Dealing with the institutions in our minds Mike Smith Clinical Director AFG dangerous dont listen to a word he says State hospital manager Denver Co Its a global issue ID: 494158
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Slide1
Whole system approachesDealing with the institutions in our minds
Mike
Smith
Clinical Director AFGSlide2
“…
dangerous, don’t listen to a word he says
”State hospital manager Denver CoSlide3
It’s a global issue !Mike Smith Clinical director AFG England
Stop seeing things in our local waysSlide4
Different interventions at different phases
Recovery as a journey (Smith 1997) whole lives/
Beginnings DestinationsA lot in the middle that’s hard to make sense of.Makes sense looking backUse the knowledge of the journey to help othersSlide5
If recovery is a journey, a process, a direction rather than an event or a
label then there has to be a map, a
guide, short cuts, beginnings and an overall direction. Slide6
Recovery from what? And to what?Slide7
They said that I was mad
And I said it was them who were mad
Damn the they outvoted meSlide8
k
If you talk to God it called prayer
If god talks back its schizophrenia!Slide9
Normalise the experience
1 in 4 people are mentally ill!
Think of your 3 best friends
Are they OK?
If they are ------- then its you!Slide10
What is normal ?Slide11
www.crazydiamond.org.uk
Functioning
Wellbeing SymptomsSlide12
Alternatives and choices
Core Beliefs of
citizenship
High Staff
Expectations and energies
Potential to
Leave completely supportive services--Exits
Rights, Responsibilities and Advocacy
Inclusion
Holistic Approach
personalisation
Social
networks, social support
Ownership -
Person
accepting & taking
Control of own life
,
Self
Determination
Informed Risk
Taking and locus of control
Interdependence
Citizenship approaches
Expert advice peer and professional
Rapid but limited
Health interventionsSlide13
Maintenance
approaches
MAINTENANCE
MODEL
Social Control
Frustrated by Risk
Removal from society
reductionist views
Loss of rights
Low Self and Staff Expectation
Service for life
no exit pathways
Symptom Management not mastery
Illness Concept
Permanence Slide14
From whatLarge institutions and imperialist illness and exclusion systems
Low throughput (they grew slowly) up to 65% did leave within 1 year, recovery rates (medical) were quite high (higher than present rates) social recovery measures low, stigma high
Low threshold of evidence for the status quo but the status quo has a tradition, power and a legacy that is still evident today.Poor practiceHuman abuseSlide15
To whatFragmented services
Gaps in systems (mind the Gap)
Funding and focus of systems changed in 1970’s Approaches to deinstitutionalisation varied across EuropeCommunity Care (but did it ?) Competition in a market for customers but who is the customer?Evidence based care, but recovery rates not increasing (Whitaker 2011) disability rates increasing and evidence is in itself politicised.Systemic abuse falling and rights growing but very expensive and politicised regulation, law can be misused Slide16
Change the structure, change the system?
Has worked as part of a process of deinstitutionalisation
Moved the buildingRestructured our funding and the market (de centralisation & personalisation)Incidence of mental illness increasing by 17% every 10 yearsPublic spending loweringSlide17
Changing whatFrom damaged goods - to people struggling
From disease - to distress
From symptom management - to self acceptance, growth and self managementHopeless - to HopefulExpert gift model - to wise advisorPatient -to personRemoval of rights - to reclaiming of Rights -to ownership of rights and responsibilities (Citizenship) Independence - to interdependenceProblem focussed to solution focussedSystem centred to person centredCredentialed by state of ColoradoSlide18
Whole person-Whole System Whole lives16 may event