title: A critical narrative analysis of shared decision-making in acute inpatient mental health care.
abstract: Shared decision-making (SDM) is a high priority in healthcare policy and is complementary to the recovery philosophy in mental health care. This agenda has been operationalised within the Values-Based Practice (VBP) framework, which offers a theoretical and practical model to promote democratic interprofessional approaches to decision-making. However, these are limited by a lack of recognition of the implications of power implicit within the mental health system. This study considers issues of power within the context of decision-making and examines to what extent decisions about patients' care on acute in-patient wards are perceived to be shared. Focus groups were conducted with 46 mental health professionals, service users, and carers. The data were analysed using the framework of critical narrative analysis (CNA). The findings of the study suggested each group constructed different identity positions, which placed them as inside or outside of the decision-making process. This reflected their view of themselves as best placed to influence a decision on behalf of the service user. In conclusion, the discourse of VBP and SDM needs to take account of how differentials of power and the positioning of speakers affect the context in which decisions take place.
authors.affiliation: a School of Health Sciences, Univeristy of Nottingham , Nottingham , UK.
authors.forename: Gemma
authors.initials: G
authors.lastname: Stacey
authors.affiliation: a School of Health Sciences, Univeristy of Nottingham , Nottingham , UK.
authors.forename: Anne
authors.initials: A
authors.lastname: Felton
authors.affiliation: b Centre for Health and Social Care Research, Sheffield Hallam University , Sheffield , UK.
authors.forename: Alastair
authors.initials: A
authors.lastname: Morgan
authors.affiliation: a School of Health Sciences, Univeristy of Nottingham , Nottingham , UK.
authors.forename: Theo
authors.initials: T
authors.lastname: Stickley
authors.affiliation: c School of Psychology, Loughborough University , Loughborough , UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Willis
authors.affiliation: d Adult Mental Health, University of Sheffield , Sheffield , UK.
authors.forename: Bob
authors.initials: B
authors.lastname: Diamond
authors.affiliation: e Adult Mental Health, Nottinghamshire Healthcare Trust , Nottingham , UK.
authors.forename: Philip
authors.initials: P
authors.lastname: Houghton
authors.affiliation: e Adult Mental Health, Nottinghamshire Healthcare Trust , Nottingham , UK.
authors.forename: Beverley
authors.initials: B
authors.lastname: Johnson
authors.affiliation: e Adult Mental Health, Nottinghamshire Healthcare Trust , Nottingham , UK.
authors.forename: John
authors.initials: J
authors.lastname: Dumenya
mesh_terms: D001291:Attitude of Health Personnel; D003299:Cooperative Behavior; D017144:Focus Groups; D006801:Humans; D007400:Interprofessional Relations; D001523:Mental Disorders / Q000628:therapy*; D010358:Patient Participation / Q000706:statistics & numerical data*; D018802:Patient-Centered Care / Q000379:methods*
keywords: Focus groups; interprofessional collaboration; mental health; narrative analysis; power; shared decision-making