Abstract
Objectives: We aimed to explore the treatment decision-making experiences of individuals with psychosis, and their implications for increasing service users’ autonomy through clinical practice and research.Design: A qualitative design was used to explore in depth service users’ experiences of treatment decision-making.Method: People with non-affective psychosis took part in semi-structured interviews that sought to elicit rich descriptions of their subjective experiences of treatment decision-making encounters. These were analysed using Interpretative Phenomenological Analysis (IPA).Results: The interviews of seven service users with multiple experiences of treatment for psychosis were analysed. Four themes emerged around influences on treatment decision-making: (1) a need to feel listened to; (2) psychotic experiences, treatment and stigma; (3) communication and support; (4) differing conceptions of recovery. There was an over-arching theme of empowerment.Conclusions: Influences on participants’ empowerment emerged at multiple levels, from their sense of self-worth to prevailing social constructions around psychosis. Service users’ participation in decision-making about treatment for psychosis might be enhanced where clinicians are able to pay close attention to disempowering aspects of their experience. The development of more comprehensive models of decisional capacity may support this endeavour.
Highlights
Where service users with mental health problems are judged to lack treatment decision-making capacity, there is support in law (Mental Capacity Act 2005: Code of Practice, 2007), and agreement in the literature (Dawson, 2015; Richardson, 2012) that everything possible should be done to support them to make their own decisions about treatment
Three participants were unable to provide in-depth reflections on their experiences, respectively due to minimal experience of treatment for psychosis, severely blunted affect or extreme tangentiality; their interviews were excluded from the analysis
We suggest that the concept of treatment decisional capacity in psychosis needs to be extended even beyond the social model advocated by McDaid and Delaney (2011), to encompass the power dynamics operating within the social context of treatment decision-making situations
Summary
Where service users with mental health problems are judged to lack treatment decision-making capacity, there is support in law (Mental Capacity Act 2005: Code of Practice, 2007), and agreement in the literature (Dawson, 2015; Richardson, 2012) that everything possible should be done to support them to make their own decisions about treatment. Group metacognitive training has recently been found to improve cognitive processing of treatment-related information (Naughton et al, 2012), though individuals’ appreciation of the personal impacts of treatment decisions remained unchanged.The wider psychosis and recovery literature, has identified a broad range of influences on how individuals make sense of the world, such as systematic cognitive biases (Broome et al, 2007); emotional distress; experiences of current and past social adversity (e.g.Garety, Kuipers, Fowler, Freeman, & Bebbington, 2001); and personal meanings of recovery Careful qualitative analysis of such experiences may have implications for the development of conceptualistaions of capacity with psychosis, and associated interventions to improve it
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