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What leads to innovation in mental healthcare? Reflections on clinical expertise in a bureaucratic age

  • Neil Armstrong (a1)
Summary

This paper considers a witness seminar in which healthcare professionals discussed working on an acute admissions ward run along therapeutic community lines from the 1960s to the 1980s. Participants remarked that older styles of working are ‘unimaginable’ today. This paper discusses why. Literature from the humanities and social sciences suggest healthcare is reactive, reflecting wider cultural changes, including a preference for a more bureaucratic, standardised, explicit style of reasoning and a high valuation of personal autonomy. Such a reflection prompts questions about the nature of professional expertise, the role of evidence and the importance of the humanities and social sciences.

Declaration of interest

None.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Correspondence to Neil Armstrong (neil.armstrong@anthro.ox.ac.uk)
References
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1Thornicroft, G, Rose, D, Kassam, A, Sartorius, N. Stigma: ignorance, prejudice or discrimination? Br J Psychiatry 2007; 190(3): 192–3.
2Spitzer, RL. The diagnostic status of homosexuality in DSM-III: a reformulation of the issues. Am J Psychiatry 1981; 138(2): 210–5.
3Davies, J. Cracked: Why Psychiatry is Doing More Harm than Good: 14–5. Icon Books, 2014.
4Atran, S. Cognitive Foundations of Natural History: Towards an Anthropology of Science: 269. Cambridge University Press, 1990.
5Beck, U. Risk Society: Towards a New Modernity. Sage, 1992.
6Giddens, A. Modernity and Self-Identity: Self and Society in the Late Modern Age. Polity, 1991.
7Porter, TM. Trust in Numbers: The Pursuit of Objectivity in Science and Public Life. Princeton University Press, 1995.
8Graeber, D. The Utopia of Rules: On Technology, Stupidity, and the Secret Joys of Bureaucracy. Melville House, 2015.
9Harrison, S. Street-level bureaucracy and professionalism in health services. In Understanding Street-Level Bureaucracy (eds Hupe, P, Hill, M, Buffat, A): 6178. Oxford University Press, 2016.
10Turner, J, Hayward, R, Angel, K, Fulford, B, Hall, J, Millard, C, et al. The history of mental health services in modern England: practitioner memories and the direction of future research. Med Hist 2015; 59(04): 615.
11Grimley Evans, J. East goes West. Ginkgo biloba and dementia. In Plants, Health and Healing (eds Hsu, E, Harris, S): 229–61. Berghahn, 2010.
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BJPsych Bulletin
  • ISSN: 2056-4694
  • EISSN: 2056-4708
  • URL: /core/journals/bjpsych-bulletin
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What leads to innovation in mental healthcare? Reflections on clinical expertise in a bureaucratic age

  • Neil Armstrong (a1)
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