The role of fear in mental health service users' experiences: a qualitative exploration

Purpose: Although studies suggest that fear plays an important role in shaping mental health service users' experiences, evidence is patchy and the contexts, conditions and consequences of fear have rarely been researched. This paper explores the role of fear in adult mental health service users' lives and describes its implications for mental health services.

Methods: Four community health service user focus groups (N32) were held. Each group was reconvened after 7-14 days. An initial thematic analysis generated a service user definition of continuity of care (reported elsewhere). A Straussian 'secondary grounded theory analysis' was conducted to gain a deeper understanding of participants' experiences.

Results: 'Being afraid' was identified as a core process, with power and control, and stigma and discrimination found to have explanatory power in determining how and why fear manifests. Consequences included distrusting staff, cooperating reluctantly, learning reticence, delaying help-seeking, avoiding services, feeling unsafe in the community and avoiding exposure as a service user.

Conclusions: Our model suggests that fear plays a substantial role in the lives of adult mental health service users. This has particular consequences for therapeutic relationships, engagement with services and engagement with the wider community. This lack of engagement is associated with adverse outcomes. Further research into the role of fear and the factors that mediate against it is warranted.