A critical narrative analysis of shared decision-making in acute, inpatient mental health care

Shared decision-making (SDM) is a high priority in healthcare policy and is complementary to the recovery philosophy in mental health care. This agenda has been operationalised within the Values-Based Practice (VBP) framework, which offers a theoretical and practical model to promote democratic interprofessional approaches to decision-making. However, these are limited by a lack of recognition of the implications of power implicit within the mental health system. This study considers issues of power within the context of decision-making and examines to what extent decisions about patients? care on acute in-patient wards are perceived to be shared. Focus groups were conducted with 46 mental health professionals, service users, and carers. The data were analysed using the framework of critical narrative analysis (CNA). The findings of the study suggested each group constructed different identity positions, which placed them as inside or outside of the decision-making process. This reflected their view of themselves as best placed to influence a decision on behalf of the service user. In conclusion, the discourse of VBP and SDM needs to take account of how differentials of power and the positioning of speakers affect the context in which decisions take place

Informed, Involved and Influential: The 3 I's model of Shared Decision Making in Mental Health Care

Collaboration between service users and mental health professionals is at the heart of values based practice and shared decision making. However, there has been limited analysis of the implications of these approaches within a healthcare context that involves depriving service users of their freedom. This article proposes a framework that aims to promote shared decision making which acknowledges, all participants must be Informed, Involved and Influential in the decision-making process. However, these are fluid; they refer to a sliding scale of influence that moves between these different positions depending on context, capacity and desire to influence

Community art project for excluded teenagers

This article describes a study of the experiences of young people who took part in a community art project in an inner-city area after being excluded permanently from school. The study used descriptive phenomenology to investigate their experiences. Unstructured interviews were conducted and two main themes were identified: the teenagers' experiences of taking part in the project and their involvement in it. Personal and social benefits of the arts identified include enjoyment, achievement, interacting with peers and engaging with the wider community

No hope without compassion: the importance of compassion in recovery-focused mental health services.

Background: Whilst current policy is replete with recovery language and references to the need for services to create a sense of hope and optimism, there is less understanding about how such hope may be engendered within services. We propose that an understanding of compassion is necessary to appreciate what actually stimulates hope-inspiring practices. Aims: An examination of the continuing relevance of compassion to mental health care and an exploration of its place within modern mental health policy and practice. Methods: A review of the compassion deficit in mental health care and a critical examination of whether the direction of current mental health policy in the UK is likely to facilitate compassionate care. Results: Compassion needs to be viewed not merely as an individual expression or property but something which must be nurtured in context, through relationships, cultures and healing environments. However, current mental health policy and practice does not appear to prioritise the development of such contexts. Conclusion: Attention to fostering compassion would help to shift the language of “recovery” (or “wellbeing”) beyond the twin dangers of rhetoric and/or imposing preconceived definitions, models or expectations of what recovery “should” be. Therefore, the development of compassionate contexts should have a stronger place in modern mental health practice and policy

A critical narrative analysis of shared decision-making in acute, in-patient mental health care.

Shared decision making (SDM) is a high priority in healthcare policy and is complementary to the recovery philosophy in mental health care. This agenda has been operationalised within the Values Based Practice (VBP) framework which offers a theoretical and practical model to promote democratic interprofessional approaches to decision making. However, these are limited by a lack of recognition of the implications of power implicit within the mental health system. This study considers issues of power within the context of decision making and examines to what extent decisions about patients’ care on acute in-patient wards are perceived to be shared. Focus groups were conducted with 46 mental health professionals, service users and carers. The data were analysed using the framework of critical narrative analysis proposed by Langdridge (2007). The findings of the study suggested each group constructed different identity positions which placed them as inside or outside of the decision making process. This reflected their view of themselves as best placed to influence a decision on behalf of the service user. In conclusion, the discourse of VBP and SDM need to take account of how differentials of power and the positioning of speakers affect the context in which decisions take place