Shared dilemmas, choice and autonomy in the management of psychosis: a phenomenological analysis

Purpose – When detaining and enforcing treatment, psychiatric services often assumed that the person is separate from their dysfunctional biology and removed from their social context. Coproduction is hindered by polarised views where one party holds power and others are not able to promote their views. But if biomedical models are abandoned, ethical grounding for mental health law would be lost. The purpose of this paper is to explore the experience of detaining and being detained, clarifying understandings of trust, illness, personhood and control. Design/methodology/approach – A hermeneutic phenomenological approach was employed. Findings – A Social Worker and man who suffers from psychosis report that their choices are limited by mental health law. They both experience themselves as passive. The man rejects society and withdraws to avoid stress; while the Social Worker just follows legal guidelines. Interaction in mental healthcare is experienced as lacking trust, involving threat, but sometimes negotiation is possible. Control over illness is associated with having a choice of treatments. Psychosis is not experienced as a separate illness process and control is exercised over the person rather than that illness. Research limitations/implications – This was a small qualitative study designed to prompt discussion and inform further research and policy review. Practical implications – To enable coproduction, detention or enforced treatment should be grounded more firmly in morality or criminal justice. Social implications – People who suffer psychosis could be understood and their views more often accepted. Originality/value – An innovative research approach is used to bring new understanding.