Psychiatrist–consumer relationships in US public mental health care: consumers’ views of a disability system

Abstract

The US public mental health system is a disability system. By this is meant that public programs for people with mental illness serve consumers who are seriously and chronically ill, functionally disabled and eligible for benefits by virtue of their disability. This study explores, through focus groups and qualitative data analysis, the perceptions of these consumers of their relationships with public sector psychiatrists. Thematic analysis finds relationships of three types – compliance, collaboration and contention – and constituent sub‐themes that specify these further. Issues of poverty and powerlessness arise in every category, but especially in contentious relationships. Although the converse is widely believed to be true, this paper argues that the economic and political empowerment of people with psychiatric disabilities is vital to the success of their clinical care

Keywords:

• psychiatric disability
• mental health
• USA
• psychiatry
• disability policy
• focus groups

Acknowledgements

The author wishes to acknowledge a seed grant from the Division of Health Services Management and Policy, College of Public Health, The Ohio State University and a project grant from the Ohio Department of Mental Health, Office of Program Evaluation and Research. Research assistance was provided by Jennifer Hill.