A qualitative emancipatory inquiry into relationships between people with mental disorders and health professionals

Abstract

Accessible summary What is known on the subject? A therapeutic alliance with people with mental disorders could help increase the efficacy of treatment. The paradigm shift from a paternalistic model to one that respects the person's autonomy has led to professionals accepting the active role of people with mental disorders making decisions that affect their treatment. What this paper adds to existing knowledge? People with mental disorders perceive paternalistic and stigmatizing attitudes from health professionals, and they do not feel involved in decisions about their health, which can render effective therapeutic alliances difficult. The findings reveal that although people in Mediterranean countries are used to paternalistic treatment from health professionals due to cultural factors, people with mental disorders are increasingly critical of how they are treated and demand greater autonomy and respect in the decision to undergo drug therapy. What are the implications for practice? In their interactions with people with mental disorders, health professionals should include efforts aimed at improving shared decision‐making capabilities and avoiding paternalistic or stigmatizing attitudes. Abstract IntroductionA therapeutic alliance with people is essential for the efficacy of treatments. However, the traditional paternalistic values of the Mediterranean society may be incompatible with patient autonomy. AimTo explore the therapeutic relationship from the perspective of people diagnosed with mental disorders with health professionals, including nurses. MethodsThis emancipatory research was performed through focus groups, with people with mental disorders who had a variety of diagnoses and experiences of acute and community‐based mental health services and other healthcare services. Data were analysed using the content analysis method. ResultsFour main themes emerged: stereotypes and prejudice; quality of interactions and treatment; emotional and behavioural impacts; and demands. DiscussionAccording to the participants' descriptions, health professionals are not exempt from prejudice against persons with psychiatric diagnoses. They reported experiencing abuse of power, malpractice, and overmedication. Thus, in the Mediterranean culture, professional attitudes may represent a barrier for an appropriate therapeutic alliance, and people with mental disorders do not feel involved in making decisions about their health. Implications for practiceKnowing how people with mental disorders perceive their interactions with health professionals and the effects is necessary to move the care model towards more symmetric relationships that facilitate a therapeutic alliance.

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“…Martínez-Martínez et al [ 25 ] found that health professionals’ perceived negative attitudes were a significant concern to consumers and recommended increasing shared decision making and reflexive practice to improve the therapeutic alliance with consumers. Core to achieving this as part of ongoing engagement is the development of epistemic trust.…”

Diagnostic overshadowing: An evolutionary concept analysis on the misattribution of physical symptoms to pre‐existing psychological illnesses

“…While not commonly listed with cognitive and clinical biases (Centre for Evidence-Based Medicine 2021; Croskerry 2015Croskerry , 2019, recognition continues to grow for this phenomenon as a type of bias within health care (Becker-Haimes et al 2021;Hinde et al 2021;Jamieson & Mason 2019). Knowledge of diagnostic overshadowing is particularly vital for nurses as they are not only hands-on care providers but lead advocates for patient care (Chuttoo & Chuttoo 2019;Mart ınez-Mart ınez et al 2021).…”

“…Knowledge of diagnostic overshadowing is particularly vital for nurses as they are not only hands‐on care providers but lead advocates for patient care (Chuttoo & Chuttoo 2019 ; Martínez‐Martínez et al . 2021 ).…”