145 Perspective matters in recovery Ingredients of collaboration for recovery Our analysis draws together three key elements of collaboration for recovery from severe mental illness in a triad: diverging perspectives, relational aspects of collaboration and process oriented practice. Firstly, we show how diverging perspectives between triad members, that are common in severe mental illness, not the least in psychosis, may challenge the experience of collaboration for recovery (or even recovery itself, since diverging perspectives may challenge connectedness, a central aspect of recovery). In this context, we note that our results show that framing mental difficulties as an illness may cause considerable tension within the triad, reflecting critique on organization of mental healthcare that is predominantly illness based (41, 42), and that building relationships, which takes time, is viewed as an essential entrance to collaboration, when finding common ground on problem definition is a challenge. Secondly, the respondents in our study from all perspectives emphasized how discontinuity of (professional) care and relationships may challenge building relationships, both as a goal in itself and as a means to effective collaboration. We draw on Muusse et al., who studied care practices in Dutch long-term mental healthcare, to note that the healthcare system context in which our study took place primarily orders care around patient/individual centered case conceptualization, time- and objective bound treatment trajectories, instead of building lasting relationships, which results in discontinuity of professional care (38). Muusse et al. argue that the matter of what “good care” is, is not resolved on a level playing field, as the medical, juridical, and bureaucratic perspectives on “good care” reinforce each other, suppressing the relational perspective. The latter is present still, but may need more explicit legitimation in the Dutch long-term mental healthcare for severe mental illnesses. This may extend to systems with a comparable ordering (43). Without this legitimation, team members may feel unsure if a relational approach to care is indeed “good care” or “part of their job”. Implementing treatment paradigms that prioritize relational practice indeed have faced organizational challenges, both at the health system and health service level (44, 45). Thirdly, our results foreground the importance of process oriented practice, that is, taking time to make explicit every party’s take on what is going on, and expectations on goals, roles and agency (e.g. who needs what, who can decide). This re-emphasizes the views on care planning of service users and family: it is not the derivation of a care plan that matters most to them, but the quality of the process that leads to it (46). Models that describe ways to process oriented practice already exist: we point to shared decision making and systemic practices geared at severe mental illness (47-50). Our results highlight aspects of the process specifically important to recovery-oriented long-term mental healthcare for persons with severe mental illness, where perspectives often diverge: to make explicit in which role(s) parties 7
RkJQdWJsaXNoZXIy MTk4NDMw