Mental health care: trust and mistrust in different caring contexts.

Aims And Objectives: To identify the factors that make trust within the context of public mental health possible. We also consider the question of patients' trust in the whole caring system. The study is based on individual interviews with 22 psychiatric patients, who were also users of social services.

Background: There are theoretical studies concerning trust between human beings in several disciplines within psychiatry and social services but few studies investigate how trust can be created and what makes it possible. The literature reveals that there is need for research concerning trust in psychiatry. In this study we examined two different caring contexts and investigated what makes trust possible in these contexts. The contexts are termed the Integrated Network and Family Model and the Traditional Model.

Design: A qualitative method based on the grounded theory approach was used.

Methods: The main focus in the analysis was on how the patients had experienced the contexts of the caring systems and how trust was created or not within them.

Results: Three categories creating trust were found in the Integrated Network and Family Model and two in the Traditional context. Acceptance of the patient's expertise concerning his/her life situation, openness and joint discussions concerning knowledge are important. Trust is closely connected to autonomy and power: patients feel that trust increases as their experience of autonomy increases and in such situations power is not owned by any one person.

Conclusions: Trust between psychiatric patients and personnel can be created in both the Integrated Network and Family Model and traditional context, but in different ways.

Relevance To Clinical Practice: Clinical workers and nursing personnel can use our findings in their practical work with psychiatric patients. Our findings support theoretical considerations concerning trust and can be used as guidelines for nursing personnel in their work.