COLLABORATIVE CARE IN MENTAL HEALTH

COMPETITIVE  PROFESSIONAL  ANGST  MUST  COME  TO  AN  END  TO MAKE  ROOM  FOR  COLLABORATIVE  CARE  IN  MENTAL  HEALTH

While the mental health sector across the country is calling for a collaborative approach to mental health care, some professional factions continue to cause division.

To be clear, partisan angst across the mental health sector is not evidence of best practice. It is evidence of something else that many are at a loss to understand fully.

Below is a quote from Epston (2008; p. 4) that provides one clear example of unethical partisan angst when one group of clinicians in Australia take a competitive partisan stance against another group. Conversely, it also clarifies the significantly positive impact that any mental health care specialist (whether from psychiatry, social work, counselling or psychology origins) can have in the primary mental health care of individuals.

To clarify, Epston (2008) published his account of the hostility Michael White had faced as a social worker in Adelaide through the formative years of his creation of Narrative Therapy.

Epston’s account below of competitive professional angst:

“I want to remind you of the luckiest breaks in the history of Narrative Therapy. In the late 1970s, Michael published a paper in the prestigious journal Family Process, reporting on his work with the problem of anorexia at the children’s hospital in Adelaide where he worked. The advisory editor (Chris Beels) informed me some years ago that it was the first paper ever published showing positive results with the problem of anorexia. ”

“Soon after that, the Deputy Director of Psychiatry obviously heard about this and forbade Michael from meeting with families in which there was a young person diagnosed with anorexia because he was a social worker and was unfit for the task which should be restricted to more august medical and psychiatric practitioners. Michael refused to adhere to this edict and continued to meet with these families and they with him. The next step the Deputy Director took was to remove all the chairs from Michael’s room. Michael and the families merely continued, now sitting on the floor. Then the Deputy Director imposed on Michael what I gather he assumed would drive him into some other form of employment, rather smartly, that from then on, he would be allowed only to meet with young people who had failed 2-year-long psychoanalytic treatments for the problem of encopresis or in common parlance, soiling. This was truly dirty work. Little did the Deputy Director know he had challenged Michael in the same way Foucault must have been challenged by what he had witnessed in a public psychiatric institution.”

“Here Michael would be required to turn the tables on conventional psychiatric wisdom and in doing so invent externalizing conversations and in turn narrative therapy. I know Michael once told me he had a 99% success rate in an average of 4 meetings. So much so that he felt obliged, perhaps with his tongue in his literary cheek, to submit these results as having to do with pseudo-encopresis because if it was true encopresis, such claims to these results would have had to have been the ravings of a lunatic”.

The excerpt above is from Epston, D. 2008. Saying hullo again: Remembering Michael White. Journal of Systemic Therapies, 27(3), 1-15.

There is a large sea of mounting evidence, that has built over the past 100 years, that confirms those things that contribute to effective psychotherapeutic practice. It’s in the application of this mounting sea of evidence, rather than on professional partisan angst, we should all be advocating.

Rising to the top: The next step on the agenda of collaborative care in mental health:

The Mental Health Reference Group of the Australian Government’s MBS Taskforce Review has offered 14 recommendations that were formed through a bipartisan process of collaboration across the mental health sector.

Here is the link to it – https://www1.health.gov.au/internet/main/publishing.nsf/Content/BEB6C6D36DE56438CA258397000F4898/$File/Report%20from%20Mental%20Health%20Reference%20Group.pdf

Start on Appendix B Page 70-80 of the report to get a clear overview of the 14 Recommendations.