Negative stance towards treatment in psychosocial assessments: The role of personalised recommendations in promoting acceptance

Bergen, Clara

doi:10.1016/j.socscimed.2021.114082

Cited by 11 publications

(5 citation statements)

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“…Participants described how practitioners should get to know the person and understand what has or has not worked previously in order to make them feel like the practitioner was listening and hopefully receive recommendations tailored to their experiences. This is consistent with the research exploring interactions between patients and practitioners in EDs which found that incorporating patients' reasons for negative expectations towards treatment options (e.g., fear of talking about bereavement underlying decision not to accept therapy) led to greater patient acceptance of recommendations [19]. Participants often felt unable to take up advice, even when they agreed with it, as it could feel overwhelming, a finding that is in line with previous research [32].…”

Section: Findings In the Context Of Other Studiessupporting

confidence: 89%

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An Ideal-Type Analysis of People’s Perspectives on Care Plans Received from the Emergency Department following a Self-Harm or Suicidal Crisis

O’Keeffe,

Suzuki,

McCabe

2023

IJERPH

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People presenting to Emergency Departments (EDs) in a self-harm/suicidal crisis in England receive a psychosocial assessment and care plan. We aimed to construct a typology of peoples’ perspectives on crisis care plans to explore the range of experiences of care plans. Thirty-two semi-structured interviews with people who presented to EDs following a self-harm/suicidal crisis in England were analysed using an ideal-type analysis. Cases were systematically compared to form clusters of cases with similar experiences of care plans. People’s perspectives on care plans fitted into three types: (1) personalised care plans (n = 13), consisting of advice or referrals perceived as helpful; (2) generic care plans (n = 13), consisting of generic advice that the person already knew about or had already tried; and (3) did not receive a care plan (n = 6) for those who reported not receiving a care plan, or who were only provided with emergency contacts. Care planning in the ED following a suicidal/self-harm crisis was perceived as supportive if it provided realistic and personalised advice, based on what had/had not worked previously. However, many people reported not receiving a helpful care plan, as it was ill-fitted to their needs or was not considered sufficient to keep them safe, which may mean that these patients are at increased risk of repeat self-harm.

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Section: Findings In the Context Of Other Studiessupporting

confidence: 89%

“…People who have attended the ED after self-harm have reported variable experiences of care plans [16][17][18]. Research shows the importance of how recommendations are given, with patients more readily accepting recommendations when practitioners acknowledge and validate patients' views and past experiences [19].…”

Section: Introductionmentioning

confidence: 99%

An Ideal-Type Analysis of People’s Perspectives on Care Plans Received from the Emergency Department following a Self-Harm or Suicidal Crisis

O’Keeffe,

Suzuki,

McCabe

2023

IJERPH

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“…Data were from three sources (1) a corpus of 46 video-recorded Liaison Psychiatry biopsychosocial assessments collected between September 2018 and April 2019 in an ED in England [see Xanthopoulou et al ( 28 ) and Bergen and McCabe ( 29 )]. Two GoPro cameras were placed in the assessment room and the assessment was recorded with no researcher present.…”

Section: Methodsmentioning

confidence: 99%

Implying implausibility and undermining versus accepting peoples’ experiences of suicidal ideation and self-harm in Emergency Department psychosocial assessments

Bergen,

Bortolotti,

Temple

et al. 2023

Front. Psychiatry

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BackgroundPatients seeking emergency care for self-harm and suicidality report varying experiences from being believed and taken seriously to not being believed and taken seriously. Epistemic injustice provides a conceptual framework to explore how peoples’ experiences of self-harm and suicidality are believed or not. We use an empirical method –conversation analysis – to analyze epistemics in clinical communication, focusing on how knowledge is claimed, contested and negotiated. In courtroom, police and political interaction, conversation analysis has identified communication practices implying implausibility in a person’s story to contest and recharacterize their accounts.AimsTo investigate communication practices in Emergency Department (ED) biopsychosocial assessments that may (1) undermine, imply implausibility and recharacterize or (2) accept peoples’ experiences of suicidal ideation and self-harm.MethodsUsing conversation analysis, we micro-analyzed verbal and non-verbal communication in five video-recorded biopsychosocial assessments with people presenting to the ED with self-harm or suicidal ideation, and conducted supplementary analysis of participants’ medical records and post-visit interviews. We present three cases where experiences were not accepted and undermined/recharacterized and two cases where experiences were accepted and validated.ResultsWhen peoples’ experiences of suicidality and self-harm were not accepted or were undermined, questioners: did not acknowledge or accept the person’s account; asked questions that implied inconsistency or implausibility (“Didn’t you tell your GP that you were coping okay?”); juxtaposed contrasting information to undermine the person’s account (“You said you were coping okay before, and now you’re saying you feel suicidal”); asked questions asserting that, e.g., asking for help implied they were not intending to end their life (“So when you called 111 what were you expecting them to do”); and resistinged or directly questioned the person’s account. Multiple practices across the assessment built on each other to assert that the person was not suicidal, did not look or act like they were suicidal; that the person’s decision to attend the ED was not justified; that an overdose was impulsive and not intended to end life; asking why the person didn’t take a more harmful medication to overdose; that self-harming behaviors were not that serious and should be in the person’s control. Alternative characterizations were used to justify decisions not to provide further support or referrals to specialist services. At times, these practices were also delivered when speaking over the patient. When peoples’ experiences were accepted, practitioners acknowledged, accepted, validated suicidality/self-harm and introduced a shared understanding of experiences that patients found helpful. Non-verbal feedback such as nodding and eye contact was central in acceptance of patients’ accounts.ConclusionThese findings advance our understanding of how peoples’ experiences of suicidality or self-harm are undermined or accepted in mental health encounters in the ED. They have important clinical implications: patients report that when their experiences are not accepted or undermined, this makes them more distressed, less hopeful about the future and discourages future help-seeking when in crisis. Conversely, acknowledging, accepting and validating suicidality/self-harm and introducing a new ways of understanding peoples’ experiences may make people less suicidal and more hopeful, generates shared understanding and encourages future help-seeking.

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“…Recordings were collected from a larger mixed-methods study of psychosocial assessments for self-harm and suicidality (see Bergen & McCabe, 2021 ; Xanthopoulou et al, 2021 , for further details on these data and the larger study). Clips from 19 psychosocial assessments with 18 patients (aged 18–25) and 11 practitioners were analysed.…”

Section: Methodology and Ethicsmentioning

confidence: 99%

“…One important aspect of recognising someone as an agent is to enable their participation in decision-making processes that bring about change ( Larner, 1998 ) and value their contribution to shared projects. In the mental health context, the young person may be asked to express their point of view on potential sources of support, such as bereavement therapy or peer support groups, based on their previous experiences (see Barnes, 2018 ; Bergen & McCabe, 2021 ).…”

Section: Involving the Young Person In The Decision-making Processmentioning

confidence: 99%

Communication in youth mental health clinical encounters: Introducing the agential stance

Bergen

Bortolotti

Tallent

et al. 2022

Theory & Psychology

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When young people seek support from mental health care practitioners, the encounters may affect the young people’s sense of self, and in particular undermine their sense of agency. For this study, an interdisciplinary team of academics and young people collaboratively analysed video-recorded encounters between young people and mental healthcare practitioners in emergency services. They identified five communication techniques that practitioners can use to avoid undermining the young person’s sense of agency in the clinical encounter. They conceptualise the use of those techniques as the adoption of an agential stance towards the young person. The agential stance consists of: (a) validating the young person’s experiences, (b) legitimising the young person’s choice to seek help, (c) refraining from objectifying the young person, (d) affirming the young person’s capacity to contribute to positive change, and (e) involving the young person in the decision-making process.

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Negative stance towards treatment in psychosocial assessments: The role of personalised recommendations in promoting acceptance

Cited by 11 publications

References 60 publications

An Ideal-Type Analysis of People’s Perspectives on Care Plans Received from the Emergency Department following a Self-Harm or Suicidal Crisis

An Ideal-Type Analysis of People’s Perspectives on Care Plans Received from the Emergency Department following a Self-Harm or Suicidal Crisis

Implying implausibility and undermining versus accepting peoples’ experiences of suicidal ideation and self-harm in Emergency Department psychosocial assessments

Communication in youth mental health clinical encounters: Introducing the agential stance

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