Scheduling in the community: Challenging partnerships in mental health

Abstract

Studies have shown that the experience of involuntary admission to a psychiatric unit is a stressful event that may contribute to secondary morbidity in vulnerable individuals. The experience preceding involuntary admission, commonly known as a "schedule", i.e., the compulsory removal and transportation of a person deemed to be mentally ill or disordered from their environment to a psychiatric facility for further assessment, has had little attention. The aim of this study was to identify the dominant factors of scheduling; the impact these factors have on the relationships between the main participants; and the current needs to develop a humane and consumer focused service. To this end, ten people who were scheduled; ten relatives of people who were scheduled; and ten clinicians involved in scheduling people participated in semi-structured interviews. These interviews evolved into a narrative style that better suited the topic under discussion and generated extensive amounts of data. A multifaceted method of analysis was used, predominantly of a thematic qualitative nature, to interpret the results. The results show that the three groups experience the scheduling event in similar ways. Fear, anxiety, concern, betrayal, and lack of options predominate in all groups. The concepts of power, crime or illness, and information and education challenge assumptions about insight, competence, informed consent and working in partnership, and set the ground rules for effective therapeutic relationships. The need for comprehensive information and education programs; forums for discussion and evaluation of events; increased family involvement; ongoing trust relationships with mental health professionals; and increased resources were identified by those involved in this sensitive area. In order to work in true partnership in mental health, particularly in the highly skilled area of acute interventions, we need to challenge our assumptions and beliefs and listen to the lived experiences of those we work with. Acute community mental health requires high levels of skill, knowledge and clinical acumen based on humanistic principles and ethical values as well as in medical knowledge. This thesis contributes to the knowledge and understanding required to develop partnerships and policies that can make this very human event more human.