Decision-Making in Mental Healthcare: A Phenomenological Investigation of Service User Perspectives

Abstract

As Victorian asylums closed down in the United Kingdom, community mental health services were set up to support patients in exercising choice and freedom; in finding a place in society. The success of these services has been questioned, so further policies have been introduced in an effort to protect rights and improve social inclusion. However, capacity to make decisions has been interpreted as no more than a process of rational mental calculation. This article reports on a phenomenological study that explores the decision-making experiences of three men who have endured psychosis. It is not only associated with choice and freedom but also with responsibility, blame, and social exclusion. These men appear to have faced common existential dilemmas, but have sought to express emotional will in conflict with other people and have, perhaps, been placed under more social pressure and become more isolated as individuals, while enduring experiences that are difficult to make meaningful for others. It seems that, paradoxically, efforts have been made to empower these men by controlling them, and medication has been imposed on them so as to regulate thoughts and moods, in attempts to serve their best interests.

Additional information

Notes on contributors

Simon J. Wharne

Simon J. Wharne is a Ph.D. student with The Open University, a Team Leader with an Assertive Outreach Team in community mental health services, and Chairperson for the National Forum for Assertive Outreach in the United Kingdom. He has published articles and contributed as an author and editor of a recently published book on current practice in Assertive Outreach.

Darren Langdridge

Darren Langdridge, Ph.D., is Head of Department of Psychology at The Open University, UK, and Honorary Professor of Psychology at Aalborg University, Denmark. He is also a United Kingdom Council for Psychotherapy registered existential psychotherapist working in private practice. His research is focussed on phenomenological psychology, sexualities, and gender, and he has published widely on these topics. He is the author of Phenomenological Psychology: Theory, Research and Method (Pearson Education), with his latest book on existential counselling and psychotherapy due to be published by Sage in 2012.

Johanna Motzkau

Johanna Motzkau, Ph.D., Dipl. Psych., is Senior Lecturer in Psychology at the Faculty of Social Sciences, The Open University, UK. She has a background in philosophy, German critical psychology, and theoretical and forensic psychology, and is interested in theoretical and practice issues surrounding memory, suggestibility, child sexual abuse, and the way psychological expertise is generated and used by different legal systems internationally. Her recent work has developed a process theoretical approach to research in the social sciences drawing on the work of Deleuze, Stengers, and Whitehead, termed researching practice as process. She has published widely on qualitative research methods, critical psychology, child witness practice, sexual abuse, memory and suggestibility.