Therapists' perceptions of out of session frame deviations.

This study explores the complex and relatively under-researched topic of out of session frame deviations. It considers the role of frame deviations in psychodynamic psychotherapy and the various conceptualisations of the frame, examining the debate between the ideas of a flexible and ‘elastic’ frame and a more unchanging and ‘impenetrable’ frame. The study uses a qualitative design to examine therapists’ understandings of out of session frame deviations as they have experienced them in practice. Six psychodynamic psychotherapists were interviewed and asked for their perceptions regarding out of session frame deviations. What emerged from the analysis of the interview material were diverse experiences of the types of frame deviations outside of the consulting room, by both therapist and patient. In addition, therapists felt that out of session frame deviations might have an impact on the therapeutic process, depending on their unconscious roots and on particular factors that were unique to the relationship. Therapists had strong countertransference reactions to out of session frame deviations and their handling of the deviations was often informed by these reactions. The handling of out of session frame deviations was also seen as specific to the relationship and, therefore, unique in each instance. Therapists’ perceptions of patient dynamics as they related to out of session frame deviations illustrated the varied functions that the deviations may serve and demonstrated that transference was sometimes prominent in the deviations. Therapists also emphasised the flexibility of the psychotherapy frame itself. The study illustrated that out of session frame deviations are important and relate significantly to the process of psychodynamic psychotherapy. They produce uncertainties and ambiguities for therapists in practice and should be examined closely rather than being overlooked

Involuntary mental health treatment in the era of the United Nations Convention on the Rights of Persons with Disabilities

The introduction of the United Nations (UN) Convention on the Rights of Persons with Disabilities (CRPD) and General Comment 1 on Article 12 (GC1) has generated considerable debate regarding the assertion that people with psychosocial disabilities (disabilities arising from mental health conditions) always possess decision-making capacity. While there is debate over the feasibility and acceptability of supported decision-making, stakeholders interviewed for this study suggested that coercive treatment is heavily overutilized and that there needs to be more dialogue between holders of divergent positions. There are a number of important unresolved questions relating to more complex cases and to whether the right guaranteed by the CRPD is absolute and immediate or subject to limitations. Ensuring participation of all key stakeholders is essential to realizing the pluralistic vision of the CRPD, as is research focusing on implementation of supported decision-making regimes, particularly in low- and middle-income countries. Training on the provisions of the CRPD is also needed to ensure implementation, and addressing stigmatized beliefs among policy makers about the decision-making and cognitive abilities of mental healthcare users (MHCUs) is critical.S1 Text. Methods.S1 Table. Sampling summary.http://www.plosmedicine.orgam2019Centre for Human Right

Establishing good practice for human rights-based approaches to mental health care and psychosocial support in Kenya

A human rights-based approach (HRBA) to health has long been seen as an important way in which to address public health needs in a manner that is equitable and conducive to social justice. Yet the actual content of an HRBA to health remains unspecific, and therefore implementation remains heterogeneous. This situation is even more challenging in the field of mental health, where human rights considerations are particularly complex and have emerged out of a history of myriad violations. Even when research has been conducted into mental health, it has focused predominantly on the Global North, raising questions of contextual and cultural relevance. Accordingly, this study examined the issue from the perspectives of stakeholders in Kenya who consider their work or the services they use to be rights based. It explored the key principles and interventions deemed to constitute an HRBA to mental health care and psychosocial support, the perceived benefits of such approaches, and the main barriers and supports relevant for implementation. The results produced seven key principles and corresponding interventions. Among other things, it highlighted the importance of economic well-being and self-efficacy, as well as the reduction of barriers to implementation, such as stigma and lack of adequate resourcing. Two key tensions were apparent—namely, the un/acceptability of coercion and the role of traditional and faithbased modalities in an HRBA to mental health care and psychosocial support.https://www.hhrjournal.orgpm2021Centre for Human Right

Mental health, human rights, and legal capacity

In September, 2021, our edited volume Mental Health, Human Rights and Legal Capacity was published. The book takes an interdisciplinary approach to engage with evolving debates related to legal capacity in the field of mental health care, documenting perspectives from legal scholars, practitioners, policy makers, advocates, and people with lived experience of mental health conditions from diverse regions worldwide. The volume is intended to stimulate a conversation. Its objective is to document good practices while also recognising that there remain considerable barriers to the implementation of non-coercive models of mental health support, as required by the 2006 UN Convention on the Rights of Persons with Disabilities (CRPD). Ultimately, our aim is to illustrate that ending coercion in mental health care is both necessary and possible, and that supported decision making in community-based mental health settings is the way of the future.http://www.thelancet.com/psychiatryhj2023Centre for Human Right

De-stigmatising psychosocial disability in South Africa

Stigma and associated discrimination against persons with psychosocial disabilities constitute a considerable barrier to the realisation of the highest attainable standard of health in South Africa, Africa, and further afield, constituting a significant human rights violation. This situation is evidenced and exacerbated by mental health as a whole remaining under-prioritised in law, policy and resource allocation. States parties to the Convention on the Rights of Persons with Disabilities (CRPD) have a duty to address stigma and discrimination through awareness raising and education. Some important commitments have been made in this respect, particularly at the policy level in South Africa. Nevertheless, and as demonstrated by tragic recent events, effective implementation remains lacking. This article lays out the obligations incumbent upon the South African government to address stigma and discrimination on the basis of psychosocial disability as a public health and human rights imperative by examining positive duties incorporated into international instruments and domestic law and policy. It further considers the role of political de-prioritisation of mental health and how this constitutes stigma of a systemic nature, using case law and examples of research and best practice from South Africa, Africa generally, and beyond. We conclude that South Africa is failing to meet its obligations to persons with psychosocial disabilities, and recommend that positive duties be emphasised in potential disability-specific legislation; high-level political commitment and co-ordination is secured for mental health; the CRPD’s independent monitoring requirement is urgently fulfilled; and contextually-relevant interventions are crafted with the active participation of persons with psychosocial disabilities and their representative organisations.http://www.adry.up.ac.zaam2018Centre for Human Right

Involuntary mental health treatment in the era of the United Nations Convention on the Rights of Persons with Disabilities.

Based on interviews with a variety of participants, Vikram Patel and colleagues advocate for philosophical and practical progress toward recognizing decision-making capacity in people with psychosocial disabilities

‘They love me, but they don’t understand me’ : family support and stigmatisation of mental health service users in Gujarat, India

BACKGROUND : Family life is a near-universal condition and a fundamental human right. It can also have a significant impact on mental health, including recovery from mental health conditions. In India, families play a considerable role, representing a source of social, cultural, religious and, often, financial support. However, families can also play a stigmatising role. AIM : To examine the experiences of mental health service users (MHSUs) relating to stigma and support provided by family members and to consider ways in which family support can be improved. METHOD : This is a qualitative study. A total of 17 residential MHSUs at the Ahmedabad Hospital for Mental Health were interviewed. The results were evaluated using thematic content analysis. RESULTS : The results revealed that all 17 MHSUs considered their families to be important sources of support, while 14 of the 17 MHSUs also experienced stigma emanating from their families. A total of 11 experienced lack of knowledge, 4 spoke of prejudicial attitudes and 5 mentioned discriminatory behaviours. There were important gender differences in experiences. MHSUs mentioned needs ranging from education and peer support for family members to financial support. CONCLUSIONS : Families act both as sources of support and stigmatisation. Education needs are considerable, while the need for peer support for families and resources to aid families in supporting people with mental health conditions are also important considerations.http://journals.sagepub.com/home/isphj2019Centre for Human Right

Establishing good practice for human rights-based approaches to mental health care and psychosocial support in Kenya

A human rights-based approach (HRBA) to health has long been seen as an important way in which to address public health needs in a manner that is equitable and conducive to social justice. Yet the actual content of an HRBA to health remains unspecific, and therefore implementation remains heterogeneous. This situation is even more challenging in the field of mental health, where human rights considerations are particularly complex and have emerged out of a history of myriad violations. Even when research has been conducted into mental health, it has focused predominantly on the Global North, raising questions of contextual and cultural relevance. Accordingly, this study examined the issue from the perspectives of stakeholders in Kenya who consider their work or the services they use to be rights based. It explored the key principles and interventions deemed to constitute an HRBA to mental health care and psychosocial support, the perceived benefits of such approaches, and the main barriers and supports relevant for implementation. The results produced seven key principles and corresponding interventions. Among other things, it highlighted the importance of economic well-being and self-efficacy, as well as the reduction of barriers to implementation, such as stigma and lack of adequate resourcing. Two key tensions were apparent—namely, the un/acceptability of coercion and the role of traditional and faithbased modalities in an HRBA to mental health care and psychosocial support