Rory Doody What are you going to do?

1. “What are you going to do?”
Mon 29th April 2013

2. When decision making was taken away
• There was a loss of:
• Self confidence
• Self respect
• Dignity
• Freedom
• Self belief
• Trust,trust,trust..............

3. • “What should move us to action is human
dignity: the inalienable dignity of the
oppressed, but also the dignity of each of us.
We lose dignity if we tolerate the
intolerable.” Dominique du Moneil
• This made me angry! .....................but was
seen as further symptoms!

4. A peer asked,
“What are you going to do?”

5. • “Critical social education, is designed to
encourage questioning and action for change,
is founded on a different worldview that of
participatory democracy forged out of
principles of cooperation and equality. Our
work is the ‘practice of freedom’ (Freire, 1976)
....... in failing to be vigilant about changes in
the political context we run the risk of
developing practice that reinforces
discrimination whilst still waving the banner of
social justice.” (Ledwith, 2007)

6. The Home Focus Team
• Home/community based
• Recovery oriented
• Partnership model
• Shared decision making – on both sides
• We have a reflective question: “Am I helping
this person to stay sick, or, am I helping this
person to get better?”

7. Peer advocacy is an important
provision:
• especially for those detained under a section of
the Mental Health Act because of the powers
given to staff. Under these circumstances
advocacy is valuable, and has an important
ethical function (Thomas & Bracken, 1999). Peer
advocates are independent of mental health
service staff and have usually had first-hand
experience of using mental health services
themselves. They can therefore be seen as
working for the patient rather than the staff. (The
Psychiatrist, 2001)

8. Implications for policy implementation
• We have a new policy in ‘Day Services’
• It is called ‘New Directions’
• The radical change is not the sole responsibility of the
Health Service Executive but rather, a collaborative
responsibility shared between the person, their
families and carers, a multiplicity of agencies,
Government and society as a whole.( H.S.E.)
• The central approach within the report focuses on the
core values of person-centeredness, community
inclusion, active citizenship and high quality service
provision.

9. Peers, professionals and ‘Open
Dialogue’
• What are the aims of an Open Dialogue approach?
• Fisher (2011) suggests that the aim is to create a space between people
for creative generation of new thoughts that may promote
understanding.
• Seikkula, Arnkil and Hoffman (2006) reiterate this, adding that the focus
should be to find a shared way of talking about what is frightening
people.
• Seikkula and Trimble (2005) describe the main aim as being to generate a
new joint language for experiences that do not yet have words.
• Ahern and Fisher (2001) agreed that the aim of Open Dialogue should be
the (re)establishment of heart-to-heart dialogue with significant persons
in their social network.
• Anderson and Goolishian (1992) see the aim as the facilitation of a
dialogue with and about the client’s narrative, through listening and
clarifying their story. They agree that through this generation of a mutual
understanding, change is inevitable.

10. • What does an Open Dialogue approach ask of staff members?
• Remember to tolerate uncertainty. Each team member has to be
confident and relaxed at the same time- ‘capable of being in
uncertainties, mysteries, doubts, without any reaching after fact
and reason’. The most important but difficult task is this tolerance
of uncertainty and anxiety.
• Avoid the desire for results. Participating sensitively and effectively
requires a capacity to be simple and ordinary but also entail certain
qualities of attentiveness and an ability to be still with the situation-
to refrain from becoming overly interventionist (Reed, 2011).
• Try to listen generously. This entails patience and slowness of pace
by the clinician, and a conscious effort to resist the pull of goals
and structures that still remain from previous training. Think of it as
though you are still a beginner. This allows space for the
unexpected, for unusual thoughts and contributions to occur in
meetings, it is a form of listening that doesn’t arise from an agenda.
• See the service user as a competent partner. It is also important to
remember that the family and network are considered as
resources, not as objects of the treatment

11. Thank you!
“What are you going to do?”

12. References
• Ledwith, Margaret (2007) 'Reclaiming the
radical agenda: a critical approach to
community development', Concept Vol.17,
No.2, 2007, pp8-12.
• The Psychiatrist (2001) 25: 477-480 doi:
10.1192/pb.25.12.477