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

2. Mental Health Revolution Changing ideas about revolution Changing ideas about revolution The nature of the dominant paradigm in mental health The nature of the dominant paradigm in mental health Causes of, and justification for, revolutionary change Causes of, and justification for, revolutionary change Implications for our profession 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 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 when paradigms change, the world itself changes with them

8. Technological Approach Medical model Cognitive approaches Language of Management

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

12. Why is Technological Paradigm dominant? Cultural support Cultural support Patient expectations Patient expectations Underscores professional roles Underscores professional roles Pharmaceutical industry 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 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 Cultural support Patient expectations Patient expectations Underscores professional roles Underscores professional roles Pharmaceutical industry 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 relationships Ethics and values Social position Cultural issues

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

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

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

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

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

23. Psychiatry and Philosophy

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

25. 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. 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.

26. Mad Pride in Cork

27. 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. 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.

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

29. Insights from Recovery Literature 1. Recovery often made through paths that are alternatives to drugs and psychotherapy 2. Importance of loss of social position that comes with being a service user 3. Community development approach

30. Relationship with service user movement From Consultation to collaboration From Consultation to collaboration