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RN16_06b: Mental Health: Styding Traditional and innovative approaches
2:00pm - 3:30pm
Session Chair: Bruce Macfarlane Cohen, University of Auckland
Location:UP.4.205 University of Manchester
Building: University Place, Fourth Floor
“It Is a Different World In Here”: Collective Identification Among Psychiatric Inpatients And The Negotiations Of Social Boundaries At An Open and Acute Ward
Malene Lue Kessing
University of Copenhagen, VIVE, Denmark
This paper explores interactions and unfolding relationships between inpatients admitted at respectively an open and an acute psychiatric ward in Denmark. Today’s psychiatric hospital care remains a black box, ‘with people being admitted and discharged, but where little is known about what happens to them while they are there’ (Quirk and Lelliott 2001). While research has illuminated what characterises inpatients interactions, this paper examines how these interactions influence the inpatients understanding of self and affiliation with others. In doing this, I combine Barker’s (2002) concept of ‘collective illness identity’ with Nelson's (1993) concept of ‘epistemological communities’ to draw attention to the inpatients collective identification and shared experiential knowledge. The analysis unfolds three aspects of the inpatients relationships. First, how the inpatients through bodily expressions and narrative accounts construct a collective illness identity, meaning that their understanding of self, and affiliation with others, is based on shared experiences of symptoms and suffering. Second, the ways in which the inpatients use their shared experiential knowledge to negotiate social boundaries at the ward. Third, how the inpatients reflections on the long-term potentials of the relationships established at the ward reveal a number of concerns related to their continuation. Centrally, the paper points to the potential and challenges that arise from the inpatients relationships and how their identification and social boundary work is embedded in a specific time and space. Empirically, the paper draws on 5 months of participant observation conducted at an open and an acute ward, and interviews with 14 psychiatric patients.
Revitalizing Disclosure: A grounded Theory Of Changing Beliefs In Mental Health
Erasmus university, Netherlands, The
Closeness to patients in healthcare is essential but with certain restrictions. It is clear that health professionals keep a professional distance from the patient. Personal experiences do not belong on the work floor, an objective attitude fits best to patients. This assumption is in coherence with the biomedical model that is still dominant in psychiatry. Since several years, experts by experience are on the agenda of many mental health organizations. The formally educated health professional meets the expert by experience. Their education is different and with that his attitude towards disclosure. Personal experiences with mental challenges are an essential resource in their work. The interaction between these workers with different perspectives was the start of a three years of research based on the methodology of classic grounded theory(Glaser & Straus, 1967) in two mental health organizations. In the end the substantive theory of revitalizing disclosure emerged.
Revitalizing disclosure is a discovered pattern that emerged in a substantive area where health professionals have a professional standard about disclosure. This standard seems to be losing ground and has to be renewed that is what revitalizing disclosure is. The old assumption about disclosure will be challenged (Alvesson & Kärreman, 2011).
The theory of revitalizing disclosure offers workers in mental health organizations the insight in a process which can help them to grow as a professional and human being. It is helpful to know how to support organizations who want to change their focus on a more recovery-oriented care with experts by experience as a crowbar (Bracken & Thomas, 2005).
“No More Mechanical Restraint in This Ward”. An Ethnography of Change in Two Acute Psychiatric Wards
Luigi Gariglio1, Mario Cardano1, Raffaella Ferrero Camoletto1, Eleonora Rossero1, Giuseppe Maina1, Alessandra Algostino1, Vladimiro Zagrebelski2, Marta Caredda2, Cristina Pardini2, Maria Grazia Imperato3, Claudio Carezana3
1University of Turin, Italy; 2LDF Collegio Carlo Alberto, Turin, Italy; 3Dsm To1, Turin Italy
In 1978, the organization of psychiatric care changed radically in Italy because of the entry into force of the so-called “Basaglia Law” (180/1978) and the following shutdown of the asylums. Ever since, small acute psychiatric wards enter into the picture and community care become standard in the Italian NHS. Although Franco Basaglia ‘the man who closed the asylums’ used medications and neuroleptics, he bluntly resisted and then refused mechanical restraint in his day-to-day psychiatric practice, thereby showing that a non-restraint psychiatry was possible also in Italy. Nowadays, however, the big majority of Italian acute psychiatric ward still use mechanical restrains with different justifications; only few wards adopt a strictly “no-restraint ward” policy; yet, others are in the process challenging their own wards organizations and clinical practices in an effort to abolish mechanical restraint in their ward. This presentation focuses on two acute psychiatric wards that are actively engaging in dismissing the practice of mechanical restraint. It intends to shed light on the differences between the two processes of becoming a non-restraint ward. Each of the two cases have been proactively engaged in the change for some times with different degree of success. The paper will focus on the heterogeneous ways in which the multiplicity of actors involved in the process of change challenged, resisted and or contributed, more or less actively, to the goal of dismissing mechanical restraint, as well as, the intended and unintended consequences they faced as result.