Trust in Mental Health Services: A neglected concept

Background: Research suggests that trust is vital for quality healthcare and effective outcomes. Trust becomes necessary in conditions of vulnerability and uncertainty. These conditions may be especially relevant to the experience and treatment of mental illness. There exists a paucity of research into trust and mental health services. Aims: To develop an understanding of trust as it relates to mental health services and their users. To identify practical contexts where trust may be particularly relevant and where research may inform policy, service organization and individual practice. Method: Review of wider literature on "trust" and application of these conceptualizations to the context of mental healthcare. Findings: Trust appears to be salient and yet problematic for mental health services, not least in terms of approachability, disclosure and cooperation with treatment programmes. Organizing services around understandings of trust, rather than risk, may be more effective both at meeting need and managing risk. Conclusions: Through an improved understanding of trust and its effect on the engagement of service-users, there are clear potential benefits for mental health services through an enhanced ability to facilitate access and develop effective cooperation towards healthcare outcomes. Research is required to inform policy, service organization and clinical practice to this end.