Opinions of Relatives of People with Mental Illness About their Participation in Clinical Decision-Making. A Focus-Group Study

Background and objectives: Mental illnesses can affect an individual's decision-making capacity, forcing family members to make decisions about treatment. Cultural variations in preferences and degree of participation in care have been reported. The objective was to identify and characterise opinions, preferences concerning participation and decision-making methods regarding treatment among relatives of patients with mental illnesses treated in mental health institutions in Bogotá, Colombia. Methods: A qualitative focus-group study with 37 adult relatives of patients with mental illness seen in two psychiatric clinics and discourse analysis on decision-making based on constructivist grounded theory. Results: Four initial categories consistent with the literature, as well as a new culturally relevant category that emerged, called “companionship”, are presented. The initial deductive categories described are: companionship, tools, method, symptoms and treatment. Specific and exclusive themes were derived that resulted in 31 final emerging subcategories. Family members were seen to want to actively participate in the decision-making process along with the psychiatrist and the patient, but to face some specific difficulties in relation to mental illness making it difficult for them to act as efficient caregivers. A systemic scheme on the interaction of the categories in decision-making is proposed. Conclusions: Family members of individuals with mental illness seek to participate in clinical decision-making with affection, responsibility and intuition, in a collaborative relationship with the psychiatrist and the institution in charge of their treatment.