Establishing contact and gaining trust: an exploratory study of care avoidance

Title. Establishing contact and gaining trust: an exploratory study of care avoidance. Aim. This paper is a report of a study conducted to explore the competencies especially deep-rooted personal qualities - of care providers who succeed in making contact and gaining trust with clients who are inclined to avoid the care they need. Background. Demands, thresholds and fragmentation of services hinder the accessibility of health care, such that some severe mentally ill people do not receive the treatment they need or avoid healthcare services. Methods of establishing contact and gaining trust in mental health care include practical assistance, realistic expectations, establishing long-term goals, empathy and a client-centred and flexible approach. Method. A public mental healthcare practice in The Netherlands with outstanding performance was studied from 2002-2007 using participant observation, interviews with experienced care providers and interviews with clients with a long history of avoiding care facilities, conflicts and troubled relationships with care providers. Findings. A number of personal qualities are vital for establishing contact and gaining trust with these clients: altruism, a degree of compassion, loyalty, involvement, tenacity, a critical attitude to the mainstream, flexibility, optimism, diplomacy, patience, creativity, and a certain degree of immunity to stress. Conclusion. Care providers who establish contact and win trust employ 'nonjudgemental appreciation'. They start from the acceptance of what is and try to connect with the client and their world. These professionals use their initial actions to identify and praise qualities and achievements of clients. This style of work is supported by a set of deep-rooted personal qualities we can summarize as 'empathy'.