Week 2: Current Conceptualizations of Mental Health Flashcards
What happened in the 1960s (the beginning of dissent)?
A time of growing dissatisfaction with traditional mental health approaches and a desire for more patient-centered and less coercive models of care.
A significant shift in the conceptualization of mental health and psychiatric care in the 1960s. This shift was largely influenced by societal and cultural factors, particularly the critique of traditional mental health institutions.
A rare convergence of left and right-wing support for asylum closure.
A place where people are isolated from the wider society and subjected to strict control, such as a prison, mental hospital, or military barracks.
Total Institution
A place of refuge or protection, especially for people who are persecuted or homeless.
Asylum
Who said that, “Total institutions actually aggravated long-term difficulties”?
Erving Goffman (1922 - 1982)
Who argued that “mental illness was an 18th-century social construct” in Madness and Civilization?
Michael Foucault (1926 - 1984)
Who denied the very existence of mental illness?
Thomas Szasz (1920 - 2012)
Who conceptualized psychiatric patients as nonconformists in One Flew Over the Cuckoo’s Nest?
Ken Kesey (1935 - 2001)
Who rejected medical psychiatry and encouraged greater attention to patients’ lived experiences?
R. D. Laing (1927 - 1989)
Is a term that refers to the unique personal experiences of an individual, particularly as they relate to their identity, social position, or circumstances.
It’s a way to understand how someone’s personal history, culture, and background shape their worldview and perspective.
Lived Experiences
Responsible for a large scale asylum closure in favor of community-based services.
Enoch Powell (Minister of Health)
What was the National Hospital Plan (1962) about?
- Psychiatry = core specialty of new district general hospitals
- Mental hospital provision halved
- Convergence with general medicine
- Therapeutic optimism
Location: Originally built outside North London.
Capacity: At its peak, it housed over 2,000 people.
Name Change: Renamed Friern Hospital in the 20th century.
Colney Hatch Lunatic Asylum
History: Britain’s oldest psychiatric institution, founded in 1247.
Current Affiliation: Part of the South London and Maudsley NHS Foundation Trust.
Bethlem Royal Hospital
It is the process of moving individuals from long-term institutional care, such as mental hospitals, to community-based settings.
This shift aimed to provide more humane and integrated care for individuals with mental health conditions, as well as to reduce the reliance on large, institutional facilities.
Deinstitutionalization
What did the 1975 White Paper, ‘Better Services for the Mentally Ill’ by Barbara Castle cover?
- Shortcomings of the Hospital Plan
- Limited scope for progress
- Concerns over closure before community-based alternatives were available
Why was Peter Barham against deinstitutionalization?
- Inability of community care to deal with the vicissitudes of mental illness
- Failures increased the stigma and isolation experienced by recently-discharged patients
What happened in the Late 20th century?
- Growth of the service user movement
- Decarceration
- Community-based studies
-Patient-authored accounts - Activism
- Peer-review later spread to other locations and services assisted by INVOLVE
What were the two user-controlled research projects in the 1990s?
1) Strategies for Living, 2000 (People’s strategies for dealing with mental distress)
2) User-Focused Monitoring, 1998 (Peer evaluation of community and hospital services)
Marked the transition of user-led research into academia.
Emerged from the efforts of its first director, Professor Dame Til Wykes, to champion service user involvement in all aspects of research.
Creation of SURE in 2001
Conducts research that tests the effectiveness of services and treatments from the perspectives of people with mental health problems on their carers.
It is the largest academic department of its kind in the world.
Service User Research Enterprise (SURE)
The government-funded group assisted in spreading peer review to other locations and services.
INVOLVE
Prominent Groups in the Research Community
- SURE Search
- The McPin Foundation
- St. George’s, University of London
- Shaping Our Lives national User Network
- The Survivor’s History Group
Research group where members include users and survivors of mental health services.
SURE Search
Independent user-controlled group, think tank and network/
Works with . wide and diverse range of service users.
Shaping Our Lives National User Network
A dedicated, user-focused mental health research organization
The McPin Foundation
A research group that critiques and strengthens knowledge about mental health.
Work alongside ‘peer’ researchers with experience of mental health problems
St. George’s, University of London
Celebrates the historical contributions of mental health service users.
Maintains a detailed online mental health timeline.
The Survivor’s History Group
What was Jasna Russo’s (2012) quote?
“Service User” (Europe) or “consumer” (Australia, New Zealand, and USA), on the one hand, and “survivor of psychiatry”, on the other, are expressions of two different perspectives on psychiatry: the first one focuses on reforming the existing system, while the second puts the entire psychiatric system in question, including the vert premise of mental illness.
What is the difference between ‘user involvement in research’ and ‘patient participation in clinical care planning’?
User involvement in research: Service user researcher, peer researcher, and expert by experience
Patient participation in clinical care planning: Patient and client
Pccurs when individuals simultaneously occupy multiple roles, such as being both a service user and a researcher, or a patient and a peer supporter. While this can sometimes be beneficial, it can also lead to challenges.
Role Blurring
A term widely used to refer to individuals who receive mental health services.
Service User
What are criticisms of the term, ‘service user’?
- Value laden
- Restrictive
- Implies passivity
- Disregards aspects of an individual’s identity
- Fails to capture those who may qualify for services but are unable or unwilling to access support
3 Types of Service User Researchers (Hugh McLaughlin)
1) Direct: Recent or current experience
2) Indirect: Involved in studies focused on related services outside their geographical area
3) Alternative: Experience of using services in one specific domain (e.g., breast cancer)
The active participation of individuals who have experience with mental health services in the research process.
Design > Data Collection > Data Analysis > Results
User Involvement
Research that aims to bridge the gap between basic research and clinical practice.
Translational Research
A commonly used phrase that describes the unidirectional movement of knowledge from the laboratory to the clinic.
Bench to Bedside
Knowledge derived from the experiences and perspectives of individuals who have experience with mental health services.
Service User Generated Knowledge
Benefits of service user generated knowledge
- Bridge the translational gap
- Evaluating and enhancing the validity of outcome measures
- Improve organizational efficiency
- Highlighting areas of concern to service users
- Assessing the acceptability and feasibility of proposed changes
It’s a type of therapy that aims to improve cognitive abilities in individuals with mental health problems.
These abilities might include:
Attention
Memory
Problem-solving
Planning
Cognitive Remediation Therapy (CRT)
It’s a medical treatment for severe mental health conditions, such as:
Major depressive disorder
Bipolar disorder
Schizophrenia
Electroconvulsive Therapy (ECT)
Systematic reviews that incorporate the perspectives of patients and service users.
Patient-centered Systematic Reviews
Literature that is not indexed in traditional databases, such as government reports or conference proceedings.
Grey Literature
Data that is not numerical, such as interviews or observations.
Qualitative Data
Measures that are completed by patients to assess their health status or experiences with care.
Patient-Reported Outcome Measures (PROMs)
PROMs that are developed and validated by patients.
Patient-Generated Patient Reported Outcome Measures (PROMs)
Research that involves collaboration between researchers and participants, with an emphasis on reducing power imbalances.
Participatory Research
It involves choosing the so-called least bad side effects, and can inform drug developers of key side effects to avoid from the service user perspective.
Discrete Choice Experiment
Small groups of individuals who participate in a moderated discussion about a particular topic.
Focus groups
A method for analyzing qualitative data that involves identifying and coding recurring themes.
Thematic Analysis
A study that is conducted to assess the practicality and feasibility of a new research method or intervention.
Feasibility Study
A type of research study that involves randomly assigning participants to different groups and comparing their outcomes.
Randomized Controlled Trial (RCT)
Often used in user-centered research to provide feedback and guidance on the development and refinement of research instruments or interventions.
Expert Panel
The process of excluding or isolating a group of people.
Marginalization
Knowledge that is based on personal experience.
Experiential Knowledge
A philosophical movement that emphasized reason, progress, and individual liberty.
Privileged reason and science, leading to the exclusion of individuals who were deemed to be irrational or unreasonable.
The Englishtenment
Challenges to User-led Research
- Conventional hierarchies of status and knowledge
- Collaborative projects are nearly always headed up by professors
- Exclusion from key discussions and dissemination of results
- Limited or denied access to training and resources
- Undermining of user-produced knowledge
Rankings of different types of research studies based on their strength and precision.
Can help healthcare professionals to make informed decisions about the best treatments and interventions for their patients.
Hierarchies of Evidence
Reviews that use a standardized methodology to identify, evaluate, and synthesize evidence on a particular topic.
Systematic Reviews
Statistical analyses that combine the results of multiple studies on a particular topic.
Meta-Analysis
Opinions from individuals who have expertise in a particular field but may not have formal training or credentials.
Lay Expert Opinion
Evidence based on personal accounts or observations rather than scientific or statistical data.
Anecdotal Evidence
An international organization that produces and maintains systematic reviews of the effects of healthcare interventions.
Cochrane Collaboration
A model of mental health care that emphasizes individual empowerment, self-management, and recovery from mental illness.
Recovery Model
A model of mental health care that focuses on the diagnosis and treatment of mental illness.
Medical Model
Challenges and Criticisms of the Recovery Model
1) Unrealistic Expectations
2) Reduction or Closure of Services
3) Hijacking of the Model
