‘Empathy gaps’ causing trauma in community mental health care

People under Community Treatment Orders are not getting the empathy they need from some mental healthcare workers. Photo: Shutterstock

Failed, traumatised, stigmatised and often left feeling worse off than when they started.

That’s the reality faced by some mental health patients under Community Treatment Orders (CTOs) because of a perceived lack of empathy and understanding among some of the workers meant to be helping them, according to a new study from Flinders University.

The report, which has just been published in BMC Psychiatry, analysed the language used by mental health workers when they talked about their patients. It acknowledges that this is arguably the most challenging and complex area of mental health service delivery and so needs high level skills.

Its findings indicate that many mental health workers don’t understand the emotional difficulties faced by psychologically troubled patients being forced to undergo treatments they often do not want, or even believe they need.

On the other side of the fence, it found many patients don’t trust their workers, while others experience traumatic contact with services, especially when they become more unwell.

Study leader, Professor Lawn, who is Director of Flinders University’s Human Behaviour and Health Research Unit, says more training is needed to ensure the mental health workers aren’t in some cases doing more harm than good.

“Some workers appeared not to reflect much on the complexity and coercion that is unfortunately inherent in their role with these patients,” says Professor Lawn.

“We also found that workers struggled to provide person-centred care to these patients, suggesting a need for more training to improve their skills and empathy towards these patients.

“These interactions left little room for recovery-oriented practice to occur.” “Despite the significant vulnerabilities apparent for this patient population, their capacity to articulate their experiences of being on a CTO were compelling and need to be listened to if we are to provide more effective care to them.”

The report, titled A qualitative study examining the presence and consequences in patients’ and mental health workers’ experiences of community treatment orders used information gathered from interviews with South Australian mental health patients and mental health workers.

Researchers from Flinders University then took the information gathered and subjected it to a thematic analysis of the data, assisted by NVIVO software.

Professor Lawn says her team was struck by the language used by both groups of participants, prompting them to examine the moral framings apparent within the data.

“It’s a fragile balance between control and care; one in which the development of trust between worker and patient is complicated by the actual mental illness symptoms,” says Professor Lawn.

“Because these patients usually don’t recognize that they have a mental health condition and don’t trust the very people trying to help them, they can often experience traumatic contact with services, such as threats and physical restraint, stigma and discrimination.”

“How mental health workers make sense of this paradox and practice their humanity towards these patients will have major consequences for how patients are treated within services and how mental illness is understood in the community more broadly.”

“The language used by each group to describe their experiences was striking because it was essentially about moral qualities: about the patient being good or bad, being deserving and worthy or unworthy of help, being trustworthy or untrustworthy, and so on.”

“We found that many patients believe the care they receive does more harm than good to their ability to trust service providers and that it stigmatizes them unnecessarily.”

Professor Lawn did, however, say that some workers were found to be much better than others at providing the critical empathy that some patients needed to make progress.

“We found that some workers positioned themselves as trying to put themselves in the patients’ shoes as a way of acting virtuously towards them, softening the coercive stick approach that underpinned the CTO,” she says.

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