Community treatment orders and care planning: How is engagement and decision-making enacted?
care planning
community treatment orders
decision-making
trust
Journal
Health expectations : an international journal of public participation in health care and health policy
ISSN: 1369-7625
Titre abrégé: Health Expect
Pays: England
ID NLM: 9815926
Informations de publication
Date de publication:
10 2021
10 2021
Historique:
revised:
12
07
2021
received:
19
05
2021
accepted:
16
07
2021
pubmed:
13
8
2021
medline:
26
10
2021
entrez:
12
8
2021
Statut:
ppublish
Résumé
In many jurisdictions worldwide, individuals with a mental illness may be forced to receive care and treatment in the community. In Australia, legislation states that such care should be driven by a care plan that is recovery-focussed. Key components in the care planning process include engagement and decision-making about a person's support needs and care options, with trust being an essential component of care planning relationships. This study examines how these components were enacted during service care contacts for individuals on community treatment orders. The study was located at two community mental health teams in South Australia. Ethnographic observations of care planning discussions between consumers, their carers and clinicians, and interviews with individuals from these groups, were conducted over 18 months. Carspecken's critical ethnography provided a rigorous means for examining the data to identify underlying cultural themes that were informing day-to-day care interactions. Care planning was not occurring as it was intended, with service culture and structures impeding the development of trusting relationships. Clinicians striving to work collaboratively with consumers had to navigate a service bias and culture that emphasized a hierarchy of 'knowing', with consumers assumed to have less knowledge than clinicians. Services and clinicians can challenge prejudicial ethical injustice and counter this through testimonial justice and implementation of tools and approaches that support genuine shared decision-making. This study included individuals with lived experience of mental illness, their carers and clinicians as participants and researchers.
Sections du résumé
BACKGROUND
In many jurisdictions worldwide, individuals with a mental illness may be forced to receive care and treatment in the community. In Australia, legislation states that such care should be driven by a care plan that is recovery-focussed. Key components in the care planning process include engagement and decision-making about a person's support needs and care options, with trust being an essential component of care planning relationships.
OBJECTIVE
This study examines how these components were enacted during service care contacts for individuals on community treatment orders.
METHODS
The study was located at two community mental health teams in South Australia. Ethnographic observations of care planning discussions between consumers, their carers and clinicians, and interviews with individuals from these groups, were conducted over 18 months. Carspecken's critical ethnography provided a rigorous means for examining the data to identify underlying cultural themes that were informing day-to-day care interactions.
RESULTS
Care planning was not occurring as it was intended, with service culture and structures impeding the development of trusting relationships. Clinicians striving to work collaboratively with consumers had to navigate a service bias and culture that emphasized a hierarchy of 'knowing', with consumers assumed to have less knowledge than clinicians.
CONCLUSIONS
Services and clinicians can challenge prejudicial ethical injustice and counter this through testimonial justice and implementation of tools and approaches that support genuine shared decision-making.
PATIENT OR PUBLIC CONTRIBUTION
This study included individuals with lived experience of mental illness, their carers and clinicians as participants and researchers.
Identifiants
pubmed: 34382300
doi: 10.1111/hex.13329
pmc: PMC8483198
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1859-1867Informations de copyright
© 2021 The Authors. Health Expectations published by John Wiley & Sons Ltd.
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