The vicious cycle of distrust: Access, quality, and efficiency within a post-communist mental health system

Abstract

Trust –a critical mechanism to manage vulnerability amidst uncertainty– may greatly influence healthcare practices, and consequently, its objectives. Building upon the work of Jürgen Habermas and the framework of trust chains, the aim of this article is to unpack how trust dynamics between the state, the provider, and the service user shape the functioning of mental healthcare in one of the former Soviet states –Lithuania. The case is of interest to medical sociology due to the region's historical and contemporary context. By drawing on in-depth interviews with healthcare providers and users, I demonstrate how the chains of reciprocal distrust underpin the workings of the mental health system and how the actors in turn employ a range of responses to such distrust. The instances of trusting relations nevertheless demonstrate how trust might facilitate the strive for mental healthcare that is more accessible, efficient, and of higher quality.