Vol.5, No.10, 1553-1560 (2013) Health
http://dx.doi.org/10.4236/health.2013.510211
Experiences of rejection by mental health patients—
A qualitative study
Bertil Lundberg1, Pia Lundqvist2, Lars Hansson2, Elisabet Wentz3, Bengt Sivberg2*
1Department of Health Sciences, Faculty of Medicine, The Swedish Institute for Health Sciences, Lund University, Lund, Sweden
2Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden;
*Corresponding Author:
3Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg, Sweden
Received 18 April 2013; revised 18 May 2013; accepted 20 June 2013
Copyright © 2013 Bertil Lundberg et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
ABSTRACT
Background and aim: People suffering from
mental illness and their experiences of attitudes
towards them are rarely investigated from the
perspective of the individual. The aim was to
gain an understanding of how a group of mental
health patients experienced social relationships
in personal settings as well as in society. Me-
thod: Open interviews with twenty-five mental
health patients were conducted and analysed
with a qualitative content analysis. Result: The
essence of the result w as that mental health pa-
tients’ experiences are still not taken enough
into account, neither by mental health profes-
sionals nor by their social networks. This was
underpinned by four core categories: Patients’
experience of deteriorated and reduced social
contacts due to various degrees of acceptance
and knowledge of people in general; service
users reported on difficulties with social con-
tacts in general, with family relationships, rela-
tionships with friends and workmates and with
employers; reduced life opportunities were ex-
pressed, including violated self-image and poor
coping competence and, ambivalent experi-
ences of contact with the mental health services
were reported. Conclusion and clinical implica-
tion: The present study contributes to the un-
derstanding of mental health patients’ experi-
ences of professional services and of their so-
cial networks. This knowledge may strengthen
the implications of patient-centred care essen-
tial for the outcome of the care.
Keywords: Mental Health Patients; Experiences;
Stigma; Attitudes; Qualitative Interviews; Society;
Family
1. INTRODUCTION
People with serious mental illness no longer spend
years of their lives in psychiatric institutions. In Sweden,
as in many other countries, there has been a transition of
care from hospitals into the community. However, this
does not guarantee an acceptable inclusion in society.
The barriers originate from the disability itself, the stig-
matizing and discriminatory attitudes, and behaviours of
the public as well as from the staff [1-3].
Stigma affects the identity of those barriers. The nega-
tive attribute is ascribed to, and complicates interactional
encounters with those “the normals” called by Goffman
[4]. To explain how the stigmatization as well as discrimi-
nation process develops, Link and Phelan [5] have des-
cribed four stages: labelling, negative stereotyping, sepa-
ration (“us” from “them”) and, finally loss of status and
discrimination. Political, economic and social powers
contribute to shaping the prejudice and discrimination
experienced by the mentally ill. These factors can ex-
plain the different ways in which the mentally ill patients
are subject to disapproval and discrimination [5]. While
there is considerable knowledge about attitudes and val-
ues in the general population towards people with mental
illness, the research focusing on mental health patients’
experiences is sparse.
Qualitative studies have been suggested to gain a
deeper understanding of subjective experience of stigma
[6-10] as well as a complement to quantitative studies.
Studies investigating first-hand experience have revealed
that stigma occurs in different dimensions, such as inter-
personal interactions, structural discrimination, public
perceptions of mental illness, access to social roles, qual-
ity of mental health services, and the internalization of

B. Lundberg et al. / Health 5 (2013) 1553-1560
1554
stigma [7,9,11]. Therefore, it is important to study pa-
tients’ experiences based on interviews to get an ex-
tended knowledge applicable for psychiatric nurses in
their encounter with this group of patients. The aim was
to gain an understanding of how a group of mental health
patients, with reported high rates of rejection, experi-
enced social relationships in personal settings as well as
in society.
2. METHODOLOGY
2.1. Participants
The sample size was set to 25 informants, consecu-
tively selected as follows. Informants from a cross-sec-
tional study [12] were first asked to participate. Of the
selected 25 informants, two declined to participate and
four were not able to be contacted. The sample was then
extended to 31 informants, to provide the final sample of
25. Since the focus was on stigma experience the infor-
mants with the highest level of experience were asked to
participate. Sociodemographic and clinical characteris-
tics are presented in Table 1. The informants were con-
tacted by a posted letter with information and after a few
days they were contacted by telephone and asked for
further participation in the present study. They were
given the opportunity to put questions to the first author.
After receiving written consent, the informants were
contacted by telephone for an interview appointment.
The majority of the interviews took place in the infor-
mants’ homes; three interviews were carried out within
the premises of the user organizations or at the first au-
thor's office. The interview environment was selected in
order to be as accommodating and calm as possible, so as
to facilitate the informants’ feelings of wellbeing. The
time-span of the interviews varied between 45 to 90
minutes.
2.2. Preunderstanding
Qualitative content analysis is always to some extent
depending on the preunderstanding of the interpreters in
their analysis of the transcripts of the interviews. One
way to stabilize a reasonable and reliable interpretation
of a text is to have a systematic method to deal with the
interpretations and at the same time to be aware of the
influence of the different preunderstandings at hand. The
text analysis was a teamwork mainly performed by the
two first and the last authors but the results were dis-
cussed between all authors to reach a consensus. Their
experiences included work as a psychiatric nurse, ex-
perience on clinical work with people with severe mental
illness as well as earlier research on these groups of pa-
tients. Finally, two of the authors have extended experi-
ences of qualitative content analysis.
Table 1. Sociodemographic and clinical characteristics (n =
25).
Gender
Male 12
Female 13
Age
23 - 29 6
30 - 39 3
40 - 49 5
50 - 59 6
60 - 65 5
Average age 44
Domestic status
Alone 14
Partner 9
Parents 2
Education
Primary School 10
Upper secondary school 10
Post secondary school 5
Diagnosis
Psychosis 15
Mood disorders 7
Disorders of adult personality and behaviour 3
Employment
Open labour market 3
Sheltered/supported employment 3
Unemployed 2
Student 2
Disability pension 15
2.3. Data Collection
An interview guide containing a few open-ended
questions was used to encourage informants to talk as
spontaneously as possible about their experiences. The
opening question was: “Would you to tell me about your
experiences as a mental health patient?” Follow-up ques-
tions were used in order to prompt the informant’s narra-
tion. The interviews were tape-recorded and later tran-
scribed verbatim by the first author.
2.4. Analysis
Content analysis was inspired by the methodology of
Burnard [13,14], a method for systematic classification
of data into categories. Each interview was read by two
of the authors to obtain a sense of the whole of the inter-
views. In the process of analysis of the interviews units
of meaning in the transcripts were identified and gath-

B. Lundberg et al. / Health 5 (2013) 1553-1560 1555
ered into codes (n = 112) covering the content of the total
transcribed text, excluding passages unrelated to the fo-
cus. This was carried out by two of the authors (BL and
BS) separately. A preliminary list of codes was estab-
lished by the first (BL), second (PL) and last author (BS).
The analysis proceeded with a holistic reading of the
transcripts in relation to the result of the coding and dis-
cussed under the tentative grouping of codes in higher
order of preliminary categories. The authors made pre-
liminary interpretations of the meaning of the text to gain
understanding expressed in categories underpinned by
the content covered by the codes. Several categories
were dismissed and new were formatted and some were
merged. During this process the codes were constantly
compared with the original text. Codes were merged into
final categories (Tabl e 2) covering the full content of the
interviews, and categories were further condensed into
core categories and one final overarching category ex-
pressing the essence of the experiences.
3. ETHICS
Ethical approval was obtained from the Regional Eth-
ics Committee, Lund Sweden (LU 667-02). Written and
oral information were given including; the design of the
study; the right to withdraw without giving a reason; and
that they were guaranteed confidentiality. All partici-
pants gave written consent to participate. The study was
performed according the guidelines of the Helsinki Dec-
laration of ethics [15].
4. RESULTS
Four core categories were emerged to illuminate the
meaning of the informants’ experiences and to gain un-
derstanding. These were condensed further into one
over-arching category—Mental health patients alter be-
tween positive and negative experiences but still the lat-
ter is overwhelming—expressing the essence of the study.
Mental health patients can not be considered a homoge-
neous group. Their experiences are dependent on the
occasion, who they meet and what situation they are in.
Despite the fact that many reported improvement the
overwhelming message of the narratives was that they
were still fragile individuals whose experiences were not
taken into account by mental health professionals or by
their social networks.
4.1. Diverging Perceptions of Mental Illness
Due to Various Acceptance and
Knowledge
The informants’ experiences of public perceptions and
attitudes regarding mental illness varied from having a
positive to a negative feeling regarding acceptance and
knowledge. Those informants who stated that acceptance
and knowledge about mental illness among the public
had increased also maintained that mental health prob-
lems have become more common recently, resulting in a
greater acceptance. Contrary to these optimistic percep-
tions there were informants who were convinced that
public knowledge and acceptance still were at a low level.
They described public perceptions as being characterized
by deeply rooted negative stereotypes. Some informants
expressed feelings that people who did not know them
often viewed them as less intelligent and incompetent.
Facing such perceptions made them feel devalued and
frustrated.
“We have so many individual problems, all of us, and
when it comes to mental illness they bunch everything
together and there’s criminals and types like the one who
murdered Anna Lind (Swedish foreign minister, author’s
comment) ··· I f eel that one is branded, well and truly.”
Media such as internet, television, newspapers and
movies were often cited as the main source of informa-
tion about mental illness for the general public. The in-
formants maintained that media were responsible for
creating the image of mentally ill persons often appear-
ing in police reports and in a context where violent acts
occur. They were afraid that this might strengthen the
general public’s fear and call for a return to traditional
institutional care. One informant stated:
There is probably a common fear ··· people project a
great fear about the mentally ill ··· that a person with
mental illness can commit a terrible, a horrible crime
without any reason at all ··· I can understand people
being afraid of that.
Table 2. Example of the analytic interpretation process.
Core category Category Code Condensed text Transcribed text
Experiences of deteriorated and
reduced social contact
Diverging
experiences of
family relationships
Spouse Spouses’ difficulties to
accept mental illness
··· even my husband has perhaps found it difficul
t
to accept when I’m ill.
Siblings
Siblings disclaiming of
brothers and sisters with
mental illness
And my siblings ··· they keep me at distance,
totally at distance ··· Their cohabitants more
easily accept it (illness) than my si bl ing s.
Experiences of reduced life
opportunities, violated sel f-image
and coping competence Proactive coping Keeping the
illness secret
Silence about the mental
illness is the best strategy to
avoid rejection
When I apply for a job I never tell them about my
mental illness. I know that if I do it is the same as
being refused ···

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4.2. Experiences of Deteriorated and
Reduced Social Contact
This core category refers to the informants’ experi-
ences in the context of social relationships. Mostly the
diagnosis had resulted in deteriorated or reduced social
contacts. This category is built up by two categories enti-
tled; Experiences of social relationships in general and
Diverging experiences of family relationships.
4.2.1. Experiences of Social Relationships
in General
Feelings of not being understood by those who were
not affected by mental illness were common among the
informants. They described difficulties in dealing with
new acquaintances, since they did not know how these
would react when being told about their problems. They
described the fear of losing new friends. One informant
described it as: “If this person finds out that I have a
mental illness, what will happen then? Will that person
disappear, will that person stay? Those are the thoughts
that come almost automatically”
Some experiences were socially dismissing, leaving
the informants with a sense of being overprotected or
viewed as infantile.
“Either they couldn’t manage to be with me or they
would be kind and pleasant towards me as though I was
a child. This was very degrading in some way.”
The feelings of being socially insecure or worried
about people around them was often felt in new situa-
tions but these feelings were reduced when they met
friends in the same situation as themselves. The feeling
of sharing the same destiny and facing the same prob-
lems created a feeling of solidarity with others. However,
the informants sometimes experienced ambivalence to-
wards these relationships due to their situation of being
trapped in old social structures not promoting their de-
velopment.
“···you can’t be together with people who are men-
tally ill all the time. Life does not just entail finding
someone to be with who has the same illness as oneself.”
4.2.2. Diverging Experiences of Family
Relationships
The interactions in the families varied greatly. Basi-
cally the relatives either behaved in a supportive or
avoiding way. Experiences of being met with silence or
by avoidance and reluctance to talk directly about as-
pects of mental illness were common.
“Mental illness doesn ’t exist in my family. They’ve met
me with silence because one isn’t supposed to be men-
tally ill.”
Those informants, who at the time of the onset of their
illness had already started a family, spoke of a more or
less involuntary abdication from the role of being a par-
ent when they had become ill. A great fear of relapse into
illness affected their families a long time after their re-
coveries. The feeling that their family had lost confi-
dence in them was reinforced by their relatives’ worry
and overly protective manner. They described that their
need to talk to relatives could sometimes be hampered
because the latter were felt uncomfortable when they
spoke about the psychiatric diagnosis. The feeling of
suffering from an illness that was seen as being a burden
on the family’s reputation and of falling short of rela-
tives’ expectations were hard to bear.
“It was really demoralizing for such a family, upper
class and all that. It just didn’t fit in with their reality. It
was a disgrace for them.”
Some of the informants spoke about their families as
gradually learning to accept that their mental illness,
while others talked of their families disclaiming them.
When their relatives appealed to them to “just pull you
together” or “be reasonable” they felt it was frustrating.
They spooked about how the families had supported
them and been partners in the struggle to cope with and
gain control over the illness. One informant said: “My
family is very strong. They’re always there and let me
come home when I’m not well. Then it’s easier to get
back up from my down periods”. However, those infor-
mants who have been supported felt that their relatives
should have received more support from the authorities.
4.3. Experiences of Reduced Life
Opportunities, Violated Self-Image and
Coping Competence
This core category refers to the informants’ experi-
ences of daily living as well as plans of the future, and
was built of three categories: Reductions of life opportu-
nities; Influences on self-image, self-esteem and proac-
tive coping.
4.3.1. Reduction in Life Opportunities
The prejudices about mental illness and the symptoms,
such as problems with mentally focusing, being sensitive
for stress, tiredness and frequent admissions to hospital
had caused them to give up or change their plans for the
future. The informants stated that the psychiatric diagno-
sis had meant that they had lost many years. Hindrance
of developing was associated with uncompleted study
program, loss of jobs and friends who had abandoned
them.
“I’m standing on exactly the same spot as I did seven
years ago. Sometimes I can sleep for two or three days at
a time, so you think, I can sleep for the rest of my life. I
want more quality in my life.”
Their expectation of their future life was poor with
limited social networks, sometimes only to staff mem-

B. Lundberg et al. / Health 5 (2013) 1553-1560 1557
bers. Workmates made sarcastic remarks or underesti-
mated their abilities. They had also experienced that they
had been forced to resign from jobs when employers
found out that the informants suffered from mental ill-
ness.
4.3.2. Influences on Self-Image and
Self-Esteem
The reaction to their psychiatric diagnoses, especially
the period after having received their diagnoses, was
dominated by thoughts of accusing themselves, feeling
shame and lower self-esteem. They felt they did not live
up to how they were expected to be. The comparison
with other people caused feelings of inferiority and loss
of their own dignity.
“Everything has to be as new as possible, as expensive
as possible and glamorous in terms of life and every-
thing ··· well if you’re mentally ill and tried to take your
own life then yo u’re far away from this imag e of how life
should be.”
The desire to live a normal life like the other people in
the community was huge. The feeling of not having the
same possibilities as others’ was difficult to accept. Some
reported several years of self-stigmatizing and feelings of
guilt and they felt in some way responsible themselves
for having a psychiatric diagnosis.
“I had my own prejudices also. So it was very difficult
to accept that I should have an illness ··· I was stigma-
tizing myself for many years, made myself feel small. I’m
not worth anything ··· I didn’t have feelings of guilt be-
cause I had done something wrong, but because there
was something wron g with me ···”
4.3.3. Proactive Coping
Experiences varied from basically keeping their illness
as a complete secret to being able to show a greater
openness about it. Informants also conveyed an aware-
ness of the tendency to be restrained about talking about
their illness originating both from earlier experiences and
their own prejudices. A woman, who for most of her life
had chosen not to speak of her illness, described her
childhood as: “The community where I grew up ··· it was
a very destructive community, as small villages can be
where everyone is moulded in the same form. I know that
it was very difficult for thos e who had some sort of devi-
ating behaviour. Th ey had to leave···”
It was important to be able to choose wh o and wh en
they wished to talk about things associated with their
psychiatric diagnoses. Even those who had been very
restrained sometimes had a need to talk however; they
often chose situations where they could be anonymous.
The informants who had experience of stigmatizing
behaviour from people around them declared that they
had developed an ability to assess people’s attitudes to-
wards them.
This watchfulness for the attitudes of those around
them led sometimes to a feeling of being constantly tense
and a worry that was so strong that they sometimes
feared it would cause some physical illness. The infor-
mants who had some form of employment stated that if it
were known that they suffered from mental illness they
could risk losing their job.
“I become physically ill through having the pressure
on me, of not being allowed to be mental l y il l.”
The aversion to revealing symptoms to people around
them was an important incentive for them to cope with
and gain control over their illness. Those who had spent
a lot of time trying to understand their illness felt that it
was important to be able to distinguish between their
own person and the illness they had. This insight had
been a first step on the way to stopping self-stigmatizing.
4.4. Ambivalent Contacts with the Mental
Health Services
In general the informants felt that the attitudes and ap-
proach of staff had changed for the better during the
1990s. They described mental health service staff as
“more agreeable”, “more friendly” and “easier to deal
with” than they had previously been. However, they
stated that being admitted to a psychiatric ward had been
a terrifying experience, particularly on the first occasion.
Feelings of shame, confusion, failure and worry about
what was going to happen to them were common. Staff
members’ involvement created feelings of security in the
patients, while shortcomings strengthened feelings of
fear and confusion.
I didn’t know from the beginning what they were going
to do with me. I became even more scared; when I felt
bad ··· I spent th ree days in the intensive car e unit ··· And
that was good, actually. Good people who worked there
··· They understood when you weren’t feeling well.”
Lack of information on their diagnosis was something
that also affected the informants. They spoke of having
had fantasies and had wondered about what their diagno-
sis actually meant to them. Not knowing about the diag-
nosis had meant that they had been prevented from un-
derstanding their own reactions and behaviour.
The informants also criticised the doctors for giving
different and new diagnoses on the different occasions
they had been admitted. One informant wondered: “How
can people who are educated in the same field give so
different, so many different, diagnoses.”
They also stated that they themselves, as well as many
others with mental illness, did not receive the help they
needed and wondered why it was so difficult to get ac-
cess to mental health services. Why had one to be so
“extremely ill” in order to be admitted? The informants

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1558
spoke of their wish for the development of new services,
where they could meet with others in the same situation
and gain access to professional staff. They were also
critical of staff members who did not listen to what they
had to say or did not pay attention to their individual
needs. Their experience was of being offered a standard
treatment, which generally consisted of which medica-
tion to be prescribed: “Th ey only see a condition, a sym-
ptom and give medi cation straight aw ay.”
Those who had received counselling therapy spoke
very positively of this. They thought that they had been
helped and that “without the therapy I wouldn’t have
been as well as I am today”. But the informants voiced
an opinion that they had often not recognized the de-
scriptions of themselves as reported in the documents
when they had been subjected to compulsory care. This
had created feelings of confusion and distrust towards
the doctors. They thought that compulsory care could
have been avoided if the staff had endeavoured to moti-
vate them to receive care voluntarily. One informant
said;
“It can be a shocking experience if there’s violence
and the police are involved. Why not send a doctor who
can take a little at a time. Why do the police have to be
involved at all? One hasn’t committed a crime.”
5. DISCUSSION
The aim of the present study was to gain an under-
standing of experiences of mental health patients related
to their mental illness. Trustworthiness of the analysis
[16,17] was supported through analyses by three of the
authors (BL, PL, and BS) and further strengthened by the
fact that the first author conducted all of the interviews.
Further follow up questions were used to improve trust-
worthiness. The interviews varied in richness, and in-
cluded a wide range of experiences. The non-directive
interview style, with the use of one opening question,
offered a possibility for the informants to talk about their
experiences without restricting themselves. Thus it is
hoped that the complexity of the informants’ experiences
was expressed and the credibility of the findings enhanc-
ed.
Findings showed that the mental health patients’ ex-
periences varied a lot in many aspects related to affirma-
tive and discriminative relationships in many different
social constellations as family, friends, work settings and
care situations. However, despite of some affirmative
experiences the overwhelming narratives disclosed an
exposed situation? Their telling during the interviews
strongly emphasized that society, care and closer social
networks still did not account their experiences enough
to change the interactions to the better. Maybe the gen-
eral perception is that the main problem is within the
patient.
Findings from the present study also mirror those of
previous studies using questionnaires investigating per-
ceptions of stigma and strengthen the conception that
stigma is a reality for patients with mental illness. There
is strong evidence that patients with a psychiatric diag-
nosis expect or anticipate discrimination, whether or not
this actually takes place [18,19].
The personal distance in proximate relationships has
been reported previously [9,20] but the intensity of ex-
periences reported here was very strong and was unani-
mously expressed. Thornicroft [21] suggests that the use
of stigma is limited and focuses on individual aspects of
discrimination, rather than identifying social causes
leading to social exclusion. The focus should rather be
on the power to discriminate [22], not the results of dis-
criminative processes. Proactive coping expressed an
awareness of the mutual aspects of the discriminative
process in the sense that informants mainly tried to cope
with situations in which they expected themselves to feel
uncomfortable or devaluated by avoiding them. Still, this
was an individualistic style of coping since they experi-
enced little or no power to affect their environment.
Findings by Angermeyer et al. and Ucok et al., [19,23]
have indicated that patients anticipate stigmatization
more frequently than they actually experience stigmati-
zation, particularly regarding access to work. The latter
finding is in agreement with the results from the present
study. The development and growth of self-image is a
relational activity involving many social aspects of in-
terpersonal expectations. Reduced life opportunities are a
result of a social exchange process involving at least two
parts, and often many more. To increase quality of life is
not only a passive position of receiving qualities but an
active acceptance of the qualities available to develop a
positive spiral of higher and higher levels of life satisfac-
tion. The anticipation of stigmatization can be a hin-
drance in the process of taking a proactive attitude to
possibilities at hand in the life situation. However, if
mental health patients are denied inclusion into social
networks, the individual is highly discriminated in the
task of gaining inclusion.
Our results indicated that attempts to hide or conceal a
history of psychiatric treatment sometimes resulted in
stress and isolation. These findings are in accordance
with Goffman [4] who believed that managing a discred-
itable identity that is not apparent to others can be a
powerful source of anxiety. Smart and Wegner and Lv et
al. [24,25] found that people who conceal their stigmas
reported a continuing preoccupation with secrecy. This
preoccupation with secrecy has been described as a “pri-
vate hell” [26]. Most informants in the present study
chose to selectively share information about their illness
to avoid exposing themselves to stereotypes and preju-
dices held by the public.

B. Lundberg et al. / Health 5 (2013) 1553-1560 1559
Schulze [27] highlights the experience expressed by
the users that psychiatrists need to acknowledge that they
sometimes focus too much on careless use of diagnostic
labels instead on focusing on recovery, collaboration in
treatment and promotion of community-based services.
However, the service users in this study expressed clear-
ly a need of more agreement between the psychiatrist’s
diagnosis and the view of the person concerned to avoid
the feeling of being reduced as a person.
Findings also showed that meeting others in a similar
situation increased understanding of their own situation
and decreased social isolation. Informants developed a
feeling of self-worth and reduced feelings of loneliness.
Many emphasized that this realization had helped them
to recover from stigma. However, the results also show-
ed that the relationships with other users sometimes were
perceived as too focused on issues related to their illness.
Although issues of friendship may be important for users
of mental health services, this is an area which has at-
tracted very little interest among researchers [23]. The
research up to now in this field has revealed that people
with more severe forms of mental illness have more lim-
ited social networks than others and have relatively more
family members than friends in their social net [28,29].
Our data on the experiences of mental health patients
correspond with findings in other studies [30,31] and
illustrate that consumer groups want more participation
and collaboration in planning their own care and im-
provement in routines of post-discharge follow-up. There
is a broad common sense among mental health patients
that every human being has an intrinsic value, but still
the question can be raised if every human being has an
equal life value? This question is very problematic in
relation to the beginning and end of life, but it is relevant
for many other situations and groups of human beings,
such as people with a psychiatric functional disability.
The informants’ experiences give a unanimous answer to
the question. If they are treated and reaffirmed as human
beings, as persons, we are better able to handle hassles in
everyday situations. The better the mental health patient
is reaffirmed by care providers, family, employers and
friends the more they feel themselves to be included in
social relationships and societal activities. They also main-
tained that it was easier for them to feel self-confidence
and to look upon themselves as persons with an intrinsic
value independent of their mental health history. On the
contrary, almost all informants reported experiences un-
dermining their self-confidence leading to hopelessness,
alienation, and social withdrawal. These experiences
over time undermined their capability to look upon them-
selves as valuable and capable persons with an intrinsic
human value. It is problematic that discriminative expe-
riences were also experienced as having been betrayed
by mental health professionals [32,33]. Service users are
sometimes not capable of speaking for themselves or are
not listened to. This study confirms Bolton’s [32] ethical
reasoning.
6. CONCLUSION
In conclusion, the findings from the present study can
contribute to the understanding of mental health patients’
situation and to improve the professional contact with
them. Further research is needed to confirm the findings
of the present study.
7. CLINICAL IMPLICATIONS
The results may help nurses and other professionals in
many contexts to understand the importance of mental
health patients’ earlier experiences in caring situations.
This knowledge may strengthen the implications of pa-
tient centred care essential for the outcome of the care.
8. ACKNOWLEDGEMENTS
The authors wish to thank the participants’ who participated in the
study.
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