Patients' negative experiences with health care settings brought to light by formal complaints: A qualitative metasynthesis.

INTRODUCTION: Narratives of negative patient experiences expressed in complaints can help health care professionals reflect on their practices. AIMS: To synthesise evidence from qualitative primary studies on patients' negative experiences with different health care settings and to obtain a detailed picture of what patients find problematic while receiving health care. DESIGN: Metasynthesis inspired by Sandelowski and Barroso. METHODS: A protocol was published in the International Prospective Register of Systematic Reviews (PROSPERO). A systematic search was conducted in CINAHL (EBSCOhost), MEDLINE (EBSCOhost), PsycInfo (Ovid) and Scopus, on 20.04.2021. Backward and forward citations of included reports were searched for relevant studies and the search was completed in March 2022. Two researchers independently screened and appraised the included reports. A metasynthesis using reflexive thematic analysis and a metasummary were conducted. RESULTS: Twenty-four reports were included, and four main themes were extracted from the metasynthesis: (1) problems with access to health care services; (2) failure to acquire information about diagnosis, treatment and the expected patient role; (3) experiencing inappropriate care and bad treatment; (4) problems with trusting health care service providers. CONCLUSIONS: Negative patient experiences impact patients' physical and psychological health, leading to suffering and hampering patients from involving themselves in their health care. RELEVANCE TO CLINICAL PRACTICE: Narratives of negative patient experiences aggregated from the findings provide knowledge about what patients need and expect from health care providers. These narratives can help health care professionals reflect on the way they interact with patients and improve their practice. Health care organisations need to prioritise patient participation. REPORTING METHOD: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. PATIENT OR PUBLIC CONTRIBUTION: Findings were presented and discussed in a meeting with a reference group representing patients, health care professionals and the public.

The Lost Social Context of Recovery Psychiatrization of a Social Process.

From being a concept questioning the core of psychiatric knowledge and practice, recovery has been adopted as a guiding vison for mental health policy and practice by different local, national, and international organizations. The aim of this article is to contextualize the different understandings of recovery and its psychiatrization through the emergence of an individualizing and de-contextualized definition which have gained a dominant position. It ends with an attempt to formulate a new definition of recovery which integrates people in their social context. Research results from various follow-up studies showing the possibility of recovery from severe mental distress have stressed the importance of societal, social and relational factors as well of the person's own agency when facing their distress and reactions from their environment. These researches were published in the 1970s and 80s; a period of struggle for liberation from colonialism, of struggle by women and black people for their civil rights, and a time of de-institutionalization of services directed toward the poor, elderly, handicapped, prisoners, and people with mental health problems. Recovery research pointed at the central role of individuals in their recovery journey and it was understood as a personal process in a social context. However, with neo-liberal political agenda, the personal role of individuals and their own responsibility for their well-being was stressed, and contextual understandings and the role of social, material and cultural changes to promote recovery faded away. Thus, during recent decades recovery has been mostly defined as an individualistic journey of changing the persons and their perception of their situation, but not of changing this situation. Contextual aspects are almost absent. The most quoted definition accepts the limits posed by an illness-based model. This kind of definition might be a reason for the wide acceptance of a phenomenon that was initially experienced as a break with the bio-medical paradigm. Recently, this dominant individualized understanding of recovery has been criticized by service users, clinicians and researchers, making possible a redefinition of recovery as a social process in material and cultural contexts.

"I will never forget him". A qualitative exploration of staff descriptions of helpful relationships in supportive housing.

WHAT IS KNOWN ON THE SUBJECT?: Recovery-oriented studies show that the quality of the professional relationship plays an essential role in the recovery from mental illness. Within mental health care in general, previous studies show that helpful professional relationships are characterized by several reciprocal aspects, such as friendship resemblance and self-disclosure. The literature is scarce on in-depth explorations of professional relationships within the often long-lasting and intimate help context of institutional supportive housing. Explorations of staff members' experiences are absent. The scientific rationale of this study was to expand the current knowledge about professional relationships in mental health care by exploring staff members' descriptions of helpful professional relationships in supportive housing institutions. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE: The study shows that helpful relationships may involve staff experiences of reciprocity in terms of both a two-way influence between staff and residents and a reciprocal gain from being part of the helpful relationships. A conceptualization of reciprocity that complements existing concepts is suggested and connected to a "good match" between staff and residents. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: When support and care are intended to be provided within a dyadic relationship, both parties' preferences should be considered when pairing service users and professionals. Practitioners should get involved in ways that open up for being influenced and inspired by the service user's characteristics, such as personality and attitude. Furthermore, they should dare to enjoy and make use of the company of the service user in ways that promote multifaceted reciprocity. ABSTRACT: Introduction In the aftermath of the deinstitutionalization in western countries, new community-based mental health services have been established. An essential object of studies in this new institutional landscape has been helpful professional relationships, but we still lack knowledge about helpful relationships in community-based institutional supportive housing. Aim To explore how staff members describe their relationships with residents who have identified them as helpful. Methods Qualitative interviews with nine staff members were analysed using thematic analysis. Results "Reciprocity" was identified as the main theme, and two subthemes were developed: "Something influential about the resident" and "Value for the staff member." Discussion The findings are discussed and related to existing conceptualizations of reciprocity in professional relationships, and an additional conceptualization is suggested. Implications for practice To promote reciprocity, managers should consider both parties' personal preferences when matching professionals and service users. Further, professionals should get involved in ways that open up for being influenced and inspired by several of the service user's characteristics. They should allow themselves to enjoy the company of the service user in ways that promote multifaceted reciprocity.

Experiences of participating in individual placement and support: a meta-ethnographic review and synthesis of qualitative studies.

AIM: To provide increased understanding about how work applicants, employment specialists, social workers in the welfare service and clinicians in mental healthcare service experience participating in individual placement and support (IPS). METHODS: We searched in several databases and identified 17 studies published from 2007 to 2017 in Sweden, USA, Canada, UK, Australia and Denmark, and applied meta-ethnographic reinterpretation and synthesis. RESULTS: The employment specialists followed the core ideas of IPS, where work is seen as a way to recover. They saw the work applicants' preferences and needs as important for health and well-being, and crucial for successful work rehabilitation. In order to reach these goals, they offered a personal relationship to the work applicants. Work applicants clearly appreciated this personalised recovery-oriented mindset. Furthermore, work applicants needed the employment specialists as culture brokers between health-related questions and the expectations met in the labour market. Social workers lacked resources to such personalised support, and they were under demand of welfare regulations made for a 'train then place' model, which conflicts with the view that work leads to recovery as IPS sees it in their 'place then train' model. The scarce knowledge of the clinicians' experiences in the present study suggests that they are sceptical to work as a way to recover, which is in conflict with IPS. CONCLUSIONS: The work applicants highlighted the significance of the individualised support they received. Social workers and some clinicians found it difficult to provide this important personalised support towards work. Conflicting mindsets between the traditional gradual work rehabilitation paradigm and the IPS approach as a way of recovering might explain these frustrations and distance. Recommendations for practice. An improvement of IPS may depend on more cooperation based on an acceptance of the recovery-oriented mindset, which for some will mean an acceptance of new knowledge.

Things matter: about materiality and recovery from mental health difficulties.

PURPOSE: The aim of this study is to explore how material things might become involved in the recovery process of people with mental health difficulties. METHOD: Empirical material from three different studies on various aspects concerning mental health issues that each of the authors had conducted was reanalysed through a phenomenological item analysis. RESULTS: We discovered that mundane objects such as a mobile phone, a bench, a door and a key have agency to contribute to peoples' recovery and wellbeing. Things became agents that created contexts that initiated physical, social and emotional movements. CONCLUSION: By giving attention to materiality we might become aware of the importance of things as agents in living in general and in recovery processes for people with mental health difficulties in particular.

Materialities in supported housing for people with mental health problems: a blurry picture of the tenants.

Our daily lives and sense of self are partly formed by material surroundings that are often taken for granted. This materiality is also important for people with mental health problems living in supported housing with surroundings consisting of different healthcare services, neighbourhoods, buildings or furniture. In this study, we explored how understandings of tenants are expressed in the materialities of supported housing. We conducted ethnographic fieldwork in seven different supported accommodations in Norway and analysed the resultant field notes, interviews, photographs and documents using Situational Analysis. The analysis showed that supported housing materialities expressed a blurry picture comprising widening and narrowing understandings of tenants, both by others and by themselves. Widening understandings concerned how tenants were living their lives in their own ways in private rooms while maintaining a social life in common areas. Narrowing understandings pertained to understand the tenants based solely on their diagnosis and need for care and control in hospital-like buildings. The following discussion focusses on the ideas that underlie narrowing materialities and on the importance of striving for atmospheres that entail a sense of belonging.

Nothing matters: the significance of the unidentifiable, the superficial and nonsense.

Purpose: The aim of this study is to explore the ways in which "small things" may be of importance for people with mental health difficulties.Method: Empirical material from three different studies was reanalysed through a phenomenological, dialogical, approach.Results: We discovered some paradoxical aspects of small things: i.e., they could be about "something" that was difficult or even impossible to identify. The unidentifiable could be about bodily, sensual experiences that are superficial (i.e., belonging to the surface). The interaction with others highlighted as significant could be about doing something fun, talking nonsense or kidding around, and hence not at all about making sense of something-a kind of important nonsense. We summarize these aspects in three themes: the importance of the unidentifiable, the superficial and nonsense. These aspects can be regarded as small things-even "nothings"-that make it possible "to stay in the world".Conclusion: We elaborate on the findings in relation to the following: Gumbrecht's critique of the prevailing hermeneutic world-view with its idea that "interpretation is humankind's exclusive way of relating to the world", Ingold's idea that social life is lived in relations of "interfacility" and hence a turn to surfaces is needed for a "restoration of social life", and Biesta's idea of existence as "coming into the world in the presence of others".

Studies regarding supported housing and the built environment for people with mental health problems: A mixed-methods literature review.

Places where people live are important for their personal and social lives. This is also the case for people with mental health problems living in supported housing. To summarise the existing knowledge, we conducted a systematic review of 13 studies with different methodologies regarding the built environment in supported housing and examined their findings in a thematic analysis. The built environment of supported housing involves three important and interrelated themes: well-being, social identity and privacy. If overregulated by professionals or located in problematic neighbourhoods or buildings, the settings could be an obstacle to recovery. If understood as meaningful places with scope for control by the tenants or with amenities nearby, the settings could aid recovery.

Textbook descriptions of people with psychosis - some ethical aspects.

BACKGROUND: Textbooks are central for the education of professionals in the health field and a resource for practitioners already in the field. OBJECTIVES: This article focuses on how 12 textbooks in psychiatric nursing and psychiatry, published in Norway between 1877 and 2012, describe and present people with psychosis. RESEARCH DESIGN: We used qualitative content analysis. ETHICAL CONSIDERATIONS: The topic is published textbooks, made available to be read by students, teachers and professionals, and no ethical approval was required. FINDINGS: The analysis shows that all 12 textbooks describe and present people who are considered as psychotic from a 'perspective from above'. In this perspective, the readers are learning about psychosis in the professional's language and from the author's viewpoint. Most often the textbooks communicate a universal image of people with psychosis, a description that fits with the diagnostic criteria. The analysis also shows that two textbooks in psychiatric nursing combined this perspective with a 'perspective from within'. Here, the readers are learning about psychosis from the patients' own viewpoint. The authors communicate a personal, psychotic universe that differs from various people, even if they have the same diagnosis, and the descriptions are focusing on the patient as a whole person. DISCUSSION AND CONCLUSION: Drawing partly on Rita Charon's writings about narrative knowledge in the health field, and partly on insights from Martha Nussbaum and her concept of narrative imagination, we argue that mental health professionals need to learn about, understand and fathom what patients go through by reading, listening to and acknowledging the patients' own stories and experiences. Cultivating the capacity for empathy and compassion are at the very heart of moral performance in the mental health field. A valuable moral resource in that regard is leading textbooks and how they describe and present people with severe mental illness.

Small Things, Micro-Affirmations and Helpful Professionals Everyday Recovery-Orientated Practices According to Persons with Mental Health Problems.

The aim of this study is to present concrete descriptions of the content in the construction of helpful relationships with staff, according to users. Starting with the re-occurring concept of the meaning of "little things" in recovery studies, a literature review was done. A thematic analysis shows that small things play an important role in improving a person's sense of self. Small things seem to be an invisible but effective parts of a recovery-orientated practice, but they might be defined as unprofessional and their efficacy negated.

A place for the heart: A journey in the post-asylum landscape. Metaphors and materiality.

The downsizing of psychiatric hospitals has created a new institutional landscape in the local community to support people with severe mental problems in their daily living. This study explores meeting places in Norway from the users' perspectives. The users used four metaphors to describe these meeting places: "like a home", "like a family", "like a landing ground" and "like a trampoline". The users have decorated the interiors of the meeting places with hearts made from various materials, and these could be considered as symbols of the places. The metaphors used: the hearts and the rooms and interiors, reflect old ideas about calmness and dignity rather than new ideas based on New Public Management.

Fear, danger and aggression in a Norwegian locked psychiatric ward: Dialogue and ethics of care as contributions to combating difficult situations.

BACKGROUND: Fear and aggression are often reported among professionals working in locked psychiatric wards and also among the patients in the same wards. Such situations often lead to coercive intervention. In order to prevent coercion, we need to understand what happens in dangerous situations and how patients and professionals interpret them. RESEARCH QUESTIONS: What happens when dangerous situations occur in a ward? How do professionals and patients interpret these situations and what is ethically at stake? RESEARCH DESIGN: Participant observation and interviews. PARTICIPANTS: A total of 12 patients and 22 professionals participated. ETHICAL CONSIDERATIONS: This study has been accepted by the Regional Committee for Medical and Health Research Ethics in Norway. FINDINGS: (a) Both atmosphere and material surroundings were interweaved within dangerous situations, (b) the professionals applied stereotypes when interpreting dangerous situations and (c) the professionals and the patients had different interpretations of what triggered dangerous situations. DISCUSSION: The discussion centres on how care ethics and a dialogical practice might contribute towards combating difficult situations and the ways in which change is an ongoing ethical process of becoming. CONCLUSION: The ethics of care and a dialogical approach are suggested as ethical frameworks for preventing fear, danger and aggression in psychiatric wards. Both frameworks can be understood as patient-driven, including the relational and contextual perspectives. It means a shift from professionally driven processes to patient-driven dialogue.

Generating dialogical practices in mental health: experiences from southern norway, 1998-2008.

In Norway and many other countries, political guidelines prescribe the development of mental health strategies with both a service user's perspective and a treatment system established by the local authority. The development of new strategies frequently involves challenges regarding procedures and treatment as well as a view of knowledge and humanity. Dialogical practices might provide a solution for these challenges not only because of its procedures but also due to its attitudes toward service users. The aim is to explore the implementation of three dialogical practice programs in Southern Norway from 1998 to 2008 and to critically analyze and discuss the authors' experiences during the implementation process. Three different programs of dialogical practices were initiated, established, and evaluated within the framework of participatory action research. Sustainable changes succeed individually and organizationally when all participants engage as partners during the implementation of new mental health practices. Generating dialogic practice requires shared understanding of the Open Dialogue Approach (ODA) and collaboration between professional networks and among the leaders. Developing a collaboration area that includes service users in all stages of the projects was one of the essential implementation factors. Other factors involved a common vision of ODA by the leaders and the actors, similar experiences, and a culture of collaboration. However, ODA challenged traditional medical therapy and encountered obstacles to collaboration. Perhaps the best way of surmounting those obstacles is to practice ODA itself during the implementation process.

The locked psychiatric ward: hotel or detention camp for people with dual diagnosis.

BACKGROUND: The concepts of autonomy and liberty are established goals in mental health care; however, involuntary commitment is used towards people with mental health and substance abuse problems (dual diagnosis). AIMS: To explore how patients and staff act in the context of involuntary commitment, how interactions are described and how they might be interpreted. METHOD: Ethnographic methodology in a locked psychiatric ward in Norway. RESULTS: Two parallel images emerged: (a) The ward as a hotel. Several patients wanted a locked ward for rest and safety, even when admission was classified as involuntary. The staff was concerned about using the ward for real treatment of motivated people, rather than merely as a comfortable hotel for the unmotivated. (b) The ward as a detention camp. Other patients found involuntary commitment and restrictions in the ward as a kind of punishment, offending them as individuals. Contrary, the staff understood people with dual diagnoses more like a generalized group in need of their control and care. CONCLUSION: Patients and staff have different perceptions of involuntary commitment. Based on the patients' points of view, mental health care ought to be characterized by inclusion and recognition, treating patients as equal citizens comparable to guests in a hotel.

Hell on earth: textual reflections on the experience of mental illness.

BACKGROUND: Some people who by themselves or by others are understood as having mental health problems have written autobiographies about their experiences. AIMS: The aim of this study is to explore how people write about their experiences of being mentally ill. METHOD: Twelve Scandinavian autobiographies were studied using content analysis based on phenomenology and hermeneutics. RESULTS: Three themes were identified: feeling like a stranger in life and places, the transformation of life experiences into questions of disease and feeling ashamed. CONCLUSIONS: People's experiences of being mentally ill might be understood as the result of medical constructions unsuitable for the persons themselves. We could instead say that mental problems are not diseases, but severe and painful phenomena in people's lives.