Responsibilisation of caregivers in depression: the limitations of policy-based evidence

What are dually diagnosed patients’ problems represented to be in mental health? A WPR analysis of the multistability purpose of digital health records

“…Second, structured ‘ psychoeducation ’ for both patients and relatives was presented as a means to enhance self‐management to optimise treatment adherence and illness prevention. This aligns with a responsibilisation agenda from the Nordic region and the UK, known as a general mental health policy to increase patients’ self‐management and adherence by individualising patients’, relatives’ and civil actors’ treatment responsibilities (McPherson & Oute, 2021).…”

“…In recent years, the WHO and the UN have called for a paradigmatic revolution in mental health in the wake of decades of the unethical persistence of over‐medicalisation, use of coercion, systematic violations of patients’ rights to be heard and dehumanising practices (United Nations, 2017). Similarly, mental health policies have made requirements about PPI (Patient and Public Involvement) and aligning services with a recovery orientation across the Nordic region, the UK and most western industrialised countries (Harper & Speed, 2014; McPherson & Oute, 2021). These policies emphasise that professionals should elicit and honour patients’ experiences within the context of supportive relationships, community inclusion, meaningful employment, citizenship and material surroundings that promote personal recovery in their life outside psychiatry (Davidson et al., 2008; Davidson et al., 2009).…”

“…The WPR approach is a welfare‐sociological approach that presents a set of particularly useful ideas and questions to ask when considering communication in/of health records. WPR has previously been applied in policy analysis, both within alcohol and drug studies (Duke, 2020; Houborg et al., 2020; Lancaster et al., 2019) and in critical mental health (McPherson & Oute, 2021; Oute & Johansen, 2021). As opposed to critical discourse analysis and discourse theory, it explicitly draws on the Foucauldian concept of ‘problematization’ as a way to analyse taken‐for‐granted assumptions that constitute something/someone as an ‘object of thought’ (Bacchi & Goodwin, 2016; Houborg et al., 2020; Lancaster et al., 2019).…”

Reform eller stabilitet?

“…Vi har valgt denne tilgang, fordi der her er tale om en metodisk-analytisk til- (Witthøfft, 2020). Aktuelt omfatter denne forskning studier af kliniske indsatser som åben dialog, patient-og pårørendeinddragelse (McPherson & Oute, 2020), safe wards og professionelles brug af smartphone apps i psykiatrisk behandling og -forebyggelse (Lindgreen et al, 2018). Andre studier adresserer i højere grad tjenesteudvikling via satsning på at organisere behandlingen i F:ACT teams (Lofthus et al, 2016(Lofthus et al, , 2018, udvikling af hjaelpeapparatet via tvaersektorielt samarbejde og samskabelsesprocesser og anvendelse af fleksible recovery-mentorer i det kliniske arbejde (Witthøfft, 2020).…”

“…Det ideal baner vejen for, at vi potentielt også får muligheden for at se bagsiden af dette menneskesyn, hvor personer med psykisk lidelse, der potentielt set kan misbruge sin forbrugerrolles økonomiske frihed og ret til selvbestemmelse, kan vaelge at undlade at deltage i behandlingstiltag. Det neoliberale ideal muliggør altså, at personer med psykisk lidelse kan vaelge at forvalte sin frihed "uhensigtsmaessigt" ved at vaere adfaerdsmaessig uansvarlig set i velfaerdsstatens perspektiv, når vedkommende fx vaelger at leve usundt, unyttigt og vaere voldelig og/eller stof-og alkoholmisbrugende (McPherson & Oute, 2020;Oute et al, 2015;Petersen, 2016;Taggart & Speed, 2019). Senere i perioden, og måske som respons på enkeltindividers "uhensigtsmaessige" forvaltning af sin psykiske sundhed, ses der tegn på et skifte hen imod, at politikkerne i stigende grad abonnerer på en pseudohumanistisk repraesentation af den traditionelle psykiatriske subjekt-position.…”