Finding Common Ground for Diverging Policies for Persons with Severe Mental Illness
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Finding Common Ground for Diverging Policies for Persons with Severe Mental Illness Phyllis Solomon 1 & Ryan Petros 2 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract
Two diametrically opposed positions predominate discourse for the care and treatment of persons with severe mental illness: anti-deinstitutionalization and anti-institutionalization. Both share the same goal of ensuring best quality of life for those with severe psychiatric disorders, but pathways to achieving this goal are very different and have resulted in much contention. Supporters of each position espouse a different belief system regarding people with psychiatric disorders and their presumed capabilities, placing varying emphasis on maximizing protection of the community versus protection of individual rights, and result in contrasting mental health policies and practice orientations. The authors delineate the history from which these positions evolved, consequent views, and policies and practices that emerged from these differing attitudes. The article culminates in a proposed practice approach that offers a more balanced approach to serving adults with mental illness –navigating risk management by preserving freedom and opportunities of risk while affording mutually satisfactory “risk control.” Keywords Recovery . Coercion . Severe mental illness . Risk management In the US and other countries such as the UK, Australia, and New Zealand, there are two prevailing policy positions being promoted for the care and treatment of persons with severe mental illness, specifically those diagnosed with schizophrenia spectrum disorders, major depression, and bipolar illnesses. While the two positions are dialectically in opposition to An earlier version of this was delivered at Annual Sidney Ball Memorial Lecture at Barnett House, University of Oxford in 2015 by the first author.
* Phyllis Solomon [email protected] Ryan Petros [email protected]
1
School of Social Policy & Practice, University of Pennsylvania, 3701 Locust Walk, Philadelphia, PA 19104, USA
2
School of Social Work, University of Washington, 4101 15th Ave NE, Seattle, WA 98105, USA
Psychiatric Quarterly
one another, their ultimate goal is the same: to ensure the best quality of life for people with severe psychiatric disorders. However, the pathways to reaching this goal are very different and, consequently, have resulted in much tension and contention, provoked by divergent approaches to navigating risk related to concerns about violence. On one side of the argument is what we are calling anti-deinstitutionalization, and on the other side is anti-institutionalization. Although both share an historical foundation, each espouses a different belief system regarding persons with severe mental illness, their presumed capabilities, and varying emphasis on maximizing protection of the community versus protection of individual rights. What results from these opposing positions are very different mental health policies and practice orientations. The authors wi
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