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Cross L, Banham D, Melendez-Torres GJ, Ford T, van Sluijs E, Liabo K. Developing inclusive public involvement and engagement activities with secondary school students and educational professionals: a protocol. RESEARCH INVOLVEMENT AND ENGAGEMENT 2024; 10:68. [PMID: 38951878 PMCID: PMC11218269 DOI: 10.1186/s40900-024-00581-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 05/01/2024] [Indexed: 07/03/2024]
Abstract
BACKGROUND Public involvement and engagement (PI&E) is increasingly recognised as an important component of research. It can offer valuable insights from those with experiential knowledge to improve research quality, relevance, and reach. Similarly, schools are ever more common sites for health research and, more recently, PI&E. However, 'gold-standard' practice is yet to be established, and activities/approaches remain underreported. As a result, knowledge can remain localised or lost. Diversity and inclusion also remains a challenge. METHODS This protocol has been informed by UK national guidance, evidence-based frameworks and available implementation literature. It describes both rationale and approach to conducting PI&E activities within a secondary school context. Activities are designed to be engaging, safe and accessible to young people with diverse experiences, with scope to be iteratively developed in line with public collaborator preference. DISCUSSION Young people should be architects of their involvement and engagement. Ongoing appraisal and transparency of approaches to PI&E in school settings is crucial. Expected challenges of implementing this protocol include facilitating a safe space for the discussion of sensitive topics, absence and attrition, recruiting students with a diverse range of experiences, and potential knowledge and capacity barriers of both facilitator and contributors. Activities to mitigate these risks are suggested and explored.
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Affiliation(s)
- Lauren Cross
- University of Cambridge (MRC Epidemiology Unit), Cambridge, UK.
| | | | | | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
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2
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Côté CI. A critical and systematic literature review of epistemic justice applied to healthcare: recommendations for a patient partnership approach. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2024:10.1007/s11019-024-10210-1. [PMID: 38833134 DOI: 10.1007/s11019-024-10210-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/15/2024] [Indexed: 06/06/2024]
Abstract
Invalidation from healthcare practitioners is an experience shared by many patients, especially those marginalized or living with contested conditions (e.g., chronic pain, fibromyalgia, etc.). Invalidation can include not taking someone's testimony seriously, imposing one's thoughts, discrediting someone's emotions, or not perceiving someone's testimony as equal and competent. Epistemic injustices, that is, the disqualification of a person as a knower, are a form of invalidation. Epistemic injustices have been used as a theoretical framework to understand invalidation that occurs in the patient-healthcare provider relationship. However, to date, the different recommendations to achieve epistemic justice have not been listed, analyzed, nor compared yet. This paper aims at better understanding the state of the literature and to critically review possible avenues to achieve epistemic justice in healthcare. A systematic and critical review of the existing literature on epistemic justice was conducted. The search in four databases identified 629 articles, from which 35 were included in the review. Strategies to promote epistemic justice that can be applied to healthcare are mapped in the literature and sorted in six different approaches to epistemic justice, including virtuous, structural, narrative, cognitive, and partnership approaches, as well as resistance strategies. These strategies are critically appraised. A patient partnership approach based on the Montreal Model, implemented at all levels of healthcare systems, seems promising to promote epistemic justice in healthcare.
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Affiliation(s)
- Catherine Isadora Côté
- Department of Political Science, Faculty of Arts and Sciences, Université de Montréal, Montréal, QC, Canada.
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3
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Béhague DP, Gonçalves H, da Cruz SH, de Cruz L, Horta BL, Lima NP. The politicizing clinic: insights on 'the social' for mental health policy and practice. Soc Psychiatry Psychiatr Epidemiol 2024; 59:523-536. [PMID: 38108834 PMCID: PMC10944422 DOI: 10.1007/s00127-023-02573-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 09/28/2023] [Indexed: 12/19/2023]
Abstract
PURPOSE In this paper, we explore how Brazilian socially sensitive therapy can respond to care-users' desire to change the social and political forces shaping their lives. We use this case to demonstrate the limits of the "social determinants of health" agenda which, when operationalized, tends to leave questions of lasting structural change aside. METHODS We report on mixed methods ethnographic and epidemiological results from the 1982 Pelotas (Brazil) birth cohort study, a prospective study of 5914 children. Ethnographic analysis explored the cyclical relationship between schooling, mental health care, conceptualizations of mental distress, social and political engagement, and experiences with diverse forms of discrimination. Epidemiological bivariate and multivariate analyses examined differences in socio-political participation and the reporting of discrimination at different time-points for participants who used therapy with those who did not. Effect modification analysis tested the hypothesis that the socially empowering effects of therapy were greater for marginalized and minoritized youth. RESULTS Most young people living in situations of precarity experienced therapy, particularly when based in schools, to be a blame-inducing process. A more fulfilling and impactful therapeutic experience took shape when young people were able to shift the focus away from symptom reduction and behavioral management toward narrative life analyses, social debate, and political agency. Use of socially sensitive therapy was statistically associated with increased political participation and reporting of discrimination after controlling for confounders. The empowering effects of therapy were greater for those with less formal education and family income, but not for young people who identified as black, brown, or non-white. CONCLUSION The findings underscore the importance of considering agency, sociality, and politics when theorizing "the social" in clinical practice, and health and social policy.
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Affiliation(s)
- Dominique P Béhague
- Vanderbilt University, Medicine Health, and Society, Nashville, Tennessee, USA.
- Kings College London, Social Medicine & Global Health, London, UK.
| | - Helen Gonçalves
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | | | - Larissa de Cruz
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Bernardo L Horta
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Natália P Lima
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
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Della Croce Y. Epistemic Injustice and Nonmaleficence. JOURNAL OF BIOETHICAL INQUIRY 2023; 20:447-456. [PMID: 37378755 PMCID: PMC10624719 DOI: 10.1007/s11673-023-10273-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 02/03/2023] [Indexed: 06/29/2023]
Abstract
Epistemic injustice has undergone a steady growth in the medical ethics literature throughout the last decade as many ethicists have found it to be a powerful tool for describing and assessing morally problematic situations in healthcare. However, surprisingly scarce attention has been devoted to how epistemic injustice relates to physicians' professional duties on a conceptual level. I argue that epistemic injustice, specifically testimonial, collides with physicians' duty of nonmaleficence and should thus be actively fought against in healthcare encounters on the ground of professional conduct. I do so by fleshing out how Fricker's conception of testimonial injustice conflicts with the duty of nonmaleficence as defined in Beauchamp and Childress on theoretical grounds. From there, I argue that testimonial injustice produces two distinct types of harm, epistemic and non-epistemic. Epistemic harms are harms inflicted by the physician to the patient qua knower, whereas non-epistemic harms are inflicted to the patient qua patient. This latter case holds serious clinical implications and represent a failure of the process of due care on the part of the physician. I illustrate this through examples taken from the literature on fibromyalgia syndrome and show how testimonial injustice causes wrongful harm to patients, making it maleficent practice. Finally, I conclude on why nonmaleficence as a principle will not be normatively enough to fully address the problem of epistemic injustice in healthcare but nevertheless may serve as a good starting point in attempting to do so.
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Affiliation(s)
- Yoann Della Croce
- Department of Political Science and International Relations, University of Geneva, 40 Boulevard du Pont d'Arve, 1205, Geneva, Switzerland.
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5
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McCradden M, Hui K, Buchman DZ. Evidence, ethics and the promise of artificial intelligence in psychiatry. JOURNAL OF MEDICAL ETHICS 2023; 49:573-579. [PMID: 36581457 PMCID: PMC10423547 DOI: 10.1136/jme-2022-108447] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 11/29/2022] [Indexed: 05/20/2023]
Abstract
Researchers are studying how artificial intelligence (AI) can be used to better detect, prognosticate and subgroup diseases. The idea that AI might advance medicine's understanding of biological categories of psychiatric disorders, as well as provide better treatments, is appealing given the historical challenges with prediction, diagnosis and treatment in psychiatry. Given the power of AI to analyse vast amounts of information, some clinicians may feel obligated to align their clinical judgements with the outputs of the AI system. However, a potential epistemic privileging of AI in clinical judgements may lead to unintended consequences that could negatively affect patient treatment, well-being and rights. The implications are also relevant to precision medicine, digital twin technologies and predictive analytics generally. We propose that a commitment to epistemic humility can help promote judicious clinical decision-making at the interface of big data and AI in psychiatry.
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Affiliation(s)
- Melissa McCradden
- Joint Centre for Bioethics, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
- Bioethics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Genetics & Genome Biology, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
| | - Katrina Hui
- Everyday Ethics Lab, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Z Buchman
- Joint Centre for Bioethics, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
- Everyday Ethics Lab, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Patel K, Cardno A, Isherwood T. ' Like I said about culture. You don't talk about mental health ' : An interpretative phenomenological analysis of the experience of first-episode psychosis in South Asian individuals. Early Interv Psychiatry 2023; 17:771-783. [PMID: 36639135 DOI: 10.1111/eip.13368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 09/27/2022] [Accepted: 01/02/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND There is strong evidence of inequalities in mental healthcare access, experiences and outcomes for service users belonging to Black and Asian Minority Ethnic groups experiencing psychosis. Clinicians and academics have speculated that cultural variation in conceptualisations of psychosis, alongside inequitable service provision may explain disparities. There is, however, a dearth of literature exploring this in a South Asian population, despite this ethnic group being the second largest in the United Kingdom. The present study aimed to explore how people from this minority group have experienced and made sense of first-episode psychosis (FEP). METHODS A qualitative approach was used to explore the lived experience and sense-making of South Asian individuals experiencing FEP and accessing early intervention services. Eight people were interviewed using a semi-structured format. The data were analysed using Interpretative Phenomenological Analysis. RESULTS Three superordinate themes were identified in the group analysis: (1) Disconnection from self and others (2) Doubt and dispute (3) Power and shame. CONCLUSIONS Distinctive ethnic, cultural and systemic influences were strongly evident in how people conceptualized their experiences, how they managed their sense-making and where they sought support. Experiences were discussed in the context of power and shame, and this research proposes that socio-cultural context and racialised discourses have an impact on self-concept, the experiences of help-seeking (formal and informal), and fundamentally how services help individuals from marginalized communities.
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Affiliation(s)
- Krisna Patel
- School of Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Alastair Cardno
- Psychological & Social Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Tom Isherwood
- School of Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Salla A, Newbigging K, Joseph D, Eneje E. A conceptual framework for culturally appropriate advocacy with racialised groups. Front Psychiatry 2023; 14:1173591. [PMID: 37496683 PMCID: PMC10367102 DOI: 10.3389/fpsyt.2023.1173591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/24/2023] [Indexed: 07/28/2023] Open
Abstract
Independent mental health advocacy was introduced in England to protect and promote the rights of people detained under mental health legislation. However, shortcomings in access and delivery to racialised people, raising concerns about equity, were identified by a review of the Mental Health Act. The development of culturally appropriate advocacy was recommended. While the term culturally appropriate may be taken for granted it is poorly defined and limited efforts have conceptualized it in relation to advocacy. Ideally, advocacy operates as a liberatory practice to challenge epistemic injustice, which people experiencing poor mental health are at acute risk of. This is amplified for people from racialised communities through systemic racism. This paper argues that advocacy and culturally appropriate practices are especially relevant to racialised people. It clarifies the importance of culture, race and racism to the role of advocacy, and understanding advocacy through the conceptual lens of epistemic injustice. A central aim of the paper is to draw on and appraise cultural competency models to develop a conceptual framing of cultural appropriate advocacy to promote epistemic justice.
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Affiliation(s)
| | - Karen Newbigging
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Doreen Joseph
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Emachi Eneje
- School of Social Policy, University of Birmingham, Birmingham, United Kingdom
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Bastidas-Bilbao H, Stergiopoulos V, van Kesteren MR, Stewart DE, Cappe V, Gupta M, Buchman DZ, Simpson AIF, Castle D, Campbell BH, Hawke LD. Searching for relief from suffering: A patient-oriented qualitative study on medical assistance in dying for mental illness as the sole underlying medical condition. Soc Sci Med 2023; 331:116075. [PMID: 37441977 DOI: 10.1016/j.socscimed.2023.116075] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/28/2023] [Accepted: 07/02/2023] [Indexed: 07/15/2023]
Abstract
Medical assistance in dying (MAiD) was introduced into Canadian legislation in 2016. Mental illness as the sole underlying medical condition (MI-SUMC) is excluded from eligibility; this is expected to change in 2024. Incurability, intolerable suffering, capacity to make healthcare decisions, and suicidality have been publicly debated in connection with mental illness. Few studies have explored the views of persons with mental illness on the introduction and acceptability of MAiD MI-SUMC; this study aimed to fill this gap. Thirty adults, residing in Ontario, Canada, who self-identified as living with mental illness participated. A semi-structured interview including a persona-scenario exercise was designed to discuss participants' views on MAiD MI-SUMC and when it could be acceptable or not. Reflexive thematic analysis was used to inductively analyze data. Codes and themes were developed after extensive familiarization with the dataset. A lived-experience advisory group was engaged throughout the study. We identified six themes: The certainty of suffering; Is there a suffering threshold to be met? The uncertainty of mental illness; My own limits, values, and decisions; MAiD MI-SUMCas acceptable when therapeutic means, and othersupports, have been tried to alleviate long-term suffering; and Between relief and rejection. These themes underline how the participants' lived experience comprised negative impacts caused by long-term mental illness, stigma, and in some cases, socioeconomic factors. The need for therapeutic and non-therapeutic supports was highlighted, along with unresolved tensions about the links between mental illness, capacity, and suicidality. Although not all participants viewed MAiD MI-SUMC as acceptable for mental illness, they autonomously embraced limits, values, and decisions of their own along their search for relief. Identifying individual and contextual elements in each person's experience of illness and suffering is necessary to understand diverse perspectives on MAiD MI-SUMC.
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Affiliation(s)
| | - Vicky Stergiopoulos
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | | | - Donna Eileen Stewart
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Centre for Mental Health and Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Vivien Cappe
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Mona Gupta
- Centre hospitalier de l'Université de Montréal, Département de Psychiatrie, Montréal, Québec, Canada
| | - Daniel Z Buchman
- Education and Professional Practice Office, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Dalla Lana School of Public Health and University of Toronto Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada
| | - Alexander I F Simpson
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Forensic Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - David Castle
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | | | - Lisa D Hawke
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
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Barker C, Ford S, Eglinton R, Quail S, Taggart D. The truth project paper one-how did victims and survivors experience participation? Addressing epistemic relational inequality in the field of child sexual abuse. Front Psychiatry 2023; 14:1128451. [PMID: 37333914 PMCID: PMC10272443 DOI: 10.3389/fpsyt.2023.1128451] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 05/16/2023] [Indexed: 06/20/2023] Open
Abstract
The last 30 years has seen an exponential increase in Historical Institutional Abuse Inquiries. One feature of these has been to place adult survivor voices at the center of Inquiry work, meaning that child abuse victims and survivors are engaging with Inquiries, sharing their experiences, with this participation often presented as empowering and healing. This initiative challenges long held beliefs that child sexual abuse survivors are unreliable witnesses, which has led to epistemic injustice and a hermeneutical lacunae in survivor testimony. However to date there has been limited research on what survivors say about their experiences of participation. The Truth Project was one area of work of the Independent Inquiry into Child Sexual Abuse in England and Wales. It invited survivors of Child Sexual Abuse to share their experiences including the impacts of abuse and their recommendations for change. The Truth Project concluded in 2021 and heard from more than 6,000 victims of child sexual abuse. The evaluation of the Trauma Informed Approach designed to support survivors through their engagement with the project was a mixed methods, two phase methodology. A total of 66 survey responses were received. Follow-up interviews were conducted with seven survey respondents. The Trauma Informed Approach was found to be predominantly helpful in attending to victim needs and minimizing harm. However, a small number of participants reported harmful effects post-session. The positive impacts reported about taking part in the Truth Project as a one-off engagement challenges beliefs that survivors of child sexual abuse cannot safely talk about their experiences. It also provides evidence of the central role survivors should have in designing services for trauma victims. This study contributes to the epistemic justice literature which emphasizes the central role of relational ethics in the politics of knowing, and the importance of developing a testimonial sensibility when listening to marginalized groups.
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Affiliation(s)
| | - Stephanie Ford
- School of Health and Social Care, University of Essex, Colchester, United Kingdom
| | | | | | - Daniel Taggart
- School of Health and Social Care, University of Essex, Colchester, United Kingdom
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10
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LeBlanc-Omstead S, Kinsella EA. "Come and share your story and make everyone cry": complicating service user educator storytelling in mental health professional education. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:387-410. [PMID: 36074308 PMCID: PMC10169883 DOI: 10.1007/s10459-022-10157-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 08/16/2022] [Indexed: 05/11/2023]
Abstract
It has become relatively common practice within health professional education to invite people who have used mental health and social care services (or service user educators) to share their stories with health professional learners and students. This paper reports on findings from a postcritical ethnographic study of the practice of service user involvement (SUI), in which we reflexively inquired into conceptualizations of service user educators' knowledge contributions to health professional education in the accounts of both service user- and health professional educators. This research was conducted in response to recent calls for greater scrutiny surrounding the risks, challenges, and complexities inherent in involving service users in health professional education spaces. 'Story/telling' was identified as a pronounced overarching construct in our analysis, which focuses on participants' reports of both the obvious and more subtle tensions and complexities they experience in relation to storytelling as a predominant tool or approach to SUI. Our findings are presented as three distinct, yet overlapping, themes related to these complexities or tensions: (a) performative expectations; (b) the invisible work of storytelling; and (c) broadening conceptualizations of service user educators' knowledge. Our findings and discussion contribute to a growing body of literature which problematizes the uncritical solicitation of service user educators' stories in health professional education and highlights the need for greater consideration of the emotional and epistemic labour expected of those who are invited to share their stories. This paper concludes with generative recommendations and reflexive prompts for health professional educators seeking to engage service user educators in health professional education through the practice of storytelling.
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Affiliation(s)
- Stephanie LeBlanc-Omstead
- Health Professional Education, Faculty of Health Sciences, Western University, 1201 Western Rd., Elborn College, London, ON, N6G 1H1, Canada.
| | - Elizabeth Anne Kinsella
- Health Professional Education, Faculty of Health Sciences, Western University, 1201 Western Rd., Elborn College, London, ON, N6G 1H1, Canada
- Institute of Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, 1110 Pine Avenue West, Montreal, QC, H3A 1A3, Canada
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, H3A 1A3, Canada
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Jordan G, Ng F, Thomas R. How clinicians can support posttraumatic growth following psychosis: a perspective piece. Ir J Psychol Med 2023:1-6. [PMID: 36799213 DOI: 10.1017/ipm.2023.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Psychosis is often a traumatic experience that can lead to significant suffering. However, people may also experience posttraumatic growth following psychosis. Posttraumatic growth refers to the positive changes that people experience following a struggle with an adversarial event and has been shown to occur in at least five domains, including a greater appreciation for life; improved relationships with others; greater personal strengths; new life possibilities and spiritual/existential growth. Studies have shown that mental health services can play a key role in facilitating posttraumatic growth. However, there are no recommendations that clinicians can follow to best support posttraumatic growth following psychosis specifically. Without guidance, clinicians risk invalidating people's experiences of, or providing improper support for, posttraumatic growth. To address this knowledge gap, we reflect on current research and clinical guidelines to recommend ways that clinicians can support posttraumatic growth following psychosis.
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Affiliation(s)
- Gerald Jordan
- University of Birmingham, College of Life and Environmental Science, School of Psychology, Institute for Mental Health, Centre for Urban Wellbeing, Birmingham, UK
| | - Fiona Ng
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Medical School, Queen's Medical Centre, Nottingham, UK
| | - Robyn Thomas
- School of Social and Political Science, University of Edinburgh, 15a George Square, Edinburgh, UK
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12
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Wilson K, Foye U, Thomas E, Chadwick M, Dodhia S, Allen-Lynn J, Allen-Lynn J, Brennan G, Simpson A. Exploring the use of body-worn cameras in acute mental health wards: A qualitative interview study with mental health patients and staff. Int J Nurs Stud 2023; 140:104456. [PMID: 36821953 DOI: 10.1016/j.ijnurstu.2023.104456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/30/2023] [Accepted: 02/06/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Body-worn cameras are increasingly being used as a violence prevention tool in inpatient mental health wards. However, there is a dearth of research on their use in these settings, particularly when it comes to patient perspectives. OBJECTIVE This study aimed to explore the perspectives of patients, mental health staff, and senior management on body-worn cameras to identify the possible impacts of this technology in inpatient mental health settings. DESIGN This was an exploratory qualitative study. SETTING We undertook interviews online and in-person on a number of acute inpatient wards across five mental health hospitals in England. Participants were recruited in-person, online via social media, and through professional networks. PARTICIPANTS This study recruited 24 patients from acute wards, 25 staff from acute wards, six Mental Health Nursing Directors, and nine community-based patients. METHODS Semi-structured interviews were conducted online and in-person. Interviews were analysed using reflexive thematic analysis. Ethical approval was granted by the Health Research Authority. RESULTS The subjective nature of how violence and aggression is defined shapes how staff and patients view the prospect of using body-worn cameras. Both staff and patients cited issues resulting from an underlying culture of mistrust in inpatient settings that leave staff and patients feeling unsafe. Body worn cameras may intensify power dynamics and undermine therapeutic relationships. Participants felt that engaging existing interventions and addressing systemic causes of violence and aggression should take priority over introducing body-worn cameras. CONCLUSIONS There is no indication that staff or patients believe body-worn cameras will deter violence and aggression on inpatient mental health wards. They may serve as a tool for safeguarding and staff training, but there are still unexplored ethical concerns about their use and a lack of evidence to support use of this technology to deter violence in NHS mental health settings. TWEETABLE ABSTRACT Mental health patients & staff have complex perspectives on controversial body-worn camera technology @thekeiranwilson @unafoye @maddych4dwick @gbrennancafc @cityalan.
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Affiliation(s)
- Keiran Wilson
- Mental Health Nursing, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom; Mental Health Nursing, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom. https://twitter.com/thekeiranwilson
| | - Una Foye
- Mental Health Nursing, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom; Mental Health Nursing, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom. https://twitter.com/unafoye
| | - Ellen Thomas
- Mental Health Nursing, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom; Mental Health Nursing, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom
| | - Madeleine Chadwick
- Mental Health Nursing, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom; Mental Health Nursing, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom. https://twitter.com/maddych4dwick
| | - Sahil Dodhia
- Mental Health Nursing, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Jenny Allen-Lynn
- Mental Health Nursing, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Jude Allen-Lynn
- Mental Health Nursing, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Geoff Brennan
- Mental Health Nursing, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom. https://twitter.com/gbrennancafc
| | - Alan Simpson
- Mental Health Nursing, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom; Mental Health Nursing, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom.
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13
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Kidd IJ, Spencer L, Carel H. Epistemic injustice in psychiatric research and practice. PHILOSOPHICAL PSYCHOLOGY 2022. [DOI: 10.1080/09515089.2022.2156333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Ian James Kidd
- Department of Philosophy, University of Nottingham, Nottingham, United Kingdom of Great Britain and Northern Ireland
| | - Lucienne Spencer
- Institute of Mental Health, University of Birmingham, Birmingham, United Kingdom of Great Britain and Northern Ireland
| | - Havi Carel
- Department of Philosophy, University of Bristol, Bristol, United Kingdom of Great Britain and Northern Ireland
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14
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Liabo K, Cockcroft EJ, Boddy K, Farmer L, Bortoli S, Britten N. Epistemic justice in public involvement and engagement: Creating conditions for impact. Health Expect 2022; 25:1967-1978. [PMID: 35774005 PMCID: PMC9327822 DOI: 10.1111/hex.13553] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/16/2022] [Accepted: 06/03/2022] [Indexed: 11/27/2022] Open
Abstract
Introduction Patient and public involvement in research is anchored in moral and epistemological rationales. Moral rationales relate to the public having a right to influence how knowledge about them is generated. Epistemological rationales relate to how research design and implementation can improve when informed by experiential, as well as technical, knowledge. In other words, public involvement can increase the epistemological resources of researchers, and contribute to research that is fit for purpose and has high external validity. Methods This article presents an analysis of 3 meetings and 11 interviews with public collaborators and researchers in three UK‐based health research studies. Data comprised transcripts of audio‐recorded research meetings and interviews with public collaborators and researchers. Data were first analysed to develop a data‐informed definition of experiential knowledge, then thematically to investigate how this experiential knowledge was considered and received within the research space. Results At meetings, public collaborators shared their experiential knowledge as stories, comments, questions, answers and when referring to their own roles. They were aware of crossing a boundary from everyday life, and some adapted their contributions to fit within the research space. Although researchers and public collaborators made efforts to create an inclusive climate, obstacles to impact were identified. Conclusions Considering experiential knowledge as a boundary object highlights that this knowledge has a different form to other kinds of knowledge that contribute to research. To enable impact from experiential knowledge, researchers need to create a space where public collaborators experience epistemic justice. Patient and Public Contribution The Peninsula Public Engagement Group (PenPEG) was involved in the planning and conceptualization of the study, including the development of the ethics application and the interview schedules. One member of this group (Richard Fitzgerald) and one from outside the group (Leon Farmer), were full members of the author team and were involved in the data analysis. Leon Farmer has since become a member of PenPEG. Richard Fitzgerald and Leon Farmer were not involved in the three research studies sampled for this study. Sadly Richard Fitzgerald died during the course of this study.
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Affiliation(s)
- Kristin Liabo
- Institute for Health Research, University of Exeter Medical School, Exeter, UK
| | - Emma J Cockcroft
- Institute for Health Research, University of Exeter Medical School, Exeter, UK
| | - Kate Boddy
- Institute for Health Research, University of Exeter Medical School, Exeter, UK
| | - Leon Farmer
- Peninsula Public Engagement Group (PenPEG), NIHR ARC South West Peninsula, Institute for Health Research, University of Exeter Medical School, Exeter, UK
| | - Silvia Bortoli
- Living Systems Institute, University of Exeter, Exeter, UK
| | - Nicky Britten
- Institute for Health Research, University of Exeter Medical School, Exeter, UK
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15
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Levin L. Perspective: Decolonizing postmodernist approaches to mental health discourse toward promoting epistemic justice. Front Psychiatry 2022; 13:980148. [PMID: 36276325 PMCID: PMC9582654 DOI: 10.3389/fpsyt.2022.980148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Currently, it is possible to observe a slowly (but surely) growing volume of claims seeking to disprove Foucauldian ideas about knowledge and power as overlapping basic theories of epistemic justice. Prompted by these claims, alongside adopting tenets of Critical Race Theory to address injustices inflicted upon people facing mental health challenges, I propose applying decolonizing deconstruction to Foucault's terminology, toward identifying opportunities to enhance epistemic justice, primarily in direct interventions in mental health services.
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Affiliation(s)
- Lia Levin
- Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
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16
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Moberg J, Schön UK. Staff's experiences of implementing patient-initiated brief admission for adolescents from the perspective of epistemic (in)justice. Front Psychiatry 2022; 13:1054028. [PMID: 36590620 PMCID: PMC9797670 DOI: 10.3389/fpsyt.2022.1054028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The implementation of Patient-Initiated Brief Admission (PIBA) in child and adolescent psychiatry (CAP) in Sweden is ongoing. This intervention enables adolescents between the ages of 13-17 and with complex mental health problems to initiate a short care period for relief and support rather than the care apparatus being controlling in this process. Offering it is likely to promote epistemic agency, an exchange of knowledge and recovery from mental health problems. AIM The aim of this study was to explore staff's perspectives of PIBA for adolescents with complex mental health problems, and what facilitates or hinders its implementation. METHODS Twenty seven employees, 21 women and six men, with various professions in CAP were interviewed and the material was analyzed thematically. RESULTS Two overall themes emerged: "Staff's Experiences of PIBA" and "Managing Clinical PIBA Work." The results were discussed in relation to the theoretical frameworks of epistemic injustice and Normalization Process Theory (NPT). The main findings indicate that PIBA was generally viewed in a positive way, but that obstacles arose when it was actually put into practice. Findings also point at an overall lack of agency among staff when implementing this new way of working, at the same time as the need to adapt PIBA from an adult psychiatric intervention to one for adolescents in CAP is addressed. CONCLUSION This article offers insights into the views of psychiatric staff regarding the implementation of PIBA. If staff wish to support epistemic agency and recovery among adolescents, their agency may be an important aspect in the continued implementation. Furthermore, in order for PIBA to become normalized in a sustainable way, we suggest that the continued implementation should be characterized by a youth-friendly framework.
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Affiliation(s)
- Jennie Moberg
- Department of Social Work, Stockholm University, Stockholm, Sweden
| | - Ulla-Karin Schön
- Department of Social Work, Stockholm University, Stockholm, Sweden
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17
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Speaking Up: How Family Members Advocate for Relatives Living with a Mental Illness. Community Ment Health J 2021; 57:1547-1555. [PMID: 33486676 DOI: 10.1007/s10597-021-00775-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 01/06/2021] [Indexed: 12/14/2022]
Abstract
Consumers with a mental health condition often feel powerless and overwhelmed in interactions with mental healthcare providers. Consumer self-advocacy and advocacy actions undertaken by their family members on the behalf of their relative contribute to a sense of empowerment for both consumers and their family members. This qualitative study explored family member perspectives of advocacy actions they took on behalf of their relatives and themselves. Data analysis of interviews with 20 family members, including parents, partners/spouses, siblings, and adult children, yielded three themes of family member advocacy actions: advocating for a relative's mental healthcare, normalizing mental illness, and engaging in social and political actions. Advocacy frameworks offer useful guidelines for speaking up for individuals who live with a mental illness.
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18
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Sebring JCH. Towards a sociological understanding of medical gaslighting in western health care. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:1951-1964. [PMID: 34432297 DOI: 10.1111/1467-9566.13367] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 07/05/2021] [Accepted: 08/11/2021] [Indexed: 06/13/2023]
Abstract
In recent years, the term 'medical gaslighting' and accompanying accounts of self-identified women experiencing invalidation, dismissal and inadequate care have proliferated in the media. Gaslighting has primarily been conceptualized in the field of psychology as a phenomenon within interpersonal relationships. Following the work of Paige Sweet (American Sociological Review, 84, 2019, 851), I argue that a sociological explanation is necessary. Such an explanation illustrates how medical gaslighting is not simply an interpersonal exchange, but the result of deeply embedded and largely unchallenged ideologies underpinning health-care services. Through an intersectional feminist and Foucauldian analysis, I illuminate the ideological structures of western medicine that allow for medical gaslighting to be commonplace in the lives of women, transgender, intersex, queer and racialized individuals seeking health care. Importantly, these are not mutually exclusive groups, and I use the term bio-Others to highlight and connect how those with embodied differences are treated in medicine. This article indicates the importance of opening a robust discussion about the sociology of medical gaslighting, so that we might better understand what structural barriers people of marginalized social locations face in accessing quality health care and develop creative solutions to challenge health-care inequities.
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Affiliation(s)
- Jennifer C H Sebring
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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19
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Smith K, McLeod J, Blunden N, Cooper M, Gabriel L, Kupfer C, McLeod J, Murphie MC, Oddli HW, Thurston M, Winter LA. A Pluralistic Perspective on Research in Psychotherapy: Harnessing Passion, Difference and Dialogue to Promote Justice and Relevance. Front Psychol 2021; 12:742676. [PMID: 34552542 PMCID: PMC8450328 DOI: 10.3389/fpsyg.2021.742676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 08/05/2021] [Indexed: 11/23/2022] Open
Abstract
The adoption of a pluralistic perspective on research design, processes of data collection and analysis and dissemination of findings, has the potential to enable psychotherapy research to make a more effective contribution to building a just society. A review of the key features of the concept of pluralism is followed by a historical analysis of the ways in which research in counselling, psychotherapy and related disciplines has moved in the direction of a pluralistic position around knowledge creation. Core principles of a pluralistic approach to research are identified and explored in the context of a critical case study of contemporary research into psychotherapy for depression, examples of pluralistically oriented research practices, and analysis of a pluralistic conceptualisation of the nature of evidence. Implications of a pluralistic perspective for research training and practice are discussed. Pluralistic inquiry that emphasises dialogue, collaboration, epistemic justice and the co-existence of multiple truths, creates opportunities for individuals, families and communities from a wide range of backgrounds to co-produce knowledge in ways that support their capacities for active citizenship and involvement in open democratic decision-making. To fulfil these possibilities, it is necessary for psychotherapy research to be oriented towards social goals that are sufficiently relevant to both researchers and co-participants to harness their passion and work together for a common good.
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Affiliation(s)
- Kate Smith
- School of Applied Sciences, Abertay University, Dundee, United Kingdom
| | - John McLeod
- School of Applied Sciences, Abertay University, Dundee, United Kingdom
| | | | - Mick Cooper
- Department of Psychology, Roehampton University, London, United Kingdom
| | - Lynne Gabriel
- School of Education, Language and Psychology, York St John University, York, United Kingdom
| | - Christine Kupfer
- School of Applied Sciences, Abertay University, Dundee, United Kingdom
| | - Julia McLeod
- School of Applied Sciences, Abertay University, Dundee, United Kingdom
| | | | - Hanne Weie Oddli
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Mhairi Thurston
- School of Applied Sciences, Abertay University, Dundee, United Kingdom
| | - Laura Anne Winter
- Manchester Institute of Education, Schools of Environment, Education, and Development, University of Manchester, Manchester, United Kingdom
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20
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de Boer ML. Epistemic in/justice in patient participation. A discourse analysis of the Dutch ME/CFS Health Council advisory process. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:1335-1354. [PMID: 34137042 PMCID: PMC8453904 DOI: 10.1111/1467-9566.13301] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 03/25/2021] [Accepted: 05/05/2021] [Indexed: 05/28/2023]
Abstract
In healthcare settings, patient participation is increasingly adopted as a possible remedy to ill people suffering from 'epistemic injustices' - that is to their unfair harming as knowers. In exploring and interpreting patient participation discourses within the 2013-2018 Dutch Myalgic Encephalomyelitis (ME)/Chronic Fatigue Syndrome (CFS) Health Council advisory process, this paper assesses the epistemological emancipatory value of this participatory practice. It reveals that in the analysed case, patient representatives predominantly offer biomedical knowledge about ME/CFS. They frame this condition as primarily somatic, and accordingly, perceive appropriate diagnostic criteria, research avenues and treatment options as quantifiable, objectifiable and explicitly non-psychogenic. This paper argues that such a dominant biomedical patient participatory practice is ambiguous in terms of its ability to correct epistemic injustices towards ill people. Biomedicalized patient participation may enhance people's credibility and their ability to make sense of their illness, but it may also undermine their valid position within participatory practices as well as lead to (sustaining) biased and reductive ideas about who ill people are and what kind of knowledge they hold. The final section of this paper offers a brief reflection on how to navigate such biomedicalized participatory practices in order to attain more emancipatory ones.
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Affiliation(s)
- Marjolein Lotte de Boer
- Department of Culture Studies, School of Humanities, Tilburg University, Tilburg, The Netherlands
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21
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Raphel S, Black K, Peterson B, Galehouse P, Handrup C, Yearwood EL. Social justice & social responsibility an official statement from The International Society of Psychiatric-Mental Health Nurses. Arch Psychiatr Nurs 2021; 35:111-112. [PMID: 33593502 DOI: 10.1016/j.apnu.2020.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Sally Raphel
- International Society for Psychiatric-Mental Health Nurses, Policy Committee Chair, Retired Psychiatric Mental Health Faculty, Johns Hopkins University School of Nursing, Baltimore, MD, United States of America.
| | - Karen Black
- Interprofessional Education Coordinator, University of Louisville School of Nursing, Louisville, KY, United States of America
| | - Barbara Peterson
- School of Nursing, University of Minnesota, Psychiatric Clinical Nurse Specialist, Community University Health Care Center, Minnapolis, MN, United States of America
| | - Pamela Galehouse
- Seton Hall University, South Orange, NJ, United States of America
| | - Cynthia Handrup
- College of Nursing, Department of Population Health Nursing Science, University of Illinois at Chicago, Chicago, IL 60612, United States of America; Global Alliance for Behavioral Mental Health and Social Justice, United States of America
| | - Edilma L Yearwood
- School of Nursing & Health Studies, Georgetown University, Washington, DC 20057, United States of America
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22
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Gaspar M, Marshall Z, Rodrigues R, Adam BD, Brennan DJ, Hart TA, Grace D. Mental health and structural harm: a qualitative study of sexual minority men's experiences of mental healthcare in Toronto, Canada. CULTURE, HEALTH & SEXUALITY 2021; 23:98-114. [PMID: 31794349 DOI: 10.1080/13691058.2019.1692074] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 11/08/2019] [Indexed: 06/10/2023]
Abstract
Compared to the general population, sexual minority men report poorer mental health outcomes and higher mental healthcare utilisation. However, they also report more unmet mental health needs. To better understand this phenomenon, we conducted qualitative interviews with 24 sexual minority men to explore the structural factors shaping their encounters with mental healthcare in Toronto, Canada. Interviews were analysed using grounded theory. Many participants struggled to access mental healthcare and felt more marginalised and distressed because of two interrelated sets of barriers. The first were general barriers, hurdles to mental healthcare not exclusive to sexual minorities. These included financial and logistical obstacles, the prominence of psychiatry and the biomedical model, and unsatisfactory provider encounters. The second were sexual minority barriers, obstacles explicitly rooted in heterosexism and homophobia sometimes intersecting with other forms of marginality. These included experiencing discrimination and distrust, and limited sexual minority affirming options. Discussions of general barriers outweighed those of sexual minority barriers, demonstrating the health consequences of structural harms in the absence of overt structural stigma. Healthcare inaccessibility, income insecurity and the high cost of living are fostering poor mental health among sexual minority men. Research must consider the upstream policy changes necessary to counteract these harms.
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Affiliation(s)
- Mark Gaspar
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Zack Marshall
- School of Social Work, McGill University, Montréal, QC, Canada
| | - Ricky Rodrigues
- Department of Psychology, Ryerson University, Toronto, ON, Canada
| | - Barry D Adam
- Department of Sociology, Anthropology, and Criminology, University of Windsor, Windsor, ON, Canada
- Ontario HIV Treatment Network, Toronto, ON, Canada
| | - David J Brennan
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Trevor A Hart
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Psychology, Ryerson University, Toronto, ON, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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23
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Sullivan MJL, Adams H, Yamada K, Kubota Y, Ellis T, Thibault P. The relation between perceived injustice and symptom severity in individuals with major depression: A cross-lagged panel study. J Affect Disord 2020; 274:289-297. [PMID: 32469818 DOI: 10.1016/j.jad.2020.05.129] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 04/25/2020] [Accepted: 05/17/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Perceived injustice has been associated with problematic recovery outcomes in individuals with debilitating health conditions. However, the relation between perceived injustice and recovery outcomes has not been previously examined in individuals with debilitating mental health conditions. The present study examined the relation between perceived injustice and symptom severity in individuals undergoing treatment for Major Depressive Disorder (MDD). METHODS The study sample consisted of 253 work-disabled individuals with MDD who were referred to an occupational rehabilitation service. Participants completed measures of depressive symptom severity, perceived injustice, catastrophic thinking, pain and occupational disability at three time-points (pre-, mid- and post-treatment) during a 10-week behavioural activation intervention. RESULTS Regression analysis on baseline data revealed that perceived injustice contributed significant variance to the prediction of depressive symptom severity, beyond the variance accounted for by time since diagnosis, pain severity and catastrophic thinking. Prospective analyses revealed that early treatment reductions in perceived injustice predicted late treatment reductions in depressive symptom severity. LIMITATIONS The study sample consisted of work-disabled individuals with MDD who had been referred to an occupational rehabilitation service. This selection bias has implications for the generalizability of findings. CONCLUSION The findings suggest that perceived injustice is a determinant of symptom severity in individuals with MDD. The inclusion of techniques designed to reduce perceived injustice might augment positive treatment outcomes for individuals receiving treatment for MDD.
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Affiliation(s)
- Michael J L Sullivan
- Department of Psychology, McGill University, 2001 McGill College Avenue, Montreal, Quebec H3A 1G1, Canada.
| | - Heather Adams
- University Centre for Research on Pain and Disability, 5595 Fenwick Street, Suite 314. Halifax, Nova Scotia, B3H 4M2 Canada
| | - Keiko Yamada
- Department of Psychology, McGill University, 2001 McGill College Avenue, Montreal, Quebec H3A 1G1, Canada
| | - Yasuhiko Kubota
- Osaka Center for Cancer and Cardiovascular Diseases Prevention, 1-6-107 Morinomiya, Jyoto-ku, Osaka 536-0025, Japan
| | - Tamra Ellis
- Centre for Rehabilitation and Health, 27 Roncesvalles Ave. Unit 510, Toronto, Ontario M6R 3B2, Canada
| | - Pascal Thibault
- Department of Psychology, McGill University, 2001 McGill College Avenue, Montreal, Quebec H3A 1G1, Canada
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24
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From shame to blame: institutionalising oppression through the moralisation of mental distress in austerity England. SOCIAL THEORY & HEALTH 2020. [DOI: 10.1057/s41285-020-00148-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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25
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Soklaridis S, de Bie A, Cooper RB, McCullough K, McGovern B, Beder M, Bellissimo G, Gordon T, Berkhout S, Fefergrad M, Johnson A, Kalocsai C, Kidd S, McNaughton N, Ringsted C, Wiljer D, Agrawal S. Co-producing Psychiatric Education with Service User Educators: a Collective Autobiographical Case Study of the Meaning, Ethics, and Importance of Payment. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2020; 44:159-167. [PMID: 31873923 PMCID: PMC7078174 DOI: 10.1007/s40596-019-01160-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 11/26/2019] [Indexed: 05/25/2023]
Abstract
OBJECTIVE Co-production involves service providers and service users collaborating to design and deliver services together and is gaining attention as a means to improve provision of care. Aiming to extend this model to an educational context, the authors assembled a diverse group to develop co-produced education for psychiatry residents and medical students at the University of Toronto over several years. The authors describe the dynamics involved in co-producing psychiatric education as experienced in their work. METHODS A collaborative autobiographical case study approach provides a snapshot of the collective experiences of working to write a manuscript about paying service users for their contributions to co-produced education. Data were collected from two in-person meetings, personal communications, emails, and online comments to capture the fullest possible range of perspectives from the group about payment. RESULTS The juxtaposition of the vision for an inclusive process against the budgetary constraints that the authors faced led them to reflect deeply on the many meanings of paying service user educators for their contributions to academic initiatives. These reflections revealed that payment had implications at personal, organizational, and social levels. CONCLUSION Paying mental health service user educators for their contributions is an ethical imperative for the authors. However, unless payment is accompanied by other forms of demonstrating respect, it aligns with organizational structures and practices, and it is connected to a larger goal of achieving social justice, the role of service users as legitimate knowers and educators and ultimately their impact on learners will be limited.
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Affiliation(s)
| | | | | | | | - Brenda McGovern
- , 1353 Danforth Ave, suite #2, Toronto, M4J 1N1, Ontario, Canada
| | - Michaela Beder
- University of Toronto, Toronto, ON, Canada
- Unity Health Toronto, Toronto, ON, Canada
| | - Gail Bellissimo
- , 2548 Strathmore Crescent, Mississauga, L5M 5L1, Ontario, Canada
| | - Tucker Gordon
- The Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | | | - Andrew Johnson
- The Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Csilla Kalocsai
- The Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Sean Kidd
- The Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | | | | | - Sacha Agrawal
- The Centre for Addiction and Mental Health, Toronto, ON, Canada
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26
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Pelletier JF, Davidson L, Gaulin D, Bordet J. Recovery Mentors as continuing professional development trainers for better recognition of the epistemic value of the experiential knowledge and improved access to recovery-oriented practices. AIMS Public Health 2020; 6:447-460. [PMID: 31909066 PMCID: PMC6940576 DOI: 10.3934/publichealth.2019.4.447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 10/20/2019] [Indexed: 01/04/2023] Open
Abstract
Objectives To lay the groundwork for the arrival of Recovery Mentors (RMs) in some of its multidisciplinary teams, a Continuing Professional Development (CPD) conference was organized in a large public agency in the province of Quebec, Canada. The aim was to come up collectively with recommendations to improve access to recovery-oriented care and services for this vulnerable population by recognizing the epistemic value of their lived experience. Methods A series of workshops were organized among health professionals to reflect on their practice and to discuss the role of RMs for improving epistemic equity and recognition of the experiential knowledge. In preparation for these workshops participants completed the Recovery Self-Assessment (RSA). The RSA is a 32-item questionnaire designed to gauge the degree to which programs implement recovery-oriented practices, which should notably include RMs in multidisciplinary teams (five-point Likert scale: 1= strongly disagree ; 5 = strongly agree). The interactive workshops were hosted by RMs as trainers who first shared their lived experience and understanding of recovery. Results Eighty-height of the 105 participants completed the RSA. The highest score on the RSA was for the item Staff believe in the ability of program participants to recover (mean = 4.2/5). The lowest score was for the item People in recovery are encouraged to attend agency advisory boards and management meetings (mean = 2.2/5). Based on the average inter-item correlation, a reliability test confirmed an excellent internal consistency for the French RSA scale, with a Cronbach's Alpha of .9. Means and standard deviation for each item of the RSA questionnaires were calculated. The results did not differ by participant characteristics. Results to the RSA and results from the workshops that were co-hosted by RMs were reported in the plenary session and further discussed. The workshops, the RSA and the whole CPD conference raised awareness among health professionals about stigmatizing attitudes and epistemic inequity in actual service provision. Conclusion RMs could be invited to actively participate and attend advisory boards and management meetings more frequently and on a more regular basis for ongoing quality improvement towards better access to recovery-oriented practices. This CPD conference has shown the acceptability and feasibility of including RMs as trainers for better recognition of the epistemic value of the experiential knowledge of recovery. They can help health professionals to recognize and better appreciate service users as knowers and potential contributors to knowledge.
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Affiliation(s)
- Jean-François Pelletier
- Research Centre of Montreal Mental Health University Institute, Montreal East Island Integrated University Health and Social Services Centre, Montreal QC, Canada.,Program for Recovery & Community Health, Department of Psychiatry, Yale University, New Haven CT, USA.,Department of Psychiatry & Addictology, University of Montreal, Montreal QC, Canada
| | - Larry Davidson
- Program for Recovery & Community Health, Department of Psychiatry, Yale University, New Haven CT, USA
| | - David Gaulin
- Department of Mental Health and Addictions, Montreal South-Center Island Integrated University Health and Social Services Centre, Montreal QC, Canada
| | - Jonathan Bordet
- Research Centre of Montreal Mental Health University Institute, Montreal East Island Integrated University Health and Social Services Centre, Montreal QC, Canada
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27
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Sheehan R, Hassiotis A, Strydom A, Morant N. Experiences of psychotropic medication use and decision-making for adults with intellectual disability: a multistakeholder qualitative study in the UK. BMJ Open 2019; 9:e032861. [PMID: 31780594 PMCID: PMC6887070 DOI: 10.1136/bmjopen-2019-032861] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Understanding patient and carer perspectives is essential to improving the quality of medication prescribing. This study aimed to explore experiences of psychotropic medication use among people with intellectual disability (ID) and their carers, with a focus on how medication decisions are made. DESIGN Thematic analysis of data collected in individual semistructured interviews. PARTICIPANTS AND SETTING Fourteen adults with ID, 12 family carers and 12 paid carers were recruited from specialist psychiatry services, community groups, care providers and training organisations in the UK. RESULTS People with ID reported being highly compliant with psychotropic medication, based on a largely unquestioned view of medication as important and necessary, and belief in the authority of the psychiatrist. Though they sometimes experienced medication negatively, they were generally not aware of their right to be involved in medication decisions. Paid and family carers reported undertaking a number of medication-related activities. Their 'front-line' status and longevity of relationships meant that carers felt they possessed important forms of knowledge relevant to medication decisions. Both groups of carers valued decision-making in which they felt they had a voice and a genuine role. While some in each group described making joint decisions about medication with psychiatrists, lack of involvement was often described. This took three forms in participants' accounts: being uninformed of important facts, insufficiently included in discussions and lacking influence to shape decisions. Participants described efforts to democratise the decision-making process by gathering information, acting to disrupt perceived power asymmetries and attempting to prove their credibility as valid decision-making partners. CONCLUSIONS Stakeholder involvement is a key element of medication optimisation that is not always experienced in decisions about psychotropic medication for people with ID. Forms of shared decision-making could be developed to promote collaboration and offer people with ID and their carers greater involvement in medication decisions.
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Affiliation(s)
- Rory Sheehan
- Division of Psychiatry, University College London, London, UK
| | | | - André Strydom
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Nicola Morant
- Division of Psychiatry, University College London, London, UK
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