Thirteen professionals expressed an interest in taking part in the research. Two potential participants were eligible but were either unable to commit to a time or did not respond to further correspondence. Another potential participant did not meet the inclusion criteria. As part of the ethics application process, permission was sought to contact former staff members should there be an insufficient response from current staff members (see 2.5). A physiotherapist who had previously worked with the team was invited to participate after it became apparent that the current physiotherapist working in the service did not meet eligibility criteria. It was felt to be essential that the profession was represented given the crucial role of physical rehabilitation in clinical management (Lask, 2004; Nunn et al., 1998). Although this participant was perhaps not drawing from as recent examples as some of the other participants, her account largely corresponded with others and there was no obvious difference between the content of the interviews. The final sample comprised eleven clinicians from various professional backgrounds. A profile of participants can be found in Table 3. Demographic data was sought in order to contextualise the findings. Seven participants were female and four were male. Ages ranged between 28 and 48. Six participants identified as White British. One participant identified as White Other. Four participants declined to give information about their age and ethnicity. 2.5. Data collection 2.5.1. Semi-structured individual interviews Individual face-to-face interviews were chosen as the method of data collection. Alternative methods, including focus groups, were considered; however, it was considered that individual interviews afforded a greater degree of confidentiality and opportunities for depth than many alternatives.
4: Themes and subthemes Theme Subtheme Making Similar yet different Pervasive. Refusal. Syndrome? Frameworks for understanding Uncertainty The impact Negotiating uncertainty Our way Re-humanising relationships A family alliance Clear expectations Censoring talk 3.3. Making sense This theme refers to the variety of ways in which the concept of PRS was perceived and understood. The large majority of participants spoke about the complexity of the meaning-making process. “…I find it sort of completely baffling’’. SR. Line 12. “…it’s just really complicated”. Sunshine. 25-26. “…it’s a puzzle”. Sean. Line 107. Complexity was reflected in the way some participants spoke in a longwinded or circuitous manner. Katie reflected on this directly. “…I think possibly my ramblings or not cloudy but complex answers and not being able to give you straight answers just represents it (PRS) itself”.
increased anxiety, which was seen to have an insidious impact on the confidence of all those involved in the admission:“…I think confidence (is helpful) and if you don’t have it then you pretend to have it” (Bella. Lines 129-131). In the absence of consensus, ostensibly rather modest differences in opinion were interpreted as becoming amplified and polarised. This was most notable in the way in which some participants highlighted the distinctive approach taken by the service and/or compared the service model to alternative approaches. The extracts below demonstrate the way in which stressing the differences between approaches could be seen to result in the formation of an ‘us’ and ‘them’ dynamic. “(the view is) basically you leave people and you do minimum care and…you don’t do any more than that, it’s very much that’s what they want you to do, that’s not what we do”. Sean. Lines 194-197. “…at (hospital) we’ve got (service). That’s very different from everywhere else in the Max. Lines 319-320. Beth: “What’s the impact of that (conflicting opinion)?” Sarah: “I think it makes people believe in our approach more”. 524-527. In some ways this dynamic appeared to be perpetuated by the very widely held perception amongst participants of a weak and inadequate evidence-base. Existing literature was widely regarded to be of poor quality on the basis of being ‘unscientific’ in contrast to more rigorous and systematic evidence such as that obtained from randomised control trials.
Sarah. Lines 735-738. “…the temptation…is to put plans in place and plans are essential…but that is part of the issue”. Bobby. Lines 100-106. Participants also reflected upon how best to facilitate relationships in a context of predominating ‘refusal’ and ongoing medical risk, which can change the focus of the intervention. 3.5.2. A family alliance This subtheme recognises the importance of families and the team working in partnership in order to promote recovery. Working with parents was seen to be extremely important, not least due to the voluntary legal status of the admission and the perceived importance of the young person experiencing professionals and parents working together in ‘alliance’. “…the alliance between the family and the parents in particular is very, very important”. Andrew. Lines 335-337. “…staff and parents working together that’s a big one, a really big one”. SR. Lines 215-216. “…the others that I can think of that did go well…it always felt like everyone was on the same page or singing from the same song sheet”. Bella. Lines 304-310.
Appendix C: Published journal articles describing individual cases Authors Country No. of cases Ages Sex Country of origin Context of admission Lask et al., (1991) UK 4 9-14 Female UK Psychiatric Graham & Foreman (1995) UK 1 8 Female UK Psychiatric Thompson & Nunn (1997) Australia 7 10-15 6 Female 1 Male Australia 6 Psychiatric 1 Outpatient McGowan & Green (1998) UK 1 11 Female UK Psychiatric Taylor et al., (2000) Australia 1 4 Male Australia (Chinese parents) Paediatric Anonymous (2001) UK 1 8 Male UK Psychiatric Lask (2004) UK 1 14 Female UK Psychiatric Magagna (2004) UK 1 17 Female China Psychiatric Edwards & Done (2004) UK 1 11 Female Not stated Paediatric Bodegård Sweden 5 7-10 3 Female 2 Male Former Soviet Republic states Psychiatric Bodegård Sweden 16 7-12 6 Female 10 Male Former Soviet Republic states Psychiatric Van der Walt & (2006) Australia 1 11 Female Not stated Psychiatric Jaspers et al., (2009) Netherlands 1 11 Female Not stated Psychiatric Guirguis et al., (2011) UK 4 12 1 Male 3 Female Not stated Psychiatric Jans et al., (2011) Germany 3 14-16 2 Female 1 Male 2 German 1 Ukraine Psychiatric Wright & Beverley (2012) UK 1 14 Male Not stated Home treatment