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      “¿En qué puedo ayudarle?”. Entre la solución individual tecnológica y la metaperspectiva sociopolítica Translated title: “How can I help you?” Between the individual technological solution and the socio-political meta-perspective

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          Abstract

          Resumen: En este artículo se expone el condicionamiento sociocultural y político de la demanda (en forma y cantidad) y de la respuesta clínica individual que ofrecemos habitualmente. Se plantea una metaperspectiva sociopolítica que da cuenta del papel de los servicios de salud mental en la sociedad actual marcada por las políticas neoliberales. Se reflexiona sobre el daño que provoca el solucionismo individual y cómo reducirlo. Se hace hincapié en la necesidad de que los profesionales en formación aprendan sobre los sesgos, limitaciones y daños de la atención en salud mental, sobre prevención cuaternaria y su práctica, como la indicación de no-tratamiento.

          Translated abstract

          Abstract: The socio-cultural and political conditioning of the demand (in form and quantity) and of the individual clinical response we usually offer is exposed in this article. A socio-political meta-perspective is put forward to account for the role of mental health services in today’s society marked by neoliberal policies. It reflects on the harm caused by individual solutionism and how to reduce it. Emphasis is placed on the need for professionals in training to be aware of the biases, limitations, and harms of mental health care, on quaternary prevention and its practice, such as the indication for non-treatment.

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          Most cited references27

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          The need for a new medical model: a challenge for biomedicine

          G. Engel (1977)
          The dominant model of disease today is biomedical, and it leaves no room within tis framework for the social, psychological, and behavioral dimensions of illness. A biopsychosocial model is proposed that provides a blueprint for research, a framework for teaching, and a design for action in the real world of health care.
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            Psychological Treatments That Cause Harm.

            The phrase primum non nocere ("first, do no harm") is a well-accepted credo of the medical and mental health professions. Although emerging data indicate that several psychological treatments may produce harm in significant numbers of individuals, psychologists have until recently paid little attention to the problem of hazardous treatments. I critically evaluate and update earlier conclusions regarding deterioration effects in psychotherapy, outline methodological obstacles standing in the way of identifying potentially harmful therapies (PHTs), provide a provisional list of PHTs, discuss the implications of PHTs for clinical science and practice, and delineate fruitful areas for further research on PHTs. A heightened emphasis on PHTs should narrow the scientist-practitioner gap and safeguard mental health consumers against harm. Moreover, the literature on PHTs may provide insight into underlying mechanisms of change that cut across many domains of psychotherapy. The field of psychology should prioritize its efforts toward identifying PHTs and place greater emphasis on potentially dangerous than on empirically supported therapies.
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              A paradigm shift: relationships in trauma-informed mental health services

              SUMMARY Trauma-informed approaches emerged partly in response to research demonstrating that trauma is widespread across society, that it is highly correlated with mental health and that this is a costly public health issue. The fundamental shift in providing support using a trauma-informed approach is to move from thinking ‘What is wrong with you?’ to considering ‘What happened to you?’. This article, authored by trauma survivors and service providers, describes trauma-informed approaches to mental healthcare, why they are needed and how barriers can be overcome so that they can be implemented as an organisational change process. It also describes how past trauma can be understood as the cause of mental distress for many service users, how service users can be retraumatised by ‘trauma-uninformed’ staff and how staff can experience vicariously the service user's trauma and can themselves be traumatised by practices such as restraint and seclusion. Trauma-informed mental healthcare offers opportunities to improve service users' experiences, improve working environments for staff, increase job satisfaction and reduce stress levels by improving the relationships between staff and patients through greater understanding, respect and trust. LEARNING OBJECTIVES • Appreciate broad-based definitions of trauma • Gain an understanding of what trauma-informed approaches are and why they have emerged, including the potential for (re)traumatisation in the mental health system • Consider how to practise trauma-informed approaches, including in ‘trauma-uninformed’ organisations, and the potential barriers to and opportunities from doing so DECLARATION OF INTEREST A. S. is funded by a National Institute for Health Research (NIHR) Post-Doctoral Fellowship. This article presents independent research partially funded by the NIHR. The views expressed are those of the authors and not necessarily those of the National Health Service, the NIHR or the Department of Health.
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                Author and article information

                Journal
                neuropsiq
                Revista de la Asociación Española de Neuropsiquiatría
                Rev. Asoc. Esp. Neuropsiq.
                Asociación Española de Neuropsiquiatría (Madrid, Madrid, Spain )
                0211-5735
                2340-2733
                June 2022
                : 42
                : 141
                : 17-30
                Affiliations
                [1] Madrid orgnameHospital Universitario La Paz orgdiv1Hospital de Día de Salud Mental Carlos III España
                Article
                S0211-57352022000100017 S0211-5735(22)04214100017
                10.4321/s0211-57352022000100002
                2853db59-075d-47af-a0e3-ec7e49a0cd1f

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 International License.

                History
                : 07 April 2022
                : 09 October 2021
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 27, Pages: 14
                Product

                SciELO Spain

                Categories
                Artículos

                demanda,indication for non-treatment,quaternary prevention,iatrogenia,socio-political meta-perspective,clinical response,demand,indicación de no-tratamiento,prevención cuaternaria,metaperspectiva sociopolítica,respuesta clínica

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