Exploring Chains of Trust and Mistrust Across Mental Health Services: Towards an Understanding of Virtuous and Vicious Circles of Trust within Organisations

Levels of trust bear decisively upon the nature of healthcare practice. Trust relations between professionals and patients, as well amongst professionals and managers, create certain dynamics which can be supportive or obstuctive for ethical care provision. Existing research denotes the mutual influence of different trust relationships across healthcare organisations, although the interdependencies between these different relations have not been explored in significant depth. This paper begins to fill this gap through analysis of trust relations in the context of mental health services within the English National Health Service. Developing from an initial conceptual framework, qualitative data from interviews with service-users, professionals and managers involved with three services providing care for people experiencing psychosis are analysed. The analysis points to interwoven chains of trust-building or trust-eroding dynamics across the different relations: managerial-professional relations, inter-professional relations, and professional-user relations. Overarching policy frameworks were especially active in shaping experiences of management vulnerability and corresponding working demands at the local-organisational level, in turn influencing professional relations with other professionals and moreover with service-users. Changing dynamics within one form of relationship often relieved or intensified experiences of vulnerability and uncertainty amongst involved actors. These shifting vulnerabilities and uncertainties resulted in modified practices which impacted upon other relationships in terms of trust. Considerations of time and communication, as both necessary for, and products of, trust, were also vital to virtuous or vicious circular dynamics within trust relations within the organisations. The erosion of time, communication and therfore trust has important implications for ethical practice within mental healthcare contexts.