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在全球心理健康中引出康复叙事:服务使用者参与的益处和潜在危害。

Eliciting recovery narratives in global mental health: Benefits and potential harms in service user participation.

机构信息

Department of Anthropology.

Department of Anthropology, Dartmouth College.

出版信息

Psychiatr Rehabil J. 2020 Jun;43(2):111-120. doi: 10.1037/prj0000384. Epub 2019 Jul 29.

Abstract

OBJECTIVE

The engagement of peers and service users is increasingly emphasized in mental health clinical, educational, and research activities. A core means of engagement is via the sharing of recovery narratives, through which service users present their personal history of moving from psychiatric disability to recovery. We critically examine the range of contexts and purposes for which recovery narratives are elicited in global mental health.

METHOD

We present 4 case studies that represent the variability in recovery narrative elicitation, purpose, and geography: a mental health Gap Action Programme clinician training program in Nepal, an inpatient clinical service in Indian-controlled Kashmir, a recovery-oriented care program in urban Australia, and an undergraduate education program in the rural United States. In each case study, we explore the context, purpose, process of elicitation, content, and implications of incorporating recovery narratives.

RESULTS

Within each context, organizations engaging service users had a specific intention of what "recovery" should constitute. This was influenced by the anticipated audience for the recovery stories. These expectations influenced the types of service users included, narrative content, and training provided for service users to prepare and share narratives. Our cases illustrate the benefit of these coconstructed narratives and potential negative impacts on service users in some contexts, especially when used as a prerequisite for accessing or being discharged from clinical care.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Recovery narratives have the potential to be used productively across purposes and contexts when there is adequate identification of and responses to potential risks and challenges. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

摘要

目的

同伴和服务使用者的参与在精神健康临床、教育和研究活动中越来越受到重视。一种核心的参与方式是通过分享康复叙事,通过这种方式,服务使用者展示他们从精神残疾到康复的个人经历。我们批判性地审视了在全球精神健康领域中征集康复叙事的各种背景和目的。

方法

我们呈现了 4 个案例研究,这些研究代表了康复叙事征集、目的和地理区域的多样性:尼泊尔的精神健康差距行动方案临床医生培训计划、印度控制的克什米尔的住院临床服务、澳大利亚的以康复为导向的护理计划以及美国农村地区的本科教育计划。在每个案例研究中,我们探讨了征集、目的、过程、内容和纳入康复叙事的影响。

结果

在每种情况下,与服务使用者合作的组织都对“康复”应该包含什么有具体的意图。这受到康复故事预期受众的影响。这些期望影响了纳入的服务使用者类型、叙事内容以及为服务使用者提供的准备和分享叙事的培训。我们的案例说明了这些共同构建的叙事的好处,以及在某些情况下对服务使用者的潜在负面影响,尤其是当它们被用作获得或离开临床护理的前提条件时。

结论和对实践的影响

当充分识别和应对潜在风险和挑战时,康复叙事有可能在各种目的和背景下被有效地使用。

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