When decision making was taken away• There was a loss of:• Self confidence• Self respect• Dignity• Freedom• Self belief• Trust,trust,trust..............
• “What should move us to action is humandignity: the inalienable dignity of theoppressed, but also the dignity of each of us.We lose dignity if we tolerate theintolerable.” Dominique du Moneil• This made me angry! .....................but wasseen as further symptoms!
• “Critical social education, is designed toencourage questioning and action for change,is founded on a different worldview that ofparticipatory democracy forged out ofprinciples of cooperation and equality. Ourwork is the ‘practice of freedom’ (Freire, 1976)....... in failing to be vigilant about changes inthe political context we run the risk ofdeveloping practice that reinforcesdiscrimination whilst still waving the banner ofsocial justice.” (Ledwith, 2007)
The Home Focus Team• Home/community based• Recovery oriented• Partnership model• Shared decision making – on both sides• We have a reflective question: “Am I helpingthis person to stay sick, or, am I helping thisperson to get better?”
Peer advocacy is an importantprovision:• especially for those detained under a section ofthe Mental Health Act because of the powersgiven to staff. Under these circumstancesadvocacy is valuable, and has an importantethical function (Thomas & Bracken, 1999). Peeradvocates are independent of mental healthservice staff and have usually had first-handexperience of using mental health servicesthemselves. They can therefore be seen asworking for the patient rather than the staff. (ThePsychiatrist, 2001)
Implications for policy implementation• We have a new policy in ‘Day Services’• It is called ‘New Directions’• The radical change is not the sole responsibility of theHealth Service Executive but rather, a collaborativeresponsibility shared between the person, theirfamilies and carers, a multiplicity of agencies,Government and society as a whole.( H.S.E.)• The central approach within the report focuses on thecore values of person-centeredness, communityinclusion, active citizenship and high quality serviceprovision.
Peers, professionals and ‘OpenDialogue’• What are the aims of an Open Dialogue approach?• Fisher (2011) suggests that the aim is to create a space between peoplefor creative generation of new thoughts that may promoteunderstanding.• Seikkula, Arnkil and Hoffman (2006) reiterate this, adding that the focusshould be to find a shared way of talking about what is frighteningpeople.• Seikkula and Trimble (2005) describe the main aim as being to generate anew joint language for experiences that do not yet have words.• Ahern and Fisher (2001) agreed that the aim of Open Dialogue should bethe (re)establishment of heart-to-heart dialogue with significant personsin their social network.• Anderson and Goolishian (1992) see the aim as the facilitation of adialogue with and about the client’s narrative, through listening andclarifying their story. They agree that through this generation of a mutualunderstanding, change is inevitable.
• What does an Open Dialogue approach ask of staff members?• Remember to tolerate uncertainty. Each team member has to beconfident and relaxed at the same time- ‘capable of being inuncertainties, mysteries, doubts, without any reaching after factand reason’. The most important but difficult task is this toleranceof uncertainty and anxiety.• Avoid the desire for results. Participating sensitively and effectivelyrequires a capacity to be simple and ordinary but also entail certainqualities of attentiveness and an ability to be still with the situation-to refrain from becoming overly interventionist (Reed, 2011).• Try to listen generously. This entails patience and slowness of paceby the clinician, and a conscious effort to resist the pull of goalsand structures that still remain from previous training. Think of it asthough you are still a beginner. This allows space for theunexpected, for unusual thoughts and contributions to occur inmeetings, it is a form of listening that doesn’t arise from an agenda.• See the service user as a competent partner. It is also important toremember that the family and network are considered asresources, not as objects of the treatment