Challenges with Systems Level Recovery Transformation in Westernized Cultures: Inpatient Psychiatric Settings in Public Mental Health and Avenues for Hope and Change
Main Article Content
Abstract
There has been much written now in the field on recovery-oriented care, its empirical impact, and the need for systems transformation for working with those with serious mental illness across the globe. However, there is still a dearth of that systems level recovery transformation occurring within inpatient settings, as opposed to outpatient, in public mental health and effectively, as the literature reflects. There are even questions of whether it is possible to engage in systems level recovery transformation within inpatient settings that are so structured and set in form, while there is more evidence of recovery transformation systemwide within outpatient services in mental health. This article highlights challenges for recovery-oriented systems change and how inpatient psychiatric settings within public mental health may be experienced, including issues of power and control, violation of basic human rights, racist experiences and overuse of seclusion and restraints for patients with racial minority identities, exacerbation of intersecting oppressive experiences, challenges with civil commitment and conservatorship, arbitrary and inhumane rules, and a strong focus still on diagnosis, medications and symptom amelioration. Despite barriers this article advocates for continuing hope and effort into providing systems level recovery transformation and discusses mechanisms of change in the direction of that transformative process for systems and providers to engage. Such mechanisms include involving senior administration and others throughout systems towards this overall goal and effective manners of collaborative change across disciplines. The article details those skillful systems change strategies in leadership and practical applications to help systems conceptualize how they may make such transformation.
Keywords:
Recovery-oriented care and systems change, serious mental illness, inpatient psychiatric care
Article Details
How to Cite
CARR, Erika.
Challenges with Systems Level Recovery Transformation in Westernized Cultures: Inpatient Psychiatric Settings in Public Mental Health and Avenues for Hope and Change.
Medical Research Archives, [S.l.], v. 12, n. 7, july 2024.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/5386>. Date accessed: 05 aug. 2024.
doi: https://doi.org/10.18103/mra.v12i7.5386.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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14. Dixon, LB, Holoshitz, Y, & Nossel, I. Treatment engagement of individuals experiencing mental illness: review and update. World Psychiatry. 2016; 15(1), 13-20.
15. Removed for peer review. Supporting mental health recovery, citizenship, and social justice. Community Mental Health Journal.2022; 1-9.
16. Schnitzer, K, Merideth, F, Macias-Konstantopoulos, W, Hayden, D, Shtasel, D., Bird, S. Disparities in care: the role of race on the utilization of physical restraints in the emergency setting. Academy of Emergency Medicine. 2020; 27, 943-950.
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18. Dotson, S, Ogbu-Nwobodo, L, & Shtasel, D. Demilitarizing hospital restraints: recognizing the stones in our glass houses. Psychiatric Services. 2022;3(1), 100-102.
19. Menand, E, & Moster, R. Racial disparities in the treatment of schizophrenia spectrum disorders: How far have we come? Current Behavioral Neuroscience Reports. 2021; (8)179-186. doi: 10.1007/s40473-021-00236-7
20. Pan, I. Association between race/ethnicity and the receipt of outpatient second-generation antipsychotic agents stratified by metabolic effects. Thesis Presented to the Faculty of the Graduate School of The University of Texas at Austin in Partial Fulfillment of the Requirements for the Degree of Master of Science in Pharmaceutical Sciences. Austin, TX: The University of Texas at Austin; 2016.
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26. Fellner, J. A corrections quandary: Mental illness and prison rules. Harvard Civil Rights- Civil Liberties Law Review. 2006; 41, 391.
27. Hall, D, Lee, LW, Manseau, MW, Pope, L, Watson, AC, & Compton, MT. Major mental illness as a risk factor for incarceration. Psychiatric Services. 2019; 70(12), 1088-1093.
28. Steadman, HJ, Osher, FC, Robbins, PC, Case, B, & Samuels, S. Prevalence of serious mental Illness among jail inmates. Psychiatric Services. 2009; 60, 761–765.
29. Silva, B, Golay, P, & Morandi, S. Factors associated with involuntary hospitalization for psychiatric patients in Switzerland: a retrospective study. BMC Psychiatry, 2018; 18, 1-10.
30. Morris, NP. Detention without data: Public tracking of civil commitment. Psychiatric Services. 2020; 71.
31. Brooks, RA. Psychiatrists’ opinions about involuntary civil commitment: Results of a national survey. Journal of American Academy of Psychiatry Law. 2007; 35, 219-228.
32. Barnett, P, Matthews, H, Llyod-Evans, B, Mackay, E, Pilling, S, & Johnson, S. Compulsory community treatment to reduce readmission to hospital and increase engagement with community care in people with mental illness: A systematic review and meta-analysis. Lancet Psychiatry. 2018;5, 1013-1022.
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35. Juríčková, L, Filka, J, & Ivanová, K. Identification of topical problems in performance of public custodian function. Health & Social Sciences. 2012.
36. Barton, R., Lau, S., & Lockett, L.L. (2014). The use of conservatorships and adult guardianships and other options in the care of the mentally ill in the United States. World Guardianship Congress. Accessed from:
http://www.guardianship.org/IRL/Resources/Handouts/Family%20Members%20as%20Guardians_Handout.pdf
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https://www.guardianship.org/wpcontent/uploads/2018/09/UGCOPPAAct_UGPPAct.pdf
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39. Ireland, J, & Snowdon, P. Bullying in Secure Hospitals. Journal of Forensic Psychiatry and Psychology. 2002;13(3):538–554.
40. Pescosolido, BA, Halpern-Manners, A, Luo, L, & Perry, B. Trends in public stigma of mental illness in the US, 1996-2018. JAMA network open, 2021; 4(12), e2140202-e2140202.
41. Barret, R. J. The Psychiatric Team and the Social Definition of schizophrenia: Anthropological Study of Person and Illness. Cambridge, MA: Cambridge University Press; 1996.
42. Strauss, A. Psychiatric Ideologies and Institutions. London: Collier Macmillan; 2017.
43. Thibeault, CA, Trudeau, K, d’Entremont, M, & Brown, T. Understanding the milieu experiences of patients on an acute inpatient psychiatric unit. Archives of psychiatric nursing. 2010; 24(4), 216-226.
44. Bowser, A, Link, W, Dickson, M, Collier, L, & Donovan-Hall, MK. A qualitative study exploring the causes of boredom for men with a psychosis in a forensic setting. Occupational Therapy in Mental Health. 2018;34, 32–48.
45. Kanyeredzi, A, Brown, SD, McGrath, L, Reavey, P, & Tucker, I. The atmosphere of the ward: Attunements and attachments of everyday life for patients on a medium-secure forensic psychiatric unit. The Sociological Review. 2019; 67(2), 444-466.
46. Sumartojo, S, Pink, S, Duque, M, & Vaughan, L. Atmospheres of care in a psychiatric inpatient unit. Design for Health. 2020; 4(1), 24-42.
47. O’Connor, N, Zantos, K, & Sepulveda-Flores, V. Use of personal electronic devices by psychiatric inpatients: Benefits, risks and attitudes of patients and staff. Australasian Psychiatry. 2018; 26(3), 263-266.
48. Parrott, FR. ‘Real Relationships’: sociable interaction, material culture and imprisonment in a secure psychiatric unit. Culture, Medicine, and Psychiatry. 2010; 34, 555-570.
49. Shattell, MM, Andes, M, & Thomas, SP. How patients and nurses experience the acute care psychiatric environment. Nursing inquiry. 2008; 15(3), 242-250.
50. Mohr, WK., & Pumariega, A J. Level systems: Inpatient programming whose time has passed. Journal of Child and Adolescent Psychiatric Nursing. 2004;17(3), 113-125.
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