Therapeutic relationships and involuntary treatment orders: Service users' interactions with health‐care professionals on the ward

Abstract

There is increasing evidence that an involuntary hospital admission and treatment can undermine the therapeutic relationship. While good relationships with staff are important factors influencing long-term recovery, there is little information on how people experience their relationships with staff while under an involuntary treatment order (ITO). Twenty-five involuntary inpatients were interviewed about their experiences of an ITO. The interviews were analysed by a general inductive approach. Participants described the following themes: (i) the ITO admission was a daunting and frightening experience; (ii) staff behaviours and attitudes shaped their experiences in hospital; (iii) importance of staff listening to their concerns; (iv) importance of having a space to make sense of their experiences; (v) importance of staff ability to look beyond their illness and diagnosis; and (vi) importance of staff working in partnership. These findings highlight that when using recovery principles, such as an empathic engagement with the patients' lived experience, forging partnerships with patients in treatment decision-making to enhance agency, an involuntary treatment order does not have to limit the ability to establish positive relationships.

“Treat me with respect”. A systematic review and thematic analysis of psychiatric patients’ reported perceptions of the situations associated with the process of coercion

“…“Protest behaviour” was the result of a perceived loss of autonomy, along with other “negative patient‐perceived impacts” such as anger, frustration and powerlessness. This theme was characterized by patients’ perceptions of themselves as showing verbal and/or physical aggression (Bonner et al., ; Wynn, ; Chien et al., ; Haw et al., ; Faschingbauer et al., ; Van Wijk et al., ; Ling et al., ; Wyder, Bland, Blythe, Matarasso, & Crompton, ) or direct assaults on/violence towards staff or objects (Haw et al., ; Van Wijk et al., ). “Protest behaviour” could also include refusing treatment (Wynn, ), to follow professionals’ directions/rules (Wynn, ; Haw et al., ; Ezeobele et al., ) or was simply perceived by the patients themselves, as bad behaviour (Holmes, Kennedy, & Perron, ; Haw et al., ).…”

“…“Communication” is characterized by patients’ perceptions of insufficient or untrustworthy information provided by professionals (Meehan et al., ; Bonner et al., ; Mayers et al., ; Ling et al., ; Wyder et al., ). This connects to the theme “being subjected to professionals’ control,” as patients in particular perceived a loss of autonomy due to professionals’ behaviour.…”

Implementing evidence‐based practices on the therapeutic relationship in inpatient psychiatric care: A participatory action research

“…In their evaluation, the nurses reported that patients’ trust and confidence in them had increased. This is an important desire and expectation among patients in the framework of the TR because it increases patient empowerment (Borille et al, ; Duxbury et al, ; Hopkins et al, ; Schroeder, ; Wyder et al, ). As well as observing improvements in the nursing team, participants also noted that the changes increased motivation in other colleagues (Dawber, ; Kemmis & Mctaggart, ; Oelofsen, ).…”

Our Sunshine place: A collective narrative and reflection on the experiences of a mental health crisis leading to an admission to a psychiatric inpatient unit

“…A partnership approach supports engagement and promotes trust (Wyder et al . ). By implementing a safe environment and utilizing a partnership approach, the inpatient environment becomes more conducive to healing (Muskett ).…”