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Title: A critical realist study of shared decision-making in young people's mental health inpatient units
Author: Martin, Kate
Awarding Body: UCL (University College London)
Current Institution: University College London (University of London)
Date of Award: 2019
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There is little research about shared decision-making with children and young people in mental health services, particularly inpatient units. Shared decision-making involves bringing the knowledge, values and expertise of young people into the decision-making process, and potentially giving them equal weight alongside professional knowledge and evidence. This thesis presents a critical analysis of how young people and staff in mental health inpatient units understood and experienced shared decision-making. The thesis identifies structures, mechanisms, contexts and relationships that enable or constrain young people's involvement in making decisions. This ethnographic study observed two inpatient units in England. Interviews were held with 16 young people aged 13-17 years and 23 staff. The thematic analysis was informed by Archer's (2000; 2003) theories of agency and Bhaskar's (1998) concept of four-planar social being, a framework to explore how structure and agency interact. Shared decision-making requires that the practitioners respect, listen to and take account of the young person's testimony (their core concerns and inner self). However, the research revealed that these were the very things that were, in many ways, routinely constrained or denied within the environment and systems of inpatient units. Young people's ability to be involved in decision-making was severely undermined by the significant constraints placed upon them by being displaced in new, unfamiliar and restrictive 3 environments, which limited not only their privacy and movement, but their autonomy, reflexivity, inner being and moral identity as decision-makers. The different ways young people exercised reflexivity are identified, in order to offer new ways of understanding how they responded to constraints and saw their inner self in relation to decision-making.
Supervisor: Alderson, P. ; Sutcliffe, K. Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available