Estranged relations: coercion and care in narratives of supported decision-making in mental healthcare.
medical anthropology
medical humanities
patient narratives
psychiatry
sociology
Journal
Medical humanities
ISSN: 1473-4265
Titre abrégé: Med Humanit
Pays: United States
ID NLM: 100959585
Informations de publication
Date de publication:
Mar 2020
Mar 2020
Historique:
accepted:
03
05
2019
pubmed:
1
8
2019
medline:
12
9
2020
entrez:
1
8
2019
Statut:
ppublish
Résumé
Supported decision-making has become popular among policymakers and mental health advocates as a means of reducing coercion in mental healthcare. Nevertheless, users of psychiatric services often seem equivocal about the value of supported decision-making initiatives. In this paper we explore why such initiatives might be rejected or ignored by the would-be beneficiaries, and we reflect on broader implications for care and coercion. We take a critical medical humanities approach, particularly through the lens of entanglement. We analyse the narratives of 29 people diagnosed with mental illness, and 29 self-identified carers speaking of their experiences of an Australian mental healthcare system and of their views of supported decision-making. As a scaffolding for our critique we consider two supported decision-making instruments in the 2014 Victorian Mental Health Act: the advance statement and the nominated person. These instruments presuppose that patients and carers endorse a particular set of relationships between the agentic self and illness, as well as between patient, carer and the healthcare system. Our participant narratives instead conveyed 'entangled' relations, which we explore in three sections. In the first we show how ideas about fault and illness often coexisted, which corresponded with shifting views on the need for more versus
Identifiants
pubmed: 31363013
pii: medhum-2018-011521
doi: 10.1136/medhum-2018-011521
pmc: PMC7042964
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
62-72Subventions
Organisme : Wellcome Trust
Pays : United Kingdom
Informations de copyright
© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
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