Workshop on Neil Armstrong’s 'Collaborative Ethnographic Working in Mental Health'
A workshop discussion on Neil Armstrong’s recent publication, Collaborative Ethnographic Working in Mental Health: Knowledge, Power and Hope in an Age of Bureaucratic Accountability, took place on Tuesday 23 January 2023, 2pm - 4pm in the seminar Room of the Radcliffe Humanities Building. The book attempts to use anthropological methods to produce knowledge that is useful to clinical research. It draws on a range of ethnographic styles and positions to argue that we need to think more about the impact of the institutional setting of mental healthcare. The book calls for interdisciplinary research into how healthcare is organised, rather than continuing largely unproductive research into interventions.
The workshop was intended to be an instance of the methods used in the book, in that the aim was to encourage dialogue and open discussion. Alongside Neil were four speakers, each with a different relationship with mental healthcare. Lamis Bayar is CEO of Mental Fight Club, a service user organisation that provides arts-based approaches to mental health. Kam Bhiu is a professor of psychiatry at Oxford with a longstanding interest in the biases and limitations of mental healthcare. Stephanie Hess is the Head of the Oxfordshire Recovery College, that provides coproduced education-based approaches to distress. David Mosse is a professor of anthropology at SOAS currently leading an ethnographic investigation into an attempt to introduce a new treatment philosophy, ‘Open Dialogue’, into NHS secondary mental healthcare.
Neil began by outlining the content of the book, presenting it as inspired by anger at both the quality of mental healthcare and the apparent inability of research to improve it. The solution, he suggested, lay in dialogue, both between different research disciplines and between researchers, clinicians and service users. Kam recognised the problems with mental healthcare discussed by the book, and suggested that, if anything, he was angrier than Neil. He suggested that judicious use of theory is required to make careful observation and individual stories legible to the wider research process. David explored a key contradiction made in the book between bureaucratic accountability and central aspects of care, such as respectful dialogue. The book calls for a reimaging of care in which responsibility is disentangled from care. David queried whether the two might be rebalanced rather than separated. Lamis spoke about ways that accountability and care might be disentangled, pointing to the experience of the organisation she heads, which runs events for service users in which the relationships between the organisation and those who attend is reconfigured. Stephanie drew parallels between the autoethnography chapter of the book, which contrasts Neil’s medical notes with a retelling of his distress using anthropological theory, and her own experiences at Oxford. She reflected on how mutable life narratives can be, and how they serve different, sometimes competing purposes, such as to facilitate interaction with the state, and promote personal recovery.
Following a brief cake interval, there was a lively Q & A session, in which all members of the panel addressed audience questions, and at times led to a wider audience conversation. Some attendees brought lived experience to bear on the arguments made in the book, and others posed conceptual questions, such as whether accountability might take different forms, and whether less bureaucratically dominated services might be scalable.
