Department of Nursing, University of Birmingham, Birmingham, UK.
Department of Psychology, University of Birmingham, Birmingham, UK.
Int J Ment Health Nurs. 2018 Feb;27(1):158-167. doi: 10.1111/inm.12305. Epub 2016 Dec 26.
Whilst mental disorders can be disabling they are also treatable, yet engagement with services is often poor and disengagement from treatment is a major concern for mental health nurses. Participants were service users typically perceived as the most disengaged from mental health services, yet they were willing to engage in the research interviews. The seven participants were all male with a diagnosis of schizophrenia, a history of disengagement from mental health services and described their ethnicity as 'black'. Participants were under the care of Assertive Outreach Teams and were recruited after the researcher was introduced to them by clinicians who were working with them. After ethical approval, in-depth, semi-structured interviews were used to elicit the experiences of participants. Through interpretative phenomenological analysis, themes were developed. Interpretative Phenomenological analysis generated four themes: (i) "People just keep hounding me", (ii) Antipathy to Medication, (iii) Choice and the value of services, (iv) Stigmatisation and identity. By rigorously examining how service users with schizophrenia make sense of their experience of their relationship with mental health services, there is potential to give voice to the experiences of the recipients of mental health services. This study uncovered the complex nature of disengagement and in view of this there may never be a straightforward mechanism developed to engage all people with schizophrenia with mental health services. When the participants' experiences are considered in a broader social context it may be possible to reflect on how services can be adapted to facilitate better engagement.
虽然精神障碍可能使人丧失能力，但它们也是可治疗的，然而，人们对服务的参与往往很差，精神健康护士非常关注人们脱离治疗的情况。参与者通常被视为最脱离精神卫生服务的服务使用者，但他们愿意参与研究访谈。这七名参与者均为男性，被诊断患有精神分裂症，他们有脱离精神卫生服务的历史，并将自己的种族描述为“黑人”。参与者受主张性外展队的照顾，并在研究人员被与他们合作的临床医生介绍给他们后被招募。在获得伦理批准后，使用深入的半结构化访谈来引出参与者的经验。通过解释性现象学分析，发展出主题。解释性现象学分析产生了四个主题：（一）“人们一直纠缠我”，（二）对药物的反感，（三）选择和服务的价值，（四）污名化和身份。通过严格检查精神分裂症患者如何理解他们与精神卫生服务的关系的经验，有可能为精神卫生服务的接受者的经验发声。本研究揭示了脱离的复杂性质，鉴于此，可能永远不会开发出一种简单的机制来让所有精神分裂症患者都参与精神卫生服务。当从更广泛的社会背景来考虑参与者的经验时，就有可能反思如何调整服务以促进更好的参与。
