Trust as a Means of Bridging the Management of Risk and the Meeting of Need: A Case Study in Mental Health Service Provision

Abstract

Shifts in public policy towards an increasing focus on risk have been deemed problematic at a number of levels, particularly the tendency for concerns over reputational risk to institutions to trump the interests and needs of service-users. This article explores the tension between these two dimensions, of risk and need, in a case study of local mental health services -a setting where conflicting objectives to manage risk and meet need are apparent. Media-driven pressure to ward against the 'risk' represented by service-users tends towards more coercive policy which may obstruct the meeting of need, which in turn may undermine service-user engagement and hinder risk management. Drawing on qualitative data from interviews with service-users, professionals and managers, the article explores the process of trust and its facilitative role in meeting need and managing risk. Findings suggest that while existing foci on risk are at times counter-productive, trust plays a significant role in service-users' initial and ongoing engagement, communication and co-operation with professionals. Yet inherent obstacles to trust within mental healthcare contexts remain, due to cultural pressures on professionals, the nature of the illness experience and negative past experiences of in-patient care.

The Role of Perceived Helpfulness in Predicting Subjective Unmet Need and the Frequency of Health Care Use

“…Based on these findings we argue that an effort should be made to improve the quality of care. Previous studies have shown that treatment quality can be improved by providing more information on the diagnosis and treatment to the patients and their relatives (Brown & Calnan, 2013;Tyson et al, 2002) by making enough time for patients, achieving constructive dialogue with patients, discussing their needs and expectations (Brown, & Calnan, 2013;Naber & Kasper, 2000), and by actively involving patients in their treatment planning (Bhugra, La Grenade, & Dazzan, 2000). Hence, psychiatric nurses could also play an important role in the improvement of the quality of care, as they are well-placed to build trusting relationship with patients, to discuss the patient's needs and whether they feel the treatment is working.…”

“…However, if we draw on patient satisfaction literature, an alternative hypothesis can be formulated. More specifically, this research stance has shown that patient satisfaction, perceived helpfulness, and trust in physicians are related to better treatment outcomes and the future use of health care (Brown & Calnan, 2013;Kjeken et al, 2006). Therefore, for patients who perceive received help as effective, we could expect better treatment outcomes and consequently, fewer contacts with the health care provider (hypothesis 2b).…”

Ordinary risks and accepted fictions: how contrasting and competing priorities work in risk assessment and mental health care planning

“…Contrasts in worker and patient assessments highlight that patients soften risk towards others and draw attention instead to vulnerability . Given the uncertainty around risk decisions, it has been noted that trust is central to engagement and communication between service users and workers …”

Chains of (Dis)Trust: Exploring the Underpinnings of Knowledge‐Sharing and Quality Care Across Mental Health Services

“…Effective and detailed analyses of micro-level mechanisms through which cultures of trust or distrust propagate are vital to sociological studies of quality and safety due to the multifarious ways in which trusting relations underpin quality healthcare practices both directly, as a component of quality patient experiences (Calnan and Rowe 2008), and indirectly through facilitating: patients' sharing of information (illuminating needs and appropriate care) (Brown and Calnan 2013); the flow of knowledge within healthcare organisations (Sheaff and Pilgrim 2006) …”