This chapter will develop a theoretical framework for understanding how trustin the context of psychosis services is possible – in spite of theemphasis upon more negative characteristics of mental heath institutionswithin a range of narratives in public sphere discussions and, moreover,within the experiences of many service users. As touched upon in ChapterOne, there are a range of potentially significant obstacles to trust in thecontext of psychosis services and it has been argued that trust, thoughnecessary, would appear prima facie unlikely (Brown et al,2009: 453). First of all, we survey a range of sources of knowledge aboutservices – and the institution of psychiatry– which may be drawn upon by service users in contexts ofvulnerability and uncertainty, and which accordingly shape the likelihood ofprocesses of trust, distrust or mistrust. The central section of the chapterwill then, drawing on Schutzian phenomenology and a typology of knowledgeformats outlined by Habermas (1971), develop a framework for understandingthe varying significance of different types of knowledge for trust. Thiswill be useful in understanding why, despite negative institutionalperceptions and problematic personal experiences, a number of participantsin our study described their experiences of relationships within services interms of high levels of trust.

Three sources of negative institutional conceptions

Psychiatry: history and media portrayals

In a number of senses, ‘psychiatry’ is an overly narrow headingfor this subsection as, of course, modern mental health services includesocial workers, community psychiatric nurses (CPNs) and psychologists(alongside various other professions allied to medicine such as occupationaltherapy) and are thus profoundly multidisciplinary. And yet, althoughdoctors make up only a small proportion of the professionals with whomservice users are in contact, their influence, profile and history,nonetheless, looms large within general perceptions of the nature of carefor people experiencing severe mental health problems, as well as within anumber of connotations associated with labels such as schizophrenia andbipolar. The power of the psychiatrist in diagnosing and sectioning andtheir central role in prescribing decisions renders their presence andreputation as fundamental for how mental health services are viewed withinthe public sphere.

General public conceptions of mental health services and their portrayal inthe public sphere are decidedly, albeit not solely, psychiatry-oriented.