Psychiatric Chart Documentation and Systemic Oppression in Mental Health Care

About the workshop

The Psychiatric Chart Documentation and Systemic Oppression in Mental Health Care workshop offers a 3-hour interactive experience during which current and aspiring mental health care professionals can explore the integration of social justice-based theory with clinical documentation practices. 

The workshop draws on cutting-edge chart documentation theory and practice that emerged from a study that analyzed 161 psychiatric in-patient charts for the ways that race, Indigeneity, gender, sexuality, class, and disability, among other sites of difference, were documented by social workers, nurses, and psychiatrists. Workshop participants will explore how dominant worldviews and their own social locations inform their chart documentation practices and how charting practices can both support and challenge the structural power dynamics that dis/empower service users. The workshop will support students and professionals to use critical documentation practice as a strategy towards revealing and resisting the pathologization of everyday life and the dehumanization of service users. Participants will be guided through solo and group exercises, working together to explore the various implications of documentation for service users and reimagine documentation through a social justice lens. Participants should note that difficult topics will be explored, including coercive treatment and examples of systemic violence (e.g. gender-based violence, transphobia, and racism).

While the workshop draws on documentation theory and practice based on an analysis of psychiatric in-patient charts specifically, the key ideas and skills related to critical documentation are transferable across sites of mental health care. The workshop is the outcome of a project funded by the Social Sciences and Humanities Research Council of Canada (SSHRC) called Social Justice Praxis and Clinical Chart Documentation in Mental Health Care and is based on findings from a SSHRC-funded project entitled Cultural Representations of Gender in Psychiatric Narratives. More information about study findings can be found in the books linked below.

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Interrogating Psychiatric Narratives of Madness: Documented Lives
Edited by Andrea Daley & Merrick D. Pilling

This book challenges the perception of the psychiatric chart as a neutral and objective text. The chapters included in this book coalesce to reveal the psychiatric chart as a text that is, in fact, “storied” by institutional ideology that reflects, reinforces, reinterprets, and, at times, resists gendered, raced, sexualized, and classed norms, values, and presuppositions. Intersectional analysis highlights the nuanced ways in which dominant ideologies are activated in chart documentation to produce qualitatively specific psychiatric narratives of distress and related responses in the psychiatric institution. The book serves as a much-needed resource for mental health professionals, education and training programs, and researchers that meaningfully takes into account the social and structural materiality of people’s lives and its impact on experiences of distress. It will also appeal to scholars investigating equity in health care across the fields of Critical Psychology, Disability Studies, Social Work, Allied Health, Mad Studies and Social Justice.

Queer and Trans Madness: Struggles for Social Justice
By Merrick D. Pilling

This book urges those invested in social justice for 2SLGBTQ people to interrogate the biomedical model of mental illness beyond the diagnoses that specifically target gender and sexual dissidence. In this first comprehensive application of Mad Studies to queer and trans experiences of mental distress, Pilling advances a broad critique of the biomedical model of mental illness as it pertains to 2SLGBTQ people, arguing that Mad Studies is especially amenable to making sense of queer and trans madness. Based on empirical data from two qualitative research studies, this book includes analyses of inpatient chart documentation from a psychiatric hospital and interviews with those who have experienced distress. Using an intersectional lens, Pilling critically examines what constitutes mental health treatment and the impacts of medical strategies on mad queer and trans people. Ultimately, Queer and Trans Madness: Struggles for Social Justice explores the emancipatory promise of queer and trans madness, advocating for more resources to respond to crisis and distress in ways that are non-coercive, non-carceral, and honour autonomy as well as interdependence within 2SLGBTQ communities.