Mental Health User Narratives is an interesting book bringing together changes in mental health services, new ways of working in psychiatry and using mental health service user narratives as a way of trying to ensure that assumptions are not made about the needs of those with severe acute or chronic mental ill health. It is based around English services with emphasis on hospital and home treatment teams.
This book covers the history of the care of those with a mental health problem and the theories as to what caused those problems, from the Middle Ages to what is called the ‘post-community care’ period. Then there is a chapter on the history and theoretical content of narratives, looking at them from the perspective of personality theory, social constructionism and social science. After a chapter explaining crisis intervention and home treatment and one on the methods used to collect the narratives used in the book, are several chapters of narrative. Then themes are explored - descent into illness, psychiatric intervention, recovery from illness and self-coping.
On the whole I found the book very interesting, well researched and respectful of the service-user voice - the service users were from Bradford. It is great to read stories about their ill health in the context of their whole life albeit in broad Yorkshire dialect! I found some of the more theoretical chapters, especially that on narrative, very difficult to read which made me wonder who the book was actually aimed at.
The thematic review of the narratives was perhaps the most interesting part for me. Bradford has always had a tradition of listening to service users in the planning of new services and the author was involved in the setting up of the home treatment service. Therefore, perhaps it is not that surprising that the book finds this service most useful among service users in their recovery. One could maybe argue that those who find the home treatment team the most helpful were the most advanced in their recovery anyway and that those still ending up in hospital were more ill. It is sad, though, to read the comment at the end that the service had been changed from what the users and planners wanted it to be, to bring it more in line with Government policy.
Many of the usual issues for service users came up - medication, the vacuum that is the psychiatric hospital and the difficulties around relationships, employment and meaningful daytime activity. Because the narratives are from Bradford, which has a large Asian population, there is the chance to compare the issues this group had in common with their English compatriots and those that were different, and this is fascinating.
The author dedicates the book to those who have had mental health problems with the comment, ‘This is just the beginning’. I think it would be a good beginning to use the themes of service-user narrative as well as evidence bases to move mental health services on in the future.
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