Pragmatic strategies in medical encounters with mental health

Abstract

Effective communication is critical in mental health care, as language shapes therapeutic outcomes and patient experiences. In Nigeria, where mental health care is under-resourced, the role of pragmatic strategies in medical encounters remains underexplored, despite their impact on patient outcomes. This research sought to characterize the key pragmatic acts employed as communication strategies during medical consultations with mental health patients in Nigeria and to elucidate their role in facilitating effective diagnosis and treatment. A qualitative design was employed at the Neuropsychiatric Hospital, Aro, Abeokuta. Seven medical encounters (average length 10 min 17s; range 2m 18s - 29m 26s) were audio-recorded between March and June 2022 with ethical approval and informed consent. Data were transcribed, translated, and analyzed using Mey’s (2001) Pragmatic Acts Theory. Findings show that mental health practitioners deployed six preponderant pragmatic acts as linguistic strategies to aid the diagnosis and treatment processes of mental health patients in Nigeria. The pragmatic acts are counselling, interjectory, suggesting, inquiring, re-assessing, and assuring. Respectively, these acts were used by doctors/psychiatrists to perform the pragmatic functions of encouraging, prompting responses, tracking mental health history, showing medical concern, confirming, and assuring. These functions were realized through pragmatic cues such as relevance (REL), shared situation knowledge (SSK), reference (REF), inference (INF), prosody, and indirect speech acts. This study highlights the essential role of pragmatic strategies in enriching the diagnosis and treatment of mental health patients in Nigeria, offering valuable insights into communication patterns that can enhance patient engagement and clinical outcomes in mental health care, particularly in under-resourced settings.