OBSTACLES TO SHARED DECISION- MAKING IN PSYCHIATRIC PRACTICE: FINDINGS FROM THREE OBSERVATIONAL STUDIES

This thesis aims to make contributions at substantive, methodological and theoretical levels. First, the findings from three observational studies are combined to identify obstacles to the use of shared decision-making in modern psychiatric practice. Particular attention is paid to how patients ’ choices about their treatment are facilitated or constrained by the actions of mental health professionals. A typology of pressure is constructed, based on detailed analyses of how pressure is applied and resisted in routine encounters (outpatient consultations) and ‘crisis ’ situations (assessments for compulsory admission to hospital, and ward rounds in acute inpatient care). Findings from two ethnographies and one conversation analysis (CA) study are presented. ‘Meaning ’ is central to the write-up of each set of findings, however while the analytic focus of the ethnographies is ‘insider ’ knowledge and meanings, in the CA study it is on the activities that make those meanings possible in the first place. The methodological contribution of the thesis stem