The role of the organisational context across the psychosis service pathway

Section A: Presented here, is a systematic review of literature detailing experiences of mental
health professionals where the organisational context represented a challenged to their valued
practice. A critical appraisal of the 11 included studies is discussed. The qualitative aspects of
studies were synthesised using thematic synthesis. Four major analytic themes emerged. These
include ‘Perceptions of organisation: An inability to think’, ‘A climate of stress and fear’, ‘Moral
distress’, and ‘Self in relation to the organisation’. Implications for organisational unlearning
include the need to promote and facilitate reflective spaces. Recommendations for future
research include the need to understand the experiences of those considered to hold the most
power in mental health contexts.
Section B: Presented here, is a study exploring the processes used by psychologists, working
across the ‘psychosis’ service pathway, to navigate the organisational context and enable the
facilitation of meaningful therapeutic interventions (as perceived by them). Guided by a
constructivist grounded theory methodology, the constructed model identifies eight interacting
categories organised within three domains: ‘Navigating a complex system’, ‘Stepping into
authority’, and ‘Influencing change’. Findings emphasise the importance of making spaces to
enable connection and collaborative learning, facilitating a shared understanding, and a greater
receptivity to psychological positions within these contexts. Implications for clinical practice are
discussed.