This final chapter has two main aims. First, to summarise the major themesthat emerged from the theoretical and empirical analysis and discuss theirimplications for furthering the understanding of the nature and salience oftrust relations in the context of mental healthcare and beyond. This willinvolve a summary of the key conclusions that emerge from the differentelements of the analysis. The second aim is to consider the policyimplications that flow from the empirical findings and the theoreticalframework. While policy notions are applied throughout this book and formthe very context within which theorisations are developed, this concludingchapter will more explicitly draw out a number of considerations andchallenges for policy and practice, based on the findings of the research.More specifically, it will explore theoretical propositions that servicesorganised around concerns of trust will: be more likely to be approached bythose in need; enable more complete and open ‘disclosure’between service users and professionals (Dew et al, 2007); and facilitategreater levels of cooperation with agreed treatment plans. Key questions forfurther research will also be identified where relevant.

Overview of key themes

The underlying purpose of our research was to explore the nature of trust inthis context of heightened vulnerability and uncertainty. Hence, the focushere is on the clinical setting of the provision of mental health serviceswhere there is not only uncertainty about diagnostic labels (many of whichare still associated with both felt and enacted stigma) and treatmentoutcomes, but where the nature of the trusting relationship may be integralto the modes of treatment and, therefore, fundamental to therapeuticoutcomes. Certainly, trust is not something immediately identifiable, but,rather, tends to be taken for granted and routinised. Thus, its existencemay not come to the fore until it is challenged and where there is at leastthe threat of a breakdown in trust between service users and clinicians, orbetween clinicians and their managers.

A study of trust in action, therefore, needed to focus on situations wheretrust is fragile, such as in the context of mental healthcare, which wasbelieved to be a ‘low-trust’ setting (Helene Hem et al, 2008;Pilgrim et al, 2011).