ISPS Conf 2014 Panel

• All NZ MH policy docs for some years have in a range of ways had a clear focus on promoting recovery-enhancing MHS – eg reducing restraint and seclusion initiatives, growth of peer delivered services etc.

• YET:• In the past 10 years we have seen a steady increase

in rates of use of CTOs to compel people into treatment.

• This begs the questions:

1. WHAT ARE WE DOING WRONG, SUCH THAT RECOURSE TO COMPULSION REMAINS THE “NORM” IN CLINICAL PRACTICE???

2. HOW DO WE CHANGE THIS????

BEING A GOOD PSYCHIATRIST –What I Was Taught

• As clinicians we are the ones responsible for whether people “get better” or not

• Relieving people of their voices, unusual beliefs, anxiety, and depression is the core of good clinical care

and• Good clinical care is

the core of what it takes to foster recovery from severe mental illness

The “Patient”

OverOutcome

The “Zone ofDelusion”

FROM DEFINED ROLES FOR DOCTOR AND PATIENT

• Power imbalance

• Clinician responsibility

• “What’s the matter with you”

• Compliance• Constraint

Dis-Engagement

De-Activation

Dis-Connection

TO A FOCUS ON BUILDING TRUST AND PARTNERSHIP

• Partnership• Shared

responsibility• Health

Behaviour• “What matters

to you”• Liberation

MOVING FROM “WHAT’S THE MATTER WITH YOU” MEDICINE TO “WHAT MATTERS TO YOU”:

A PARADIGM SHIFT IN PHILOSOPHY OF CARE.

TO UNDERSTANDING ASPIRATIONSThe Long Beach experience

THE POWER OF CONNECTIONThe Hawkes Bay Experience - WIT

Engagement

Activation

Connection

• Multiple examples of this kind of shift in philosophy, attitudes/beliefs, and practices, exist – both within NZ and internationally… BUT

• For most MHS provision the old paradigm prevails.

• OUR CHALLENGE – what does it take to achieve the seismic shift required to see this become “business as usual”