Estonian mental health service users' experiences regarding autonomy
Agur, Mari (2021)
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A significant number of qualitative studies and autobiographical perspectives of people who are living with severe mental illness show that a growing sense of agency and autonomy is considered as the key aspect of recovery. The aim of this research was to explore how the Estonian mental health service users experience receiving mental health services in relation to their sense of autonomy. The research was carried out by using qualitative content analysis. The sample involved 5 adults with different mental health issues, with whom semi-structured interviews were conducted. The results show that respectful, genuine, emphatic and inclusive treatment that follows horizontal expertise creates trust and safety which results in better collaboration and enhanced autonomy. At the same time, providing insufficient information, not taking the service users’ opinion into consideration and overuse of coercion by medical staff can be seen as hindering the service users’ autonomy. The community based mental health center enhances the service users’ autonomy by providing tools to cope with everyday life and by supporting the person regarding the accomplishment of their personal goals. Simultaneously, paternalistic pressure in order to complete goals that do not actually belong to the service user but to the service provider themselves, can harm the person’s autonomy.The study also revealed that even though people with severe mental illness have more limitations, they can still be autonomous and sense that they direct their lives. The findings confirm the idea, that autonomy should be seen as a process of individual growth in interaction with the environment and that it might not be an “all-or-nothing” right but a shifting state. The role of the care provider is to actively facilitate the service users’ ability to exercise control over their lives as much as it is possible. The main limitation of this research was the wide scope of the study, which included the service users’ experiences regarding both psychiatric and community based mental health services. The author recommends conducting a research in Estonia focusing on either psychiatric or community based mental health services in order to go deeper into the subject of service users’ autonomy