Mental health crisis intervention : a discourse analysis involving service users, families, nurses and the police : a thesis presented in fulfilment of requirements for the degree of Doctor of Philosophy in Nursing at Massey University, Palmerston North, New Zealand

Abstract

This research is a Foucault-influenced discourse analysis, which explores the field of Aotearoa New Zealand mental health crisis intervention, with the goal to challenge current practices. The study takes place in the context of changing access to mental health crisis services, following the implementation of the Mental Health Act (1992) and subsequent policy, regulation and practice development strategies.

Analysis is centered in converging and competing discourses, strategies and technologies in the field. In order to develop a position to discuss a range of converging and competing discourses, perspectives were sought from 9 people who have accessed crisis services, 8 family members who have supported service users, 9 mental health nurses working in crisis services and 2 senior members of the New Zealand police. Analysis of the published research and grey literature took place in between interviews, data analysis and during the writing process.

The overarching findings are that crisis intervention is affected by four predominant discursive constructions. These include mental disorder, risk management, expertise and uncertainty. The discursive constructs are influenced by three dominating biomedical, accountability and social development discourses, working together to produce power/knowledge of the people involved in crisis, whilst simultaneously subjugating a personal recovery discourse and the potential of uncertainty.

Consequently, participants bear disproportionate amounts of responsibility during a mental health crisis in which they are held accountable for much of what occurs in the clinical and community setting. They have limited control over the decisions that affect care, and largely, the way services are delivered. In order to disrupt structural and systemic inequities, I argue that self-reflection is required to attend to the ways that the experiences of people involved in a mental health crisis affect and contribute to maintaining the status quo. Attending to the possible stages of resistance surrounding the dominating discourses allows the potential for building authentic relationships within crisis intervention. Foucault’s framework of ethical practice is utilised to counter conditional citizenship and redefine responsibilities in the field.