Participatory Action Research in a Psychiatric Unit: Striving Towards Optimal Practices

The experiences of working in an acute psychiatric unit were investigated in this research using multiple qualitative methodologies, particularly Reflective Topical Autobiography and Participatory Action Research. The Participatory Action Research was undertaken in an acute psychiatric unit of a major public hospital in Melbourne. The collaborative design focused on bringing staff and consumers of psychiatric services together with an aim to develop new work practices for mental health practitioners. Four consumer consultants including a Koori representative participated in this study. Consumer consultants and staff, working in collaboration with the researcher, informed the fluid and iterative research process. Data included thirty eight interviews with psychiatric health professionals (2 psychiatrists, 2 managers, 6 psychiatric registrars and 28 nurses, including two charge nurses). Horizontal violence, and its impact on the capacity for reflexive work practices, became a strong emergent theme. Other emergent and important themes included workplace hierarchy, values, power, and the impact of critical incidents and supervision. Ego-state theory was utilised to better understand the psychology of staff members, and Organisational Egostate theory was presented as an original concept to explore the psychiatric unit as an organism having its own personality characteristics. It was concluded that for there to be permanent and iterative change to the organisation that engrained automatic responses of the organisation need to be identified and new responses developed. The research resulted in a number of new work practice recommendations, including the establishment of non-discriminatory review processes where work practices that are viewed as inappropriate by staff and consumers can be assessed with consideration to the importance of all stakeholders. Specific insights and conclusions have been suggested in relation to the treatment of aboriginal (Koori) people in the psychiatric unit. A central conclusion from this study was that psychiatric staff and consumers need more inclusion in the design and review of work practices