A critical narrative analysis of shared decision-making in acute, inpatient mental health care

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.

A critical analysis of Child and Adolescent Mental Health Services policy in England, 2000‐2015

Policy in Child and Adolescent Mental Health (CAMH) in England has undergone radical changes in the last 15 years, with far reaching implications for funding models, access to services and service delivery. Using corpus analysis and critical discourse analysis, we explore how childhood, mental health, and CAMHS are constituted in 15 policy documents, 9 pre‐2010, and 6 post 2010. We trace how these constructions have changed over time, and consider the practice implications of these changes. We identify how children’s distress is individualised, through medicalising discourses and shifting understandings of the relationship between socioeconomic context and mental health. This is evidenced in a shift from seeing children’s mental health challenges as produced by social and economic inequities, to a view that children’s mental health must be addressed early to prevent future socio‐economic burden. We consider the implications CAMHS policies for the relationship between children, families, mental health services and the state. The paper concludes by exploring how concepts of ‘parity of esteem’ and ‘stigma reduction’ may inadvertently exacerbate the individualisation of children’s mental health.

Spirituality and Basketball Fanship: An Interpretative Phenomenological Analysis and Synthesis

The world of competitive sport affords an individual the opportunity to enter a spiritual community adding meaning that transcends one’s current understanding of life (Parry et al. 2007). Previously established dimensions of sports fanship (group affiliation, psychological commitment and team identification) share characteristics commonly associated with religious or spiritual affiliation indicating that fans may generate substantial life meaning from observing sporting encounters. In the present study, 12 male basketball fans (M=32.42; SD=7.97) completed semi-structured interviews immediately prior to viewing a competitive match at the 2011 European Basketball Championships (Vilnius, Lithuania). Interviews were structured under four headings; 1) the most memorable moment as a basketball fan, 2) thoughts, feelings and emotions attached to their team, 3) affiliation to the team in the context of the fan’s meaning of life, 4) connection with members of the fan’s sporting community. Interpretative Phenomenological Analysis was employed to analyse interview transcripts. Raw data clustered into four dimensions; 1) devotion, 2) obscure emotions, 3) connectedness, and 4) universal values. The results indicate that sports fanship is characterised by, and synonymous with, an established understanding of spirituality derived from membership of wider spiritual and/or religious communities. The findings hold implications for the marketing and membership of local, amateur and professional sports clubs and brands, as well as community development, health and welfare.