Understanding Relationships in Context as a Core Competence for Psychiatric Rehabilitation

Abstract

The central importance of effective working relationships between users and staff has been highlighted by a wide variety of sources. It is central to effective engagement, assessment, planning, clinical risk management, and a collaborative approach to the use of medication and other therapeutic interventions. Effective relationships may also serve to moderate some of the negative ways in which mental health services respond to people experiencing the effects of social inequalities (e.g., due to their race or gender). This paper argues that if authentic relationships are to be established then both parties will need to understand as fully as possible the social context in which they operate, the realities of the power dynamics between them, and the contradictory imperatives of care and control that operate on staff. This in turn argues for a more reflective and politically informed approach to work with disadvantaged people with severe and long-term mental health problems. This needs to be inculcated through training and evaluation, and supported by one's peers and managers over the long term.