Corrosion of care and disempowerment in acute psychiatry: As seen from the positions of therapists and suicidal patients

For people in suicidal crisis, referral to a psychiatric hospital is common. However, acute psychiatry is characterized by a lack of resources in terms of time and beds, making it challenging for therapists to provide person-centered care. In this qualitative study, we explored the experiences and positionings of therapists and suicidal patients in an acute psychiatric ward in Norway. We generated data through participatory observation and interviews with therapists and patients and analyzed the material using principles from Systematic Text Condensation supplemented with an analysis from a Positioning theory perspective. We developed two themes: <i>Therapists positioned as professionals with authority in a context with restricted action radius</i>, and <i>Patients in suicidal crisis positioned as medical subjects with limited influence</i>. In this resource-limited context, therapists managed their work and obligations by simplifying the patient's suffering and suicidality and by emphasizing medical aspects. Ensuring an efficient patient flow was a high priority. The therapists' authority and actions were closely connected to how patients were positioned and their experiences of the care. Positioning theory provides new perspectives for understanding the power imbalance in the positions of therapists and patients. The findings provide insights into acute inpatient psychiatry as a normative field where the choices and actions of both therapists and patients are restricted. In that sense, both patients and therapists can feel powerless. The findings point to significant limitations in the acute mental health care of people in suicidal crisis.