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Systemic thinking and values-based practice

  • Gwen Adshead

Values-based practice is a new approach to working with complex and conflicting values in mental health practice. Theoretically, it argues that many clinical and ethical dilemmas in psychiatry arise because of the different value perspectives taken by the players involved. By exploring the differences in value systems ‘held’ by each player, it may be possible to come to a richer consensus that can incorporate both similarities and differences. In particular, values-based practice suggests that, traditionally, the value perspective of the patient is often either not considered or is ignored, and that by giving it voice, clinical practice will become more patient-centred. In this article, I will compare values-based practice with other types of systemic thinking in mental healthcare and I will discuss some areas of clinical practice where values-based practice may be difficult to apply.

Corresponding author
Dr Gwen Adshead, Admin Building, Broadmoor Hospital, Crowthorne, Berkshire RG45 7EG, UK. Email:
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Adshead, G (2000) Care or custody? Ethical dilemmas in forensic psychiatry. Journal of Medical Ethics; 26: 302–4.
American Psychiatric Association (1989) Principles of Medical Ethics with Annotations Especially Applicable to Forensic Psychiatry. American Psychiatric Press.
Balint, M (1957) The Doctor, His Patient and the Illness. Tavistock Press.
Bateson, G (1973) Steps Toward Ecology of Kind. Paladin.
Benthall, RP (1992) A proposal to classify happiness as a psychiatric disorder. Journal of Medical Ethics; 18: 94–8.
Bowlby, J (1988) The Secure Base. Routledge.
Bracken, PJ, Thomas, P (2001) Post psychiatry. A new direction for mental health. BMJ; 322: 724–7.
Bronowski, J (1956) Science and Human Values. Messner.
Byrne, P (2000) Stigma of mental illness and ways of diminishing it. Advances in Psychiatric Treatment; 6: 6572.
Department of Health (2005) New Ways of Working for Psychiatrists. Enhancing Effective, Person-Centred Services through New Ways of Working in Multidisciplinary and Multi-agency Contexts. Executive Summary of the Final Report ‘But Not the End of the Story’. Department of Health.
Fish, D, Coles, C (1998) Developing Professional Judgement in Health Care. Elsevier.
Fulford, KWM (1989) Moral Theory and Medical Practice. Cambridge University Press.
Garland, C (1982) Group analysis. Taking the non-problem seriously. Group Analysis; 15: 414.
General Medical Council (2006) Good Medical Practice (3rd edn). General Medical Council.
Glover, J (2003) Tanner Lectures 2003. Lecture 2. Identity. University of Princeton.
Goffman, E (1963) Stigma. Notes on the Management of Spoiled Identity. Prentice Hall.
Hobson, RF (1988) Forms of Feeling. The Heart of Psychotherapy. Routledge.
Holmes, J (1998) Psychodynamics, narrative and ‘intentional causality’. British Journal of Psychiatry; 173: 279–80.
Kleinman, A (1988) The Illness Narratives. Suffering, Healing and the Human Condition. Basic Books.
Mitchison, S (2007) Next year in Jerusalem: psychotherapy training for tomorrow's consultants. Advances in Psychiatric Treatment; 13: 276–83.
Mizen, S (2007) This year in a school of psychiatry near you: psychotherapy training within the new curriculum. Advances in Psychiatric Treatment; 13: 284–90.
National Institute for Mental Health in England, Sainsbury Centre for Mental Health, National Health Service University (2004) The Ten Essential Shared Capabilities. A Framework for the Whole of the Mental Health Workforce. NIMHE, Sainsbury Centre for Mental Health & NHSU.
Oswald, A (1997) Happiness and economic performance. Economic Journal; 107: 1815–31.
Royal College of Psychiatrists (2009) Good Psychiatric Practice (3rd edn) (College Report CR154). Royal College of Psychiatrists.
Sarkar, SP (2004) Boundary violation and sexual exploitation in psychiatry and psychotherapy. A review. Advances in Psychiatric Treatment; 10: 312–20.
Sarkar, SP, Adshead, G (2003) Protecting altruism. A call for a code of ethics in British psychiatry. British Journal of Psychiatry; 183: 95–7.
Seligman, MEP (2002) Authentic Happiness. Simon & Schuster.
Steinberg, B, Bloch, S, Riley, G, et al (2000) Revising the code of ethics for Royal Australian and New Zealand College of Psychiatrists: process and outcome. Australasian Psychiatry; 8: 105–9.
Surowiecki, J (2004) The Wisdom of Crowds. Doubleday.
Tan, J, Stewart, A, Fitzpatrick, R et al (2006) Competence to make treatment decisions in anorexia nervosa. Philosophy, Psychiatry and Psychology; 13: 267–86.
Toombs, SK (1992) The Meaning of Illness. A Phenomenological Account of the Different Perspectives of Physician and Patient (Philosophy and Medicine. Vol. 42). Kluwer Academic Publishing.
Vaillant, G (1995) The Wisdom of the Ego: Sources of Resilience in Adult Life. Harvard University Press.
Wittgenstein, L (1953) Philosophical Investigations (trans GEM Anscombe). Blackwell.
Woodbridge, K, Fulford, KWM (2004) Whose Values? A Workbook for Values-Based Practice in Mental Health Care. Sainsbury Centre for Mental Health.
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BJPsych Advances
  • ISSN: 1355-5146
  • EISSN: 1472-1481
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Systemic thinking and values-based practice

  • Gwen Adshead
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