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An exploratory study of the role of trust in medication management within mental health services

Abstract

Objective To develop understandings of the nature and influence of trust in the safe management of medication within mental health services. Setting Mental health services in the UK. Method Qualitative methods were applied through focus groups across three different categories of service user—older adult, adults living in the community and forensic services. An inductive thematic analysis was carried out, using the method of constant comparison derived from grounded theory. Main Outcome Measure Participants’ views on the key factors influencing trust and the role of trust in safe medication management. Results The salient factors impacting trust were: the therapeutic relationship; uncertainty and vulnerability; and social control. Users of mental health services may be particularly vulnerable to adverse events and these can damage trust. Conclusion Safe management of medication is facilitated by trust. However, this trust may be difficult to develop and maintain, exposing service users to adverse events and worsening adherence. Practice and policy should be oriented towards developing trust.

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Acknowledgments

We acknowledge the co-operation of service users from Kent and Medway NHS and Social Care Partnership Trust in this research project.

Funding

None.

Conflicts of interest

IM has undertaken consultancy for pharmaceutical companies that produce medication used within mental health services including Eli Lilly, BMS, Lundbeck, Servier and Astra Zenecca. PB and MC none.

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Corresponding author

Correspondence to Ian D. Maidment.

Appendix

Appendix

Focus group semi-structured interview guide

  • Do you feel able to talk openly to your clinicians and tell them accurate and complete information about your medication?

  • Are you told the important potential adverse events?

  • When the adverse events of medication are discussed are your views listened to within the consultation?

  • Do you think that your clinicians give you a balanced picture about the risks, including adverse events, and benefits of treatment?

  • Have you ever received medication against your will? If yes, what impact did this have on your relationship with clinicians?

  • Have you ever come across a medication error in mental health?

  • How important do you think trust is in ensuring the safe use of medication?

  • Do you trust your clinicians to tell you the truth about medication?

  • Does trust, in relation to the use of medicines, exist in mental health?

  • What does it mean for you to trust your doctor about medication?

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Maidment, I.D., Brown, P. & Calnan, M. An exploratory study of the role of trust in medication management within mental health services. Int J Clin Pharm 33, 614–620 (2011). https://doi.org/10.1007/s11096-011-9510-5

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Keywords

  • Adverse events
  • Concordance
  • Health behaviour
  • Mental health
  • Qualitative research
  • United Kingdom