This new workbook, produced by the Sainsbury Centre for Mental Health and written by a distinguished philosopher of psychiatry plus an expert on values in mental healthcare, is aimed at mental health practitioners of all kinds, as well as service users and carers. It provides a series of exercises designed to help practitioners to reflect on the way that they work, and recognise the influence of different values on their practice.
Values are complex and although frequently associated with ethics, in their widest sense could be considered to include basically anything that is valued. Values-based practice - which this workbook intends to encourage - is supposedly based on mutual respect - so while starting from the values of the user or user group involved in a given decision, value-based practice also attends to the values of others concerned - the informal carers, clinical staff, managers, etc.
Of course where things get interesting in psychiatry is when values collide - the values of mental or medical health, or that of the legal profession, often are in conflict with other values, such as individual freedom to do what impulses command. This workbook includes several written exercises which the reader is intended to collaborate with and which clarify the reader’s value system. For example, one is a clinical vignette with a quiz that is completed afterwards that illuminates the reader’s attitudes to the problem (e.g. is it an illness?), what should be done about it and how people should be treated.
Values and science are often perceived to be in conflict
‘it’s not that you are“ill”and need “ treatment”; merely that I have a different values system to yours.’
Respondents to the consultation on the National Institute for Mental Health in England Values Framework who were from the research community indeed talked of a ‘propaganda’ war against the methods of medical science being fought with the ‘weapons of jargon and political correctness’.
This is certainly an interesting and thought-provoking book for the individual reader in uniquely raising awareness of implicit value systems that often go unrecognised. This awareness would help clinicians achieve a deeper and often surprising understanding of why they so often find themselves in conflict with patients and other professionals. Yet it was a pity there was not more advice and guidance on how to resolve value conflicts, as this is the problem area at the heart of what can be so stressful about the clinical practice of psychiatry.
At least the book reassures you that the reason you can’t seem to get yourself understood by anyone else in the ward round is not because we are in the grips of a plague of endemic personality disorder - it’s just that everyone else has different values to yours. I feel so much better now.
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