The world of mental health and madness explored in this issue can read like a series of conflicts, of stark choices between alternatives which appear mutually exclusive and often imply, “I am right, you are wrong” : Ill/well, mad/sane, biomedical/psychosocial, local/global, expert/patient, individual/collective, science/anecdote, stigmaphobic/stigmaphilic, insight/delusion, normal/abnormal, privileged/marginalized, and plenty more besides. When those of us who have been diagnosed mentally ill fall on the wrong side of most of those divides and our experience and knowledge is invalidated, psychiatry’s expertise (...) and dominance is reinforced. Engaging with the feature articles in this... (shrink)

Marie Stenlund’s careful reading of values-based practice and her demonstration of its links with Martha Nussbaum’s Capabilities Framework are innovative theoretically and have potentially important implications for policy and practice in mental health. As she indicates the two approaches converge in a number of key respects. Notably, both recognise the diversity of individual human values. This diversity crucially underpins contemporary person-centred conceptions of recovery in mental health based on quality of life as defined by reference to the values of the (...) person concerned rather than that of a generic professional ‘needs assessment’.1 2 Where the two theories diverge, too, Stenlund finds practically important consequences. Thus Nussbaum’s Capabilities Framework, as Stenlund indicates, is outcomes-oriented, while values-based practice focuses on process. The two approaches are not however thereby necessarily inconsistent. Drawing on early accounts of values-based practice, Stenlund suggests a degree of implicit blurring between it and Nussbaum’s capabilities. Here we need to be careful: values-based practice does not regard recovery as an outcome; it …. (shrink)

The world of mental health has become used to the notion of co-production as a good thing. While the paper is not a critical analysis of co-production, the authors make the case that while it is a good thing, it is not the only good thing; and it is neither sufficient, nor necessary for good things to happen in mental health services. Alternative concepts of progressive innovation in this field are introduced. Real world case studies (most of them previously unpublished) (...) are then worked through to test which concept(s) – co-production, or the alternatives, or neither – are the better fit, bearing in mind the complex relationships to be negotiated, not just between service users and mental health professionals, but between service users and members of other professions, and of the general public. Finally, the question is raised as to whether there is anything (such as the flattening of hierarchies or stigma reduction) which all these innovations – co-production and the alternatives – have in common. (shrink)