The complexity of mental healthcare and its consequences for doing good

Abstract

In recent decades we have tried to grasp the complexity of mental healthcare in terms of ‘to measure is to know’ (chapter 1). The questions of what a mental health problem is, what can we know about mental health problems and what should we do to remedy mental health problems were answered almost exclusively by the Newtonian paradigm with its reductionism and determinism (chapter 5). The question of “what may I hope”, disappeared into the background, as did a meaningful debate about good care. The classical understanding of science was supposed to make mental healthcare efficient, but is this true (chapter 12)? Mental healthcare and mental problems are rarely a stand–alone issue (chapters 6, 10) and for change, interventions are needed at various levels (chapter 7). Finding one’s way through the forest of rules and linear knowledge can be frustrating (chapters 9, 13). Mental healthcare shows characteristics of ”a wicked problem” that could not be satisfactorily answered with a lot of uniform scientific research, administrative agreements, care transitions and transformations (chapters 1, 4). Providing mental healthcare is complex and requires more than scientific knowledge of effectively proven treatment methods for well–defined mental disorders alone (chapter 8). Recovery cannot be limited to clinical recovery, it is so much more (chapters 8 and 13). Good care cannot be determined by just following the rules, there are too many rules and regulations. These rules are mostly linear and address a single aspect of the mental healthcare system. Good care is interconnected with the lives and personal needs of recovery (chapter 13) To change the current way of thinking, we need a new vocabulary to reconnect what is disjointed and compartmentalised, that respects diversity and learns us more about the interconnectedness and interdependencies. It is time for action (chapter 9). Using complexity sciences in mental healthcare research is needed. Thinking in terms of complex systems, strengthening the adaptive capacity, stimulating the learning abilities of an organization and obtaining insight into attractors and the factors that maintain an undesirable situation and contribute to a healthier dynamic, are all in accordance with this approach (chapter 11). Using the Cynafin Framework (chapters 6, 8, 9) offers handles. The mental healthcare sector is in motion now. What constitutes mental health is being formulated in broad terms, making the interconnectedness and interdependencies debatable. What we are able to know is being carefully considered, not only by those with lived experience and the self–direction and the recovery centres, but also by science. What we are supposed to do is currently being thought up, discussed and developed by an interdisciplinary community (chapter 11). What can we hope for is still in its infancy, but there is plenty to hope for. We hope for equal collaboration between all actors in the mental health ecosystem where the person with mental health issues can choose how to work on his/her recovery (chapter 15). Let us start today, filled with hope, by creating public space for (Hannah Arendt’s) action and deliberation.