“What are you going to do?”

Mon 29th April 2013

When decision making was taken away

• There was a loss of:• Self confidence• Self respect• Dignity• Freedom• Self belief• Trust,trust,trust..............

• “What should move us to action is human dignity: the inalienable dignity of the oppressed, but also the dignity of each of us. We lose dignity if we tolerate the intolerable.” Dominique du Moneil

• This made me angry! .....................but was seen as further symptoms!

A peer asked, “What are you going to do?”

• “Critical social education, is designed to encourage questioning and action for change, is founded on a different worldview that of participatory democracy forged out of principles of cooperation and equality. Our work is the ‘practice of freedom’ (Freire, 1976) ....... in failing to be vigilant about changes in the political context we run the risk of developing practice that reinforces discrimination whilst still waving the banner of social justice.” (Ledwith, 2007)

The Home Focus Team

• Home/community based• Recovery oriented• Partnership model• Shared decision making – on both sides

• We have a reflective question: “Am I helping this person to stay sick, or, am I helping this person to get better?”

Peer advocacy is an important provision:

• especially for those detained under a section of the Mental Health Act because of the powers given to staff. Under these circumstances advocacy is valuable, and has an important ethical function (Thomas & Bracken, 1999). Peer advocates are independent of mental health service staff and have usually had first-hand experience of using mental health services themselves. They can therefore be seen as working for the patient rather than the staff. (The Psychiatrist, 2001)

Implications for policy implementation

• We have a new policy in ‘Day Services’• It is called ‘New Directions’• The radical change is not the sole responsibility of the

Health Service Executive but rather, a collaborative responsibility shared between the person, their families and carers, a multiplicity of agencies, Government and society as a whole.( H.S.E.)

• The central approach within the report focuses on the core values of person-centeredness, community inclusion, active citizenship and high quality service provision.

Peers, professionals and ‘Open Dialogue’

• What are the aims of an Open Dialogue approach?• Fisher (2011) suggests that the aim is to create a space between people for

creative generation of new thoughts that may promote understanding.• Seikkula, Arnkil and Hoffman (2006) reiterate this, adding that the focus

should be to find a shared way of talking about what is frightening people.• Seikkula and Trimble (2005) describe the main aim as being to generate a

new joint language for experiences that do not yet have words. • Ahern and Fisher (2001) agreed that the aim of Open Dialogue should be

the (re)establishment of heart-to-heart dialogue with significant persons in their social network.

• Anderson and Goolishian (1992) see the aim as the facilitation of a dialogue with and about the client’s narrative, through listening and clarifying their story. They agree that through this generation of a mutual understanding, change is inevitable.

• What does an Open Dialogue approach ask of staff members?• Remember to tolerate uncertainty. Each team member has to be

confident and relaxed at the same time- ‘capable of being in uncertainties, mysteries, doubts, without any reaching after fact and reason’. The most important but difficult task is this tolerance of uncertainty and anxiety.

• Avoid the desire for results. Participating sensitively and effectively requires a capacity to be simple and ordinary but also entail certain qualities of attentiveness and an ability to be still with the situation- to refrain from becoming overly interventionist (Reed, 2011).

• Try to listen generously. This entails patience and slowness of pace by the clinician, and a conscious effort to resist the pull of goals and structures that still remain from previous training. Think of it as though you are still a beginner. This allows space for the unexpected, for unusual thoughts and contributions to occur in meetings, it is a form of listening that doesn’t arise from an agenda.

• See the service user as a competent partner. It is also important to remember that the family and network are considered as resources, not as objects of the treatment

Thank you!“What are you going to do?”

References

• Ledwith, Margaret (2007) 'Reclaiming the radical agenda: a critical approach to community development', Concept Vol.17, No.2, 2007, pp8-12.

• The Psychiatrist (2001) 25: 477-480 doi: 10.1192/pb.25.12.477