ARCHIVES OF
PSYCHIATRIC NURSING December 1991
Vol. V. No. 6 EDITORIAL
On Partnerships
M
UCH ADO IS MADE in the mental health field of the importance of partnershipsamong the core disciplines, between mental health professions and consumers, between health services and social services, and between researchers and clinicians. How has the knowledge explosion in the past 25 years and the shift from social to biological psychiatry influenced our partnerships? Although the science of mental disease has advanced rapidly over the last quarter century, progress in the day-to-day management of the illness and in community programming has lagged behind. Herein is the stuff of innovative partnerships. Central to such partnerships is a different way of thinking about the consumer of our services. Recent scientific advances in schizophrenia, for instance, should lead to a different conceptualization of the role of the patient and family in the treatment of the disorder. Understanding the differences between positive and negative symptoms and the relative efficacy of drug therapy with positive, but not negative, symptoms should lead to new partnerships with patients as we try to devise other ways to control negative symptoms (e.g., self-regulation). In other words, we need to develop partnerships with patients that are more respectful of their knowledge of the manifestations of their illnesses and the effects of treatment. Those of us who are scientists or clinicians know little about community organization, politics, and legislation-all of which affect funding, policy, and the capacity to implement innovative
Archiues
of Psychiatric Nursing,
Vol. V, No. 6 (December), 1991:
rehabilitation programs in the community. We need to rely on partnerships with organized selfhelp and advocacy groups to lead the way if we hope to establish meaningful and productive alliances with community and neighborhood groups to implement successful job and housing programs. Further, we need to deepen our partnerships with our colleagues in social work and psychologydisciplines with long traditions in community organization, consultation, and knowledge of social systems. As to partnerships among the core disciplines, it is imperative that we avoid the pitfall of assuming that “he who controls the basic science dollar should automatically control all else. ” We must be clear about the difference between maintaining scientific and clinical infrastructures, and we must be more clear with each other about unique and overlapping contributions of the disciplines to improve patient care. As we get more sophisticated at identifying the biological differences between disease states, we will also need to get sophisticated at accommodating those differences in our treatment milieu. Nurses, for example, are prepared to “nurse” environments as well as individuals and should assume increasing autonomy, authority, and accountability for the design and maintenance of inpatient and day-treatment environments. The more we utilize our clinical units for research protocols, the greater the dialogue needs to be between scientists and clinicians among the disciplines.
pp. 321-322
321
JUDITH B. KRAUSS
322
Some may be thinking that this is an old message-that we all know the importance of partnerships. However, our partnerships have slipped over the past quarter century as we have ascended from the science of muddling through to the profound discoveries of neuroscience, as the dust of community control has settled and we returned to life as usual, and as we all became entrenched in the issues of our respective disciplines or causes. We actually face new challenges as the result of
the enormous progress over the past 25 years. We must find ways to integrate science and day-to-day care in our mental health facilities, balancing the quest for new discoveries with the need for humane and tolerant environments. And so, as we anticipate the dawn of a new century, we must remain vigilant to the renewed potential of partnerships .
Judith B. Krauss Editor
PSYCHIATRIC NURSING December 1991
Vol. V. No. 6 EDITORIAL
On Partnerships
M
UCH ADO IS MADE in the mental health field of the importance of partnershipsamong the core disciplines, between mental health professions and consumers, between health services and social services, and between researchers and clinicians. How has the knowledge explosion in the past 25 years and the shift from social to biological psychiatry influenced our partnerships? Although the science of mental disease has advanced rapidly over the last quarter century, progress in the day-to-day management of the illness and in community programming has lagged behind. Herein is the stuff of innovative partnerships. Central to such partnerships is a different way of thinking about the consumer of our services. Recent scientific advances in schizophrenia, for instance, should lead to a different conceptualization of the role of the patient and family in the treatment of the disorder. Understanding the differences between positive and negative symptoms and the relative efficacy of drug therapy with positive, but not negative, symptoms should lead to new partnerships with patients as we try to devise other ways to control negative symptoms (e.g., self-regulation). In other words, we need to develop partnerships with patients that are more respectful of their knowledge of the manifestations of their illnesses and the effects of treatment. Those of us who are scientists or clinicians know little about community organization, politics, and legislation-all of which affect funding, policy, and the capacity to implement innovative
Archiues
of Psychiatric Nursing,
Vol. V, No. 6 (December), 1991:
rehabilitation programs in the community. We need to rely on partnerships with organized selfhelp and advocacy groups to lead the way if we hope to establish meaningful and productive alliances with community and neighborhood groups to implement successful job and housing programs. Further, we need to deepen our partnerships with our colleagues in social work and psychologydisciplines with long traditions in community organization, consultation, and knowledge of social systems. As to partnerships among the core disciplines, it is imperative that we avoid the pitfall of assuming that “he who controls the basic science dollar should automatically control all else. ” We must be clear about the difference between maintaining scientific and clinical infrastructures, and we must be more clear with each other about unique and overlapping contributions of the disciplines to improve patient care. As we get more sophisticated at identifying the biological differences between disease states, we will also need to get sophisticated at accommodating those differences in our treatment milieu. Nurses, for example, are prepared to “nurse” environments as well as individuals and should assume increasing autonomy, authority, and accountability for the design and maintenance of inpatient and day-treatment environments. The more we utilize our clinical units for research protocols, the greater the dialogue needs to be between scientists and clinicians among the disciplines.
pp. 321-322
321
JUDITH B. KRAUSS
322
Some may be thinking that this is an old message-that we all know the importance of partnerships. However, our partnerships have slipped over the past quarter century as we have ascended from the science of muddling through to the profound discoveries of neuroscience, as the dust of community control has settled and we returned to life as usual, and as we all became entrenched in the issues of our respective disciplines or causes. We actually face new challenges as the result of
the enormous progress over the past 25 years. We must find ways to integrate science and day-to-day care in our mental health facilities, balancing the quest for new discoveries with the need for humane and tolerant environments. And so, as we anticipate the dawn of a new century, we must remain vigilant to the renewed potential of partnerships .
Judith B. Krauss Editor
