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Justifying medication decisions in mental health care: Psychiatrists' accounts for treatment recommendations

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  • Angell, Beth
  • Bolden, Galina B.

Abstract

Psychiatric practitioners are currently encouraged to adopt a patient centered approach that emphasizes the sharing of decisions with their clients, yet recent research suggests that fully collaborative decision making is rarely actualized in practice. This paper uses the methodology of Conversation Analysis to examine how psychiatrists justify their psychiatric treatment recommendations to clients. The analysis is based on audio-recordings of interactions between clients with severe mental illnesses (such as, schizophrenia, bipolar disorders, etc.) in a long-term, outpatient intensive community treatment program and their psychiatrist. Our focus is on how practitioners design their accounts (or rationales) for recommending for or against changes in medication type and dosage and the interactional deployment of these accounts. We find that psychiatrists use two different types of accounts: they tailor their recommendations to the clients' concerns and needs (client-attentive accounts) and ground their recommendations in their professional expertise (authority-based accounts). Even though psychiatrists have the institutional mandate to prescribe medications, we show how the use of accounts displays psychiatrists' orientation to building consensus with clients in achieving medical decisions by balancing medical authority with the sensitivity to the treatment relationship.

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  • Angell, Beth & Bolden, Galina B., 2015. "Justifying medication decisions in mental health care: Psychiatrists' accounts for treatment recommendations," Social Science & Medicine, Elsevier, vol. 138(C), pages 44-56.
  • Handle: RePEc:eee:socmed:v:138:y:2015:i:c:p:44-56
    DOI: 10.1016/j.socscimed.2015.04.029
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    References listed on IDEAS

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    Cited by:

    1. Weiste, Elina & Stevanovic, Melisa & Valkeapää, Taina & Valkiaranta, Kaisa & Lindholm, Camilla, 2021. "Discussing mental health difficulties in a “diagnosis free zone”," Social Science & Medicine, Elsevier, vol. 289(C).
    2. Flore, Jacinthe & Kokanović, Renata & Callard, Felicity & Broom, Alex & Duff, Cameron, 2019. "Unravelling subjectivity, embodied experience and (taking) psychotropic medication," Social Science & Medicine, Elsevier, vol. 230(C), pages 66-73.
    3. Maryam Tabatabaee & Reza Yousefi Nooraie & Ardavan Mohammad Aghaei & Yasna Rostam-Abadi & Mina Ansari & Shamim Sharifi & Vandad Sharifi, 2023. "Loneliness in the presence of others: A mixed-method study of social networks of caregivers of patients with severe mental disorders," International Journal of Social Psychiatry, , vol. 69(1), pages 190-199, February.

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