Hierarchy and Quality of Life Among Psychiatric Service Users

Abstract

Psychiatric service users, as all other human groups, form social hierarchies that may influence quality of life in hospital or in rehabilitation services. The aim of this review is to explore social hierarchies among patients to determine their advantages and disadvantages. Psychiatry, psychology, sociology, occupational therapy, and management databases were searched with terms linking status to psychiatric service use. Clinical examples were taken from three inpatient wards and two community clinics in Toronto, Canada. The literature suggests that high social rank among psychiatric patients is linked to preferred access to the resources that mental health service users particularly value, namely safety, quality care, and autonomy. High status patients are those who procure these resources for themselves, and also facilitate access for their peers. A hierarchical structure benefits the psychiatric service user community as a whole, but may serve as either benefit or drawback to individual leaders of the community.