‘Like a human being, I was an equal, I wasn't just a patient’: Service users’ perspectives on their experiences of relationships with staff in mental health services

Abstract

Objectives The quality of therapeutic relationships in psychiatric services has a significant impact upon the therapeutic outcomes for people diagnosed with a severe mental illness. As previous work has not explicitly explored service users’ in‐depth views about the emotional impact of these relationships, the objective of this work was to bring this perspective to the fore and to gain a greater understanding about which relational components can lead to psychological change. Design The project was conducted alongside a service user organization. An interview design was used to qualitatively explore service users’ experiences and perceptions of their relationships with mental health practitioners. Methods Eight individuals who had experience of the mental health system in the United Kingdom were interviewed. Interpretative phenomenological analysis was used to analyse the data. Findings Three superordinate themes emerged from the analysis. These were (1) Trying to survive: am I a person or just an object in the system?; (2) Traumatic experiences within relationships; and (3) Helpful and transformative relationships. Further, the key transformative components of these relationships were power, safety, and identity. Conclusions Mental health services should be more focused upon care, rather than control. The Power Safety Identity (PSI) model, a reflexive model based upon key relational components highlighted by participants, is proposed for services and professionals to consider their work. The components of this model are managed by mental health practitioners and can determine whether these relationships maintain, increase, or alleviate psychological distress. Practitioner points Awareness of the relational components of power, safety, and identity has the potential to help practitioners reflect upon the tensions they experience in their relationships with service users. Mental health services and professionals that are sensitive to issues related to power, safety, and identity when responding to the needs of the service users can improve how individuals perceive the quality of care provided by them. Relationships between service users and mental health practitioners can encourage recovery if they are consistent, safe, trusting, provide protective power, and mirror a positive sense of self.

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

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Mums Alone: Exploring the Role of Isolation and Loneliness in the Narratives of Women Diagnosed with Perinatal Depression

“…However, as professional relationships were often not enduring, their temporality could ultimately increase women's feelings of loneliness or abandonment, particularly among those who relied more on these relationships because they were already isolated or marginalised. This reinforces previous research that has shown how people accessing mental health support may experience a painful sense of loss and insecurity if a therapeutic relationship ends [42].…”

Service user experiences of a novel in‐reach rehabilitation and recovery service for people with profound and enduring mental health needs

“…All service users perceived themselves to be disem power ed in some respects, particularly with regard to having to conform (see also Bacha et al . 2020). Many also described feeling power less when decisions were made on their behalf and expressed a desire for greater agency.…”