Chorlton Emma, Smith Ian, Jones Sarah Amelia
Division of Health Research, C12 Furness College, Lancaster University, Lancaster, Lancashire, LA1 4YG, UK,
Soc Psychiatry Psychiatr Epidemiol. 2015 Jan;50(1):51-8. doi: 10.1007/s00127-014-0920-2. Epub 2014 Jul 10.
Psychiatric inpatient services are often required to provide care for people with mental health difficulties who use illicit drugs or alcohol (people with coexisting difficulties). In other settings, relationships between service users and staff can be important in alleviating distress and improving outcomes. This study explored how people with coexisting difficulties experienced relationships with staff in psychiatric inpatient services to increase understanding of these relationships.
Ten adult service users (5 male, 5 female) from eight inpatient wards participated in semi-structured interviews. All participants had mental health diagnoses, and self-reported use of illicit drugs and/or heavy alcohol consumption. Data was analysed using interpretative phenomenological analysis.
Analysis yielded three consistent themes: 'weighing up the risk of relationships', 'relationships intertwined with power and control' and 'seeking compassionate care'. These themes highlighted the negative impact that service users' anticipation of rejection could have upon their willingness to develop relationships with staff, and the conflict which could occur due to their perceived difference to staff. Findings also highlighted that consistent, compassionate care by staff could minimise group differences and alleviate rejection fears.
Previous experiences of rejection and power structures within psychiatric inpatient services can influence the abilities of people with coexisting difficulties to develop relationships with staff. It is, therefore, important for staff and services to demonstrate consistent care, where staff are sympathetic and show a desire to alleviate suffering and to encourage clinical approaches which foster equality and mutual understanding between staff and service users.
精神科住院服务常常需要为有心理健康问题且使用非法药物或酗酒的人（同时存在其他问题的人）提供护理。在其他环境中，服务使用者与工作人员之间的关系对于减轻痛苦和改善结果可能很重要。本研究探讨了同时存在其他问题的人在精神科住院服务中与工作人员的关系体验，以增进对这些关系的理解。
来自八个住院病房的10名成年服务使用者（5名男性，5名女性）参与了半结构化访谈。所有参与者都有心理健康诊断，且自我报告使用非法药物和/或大量饮酒。数据采用解释性现象学分析进行分析。
分析得出三个一致的主题：“权衡关系的风险”、“与权力和控制交织的关系”以及“寻求同情关怀”。这些主题突出了服务使用者对被拒绝的预期可能对他们与工作人员建立关系的意愿产生的负面影响，以及由于他们与工作人员之间的感知差异可能发生的冲突。研究结果还突出表明，工作人员持续的同情关怀可以最小化群体差异并减轻被拒绝的恐惧。
精神科住院服务中以往的被拒绝经历和权力结构可能会影响同时存在其他问题的人与工作人员建立关系的能力。因此，工作人员和服务机构表现出持续关怀很重要，工作人员要富有同情心，表现出减轻痛苦的愿望，并鼓励采取促进工作人员与服务使用者之间平等和相互理解的临床方法。
