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  • Author or Editor: Jill Hemmington x
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This chapter asks the reader to consider communication needs at the point of decision making during statutory assessments. It focuses on participation of the person, framed here as shared decision making (SDM). Providing first the policy context and principles as to why this should happen, the chapter explores ways in which SDM can be supported for those who are deemed to have capacity, and also for those who may not. Discussing concepts such as insight and the use of jargon, the author explores the paternalism that can affect decision making, which in turn leads to a person not being meaningfully included in decisions made about them. Given the seriousness of the outcome of a Mental Health Act (MHA) assessment, such participation is key. It is argued that developing and enabling reciprocity is fundamental to SDM, and that the navigation of these boundaries is underpinned by attitudes, styles and skills. Concluding with a discussion of their own research, and developments such as Open Dialogue, the author looks ahead to the emerging shifts that may be seen in forthcoming changes suggested for mental health legislation in England and Wales.

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Boundaries, Frames and Perspectives

Designed to support training and CPD in compulsory mental health work, this book looks at assessment, detention, compulsion and coercion in a variety of mental health settings. It focuses on decision making in a variety of professional roles with people from a diversity of backgrounds including contributions from people with lived experience of mental health services. With emphasis on theory into practice, the book is essential reading for those looking to develop their reflexive and critical analytical skills.

Relevant for all professionals making decisions under mental health legislation and those developing, teaching and supporting practitioners in the workplace, it includes:

  • critical reflection techniques;

  • ‘editors’ voice’ features at the start and close of each chapter, summarising key themes.

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The opening chapter provides a rationale for the underlying themes around practice boundaries and introduces the reader to concepts such as framing, frame reflection and policy drama. These ideas have relevance for compulsory mental health work whereby outcomes are understood to be disproportionate, variable and subject to biases. Boundaries are usually subjective, representing rules (formal or informal), safety, or a theoretical, interpersonal, literal or metaphorical divide. There is a need to frame and deconstruct these binary approaches to look at different frames for critical reflection. It goes beyond viewing scenarios in terms of lawful or not lawful; ethical or not ethical; ill or healthy; powerful or powerless; medical or social; us or them; rational or irrational; health or social; mad or bad; self-determination or social control – all ideas that are ubiquitous within psychiatry. The chapter acknowledges boundary work as the different positions competing for authority in mental health. Yet differences that seem insoluble can sometimes be resolved pragmatically by ‘reframing’ the issues and understanding the taken-for-granted assumptions around policy, statements of fact and value judgements. The chapter advances Peattie’s ‘double vision’ – the ability to act from one perspective while being aware of other perspectives.

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This chapter revisits, synthesises and reconciles the ideas raised in the introductory chapter and throughout the book. It summarises how the different frames connect and reviews how to practice across boundaries, emphasising that there are alternatives to rigid thinking where there is seemingly no middle ground. Suggestion are made for ongoing professionalism and practice wisdom, in keeping with policy and statutory reforms.

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