Making sense of 'consent' in a constrained environment

Background: This project investigates patients' and practitioners' experiences and understandings of the consent process, as it is governed by the Mental Health Act in Great Britain. Aims: We aim to illuminate our respondents' experiences of the consent process, and to explore their attempts to make sense of that process. Method: Semi-structured interviews with 5 Responsible Medical Officers, and 7 of their consenting adult patients, were conducted at a medium-secure psychiatric hospital. We approached the analysis from the perspective of Interpretative Phenomenological Analysis. Results: Our analysis begins with an account of some of the common phenomenological consequences of the consent process as our participants understand them, but then moves on to discuss some of the contextual constraints which are evident from their negotiation of these understandings. Conclusions: We conclude by outlining a number of emergent issues relevant to the current development of new Mental Health legislation, These include: mechanisms to allow collaboration with user groups; a more consultative role for users in their own treatment decisions; formal training and support for those conducting competency assessments; and more flexible and transparent legislative frameworks. (C) 2009 Elsevier Ltd. All rights reserved.