needs for dependence and independence influenced their relationships with mental health practitioners. These factors in turn shaped their expectations about SDM. Four narrative positions emerged: the “Inward Expert,” the “Outward Entrustor,” the “Self-Aware Observer,” and the “Social Integrator.” These positionings influenced the type or style of support that participants expected and considered most useful. Our findings are relevant to developing effective approaches to SDM that take into account service users’ needs and preferences