Decision-Making in Mental Healthcare: A Phenomenological Investigation of Service User Perspectives

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As Victorian asylums closed down in the United Kingdom, community mental health services were set up to support patients in exercising choice and freedom; in finding a place in society. The success of these services has been questioned, so further policies have been introduced in an effort to protect rights and improve social inclusion. However, capacity to make decisions has been interpreted as no more than a process of rational mental calculation. This article reports on a phenomenological study that explores the decision-making experiences of three men who have endured psychosis. It is not only associated with choice and freedom but also with responsibility, blame, and social exclusion. These men appear to have faced common existential dilemmas, but have sought to express emotional will in conflict with other people and have, perhaps, been placed under more social pressure and become more isolated as individuals, while enduring experiences that are difficult to make meaningful for others. It seems that, paradoxically, efforts have been made to empower these men by controlling them, and medication has been imposed on them so as to regulate thoughts and moods, in attempts to serve their best interests.

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