Results for the Individual Interviews
Attitudes and opinions of Respondents to service user involvement
All participants accept the need to collaborate with the service user in order to achieve the best outcome. They believe service users’ involvement enhances quick recovery from emotional and psychological cooperation with the treatment options. It achieves reduction in the relapse rate because users will certainly have good understanding of their own problem and its genesis in order to prevent any actions that can precipitate reoccurrence. According to the representative from a National Organization- “our research shows that users are more likely to cooperate with the treatment, they are more likely to maintain the treatment over a period of time, they are less likely to have relapses”. The users claim to face repulsion when making attempt to participate in the treatment option, hence, when their contribution is withheld in most cases there is resurgence of symptoms and relapse.
Though with expression of reservations from a psychiatrist interviewee, there were considerable supports to embark on integrated form of recovery program which encompass all service providers and the service users as well. The reservation is expressed because of the sensitive aspect of the treatment where there is a non-debatable need for professional guidance as the team leader. At present, service users argue that their participation in their own care is poor, falling short of the requirement in line of the advocated Recovery Model in Mental Health.
The professionals including the nurses and psychiatrists so much hold on to the need for user restriction on matters of professional significant, they however, affirm to welcome any suggested contributions that can ease their stress. Specifically an educationalist submit that treatment and care “has to come from the top down and bottom up- as an individual you are not going to change it. There needs to be a lead from the top but commitment from the bottom as well”. According to a consultant psychiatrist who commented with restriction, “I mean it’s all great and everything and it’s great that people do get to that sort of level, but, you know, we’re so much in need of basic services…” In view all responses, it is glaring that all parties involve are of good opinion to welcome plans at getting interested service user involved in their own treatment and overall care options.
Perception of Power Imbalance between Service Providers and Users
All the participants excluding the psychiatrist are of the opinion that power imbalance exists in the management of mental health patients by relegating the significance of service users’ participation in the treatment options. Blaming the NSUE for non performance, the representative confess that “In reality, while the HSE and the government have signed up to the VFG the NSUE has not been that effective, they are now into the third year of its existence and in my opinion they haven’t made a significant contribution to the development of services”. Though the initiation of Vision for Change proposed to empower service user in participating in the management, the only development seen so far is the policy agreement. Actions are yet to be implemented as a follow up to implementation, he claimed. The two service providers comment that they only get engaged in their duty without any intention to hold on to power According to the psychiatrist “I don’t see it as a power imbalance at all, I mean I certainly don’t feel I am here to wield power in any way… we’re extremely busy, we don’t have, maybe, the sort of time people might fantasize we have or think we should have”. Service users often have sense of indignation when service providers do deprive them of desired attention.
The users opined the service providers are too over domineering during interaction with them no little respect for mutual interaction – “you know the psychiatrists are still the all powerful being and when there isn’t any choice you are kind of stuck”, an interviewee lamented.
Participants Opinions on Choice of Medication
The psychiatrist sees the patient endangering themselves when they are opting for option that lacks scientific basis and thus, contraindication in their professions. According to the psychiatrist, he stressed that treatment options have to go by proven evidence - “Well I think you have to go by the evidence, go by what is scientifically proven. As doctors we have to be very careful that we don’t impose a personal view on the information that we give, you know, at the end of the day it is people’s lives you are talking about, and I think it is great to be sort of championing psychotherapy, and I would be the first person to be saying its important, but, these are big investments that people make, you can’t just have psychotherapy instead of antipsychotics. There is no evidence to support that approach”. Interviewee argues that the mannerism of information dissemination about medication should be handled more seriously. He suggested that patients should ask several questions as the doctor would definitely discuss the side effect of medication with the patient or their relatives from the excerpt- “It is about how information is given, when and about the level of information given that is important. It is important for families, users themselves, to become I suppose aware and educate themselves about the issues and ask the right questions”.
Issues on informed Consent
A participant argues that law should be strengthened to encourage advance directives in a situation where the patient is seriously ill and obviously cannot contribute to partnership in the treatment option in that situation. The representation from the organization submits, “I think there are huge ethical and legal problems to be dealt with. Ultimately for most of the time I think informed consent can be achieved.”
Obstacles Hindering Service Users’ Participation
While it is important to come together and dialogue in seeing to the development of an improved partnership, many problems faced is the sincerity of promoters. “I think at one level it’s as simple as saying that people don’t act on their well meaning intentions. Everyone will say yes they want to involve service users, sometimes its easier for them to get on and work with the professional colleagues and to sometimes forget that they should involve users at all stages of development”, a participant argues. Another argument presents the issue of poor finance. Many argues that finances and resource availability is one of the hindrances in the actualization of structures or programs that can help bring together the expectations of the service user and providers. One interview also argues that finances have no role to play in fostering user/provider partnership adding; “I don’t think it’s a matter of finance. Consultation does not cost that much.”
Three of the participants attest that human resource is a major hindrance. Owing to the fact that it is really tasking to enroll a patient in some behavioral therapy, personnel devotee for this assignment is usually sparse. A participant argues that if people are hardly coordinated to cooperate with mere medication choice of treatment it would be more tedious to get their cooperation for behavioral programs. The staffing-to-patient ratio decreases and the return is the decreased attention to hear out the patient major concerns extensively and to patient own satisfaction. According to the psychiatrist “…nobody is going to solve that resource issue, but if service users can think of an idea in which they can present their stuff as taking some of the burden off, that would be the way to go”.
Results for First and Second the Groups
Attitudes to choice of Treatment and Power Grid Perception
They felt cheated in their own case by not allowing them to partake in the treatment option. Despite the understanding many patient have concerning the available choices of treatment and care, they felt they are still taking as poorly educated individuals by not allowing them to express choice of what they think is the best for them whereas the service provider assumes the overall power of being the major factor in the administration of treatment. They hope for less medical model. According to a group -“you just get a concoction of drugs and they’re just playing around with it for a few months’. I don’t think they understand the drugs they are giving people”, group C lamented. Group A, E, G and C express notion that most psychiatrist are rigid in their method without exploring new areas of treatment that is not dependent on medication. They felt they were not allowed to express themselves in detail for proper understanding so as to direct treatment options, said group A, B, C, and D.
Service User’s Opinion/Expectations about Treatment
According to group A, they opined that more chance should be given for the patient to reject or accept treatment option thrown at them. For example, a particular group commented that consequence of electro shock wave treatment have caused more harm to them than good. Service users express more detail interaction with them to really understand how they feel arguing that “ most doctor are middle class, who probably went to private school, went to a nice university like Trinity and is not experienced of understanding the experiences of what a lot of people who end up in the psych system have”. They express hope for more respect in the way they handle them having “the right to be fully, and granted the right to contest, as to any treatment that I might receive, whether through medication or something like ECT, and to be fully informed as to potential risks, such as side effects etc”
Opinion of Service Users’ On How to Fight for Participation in Treatment
They all hope to participate in the treatment and hope there is a need for initiation by instituted facilitator who are yet to act following 2006 Recovery Model policy. The users believe that through action group they can voice out their mind and agitate their concern collectively with stronger force. They believe this has being achieving some aim already since there has been little improvement and noise over it everywhere when compared to previous years. Furthermore, they hope power sharing should be embraced consciously to ensure that users are treated with genuine care with good human relations and not a listening-and-talking section that ends in prescription of bucket load of medications.