Confidentiality in mental health services: a negotiated order?

The negotiated order perspective developed from the study of informal practices in mental health hospitals. It has subsequently become an influential perspective in the study of organizations. This article looks at its continuing relevance to understanding the way in which mental health services operate. Since the original study was published, mental health care has been transformed, with a move in the Western world to deinstitutionalized care and an increasingly managerial approach within human services organizations. The research reported here looks at confidentiality within mental health services in Britain in order to explore the continuing relevance and limitations of the negotiated order perspective. The study examines the confidentiality practices of mental health professionals from the point of view of service users. Seventeen service users were interviewed to ascertain their experience of confidentiality practices in their encounters with health and social services, and to identify their evaluation and response to these encounters. The study suggests the continuing relevance of the negotiated order perspective in terms of understanding professional practices, but also underlines the need to understand negotiation as an active set of practices involving service users as well as professionals.