Un/kindness, shame & resistance: the care of inpatients in NHS adult acute mental health units and how it might be improved

Un/善良，羞耻

• 批准号: 2885806
• 金额: --
• 依托单位: London School of Hygiene & Tropical Medicine
• 依托单位国家: 英国
• 项目类别: Studentship
• 财政年份: 2023
• 资助国家: 英国
• 起止时间: 2023 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=studentship-2885806
• 关键词: Un; kindness; shame; resistance; care

The poor treatment of service-users in NHS acute mental-health inpatient units has recently come to light in three separate investigations. This problem is generally concealed: it has been described as the "last taboo", and research has found that complaints made by service-users about their care are dismissed by mental-health trusts, and that mental-health professionals engage in "magical thinking" to disavow negative inpatient experiences. Patients are not always well treated but what exactly this means is not clear, and the dynamics creating and sustaining poor treatment have not been articulated. Whilst working in an inpatient unit I observed that shame significantly impacted staff interactions with patients. Shame, loosely defined as a negative self-conscious emotion about how we are seen and judged by others, is an important avenue of research in environments like mental-health wards that are steeped in the phenomena of power, hierarchy and stigma, all of which facilitate shame. Shame is also a significant object of study given that it links the phenomenological with the structural, both of which are often elided by psychiatry in favour of the biological. In order to redress the epistemic injustice experienced by patients, their treatment will be conceptualised as 'un/kindness' rather than 'care', which has been institutionalised within psychiatry, or 'compassion', which centres the feelings of staff over the experience of patients as the recipients of staff actions. Using cultural theory methodology, previous work experience, new ethnography and diary-interview methodology, this research will investigate patient and staff experiences of staff un/kindness in NHS mental-health inpatient care, the role of shame in limiting kindness, how unkindness can be interrupted and subverted and how staff can sustain and enhance practices of kindness.

NHS急性精神卫生住院病房对服务使用者的糟糕待遇最近在三项单独的调查中曝光。这个问题通常是被掩盖的：它被描述为“最后的禁忌”，研究发现，服务使用者对他们的护理提出的投诉被心理健康信托基金驳回，心理健康专业人员采用“神奇思维”来否认负面的住院经历。患者并不总是得到很好的治疗，但这到底意味着什么还不清楚，造成和维持糟糕治疗的动力也没有阐明。在一家住院病房工作时，我观察到羞耻感对工作人员与病人的互动产生了很大影响。羞耻感大致定义为一种关于他人如何看待和评价我们的负面自我意识情绪，在像精神健康病房这样充斥着权力、等级和耻辱现象的环境中，羞耻感是一种重要的研究途径，所有这些都会助长羞耻感。羞耻也是一个重要的研究对象，因为它将现象学和结构性联系在一起，这两者往往被精神病学省略，而倾向于生物学。为了纠正患者所经历的认知不公，他们的治疗将被概念化为“不/善”，而不是“关怀”，后者已在精神病学中制度化，或“同情心”，将工作人员的感受集中在患者作为工作人员行动接受者的经历上。本研究将运用文化理论方法论、先前的工作经验、新的人种志和日记访谈方法，调查病人和工作人员在NHS精神健康住院护理中不友善的经历，羞耻在限制善意中的作用，不善意如何被打断和颠覆，以及工作人员如何维持和加强善意的实践。