Wednesday, April 26, 2017

Making mental health services more therapeutic

Rex Haigh (GreenShrink) has a post on his "STRUGGLING TO BE HUMAN: what we're up against" blog about the Critical Psychiatry Network conference, which I also attended yesterday. The conference theme was Recovery in a Time of Austerity. I just wanted to pick up what he says about feeling a bit more at home in the therapeutic community world. As I mentioned in my article, there are links between critical psychiatry and the therapeutic community approach.

GreenShrink also has a post of a talk he gave about therapeutic communities last year. I agree with him about their relevance for the NHS. Although numbers of beds have been reduced, inpatient facilities need to be more therapeutic rather than so custodial. Although we don't have the same degree of total institutions in psychiatry, as the asylums have been closed, inpatient facilities still suffer from such institutionalising practice. And, community services are not immune and need to become less bureaucratic.

I also agree about the relevance of Laing (see previous post about Mad to be Normal film, which I also saw yesterday) and Basaglia (e.g. see another previous post), both for therapeutic communities and critical psychiatry. And, as was said yesterday at the conference by Jo Moncrieff, the 'elephant in the room' when talking about 'recovery' is that mental health problems tend to be seen as brain disease. Such objectification of people may make psychiatry part of the problem rather than necessarily the solution to their problems. Part of the motivation of Laing and Basaglia was to counter this trend.


cobweb said...

People who experienced life in TC's were subjected to the dogma and theoretical beliefs of those running them just as others have been subjected to favoured physical treatments. To simply set up 'user-led' meetings or group therapy sessions etc does even less to inform people of the beliefs of the leaders of the institutions (which they are whether TC's or otherwise) than the information people are supposed to be given about the drugs they are prescribed. one set of therapists may prioritise for example Attachment theory and others have different perspectives - the level of information provided to people about what is provided is negligible. Trainees of psychotherapeutic organisations are still taught on university courses and via training organisations, the most bizarre way of seeing/understanding people through a maze of the jargon used by Klein or Freud whoever,or days of observing people like monkeys in a zoo - even at times through two way mirrors (even if with consent these days). One day hopefully things will really change and people will be treated with the respect all deserve and not as a group where one lot practice upon another - in it together is not such a bad philosophy.
As for the democratisation of TCs - a community is comprised of all the people who work or live in many maintenance persons;cooks; gardeners;'service users and all, were included in the trip to TCs around the world with Rex and colleagues? people who live together in communities support and help each other in all sorts of ways yet their own authentic contribution is very rarely included unless there is a scandal and they get to speak out via the media.

cobweb said...

Just read the Struggling to be Human what's happened to mutual respect for differences of opinions? Rex has made so many personal comments that he seems either very immature of very defensive. Low attendance by the way does not equal disinterest - how many funders will give expenses to attend critical psychiatry conferences compared to those held by TC promoters - which are being backed by college of psychs...a group Not exactly known for supporting ideas such as critical psychiatry has been banging on about for decades but who are politicking with TC promoters.
Very seriously How can one group of people in positions of relative power now, such as R H and colleagues stick a label of 'personality disorder' on other human beings?. What took years for people to shake off other stigmatising labels yet this is gaining credence as politicians can be influenced by those at the top of hierarchies . Both TCs and Critical Psychiatry may have things in common but hopefully this will not include support for the shameful tag of 'personality disorder'. it has no medical credibility however much brain researchers wish it - even if it did exist why are psychiatrists involved? Social coercion by targeting people, by hanging this label around their necks ,has no place in a civilised society.