"Purpose: This study aims to explore the perspectives of psychiatrists with lived experiences and what their considerations are upon integrating the personal into the professional realm. Design/methodology/approach: As part of a qualitative participatory research approach, participant observations during two years in peer supervision sessions (15 sessions with 8 psychiatrists with lived experiences), additional interviews as part of member feedback and a focus group were thematically analysed. Findings: Although the decision to become a psychiatrist was often related to personal experiences with mental distress and some feel the need to integrate the personal into the professional, the actual use of lived experiences appears still in its early stages of development. Findings reveal three main considerations related to the personal (3.1), professionality (3.2) and clinical relevance (3.3) comprising 11 facilitators and 9 barriers to harness lived experiences. Research limitations/implications: This study was conducted locally and there are no similar comparable studies known. It was small in its size due to its qualitative nature and with a homogeneous group and therefore may lack generalisability. Practical implications: Future directions to further overcome shame and stigma and discover the potential of lived experiences are directed to practice, education and research. Originality/value: Psychiatrists with lived experiences valued the integration of experiential knowledge into the professional realm, even though being still under development. The peer supervision setting in this study was experienced as a safe space to share personal experiences with vulnerability and suffering rather than a technical disclosure. It re-sensitised participants to their personal narratives, unleashing its demystifying, destigmatising and humanising potential."
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There is increasing interest in the use of experiential knowledge and the development of experiential expertise in mental health. Yet, little is known about how best to use this expertise in the role of a psychiatrist. This study aims to gain insight into the concerns of psychiatrists using their lived experiences with mental health distress as a source of knowledge for patients, colleagues and themselves. Eighteen psychiatrists with lived experience as patients in mental health care were interviewed with a semi-structured questionnaire. The interviews were analyzed using qualitative narrative thematic analysis. The majority of the respondents use their lived experience implicitly in the contact with patients, which makes the contact more equal and strengthens the treatment relationship. When explicitly using experiential knowledge in the contact with patients, thought should be given at forehand to its purpose, timing and dosage. Recommendations are that the psychiatrist should be able to reflect on his/her lived experience from a sufficient distance and should take patient factors into account. When working in a team, it is advisable to discuss the use of experiential knowledge in advance with the team. An open organizational culture facilitates the use of experiential knowledge and safety and stability in the team are vital. Current professional codes do not always offer the space to be open. Organizational interests play a role, in the degree of self-disclosure as it can lead to conflict situations and job loss. Respondents unanimously indicated that the use of experiential knowledge in the role of a psychiatrist is a personal decision. Self-reflection and peer supervision with colleagues can be helpful to reflect on different considerations with regard to the use of experiential knowledge. Having personal lived experiences with a mental disorder affects the way psychiatrists think about and performs the profession. The perception of psychopathology becomes more nuanced and there seems to be an increased understanding of the suffering. Even though harnessing experiential knowledge makes the doctor-patient relationship more horizontal it remains unequal because of the difference in roles. However, if adequately used, experiential knowledge can enhance the treatment relationship.
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Many mental health professionals have also used mental health services. What role should their personal experience play in their clinical practice - if any? - a commentary
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Background: To be accountable to laws and regulations, healthcare professionals spend more than 40% of their time on administrative tasks. The Compulsory Mental Healthcare Act (CMHA) was introduced in Dutch mental healthcare in 2020. It was hypothesized that this legislative amendment would raise the administrative burden for some care professionals. Pilot studies in 2020 and 2021 visualized the exponentially rise of the administrative burden for care professionals, especially psychiatrists due to the transition. However the total response was too small and not generalizable. Aim: gain more nationwide insight in the hypothesized raise of administrative burden of psychiatrists due to the implementation of the CMHA. Method: Under the leadership of an advisory board of three medical director psychiatrists, a Likert scale questionnaire was further developed to investigate the administrative burden of psychiatrists in the Netherlands before and after transition. Open-ended questions provided the opportunity for feedback from the psychiatrists. The study was supported by the Department of Medical Directors (DMD) of The Netherlands Psychiatric Association (NPA). Results: all mental health institutions members of the DMD of the NPA received an invitation to participate. 14 institutions (total N=158) responded. The data show a significant change in the time spent on administrative tasks, the usefulness of the administrative actions, the fit for use and ease of use of supporting systems. The forementioned all decreased significantly after the implementation. Conclusion and discussion: Psychiatrists spend more time on administration than before the legislative amendment instead of helping vulnerable patients. None of the institutions has been able to use the transition to its advantage given the time spent on administrative tasks and the usefulness of these tasks. This is an unacceptable development in the field of mental health in the Netherlands and should be addressed to those who are responsible for the decision making, especially policy makers. These results show that the introduction of the CMHA have made the field of Dutch mental health an impossible area to work for. , Administrative burden, Legislative amendment, Public governance, Information Management
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Abstract: The need for mental healthcare professionals in the Netherlands is increasing caused by the growth of patient complexity. The administration burden causes outflow of professionals and therefor they become increasingly scares. Improvement initiatives are aimed as the intended strategy and starts with (re)-structuring organizations through legislation and regulations. They entail both experienced and measured administration burden for healthcare professionals working in Long-Term Care (LTC). However, most studies only provide insight into the current administration burden or the impact of legislation and regulations on the administration burden from a broad perspective. These insights are useful to LTC managers, but more in-depth research is needed to implement laws and regulations to reduce the administration burden for LTC professionals in the future. The Compulsory Mental Healthcare Act (CMHA) was implemented in the Dutch mental healthcare and replaced the Special Admissions Act in Psychiatric Hospitals (SAAPH) on January 1, 2020. The aim of this study is to investigate the effect of the legislative transition and to determine the effect on the administration burden of Dutch mental healthcare professionals. A survey concerning the administration burden for especially psychiatrists before and after the transition was distributed to an addiction institute with a diversity of different mental healthcare professionals and a psychiatric institute that has been led by psychiatrists. Also some interviews with the lead professionals where held. The results show that the administration burden among psychiatrists has increased due to the contact with external healthcare providers and contact with the patient, family and their loved ones (a consequence of the amendment of the law). This effect was significant and in line with the results of the interviews. Therefor we conclude that the administration burden has increased as a result of the legislative amendment.
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This article explores the decision-making processes in the ongoing development of an AI-supported youth mental health app. Document analysis reveals decisions taken during the grant proposal and funding phase and reflects upon reasons why AI is incorporated in innovative youth mental health care. An innovative multilogue among the transdisciplinary team of researchers, covering AI-experts, biomedical engineers, ethicists, social scientists, psychiatrists and young experts by experience points out which decisions are taken how. This covers i) the role of a biomedical and exposomic understanding of psychiatry as compared to a phenomenological and experiential perspective, ii) the impact and limits of AI-co-creation by young experts by experience and mental health experts, and iii) the different perspectives regarding the impact of AI on autonomy, empowerment and human relationships. The multilogue does not merely highlight different steps taken during human decision-making in AI-development, it also raises awareness about the many complexities, and sometimes contradictions, when engaging in transdisciplinary work, and it points towards ethical challenges of digitalized youth mental health care.
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Het gebruik van ervaringskennis onder behandelaren in de geestelijke gezondheidszorg (ggz) is een opkomend fenomeen. Een significant percentage van alle ggz-professionals heeft zélf te maken gehad met psychische ontregeling. Studies suggereren uiteenlopende percentages in de groep ggz-professionals, variërend van 45 procent tot zeventig procent, wat hoger is dan gemiddeld genomen in de beroepsbevolking. Velen voelen zich juist ook om deze reden aangetrokken tot het hulpverlenerschap, hoewel slechts een minderheid expliciet gebruikmaakt van deze kennis. In opleidingen en nascholingen werd oorspronkelijk ruim aandacht besteed aan de risico’s van zelfonthulling. Daarnaast blijkt uit onderzoek dat het klimaat tijdens leertherapie en intervisies niet altijd veilig genoeg is om persoonlijke ervaringen met ontwrichting bespreekbaar te maken. Als dit wel het geval is, dan ligt de nadruk op het inzichtelijk krijgen van de eigen problematiek zodanig dat deze niet interfereert met toekomstig cliëntcontact. Hiermee wordt vaak uitgegaan van een mogelijk negatieve invloed van ervaringskennis. Eenmaal werkzaam in de ggz is het eveneens niet vanzelfsprekend om er openlijk over te spreken met collega’s en is er regelmatig sprake van (zelf-)stigma. Er bestaan namelijk nog veel misvattingen over het gebruik van ervaringskennis en -deskundigheid, voornamelijk voortkomend uit de psychoanalyse, zoals het idee dat het schadelijk zou zijn voor cliënten. Ggz-professionals hebben de neiging zich te verschuilen achter hun professionele identiteit, met vaak weinig ruimte voor persoonlijke aspecten. Daarbij komt dat er een trend is om in toenemende mate de interventie boven de relatie te prevaleren. Terwijl het belang van ervaringskennis in behandelingen internationaal en ook in Nederland steeds meer wordt erkend, raken psychotherapeuten op achterstand. Beroepsorganisaties als het Royal Australian and New Zealand College of Psychiatrists en de British Psychological Society benadrukken juist dat persoonlijke ervaringen een essentiële rol kunnen spelen bij het verminderen van stigma. In Nederland heeft de Nederlandse Vereniging voor Psychiatrie onlangs kenbaar gemaakt dit als een positieve ontwikkeling te zien. In Nederland is tevens een kwaliteitsstandaard en zorgstandaard voor het gebruik van ervaringsdeskundigheid en worden ervaringsdeskundigen steeds meer gewaardeerd vanwege hun unieke bijdragen. Terwijl dus steeds meer ex-cliënten worden opgeleid om hun ervaringen met psychische problemen en herstel in te zetten om anderen te helpen, wordt het psychologen nog steeds afgeleerd om open te zijn over hun persoonlijke verleden. Zodoende startte in 2019 een promotieonderzoek naar het gebruik van ervaringsdeskundigheid onder ggz-professionals. Gedurende ruim vier jaar werd kwalitatief en participatief onderzoek uitgevoerd bij vier zorgorganisaties. Naast een literatuurstudie werd er ook praktijkgericht samengewerkt met cliënten, ervaringsdeskundigen, professionals, bestuurders en managers. Een belangrijke vraag hierin was: ‘Wat levert professionele ervaringskennis binnen een therapeutische setting op en hoe kan dit door ggz-professionals worden ingezet?’
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Background Differing perspectives of self-harm may result in a struggle between patients and treatment staff. As a consequence, both sides have difficulty communicating effectively about the underlying problems and feelings surrounding self-harm. Between 2009 and 2011, a programme was developed and implemented to train mental health care staff (nurses, social workers, psychologists, psychiatrists, and occupational therapists) in how to communicate effectively with and care for patients who self-harm. An art exhibition focusing on self-harm supported the programme. Lay experts in self-harm, i.e. people who currently harm themselves, or who have harmed themselves in the past and have the skills to disseminate their knowledge and experience, played an important role throughout the programme. Methods Paired sample t-tests were conducted to measure the effects of the training programme using the Attitude Towards Deliberate Self-Harm Questionnaire, the Self-Perceived Efficacy in Dealing with Self-Harm Questionnaire, and the Patient Contact Questionnaire. Effect sizes were calculated using r. Participants evaluated the training programme with the help of a survey. The questionnaires used in the survey were analysed descriptively. Results Of the 281 persons who followed the training programme, 178 completed the questionnaires. The results show a significant increase in the total scores of the three questionnaires, with large to moderate effect sizes. Respondents were positive about the training, especially about the role of the lay expert. Conclusion A specialised training programme in how to care for patients who self-harm can result in a more positive attitude towards self-harm patients, an improved self-efficacy in caring for patients who self-harm, and a greater closeness with the patients. The deployment of lay experts is essential here
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What Big Tech companies are praised, psychologists/psychiatrists would end up in jail for. If they don 't want to end up behind bars, politicians must also have a very good story if they carry out an operation in which thousands of people lose their jobs, with all the social and psychological consequences that entails. Disruption should never be an end in itself for them either. If craftsmen everywhere are replaced by smart production systems, we will have to express humanity in a different way. Remarkably, this is virtually beyond the interest and scope of any scientific research!
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This research examines the cognitive processes of people with schizophrenia as a way of studying today’s conception of the normal and the pathological in Western urban screen cultures. Through a medical humanities approach, which combines textual analysis with genealogy, this research will investigate the cultural construction of what accounts for normal and pathological behaviours. Through the diagnosis of schizophrenia, a cultural threshold is set by psychiatrists on what is different from the norm. By analysing these standards, this research attempts to reassess our conception of the pathological and the normal in these cultures. Eventually, this research argues that it may not be individuals who have pathological behaviour but that these cultures have pathological demands for the subjects that live within them that trigger this behaviour.
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