Service user involvement, authority and the ‘expert-by-experience’ in mental health

Noorani, Tehseen

doi:10.1080/2158379x.2013.774979

Cited by 134 publications

(137 citation statements)

References 12 publications

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“…However, the expert about Mr. Thompson, at least from the medical point of view, is certainly Dr. Jones. This medical expertise is complemented by Mr. Thompson himself as an expert "by experience" [7][8][9]. In the conclusion, I discuss how clinical decisions should emerge from this dual expertise of patient and clinician.…”

Section: Five Practice Polarities and The Making Of False Dilemmasmentioning

confidence: 99%

Polarities in Clinical Thinking and Practice

Sadler¹

2017

AMA Journal of Ethics

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This analysis of a case of a bereaved patient that poses two treatment options-watchful waiting or medication-focuses on five "polarities" in clinical practice: (1) the normal and the pathological, (2) the individual and the diagnostic collective, (3) the primary care physician and the consultant, (4) the expert and nonexpert, and (5) the moment and the process. These polarities can accentuate ethical problems posed by this case, for example, by creating stark contrasts that mask the complex contexts of care and characteristics of patients. These stark contrasts can create false dilemmas that may obscure simpler, shared decisionmaking solutions. Alternatives to conceiving cases in terms of polarities are discussed. CaseDr. Jones sees a new patient, Mr. Thompson, a 68-year-old man in her outpatient, primary care clinic today. In reviewing his intake forms, Dr. Jones sees that Mr. Thompson scored 18 points on the Patient Health Questionnaire (PHQ-9), suggesting "moderately severe depression." When she asks Mr. Thompson about how he is feeling, he tells her that his wife died three weeks ago but that he did not want to tell Dr. Jones about this because he did not want to trouble her.In further talking to Mr. Thompson, Dr. Jones discovers that he has lost appetite, interest in his activities, and the ability to concentrate at work. He feels tired yet has had trouble falling and staying asleep. Finally, family and friends tell him that he seems a little "distracted" or slower lately. Dr. Jones asks whether Mr. Thompson has thought of hurting himself, and Mr. Thompson says no. She also asks if he owns a gun, and he says no.Dr. Jones begins to consider how to diagnose and treat Mr. Thompson. She knows that recent changes to the Diagnostic and Statistical Manual of Mental Disorders (DSM) regarding bereavement have caused significant debate among her psychiatric colleagues. She often refers psychiatric patients to either Dr. Taylor or Dr. Martinez, who seem to have very different stances on the issue as she learned on discussions during recent consults. Dr. Taylor worries that the DSM-5 is medicalizing normal grief even more

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Section: Five Practice Polarities and The Making Of False Dilemmasmentioning

confidence: 99%

Polarities in Clinical Thinking and Practice

Sadler¹

2017

AMA Journal of Ethics

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“…Several studies describe the potential of MHSUOs to become arenas for experiential knowledge through providing space for sharing alternative narratives of self and recovery (Adame and Knudson 2007;Adame and Leitner 2008;Beresford and Branfield 2006;Chassot and Mendes 2015;Hoy 2014;Noorani 2013;Sapouna 2012;Woods 2013). Participation in countercultural communities in popular spaces, free from the involvement of the dominant system, is important in creating dialogical space for such alternative understandings of experience (Adame and Knudson 2007;Adame and Leitner 2008).…”

Section: The Integration Of Service User Knowledgementioning

confidence: 99%

Participatory Spaces of Mental Health Service User Organizations in the Post-deinstitutional Era: Mapping Roles and Challenges

2017

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By applying the concept of participatory spaces, this article maps and analyzes current research on mental health service user organizations (MHSUOs). We have analyzed research literature from 2006 to 2016 to examine how the role of and challenges facing MHSUOs are formulated in the post-deinstitutional era. The current situation is marked by MHSUOs parallel presence in invited, claimed and popular spaces for participation. The postdeinstitutional era is characterized by a shift in focus from gaining access to such participatory spaces, to critically examining the political opportunities available in these. We further argue that the dominance of psychiatry-specific spaces could prevent MHSUOs from fully exploring their potential for participation in broader social issues.

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“…This cultivation of some sort of equality might be especially important, but perhaps also particularly difficult, when working within problematics defined in terms of 'health inequalities'. It would almost certainly require researchers to challenge a (potentially widely held) perspective/ belief that they are the 'experts' when it comes to health inequalities; this might, for example, be achieved by recognizing experience of poor health as an important form of expertise (Noorani, 2013b).…”

Section: Participatory Democracy In Practicementioning

confidence: 99%

“…Inspired by Stepping Out and the Hearing Voices movement (Harpin, 2010;Noorani, 2013b;Blencowe et al, Forthcoming) and Honig's understanding of Winnicot, another rule of thumb is to attend to participatory projects that use materials in open ways that enable experimentation and knowledge. This could entail any artistic medium where the potential for a shared work or craft is infinite and where the art practice itself comes to be a crucible for the building of common lives.…”

Section: Participatory Democracy In Practicementioning

confidence: 99%

“…The essay draws together: theoretical work on participatory democracy conducted by the three authors through a literature review and collaborative retreat/workshop on theorizing participation, authority, knowledge and performance (Noorani et al, 2013); and empirical knowledge of mental health service user movements gained through a 4-year research project as well as 8 years' experience of working as a volunteer 'ally' of the steering group of a hearing voices self-help network, and other related research projects (Blencowe, 2013a;Noorani, 2013b). We have also developed these ideas through reference to the specific case studies in mental health mutual aid practice in of the Hearing Voices Movement and Stepping Out Theatre Company (Blencowe et al, Forthcoming).…”

Section: Introduction: Placing the Public In Health Inequalities Resementioning

confidence: 99%

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Theorising participatory practice and alienation in health research: A materialist approach

2015

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Health inequalities research has shown a growing interest in participatory ways of working. However, the theoretical ideas underpinning mainstream approaches to participation remain underexplored. This article contributes to theorising participatory practice for the kind of egalitarian politics to which many of those focused on reducing health inequalities are committed. First, we argue that the ambitions of participatory practice should be concentrated on 'overcoming alienation', rather than 'attaining freedom from power'. An overemphasis on negative freedom may help to explain a worrying confluence between participatory democracy and neo-liberal marketization agendas -we look instead to traditions of participatory practice that emphasize positive freedom and capacities for collaboration. Second, we discuss some such perspectives though consideration of critical pedagogy, but highlighting the role of materialised relations of authority, spaces, objects and encounters. Third, we explore the relationship between objectivity and alienation, arguing that participatory politics, against alienation, can look to reclaim objectivity for participatory, lively, practice. We then seek to show that participatory practice can play a role in creating common knowledge and culture, and in fostering a sense of public ownership over objective knowledge and institutions concerned with health. We conclude by asking what this looks like in practice, drawing some 'rules of thumb' for participatory practice in health inequalities research from existing inspiring examples.

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Service user involvement, authority and the ‘expert-by-experience’ in mental health

Cited by 134 publications

References 12 publications

Polarities in Clinical Thinking and Practice

Polarities in Clinical Thinking and Practice

Participatory Spaces of Mental Health Service User Organizations in the Post-deinstitutional Era: Mapping Roles and Challenges

Theorising participatory practice and alienation in health research: A materialist approach

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