Making Service Users the Priority

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Making Service Users the Priority

• Mental Health Ireland, AGM
• Athlone
• 16th May 2009

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Beyond Consultation Towards Meaningful Service
User Involvement

• Pat Bracken
• West Cork Mental Health Service

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Beyond Consultation

• 1. Introduction
• 2. The Emerging User Movement
• 3. Expertise and the Recovery Approach
• 4. Responding Positively to this Challenge

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The Icarus Project

• we shared a vision of being bipolar that
  differs radically from the narrow model put forth
  by the medical establishment, and wanted to
  create a space for people like us to articulate
  the way we understand ourselves, our disorder,
  and our place in the world

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20th Century Psychiatry
Focus on technology of diagnosis and treatment
relationships
Social position
Ethics and values
Cultural issues
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Technological paradigm

• Madness/distress as problems to be solved
• Importance of ordering/classification
• Interventions as discrete, measurable items,
  packages
• Includes medical, psychological, social and
  managerial interventions
• Culminates in evidence-based practice

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Modernist Psychiatry

• Primary discourse is technical and
  individualised focused on diagnosis,
  classification, biological explanation, technical
  interventions.
• Other issues become secondary
• ethics, values and priorities,
• meanings and contexts,
• relationships and power

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Recovery challenges the technological approach to
mental health
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Recovery agenda
Discourse centred on -values/ethics -meanings/co
ntexts -relationships/power
Appropriate research
Training priorities
Service models
Use of drugs and therapy
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Arguments against the technological paradigm
1. Philosophical (the limits of positivism and
reductionism) 2. Empirical (how treatments
actually work) 3. Sociological (how progress
actually happens) 4. Political (how best to
overcome social exclusion)
5. Ethical (what users actually say)
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What Service Users Want
the patients in this study valued continuity
of care, attitudes, and a willingness to listen
and learn over specific knowledge on mental
health. This suggests tensions with the direction
of current policy reforms, and it challenges
health professionals assumptions that mental
health expertise is vital to providing care for
patients with serious mental illness (Lester et
al, 2005).
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Recovery agenda
Discourse centred on -values/ethics -meanings/co
ntexts -relationships/power
Appropriate research
Training priorities
Service models
Use of drugs and therapy
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Challenges of Partnership

• Different understanding of
• -the nature of mental illness
• -the nature of expertise
• -training and research priorities
• -service developments

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Research by service users
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Insights from Recovery Literature

• Recovery often made through paths that are
  alternatives to drugs and psychotherapy
• Importance of loss of social position that often
  comes with being a service user
• Points to the need to develop a community
  development approach to mental health

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Conclusion

• The user movement is here to stay
• Need to think beyond consultation
• Recovery as involving radical rethink of the
  mental health field
• If we wish to develop recovery-orientated
  services we will need to move towards a
  partnership approach with regard to service
  developments, training, research

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Foucault on the history of psychiatry

• a monologue of reason about unreason

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• Pat.Bracken_at_hse.ie