Coercion or collaboration? Nurses doing research with people who have severe mental health problems

Nurses should address the concerns of service users in research and engage in collaborative work with them. Doing this presents ethical dilemmas, not least around the issues of assessing capacity and informed consent to participation in research. The view that judgement regarding the capacity to consent is solely the responsibility of a consultant psychiatrist is challenged as inadequate. The concept of 'moral discourse' (Pike 1991) is used to understand the process by which the assessment of capacity may be carried out. This is illustrated by the application of the concept in a qualitative research study carried out to explore what makes mental health services accessible to women with children. The role of the mental health nurse entails surveillance and the development of expertise in negotiating compliance with treatment programmes. The paper outlines the measures taken to ensure that service users felt empowered, rather than coerced, to participate in this study. While Community Mental Health Team workers were engaged in 'moral discourse' in respect of participation by service users in the study, there were difficulties in engaging General Practitioners. However, there was evidence that women themselves felt empowered both to express interest in participating and to withdraw if they so wished.