"It's Like Mental Torture": Participation and Mental Health Services

Abstract

This article discusses findings from an ethnographic research study looking at the ways in which children's participation rights are incorporated within an adolescent mental health inpatient unit. The practitioners working within this setting have reinterpreted the concept of 'participation' to suit a coercive agenda associated with the authoritarian medical model of treatment used within child psychiatry. Indeed, the use of the term 'participation' has become a tool to enforce children's compliance with adult (and practitioner) determined treatment plans. For the most part, the barriers to according children's participation rights within this setting relate to the institution's and practitioners' protectionist stance vis-à-vis children who are deemed informally to be both vulnerable and incompetent.

Facilitators and Barriers to Person‐centred Care in Child and Young People Mental Health Services: A Systematic Review

“…Finally, all studies but one (Molesworth & Crome, ) presented findings in a comprehensive manner providing quotes illustrating the main themes obtained by the analysis. Nonetheless, several studies did not provide sufficient detail on issues such as justification of the research design ( n = 3; Iachini, Hock, Thomas, & Clone, ; Molesworth & Crome, ; Street, ), recruitment strategy ( n = 6; Lee et al, ; LeFrançois, ; Ma & Lai, ; Molesworth & Crome, ; Offord, Turner, & Cooper, ; Street, ), data collection ( n = 3; LeFrançois, ; Molesworth & Crome, ; Street, ), the relationship between researcher and participants ( n = 14; Buckley et al, ; Harper, Dickson, & Bramwell, ; Hart, Saunders, & Thomas, ; Iachini et al, ; Kovshoff et al, ; Lee et al, ; LeFrançois, ; Molesworth & Crome, ; Offord et al, ; Oruche, Downs, Holloway, Draucker, & Aalsma, ; Pelto‐Piri, Engstrom, K., & Engstrom, ; Street, ; Tam‐Seto & Versnel, ; Wisdom, Clarke, & Green, ), ethical issues ( n = 4; Abrines‐Jaume et al, ; LeFrançois, ; Molesworth & Crome, ; Wisdom et al, ) and rigour of data analysis ( n = 4; Hart et al, ; LeFrançois, ; Molesworth & Crome, ; Street, ). Finally, contribution to research, knowledge or policy was not discussed in two studies (Molesworth & Crome, ; Street, ), new areas of research were not identified in six studies (Buckley et al, ; Hart et al, ; Lee et al, ; Molesworth & Crome, ; Pycroft, Wallis, Bigg, & Webster, ; Street, ) and generalizability of findings was not taken into account in nine studies (Buckley et al, ; Bury, Raval, & Lyon, ; Coyne et al, ; Kovshoff et al, ; LeFrançois, ; Molesworth & Crome, ; Offord et al, ; Pelto‐Piri et al, ; Street, …”

“…Notably, there were three studies that suffered from poor reporting across most items from the Critical Appraisal Skills Programme tool (Critical Appraisal Skills Programme, ), related to recruitment strategy, data collection or rigour of the analysis (LeFrançois, ; Molesworth & Crome, ; Street, ). Moreover, one study used open‐ended survey questions to explore experiences of youth receiving mental health services, which appeared to be a highly flawed data collection method (Lee et al, ).…”

“…Service users' capacity to be involved in decision‐making, because of age and severity of symptoms, and concerns about confidentiality were raised as key barriers to PCC by professionals, service users and carers (Idenfors, Kullgren, & Salander Renberg, ; LeFrançois, ; Oruche, Downs, Holloway, Draucker, & Aalsma, ; Simmons, Hetrick, & Jorm, , ; Tam‐Seto & Versnel, ; Wisdom, Clarke, & Green, ). However, only professionals cited that capacity to consent to treatment is determined by age and not the stage of development, which not only has ethical and legal implications but may also cause concerns if, for instance, age and developmental stage are not aligned (see also service‐level factors; Simmons et al, ).…”

Participation of youth in decision‐making procedures during residential care: A narrative review

“…Some studies report on both foster care and residential care (e.g., Munford & Sanders, 2015;Polvere, 2014), or a combination of day-patient and inpatient residential care (LeFrançois, 2008). Some studies report on both foster care and residential care (e.g., Munford & Sanders, 2015;Polvere, 2014), or a combination of day-patient and inpatient residential care (LeFrançois, 2008).…”

“…Several studies do report on indirect effects of participation during residential care in terms of young people's experiences related to the (lack) of participation (Fudge Schormans & Rooke, 2008;Hepper et al, 2005;Roesch-March, 2014), such as distressing feelings and passiveness due to lack of participation (see also LeFrançois, 2008;Polvere, 2014). Several studies do report on indirect effects of participation during residential care in terms of young people's experiences related to the (lack) of participation (Fudge Schormans & Rooke, 2008;Hepper et al, 2005;Roesch-March, 2014), such as distressing feelings and passiveness due to lack of participation (see also LeFrançois, 2008;Polvere, 2014).…”