Patient Centered Professionalism? Mental Health Care Workers' Response to Patient Participation

Patient participation is an important development in Dutch mental health care. Enhanced patient centeredness is considered an key condition to achieve quality of care. One way to realise this is allowing patients to have voice in care and treatment.

Notwithstanding a general positive attitude towards patient participation, mental health professionals show ambivalent responses to it. In practice, this development confronts them with dilemmas. What if patients make ‘wrong’ decisions from a professional perspective? Who determines ‘good care’? Patient and professional logics may clash and discussion about the boundaries of professional domains may arise.

We investigate whether these possible clashes between patient and professional logics are linked to the definition of professional domains and the occupational attitude of professionals. Professionals vary in their occupational attitude, degree of professionalization and professional content and focus. We explore how different types of mental health professionals respond to the described dilemmas and to which extent they are open to patient participation. Four types of mental health professionals are compared: psychiatrists, psychologists, nurses and social workers.

During the first research phase, a comparison is made by analyzing formal professional frameworks, displayed in documents like professional profiles, codes of conduct, professional guidelines and protocols. During the second research phase, representatives of the four professions are interviewed.

We present intermediate results, covering the document analysis and the first series of interviews. Preliminary results of the document analysis for three professions show clear differences between them. Social workers’ frameworks show more openness to patient participation than the frameworks of psychatrists and nurses, which put more emphasis on professional responsibility.

From further analysis and the interviews, we expect multiple responses of different mental health professionals to patient participation. Not acknowledging these differences may impede further development of patient participation in mental health care.