S.TRUEMAN PhD THESIS 2016

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healthcare assistance. Nurses utilise techniques such as nursing assessments to determine if the patient is ill, and formulate arguments that the patient requires mental healthcare. If the nurse does not perform this the patient’s mental state is unknown. Accordingly, they do not assume the status of an intermediary, obligatory passage point. Remote nurses also create ways of thinking about the patient in terms of the actor who is to be engaged. If, for example the patient is depressed and has a medication order then the nurse gives the medication and the thinking involved is relatively simple. No human actor has to be engaged and no negotiations, reports, techniques or language has to be employed. Conversely if a patient presented with severe depression and suicidal ideation, then more complicated thinking and language is required and human actors need to be engaged (e.g., GP, psychiatrist, nurse practitioner) requiring negotiations, reports, techniques and language. The two presentations require different ways of speaking and tools for engagement. Importantly in both, the remote nurse remains indispensable and the mental health patient’s status remains dependent. Obligatory passage points do not necessarily render silent, or necessarily subjugate any actor. Although indispensable, obligatory passage points are not an imposition on any actor. They are a necessity but are created through consultation, collaboration and negotiation, especially for those actors who are the consumers. This is reflected in Batt’s study (2012) when she examined pharma partnerships and consulting breast cancer advocacy groups in Canada, ‘Collectively, the activists’ testimony built the case that patients should be consulted on matters which had to that point been the exclusive domain of professionals, a move which positioned patients’ groups as obligatory passage