Perceiving Ethical Discomfort Triggered by Situations that Resist Meaning in Community Mental Health Settings: A Grounded Theory.

Abstract

Community mental health care is a practice setting conducive to the emergence of special situations since the intervention takes place in the client's living environment, a context fraught with multiple and often unpredictable events and triggers. In addition, the healthcare workers are often alone in making decisions. This can lead to a persistent feeling of discomfort when the situation can be seen from several different angles and the healthcare workers find it difficult to make the right decision or are uncomfortable with the consequences of a decision they must make. This is the phenomenon of ethical discomfort. The aim of this study was to develop a grounded theory to better understand the relationships between ethical discomfort situations, their impact on lived experience by healthcare workers, and the mental processes and strategies employed by community mental health workers. We used a constructivist grounded theory methodology and conducted focus group interviews with five rural and urban community mental health teams. Our findings describe the context and process surrounding the identification of ethical discomfort by community mental health workers. Strategies such as dialogue with oneself, colleagues, or clients were helpful in deepening ethical reflection and alleviating ethical discomfort. Future research on ethical issues in community mental health care could help to develop ethical support interventions adapted to this mental health care context.