De stem van de patiënt in de psychiatrie: niet gehoord, cocreatie, coöptatie of parallelle organisatie?

Abstract

BACKGROUND: A key ethical issue in psychiatry concerns the relationship with patients. A central dilemma is that experiential knowledge (regarding existential recovery) and professional knowledge (the framework of specific-medication-for-specific-brain-disorder) are not easily integrated into a practice of co-creation. AIM: To describe the status quo in health care and science. METHOD: Qualitative review. RESULTS: Under the influence of critical psychiatry ('antipsychiatry'), the recovery movement, the voice hearing movement and open science, the patient voice has gained influence while the scientific framework of academic psychiatry/psychology is critically re-examined. Co-creation in mental health services is limited whilst parallel development is more successful. For example, experience-based recovery academies are developing primarily in the domain of social care whilst evidence-based specialist treatment remains the norm in mental health services. There is, however, a growing call for co-creation around recovery-oriented work in the mental health sector, despite limited institutional readiness. There is also a growing movement of user research responding to epistemic injustice and driving patient-driven innovations - although sometimes on the basis of appropriation without source awareness. CONCLUSION: Experiential knowledge is growing as the theoretical framework of psychiatry is in the process of change. This creates the conditions for co-creation of a new values-driven psychiatry.