Mental Health, Service User Involvement, and Recovery
This book discusses issues confronting meaningful consumer guidance in behavioral health services, particularly as they relate to the United Kingdom's mental health system. Jenny Weinstein has conscientiously assembled individual and collective consumer ideas about personal recovery and how to deploy them for culture change in mental health delivery systems. It is enlightening and instructive.
Editor's note: Recovery is an enigmatic concept in contemporary psychiatry. Most practitioners in the public sector know they should be involved in assisting individuals with serious mental illness to move toward recovery, but most do not know exactly what that means. The reviews in this month's issue are of books that provide the bases for understanding recovery and its place in the evolution of the relationships in the lives of people with serious mental illnesses.
Chapter authors describe universals of social stigma, as well as more specific problems with practitioner behavior. A sense of transcendence is eloquently described, and sometimes movingly so, as the authors relate their odysseys. First-person accounts transfigure into illustrations of how fostering systems change can also advance personal recovery. Repeatedly, the role of educator of professionals emerges in this regard. For instance, there is an excellent chapter that describes student workshops based on common “Practice Dilemmas.” They are facilitated by a team of consumers and address a pedagogical need to be challenging yet supportive and nonjudgmental in professional reeducation.
Authors are vocal about advocacy and empowerment. In terms of the consumer's role, the book's single most memorable comment, by author Julie Gosling—“We are not empowered by the outside, we have to snatch power back and this is crucial to Recovery”—underscores that effective community organizing must be self-owned. This presents a challenge for progressive mental health professionals who wish to support consumer power but inadvertently risk an appearance of co-opting it. For people who experience mental illnesses, it is also a call to exploit political channels. On the individual level, it declares a need for clinicians in the 21st century to continue to reevaluate what we think collaboration really means in pursuit of healing. The playing field—that is, the interpersonal psychotherapeutic field—is being leveled beneath our feet. As clinical administrators, it reminds us that we need to actually listen to our consumers, lest they will begin to go elsewhere.
A qualified frustration concerns the book's presentation and my need to know even more about how these consumers are succeeding. As a person working on the other side of the Atlantic Ocean, I wished that Ms. Weinstein had included a chapter providing an overview of the British mental health system, if only to provide more understanding of how their systems-change efforts could be adapted in the United States. There are brief descriptions of the British system throughout the volume, though so brief that they seemed to serve only as puzzle pieces. For example, the British Department of Health is described as embracing some enlightened policies. Are they effective? What is the national department's power in relation to localities? So, context is important, and the maxim holds that all politics are local. More description would have complemented a particularly lucid introductory chapter by Philip Kemp that examines the societal evolution of mental health service user involvement.
Regardless, this fast-reading book is valuable to understand how personal experiences affect recovery and advocacy. As grounding to educate a new generation of practitioners, I recommend it to trainees and faculty. For the rest of us, clinicians and administrators alike, it is part of the wake-up call.
The reviewer reports no competing interests.
