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Mental Health Revolution

Mental Health Revolution. Pat Bracken RCPsych Oct 28 th 2008. Mental Health Revolution. Changing ideas about revolution The nature of the dominant paradigm in mental health Causes of, and justification for, revolutionary change Implications for our profession. Che Guevara.

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Mental Health Revolution

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  1. Mental Health Revolution Pat Bracken RCPsych Oct 28th 2008

  2. Mental Health Revolution • Changing ideas about revolution • The nature of the dominant paradigm in mental health • Causes of, and justification for, revolutionary change • Implications for our profession

  3. Che Guevara

  4. Killing Fields of Cambodia

  5. John Gray • “the world in which we find ourselves at the start of the new millennium is littered with the debris of utopian projects”

  6. Copernicus

  7. Kuhn: paradigms ‘when paradigms change, the world itself changes with them’

  8. Technological Approach Cognitive approaches Language of Management Medical model Technological Approach

  9. Main Assumptions of the Technological Paradigm • The problem to be addressed has to due with a faulty mechanism or process of some sort • The mechanism or process can be modelled in causal terms, ie described in a way that is universal, a way that works regardless of the context • Technological interventions are instrumental. They are not to do with opinions, values, relationships or priorities.

  10. Technical idiom • ‘Bipolar disorder is a complex, recurrent mood disorder, and its impact on everyday life can be devastating. Although pharmacological interventions remain the primary tool in its management, medicines cannot control all aspects and consequences of the disorder. Psychosocial interventions target issues untouched by pharmacological treatments, such as medication adherence, awareness and understanding of the disorder, early identification of prodromal symptoms, and coping skills’ (Beynon et al, 2008).

  11. Modernist Psychiatry • Primary discourse is technical: focused on diagnosis and classification, causal explanations, evidence-based interventions (EBM) • Other issues become secondary: ethics, values and priorities, meanings and contexts, relationships and power

  12. Why is Technological Paradigm dominant? • Cultural support • Patient expectations • Underscores professional roles • Pharmaceutical industry

  13. Roy Porter ‘Indeed, the rise of psychological medicine was more the consequence than the cause of the rise of the insane asylum. Psychiatry could flourish once, but not before, large numbers of inmates were crowded into asylums’

  14. Why is Technological Paradigm so dominant? • Cultural support • Patient expectations • Underscores professional roles • Pharmaceutical industry

  15. Role of Service-user Organisations in the Technological Paradigm -consultation -help with fund-raising and recruiting subjects for research -their expertise secondary to that of the technical knowledge of the professional

  16. 20th Century Psychiatry Focus on technology of diagnosis and treatment Social position relationships Ethics and values Cultural issues

  17. Direction of Revolutionary Change Discourse centred on: -values/ethics -meanings/contexts -relationships/power Appropriate research Training priorities Service models Use of drugs and therapy

  18. Challenges to technological paradigm • Postmodern culture • Changing understanding of technology itself • Moves away from the embrace of Pharma

  19. Why Revolution is Justified • Empirical evidence • Conceptual analysis • Political reasons • Ethical imperative

  20. CBT ‘little evidence that specific cognitive interventions significantly increase the effectiveness of the therapy’ (Longmore and Worrell, 2007)

  21. Why Revolution is Justified • Empirical evidence • Conceptual analysis • Political reasons • Ethical imperative

  22. Psychiatry and Philosophy

  23. Why Revolution is Justified • Empirical evidence • Conceptual analysis • Political reasons • Ethical imperative

  24. Ethical if we say that we are working to develop user-centred services, training and research programmes then it is simply unethical to carry on as if the user movement did not exist.

  25. Mad Pride in Cork

  26. 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’.

  27. Implications for Psychiatry • Rethinking psychopathology • A different understanding of expertise • Training • Research • Service developments

  28. Insights from Recovery Literature • Recovery often made through paths that are alternatives to drugs and psychotherapy • Importance of loss of social position that comes with being a service user • Community development approach

  29. Relationship with service user movement From Consultation to collaboration

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