Culture Values and Mental Health Hospital Managers

Kwame McKenzie

and

Philip Thomas

What are values?

‘I’m constantly working in an environment of lots of people’s different values and trying to make some sense of that. For example, I’m working with a service user who has very different values to me; not only that, but his values are different to his parents’. I’m juggling with these values, struggling to tease out the issues and bring some clarity to my own thinking.’

(CPN, in Whose Values, Woodbridge and Fulford,2004:7)

Objectives

1. Explore what we understand by values

2. Understand the difference between values and facts

3. Explore how values and culture influence our understandings of mental health

• Make a list of any short words or phrases that you associate with the word ‘values’.

• Don’t think too hard about this. Write fast, and write for yourself. Don’t try to guess what others might be saying. There are no ‘right’ answers. Your list should reflect what you associate with the word values.

• Spend a maximum of 5 minutes on this.

Exercise 1: What are values?

Exercise 1: What are values?• Compare your list with the following lists

List 1 List 2 List 3•Core beliefs

•Your perspective on the world

•Principles – cultural, individual

•Justice

•Anything that’s valued

•Integral to being human

•Quality of life

•Right to be heard

•Social values

•Self-respect

•Valuing neighbours

•Ethics

•Right and wrong

•Belief systems

•Ideals and priorities

•Govern behaviour and decisions

•Community health – individuals, society, culture

•Ideals

•Morals

•Principles

•Standards

•Conscience

•What you believe in

•Self esteem

•Principles

•Integrity

•Openness / honesty

•Personal motivating force

•Primary reference points

•Ethics

•Virtues

•Sharing

•Willing to sacrifice for

•Self-interested tenets

Discuss exercise 1

• Did the lists surprise you?

• Are there any broad differences in the lists (including your own)?

• Are there any similarities

DISCUSS

Exercise 2: Values or facts?

• We can now see that although there are many, diverse values, they may be thought of as falling into families (e.g. ethics, moral principles, cultural beliefs).

• Bearing in mind what you have already said about values, what are facts? How do facts differ from values? Make a short list of the differences between facts and values. Spend 5 minutes on this task.

Exercise 2: What are values?

• These are my own thoughts:

Facts Values

•True / False•Natural world•Based in our senses•Verifiable through consensus

•Neither true nor false•Human world•Based in our emotions•Not verifiable through consensus

Exercise 2: Discussion

Examples of facts:

• 1 + 1 = 2 ?

• 2H2 + O2 = 2 H20 ?

• Hearing Voices + Unusual Beliefs = Schizophrenia ?

Mental Disorders: Facts or Values?

Mental disorders are:

‘…a broad range of problems with different symptoms. However, they are generally characterized by some combination of abnormal thoughts, emotions, behaviour and relationships with others.’

(WHO, 2007, emphasis added)

DISCUSS

Models of distressMedical Social Psychological Conspiratorial

Description

Diagnostic categories, distinctions between health/illness, normal/abnormal

 Health and well-being / stress

 Normal / abnormalNo categories – ‘continuum’

 Mental Illness is a myth. It’s just a form of human difference

Cause

 Biological changes in the brain, e.g. chemical imbalances, genetic factors

 Socio-economic stress, cultural conflict, social exclusion

 Poor coping skills, traumatic early experiences, low self esteem

MI is a cultural artefact. It’s defined socially and politically, as a way of controlling awkward people

Response

Physical treatments aimed at correcting ‘biological’ imbalance, e.g. drugs, ECT

Social change to reduce stress, e.g. improve benefits, housing, combat racism

‘Therapy’ e.g. psychotherapy, cognitive therapy, aimed at increasing person’s responsibility

None, other than political activism to empower the oppressed

Robert is a 37 year old African-Caribbean man. He was born in Jamaica and came to England age 10. He has appealed against his detention in hospital on section 3. He was admitted for the 8th time in as many years after smashing his flat up. The neighbours constantly complained about his loud music, and he got into frequent arguments with them. The police were called because Robert became very angry, he was arrested, taken to cells, and assessed by the duty psychiatrist. He refused to come in to hospital because he denied that he was mentally ill. He puts his problems down to ‘harassment’. He believes his neighbours are against him. He says they call him racist names, and that they use chemical powders, which he can smell and see, to try to kill him. He hates being in hospital and refuses to take medication. He says the doctors are trying to poison him. He wants to take ‘herbs’ to calm himself down. He constantly tries to escape, and when he does so, he goes to a nearby café to get African foods. He refuses to eat hospital food because it’s ‘not right’

The psychiatrist says that Robert suffers from mental disorder which is treatable. He has abnormal beliefs in the form of paranoid delusions, that the neighbours and doctors are trying to poison him. He also has abnormal perceptual experiences, for example, he sees and smells the powders that he alleges the neighbours are using to try to kill him. The psychiatrist also suspects that Robert hears voices, because he listens to loud music and is often observed by the nurses to be speaking to himself. The psychiatrist’s opinion is that Robert shows evidence of chronic paranoid schizophrenia, which needs treating with medication. Robert has to stay in hospital because he has no family contact or social supports.

Exercise 3: Values and Compulsion

Questions:

1. What values inform the psychiatrist’s interpretation of Robert’s problems?

2. What values inform Robert’s understanding of his problems?

3. What values inform your understanding of Robert’s problems?

Discussion

• What broad conclusions do you think you can draw about the role of values and culture in mental health?

• What are the implications of these conclusions for your work?

DISCUSS…!

References

Woodbridge, K., and Fulford, K.W.M. (2004) Whose Values? A workbook for values-based practice in mental health care. London: Sainsbury Centre for Mental Health.

User-centred practice Wallcraft, J. (2003) Values in Mental Health – the Role of Experts by Experience.

This is a detailed discussion paper exploring some of the key issues about values for the Experts by Experience programme, one of the work programmes of the NIMHE. (Available at www.connects.org.uk’conferences

Colombo, A., Bendelow, G., Fulford, K.W.M. & Williams, S. (2003) Evaluating the influence of implicit models of mental disorder on processes of shared decision making within community-based multidisciplinary teams. Social Science & Medicine, 56: 1557-1570.