Harmful epistemic practices in antipsychotic medication prescribing and counselling

Contemporary mental health policies prioritize patient-centred approaches to care, but research has indicated challenges implying a potential disregard for service users' experiential knowledge. This article details a study of Danish mental health service users' experiences of antipsychotic medication prescription and counselling practices. Repeated semi-structured interviews were conducted with 13 participants diagnosed with schizophrenia attending an outpatient clinic specializing in guided tapering of antipsychotic medication. Data were analysed using abductive analysis, which ultimately illuminated four harmful epistemic practices as part of participants' interactions with mental health clinicians: 1) Presenting a bleak narrative, 2) Subjecting the other to alarmism and risk-aversion, 3) Diverting attention away from medication issues, and 4) Excluding the other from decision-making. We argue that these epistemic practices can be interpreted as manifestations of epistemic injustice and fearmongering. The paper highlights ostensibly helpful but paternalistic practices inadvertently leading to a marginalization of service users’ knowledge and expertise.