Experiences of Dissensus Between People Living With Mental Illness and Their Care Providers

TL;DR

This study explores how differences in values between people with mental illness and their care providers affect shared decision making in psychiatric care.

Contribution

The study introduces the concept of 'dissensus' as a context-specific, unresolved value conflict in shared decision making.

Findings

Service users felt clinical recovery was prioritized over personal recovery.

Service users reported limited opportunities for self-disclosure due to hierarchical provider positioning.

Abstract

Objective: Shared decision making (SDM) is fundamental to personal recovery; however, the values held by service users and care providers often differ. This study aimed to focus on dissensus, defined as a state in which value- and opinion-based differences between service users and care providers are not resolved but are maintained according to specific contexts, and to clarify the experiences through which service users recognized dissensus with care providers in psychiatric care settings.

Methods: Focus group interviews (FGIs) were conducted with six service users with prior experience of receiving psychiatric treatment or services. The data were analyzed using thematic analysis.

Results: Two major themes were identified as experiences of dissensus: the perception that clinical recovery was prioritized over personal recovery, and the feeling that opportunities for self-disclosure were constrained by the superior hierarchical positioning of care providers.

Discussion: The findings highlight a gap between the values of service users, who prioritize opportunities for challenge, autonomy, and identity reconstruction within equitable and collaborative relationships, and those of care providers, who prioritize safety, risk management, and role-based professional responsibilities. These dynamics suggest the importance of supporting collaborative partnerships that reconcile conflicting values in psychiatric care.

Conclusion: In the context of SDM for psychiatric care, the goal should extend beyond achieving consensus; explicitly acknowledging value conflicts arising from differing roles and fostering dissensus grounded in mutual respect may contribute to a more nuanced and effective approach to SDM.

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