Papers by Raffaella Pocobello
This work is licensed under a Creative Commons Attribution 4.0 International License.
Frontiers in Psychology
ObjectiveThis cross-sectional study investigates the characteristics and practices of mental heal... more ObjectiveThis cross-sectional study investigates the characteristics and practices of mental health care services implementing Open Dialogue (OD) globally.MethodsA structured questionnaire including a self-assessment scale to measure teams’ adherence to Open Dialogue principles was developed. Data were collected from OD teams in various countries. Confirmatory Composite Analysis was employed to assess the validity and reliability of the OD self-assessment measurement. Partial Least Square multiple regression analysis was used to explore characteristics and practices which represent facilitating and hindering factors in OD implementation.ResultsThe survey revealed steady growth in the number of OD services worldwide, with 142 teams across 24 countries by 2022, primarily located in Europe. Referrals predominantly came from general practitioners, hospitals, and self-referrals. A wide range of diagnostic profiles was treated with OD, with psychotic disorders being the most common. OD te...
Frontiers in Psychology
PurposeThe Open Dialogue (OD) approach has been implemented in different countries worldwide. OD ... more PurposeThe Open Dialogue (OD) approach has been implemented in different countries worldwide. OD not only depends on therapeutic principles but also requires a distinct set of structural changes that may impede its full implementation. In Germany, OD is currently practiced in different mental health care settings across the country. Yet, full implementation of OD principles is limited due to the extreme structural and financial fragmentation of the German mental health care system. With this as a background, the aim of this study was to investigate the efforts, challenges and obstacles of OD implementation in Germany.MethodsThis article presents the German results from the international HOPEnDIALOGUE survey, supplemented with expert interview data. Thirty eight teams currently providing OD took part in the survey. Sixteen expert interviews were carried out with stakeholders from various care settings. Survey data were analyzed descriptively and the qualitative data were evaluated us...
Open Dialogue for Psychosis, 2021
The co-produced Mental Health Center (MHC) decreased the percentage of hospitalizations by 63% co... more The co-produced Mental Health Center (MHC) decreased the percentage of hospitalizations by 63% compared to traditional services. • 39% of MCC users reported a reduction in or withdrawal from psychiatric medications against 22% of the comparison group. • Thematic analysis of focus group data identified six main differences between the MCC and traditional services: • Parity/respectful relationship versus Asymmetric relationships • Focus on participants strengths versus on the illness • Freedom versus Control • Psychological continuity versus Discontinuity • Social inclusion versus Segregation • Recovery versus Chronicity.
Journal of Psychiatric and Mental Health Nursing
International Journal of Mental Health Nursing, 2019
The Continuous Sensitivity Equation (CSE) method allows to quantify how changes in the input of a... more The Continuous Sensitivity Equation (CSE) method allows to quantify how changes in the input of a Partial Differential Equation (PDE) model affect the outputs, by solving additional PDEs obtained by differentiating the model. However, this method cannot be used directly in the framework of hyperbolic PDE systems with discontinuous solution, because it yields Dirac delta functions in the sensitivity solution at the location of state discontinuities. This difficulty is well known from theoretical viewpoint, but only a few works can be found in the literature regarding the possible numerical treatment. Therefore, we investigate in this study how classical numerical schemes for compressible Euler equations can be modified to account for shocks when computing the sensitivity solution. In particular, we propose the introduction of a source term, that allows to remove the spikes associated to the Dirac delta functions in the numerical solution. Numerical studies exhibit a strong impact of the numerical diffusion on the accuracy of this strategy. Therefore, we propose an anti-diffusive numerical scheme coupled with the approximate Riemann solver of Roe for the state problem. For the sensitivity problem, two different numerical schemes are implemented and compared: one which takes into account the contact wave and another that neglects it. The effects of the numerical diffusion on the convergence of the schemes with respect to the grid are discussed. Finally, an application to uncertainty propagation is investigated and the different numerical schemes are compared.
Frontiers in Sociology
In recent decades, the use of psychosocial and psychiatric care systems has increased worldwide. ... more In recent decades, the use of psychosocial and psychiatric care systems has increased worldwide. A recent article proposed the concept of psychiatrization as an explanatory framework, describing multiple processes responsible for the spread of psychiatric concepts and forms of treatment. This article aims to explore the potentials of the Open Dialogue (OD) approach for engaging in less psychiatrizing forms of psychosocial support. While OD may not be an all-encompassing solution to de-psychiatrization, this paper refers to previous research showing that OD has the potential to 1) limit the use of neuroleptics, 2), reduce the incidences of mental health problems and 3) decrease the use of psychiatric services. It substantiates these potentials to de-psychiatrize psychosocial support by exploring the OD’s internal logic, its use of language, its processes of meaning-making, its notion of professionalism, its promotion of dialogue and how OD is set up structurally. The conclusion touch...
Recovery represents a new paradigm in the field of mental health. It refers hereby less to the po... more Recovery represents a new paradigm in the field of mental health. It refers hereby less to the possibility of relief from symptoms than to the individual’s capacity to develop a meaningful life and a self-concept beyond the illness. Several countries adopted recovery oriented approaches to implement mental health service reforms and attracted considerable scientific interest on that subject matter. A comprehensive theory of the recovery process is however still missing. The present article argues for an analytic approach to the socio-cognitive components in the different stages of the subject’s recovery process. By the means of narratives from mental health patients, a dramatic loss of internal territoriality (“locus”) is evidenced in psychiatric treatment, whereby a subject in crisis renounces its internality to the professionals’ authority. The eventual process of a subject’s recovery, we suggest, has to be regarded as an inverse process, in which internality is privately and soci...
dipartimento per le politiche sociali del Comune di Roma, nell’ambito del Progetto di valutazione... more dipartimento per le politiche sociali del Comune di Roma, nell’ambito del Progetto di valutazione dei Centri diurni di salute mentale di Roma, svolto dall’ISTC-CNR
The Trieste mental health care model is the result of a process of change that took place in Ital... more The Trieste mental health care model is the result of a process of change that took place in Italy in the 1970s initiated by the psychiatrist Franco Basaglia. This change resulted in the closure of the psychiatric asylum and the creation of a network of 24- hour community-based services. To this day Trieste is regarded as an international reference in deinstitutionalization practice and is a World Health Organization (WHO) Collaborating Centre for Research and Training. To improve quality and good practice, the Trieste Mental Health Department is continually investing in innovative practices and strategies. One of the most recent examples has been the establishment of the Recovery House, a facility that fosters recovery processes and meaningful changes in the lives of young people who are already using mental health services. Objectives: This article explores the changes in the relationships of the group of young people who participated in the piloting of the Recovery House experien...
Therapeutic Communities: The International Journal of Therapeutic Communities
PurposeToo often people with complex mental health needs do not find their way out of the mental ... more PurposeToo often people with complex mental health needs do not find their way out of the mental health system or find satisfactory solutions that enable them to live a full life. In 2015 the Mental Health Department (MHD) of Trieste established the Recovery House pilot project to address this concern. The paper aims to Investigate the project.Design/methodology/approachThe Recovery House was co-created with and for people between 18 and 35 years old with diagnoses of psychosis and other complex mental health conditions. An integral part of the pilot was the organization of the “Recovery Community,” inspired by the Assembly model embraced by Franco Basaglia. The Recovery Community met regularly to both support and learn from the Recovery House and aimed to create a democratic and reflective space where power relationships, self-determination, responsibility and ownership by all the stakeholders, including family members, could be explored together.FindingsOver a period of 31 months,...
RIVISTA SPERIMENTALE DI FRENIATRIA
Theory & Psychology, 2017
This work aims to account for the complexity of pride, while also trying to clear some ambiguitie... more This work aims to account for the complexity of pride, while also trying to clear some ambiguities that in our view result from unwarranted assumptions about its two facets—“authentic” versus “hubristic” pride. We propose a model of pride in terms of its cognitive and motivational components; distinguish two kinds of pride proper: pride1, referring to achievement-based pride and pride2, concerning one’s stable qualities and dispositions; and identify the goals they are likely to elicit. We also argue that for pride to be felt, it is insufficient and even unnecessary that one’s self-evaluations should concern socially valued accomplishments. We suggest that hubris is distinguishable from both kinds of pride proper because, unlike the latter, it is qualified by the goal of superiority over others, and we consider its implications in terms of social attitudes. We also discuss whether hubris is a form of “false” pride.
Uploads
Papers by Raffaella Pocobello
a) preliminary assessment: conceptions of crisis and organizational issues;
b) Open Dialogue training for the professionals;
c) experimentation of OD and process evaluation;
d) outcomes evaluation, comparing two matched areas (test area vs control area).
In the preliminary assessment, we will use the multi-stakeholder approach- involving representatives of professionals, users and family members - to explore the various definitions and conceptions of “crisis”, the practices related to “crisis interventions” and how the voices of users and family members are taken into account.
In order to assess organizational issues, we will analyse the point of view of the professionals - through an open-ended questionnaire - and the heads of the seven MHD involved in project -through a semi-structured interview. We will focus on similarities and differences of their conception of OD, critical issues related to the implementation process of OD in the context of local services.
The findings of the preliminary assessment will be presented and discussed with representatives of professionals, users and family members and researchers in the context of an International Expert Round Table, which is scheduled for the 10th of July in Rome. We would like to share and discuss the results of the overall process in the present workshop.
The project started March 2015, involves eight Italian mental health departments from six different cities in Italy (Savona, Turin, Triest, Modena, Rome and Catania) and promotes the Open Dialogue Approach for the treatment of first psychiatric crises. The Italian National Research Council carries out the evaluation of the intervention, with three principal goals:
1. documenting professionals’ representations and comprehensions of the theoretic and methodological basics of the approach;
2. evaluation of the therapeutic short-term effectiveness for all the treated subjects (new patient) by the means of standardized tools. Patients treated with the open dialogue method will be compared with the outcome of patients treated with the current method of the MHD. The same instruments as those used by the Finnish colleagues will be used.
3. Investigating the point of view of the different stakeholders (users, family members and professionals) with respect to the OD experience. Specific attention will be given to changes in persons’ expectations and “crisis”-conceptions and experiences
Since 2015 May, a second recovery house experience take place in Trieste in the context of mental health services, in collaboration with IMHCN. It is a six month residential programme, where 6 users are expected to live together, planning their recovery but continuing working or studying activities outside the house. Professionals referring to mental health centers take charge of the patient even if another team of professionals is fully dedicated to the recovery house. Voice hearers group is available. Reduce medication is not a persuaded goal of the programme. The house in collocated in an urban context. Family members participate through meeting and is involved in psico- educational training.
Participatory observation and process evaluation was carried out as well outcomes evaluation (with assessment baseline, at the end of recovery house experience, every 6 months) was carried out by the National research council and is still ongoing. Parts of the results of the evaluation of both the experiences will be discussed.
After a short presentation on the current state of the art in the participating Italian mental health departments, we will address the experience of experts from the international community who are currently working towards the implementation of OD in their departments.
Ideally, a short document of recommendation may result, in which some of the best practices for the implementation of OD in a new territory are formulated.