The Iceland model Open Dialogue is proving very successful and they are conducting studies to quantify this method... Its worth looking up.

Hi Jan,

this is a great question. I had a look, and found this text, published Dec 2013 that could be useful:

Mental Health: A Person-centred Approach

Cambridge University Press

978-1-107-66772-3

Edited by Nicholas Procter, Helen P. Hamer, Denise McGarry, Rhonda L. Wilson and Terry Froggatt

Your research areas are very interesting. Good luck with your enquiry.

Regards, Natalie

There is a long tradition of studies about therapeutic communities, eg:

Bloor, Michael J.; McKeganey, Neil; Fonkert, Dick (1988): One Foot In Eden: A Sociological Study Of The Range of Therapeutic Community Practice. Routledge, London

Zimmer-Höfler, Dagmar; Meyer-Fehr, Peter (1986): Motivational Aspects of Heroin Addicts in Therapeutic Communities Compared With Those in Other Institutions. in: De Leon, George; Ziegenfuss, James T. (eds.): Therapeutic Communities for Addictions. Readings in Theory, Research and Practice, Ch.C. Thomas, Springfield, 157-168 (Meyer-Fehr: that's me)

Maxwell Jones is the "Father" of this concept, just look up Wikipedia to learn more about it.

I understand that the city of Ghent in Brussels normalised mental illness since the middle ages. It's an interesting subject. Thanks for the references - I'll take a peek, but my real interest right now is in finding something measurable within contemporary facilities.

Hi Jan,

here is an evaluation tool that might be of interest: http://www.nswcag.org.au/files//our_work/projects/final-rossat-full-20121207.pdf

Regards, Natalie

This is brilliant. Thanks so much!

Hi Jan,

Since in Australia both state (Victorian) and now national (launched at The Mental Health Services Conference last August) frameworks mandate recovery-oriented practice I think it is useful to examine patient-centred care in psychiatry using these ideas and principles.

The Australian Mental Health Outcomes and Classification Network (AMHOCN) reviewed international best practice standardised measures of recovery-oriented practice in 2010:

Burgess, P., Pirkis, J., Coombs, T., & Rosen, A. (2010). Review of recovery measures. Australian Mental Health Outcomes and Classification Network, 1-78.

For your question about "What happens when we put patients first in mental hospitals?" you might like to trial one of the tools they find promising in your setting.

Re "articles that address this issue":

I worked on a study these last 3 years examining the recovery-orientation of a mental health innovation program across clinical and community managed sectors, with consumers with severe and enduring mental illness and complex needs.

The clinical setting was using the Strengths model of care:

Chopra, P., Hamilton, B., Castle, D., Smith, J., Mileshkin, C., Deans, M., ... & Wilson, M. (2009). Implementation of the Strengths Model at an area mental health service. Australasian Psychiatry, 17(3), 202-206.

The community managed service also was drawing on recovery-oriented practice.

https://www.mindaustralia.org.au/about-mind/what-we-do/vision-purpose-goals-values.html

Our recent outcomes paper is:

Petrakis, M., Brophy, L., Lewis, J., Stylianou, M., Scott, M., Cocks, N., ... & Halloran, K. (2014). Consumer measures and research co-production: a pilot study evaluating the recovery orientation of a mental health program collaboration. Asia Pacific Journal of Social Work and Development, 24(1-2), 94-108.

(You can download it from me within ResearchGate if that is useful to you.)

Thank you for this fascinating debate. I'm interested in the application of critical psychology and critical theory to patient centred care and would find it helpful to eplore these ideas, as I understand them.

Patient centred care suggests an empowering and emancipatory approach to care, which in theory is compatible with the strength based approach and to therapeutic communities as discussed above. As patient centred care maximises the capacity of the individual and their relationships with the extant systems with whom they interact, it should also be cost effective. My background is child and adolescent mental health and there is a significant literature base on risk and protective factors and the promotion of resilience ( e.g. Offord; Rutter, Cincetti); there is also a significant evidence base on the cost efficacy of working with families in preventative work e.g. Martin Knappe.

However, I was interested in Jan's comment about 'normalising' mental illness' , which suggests a re-examination of the dominant ideology of psychiatry and the social construction of mental illness and the need to explore to what extent the experience of mental distress is influenced by social, economic, environmental and political factors. I'm aware that much of this has been well rehearsed in Laing and Szasz and the anti-psychiatry movement and also that the recovery and strength based approach seem to have moved these debates on . I wonder if there is still a fundamental tension between emancipatory patient centred care and the power bases of psychiatry, psychology and therapy? In my own research with parents of children diagnosed with behaviour problems/disorders, there appeared to be oppression of the parents and children, who were constructed to be 'ill' , when their temperamental styles ( a normative base) and developmental needs were not matched with resources e.g. in schools, where there are 30 in a class and 'normative' displays of behaviour are expected for the system to operate. Working with parents to understand their experiences and supporting them to access the 'published' literature and thus access knowledge and the language of dominant ideologies , helped them to challenge the social construction of norms within the systems with whom the children interacted and thus to improve the supports available to their children. However, the social, economic, environmental and political risks were still stacked against them. Can ' patient centred care' genuinely work within a system ,which is still governed by the hegemonies of therapy, psychiatry and psychology or does it become an apparently innocuous but insidious form of control in which the 'patient ' is still the centre with the assumption that they need to look internally for solutions , leaving institutions and governments as apparently caring, but not accountable to to provide the resources or examine the power interests and ideologies required to make systemic change?

I would find any replies or debate helpful . I would particularly like to hear from Jan in relation to how Ghent normalised mental illness .

Many thanks for this question and the opportunity to air these debates.

Best wishes. Sue

Its also a matter of overcoming "patient-centered care", and to adopt the "person-centered care". This is highly a "problematic"  issue for psychiatric wards who tends to rely upon old values and a staff-focused/dominant ward culture. However, I think that the past years has incorporated a major turn on an overall scale what concerns putting the patients first. We now see several publications with the intention to find alternatives to coercive measures and one of the secret indigence is to put the patient/person at the center. I cherish those psychiatric wards who are open minded to more forward and adopt a person-centered care culture.