Background:
Clinical decision-making (CDM) in mental healthcare is both evaluatively and ideologically complex. Literature has demonstrated that such decisions are often morally challenging; mental health professionals (MHPs) draw on a wide range of values and professional/ personal factors to make decisions. It has further been suggested that dominant discourses and normative attitudes, namely racial attitudes, continue to influence structures and practices within CDM, thus contributing to the racial disparities evidenced across the spectrum of mental healthcare. Aims:
To explore associations between sociodemographic and professional factors and moral values, moral distress and CDM in mental healthcare. In particular, to explore the influence of racial attitudes on CDM processes. Methods:
A cross-sectional design was used. A sample of adults working in UK mental healthcare (n=450) were recruited online through convenience and purposive sampling.
Participants were presented with seven vignettes to assess CDM and racial bias, and completed series of measures concerning demographic factors, moral values, moral distress and racial attitudes. Results:
Findings highlighted significant variation in participants endorsement of the seven moral values measured, in moral distress scores and in CDM. The overall level of moral distress was relatively high (mean MMD-HP score = 98.82). A number of professional and sociodemographic factors were found to predict CDM. Colour-blind racial attitudes were most consistently associated with CDM. Additionally, racial attitudes influenced CDM indirectly; greater endorsement of the moral values of deference and group loyalty increased the influence of racial attitudes on CDM. Conclusions:
There is significant variation in CDM processes among MHPs; decisions are influenced by a range of factors and are often morally challenging. While moral distress may be one consequence of the broad and ideologically complex nature of CDM in mental healthcare, another is that this largely enables decisions to be shaped by dominant discourses, namely, racial attitudes. Thus, the whiteness present within society is reflected in mental health CDM. |