Open Dialogue in Spain: an initial survey of knowledge and perspectives.

In Spain, the introduction of the Open Dialogue framework is relatively recent. This study takes a closer look at Open Dialogue training, interest and research in this region. To this end, a survey has been conducted through a convenience sample of professionals, people with their own experiences in mental health, family members, relatives, university professors and students. The results showed that a significant number of participants had no training in OD, and their exposure to relevant literature and congress attendance was limited. Amongst the different profiles, professionals reported the highest level of training. These findings highlight the urgent need for further research and training initiatives to improve the understanding and application of the OD framework in Spain. Efforts should be directed towards broadening the knowledge base, increasing access to training programmes and fostering interest amongst different stakeholders. By addressing these gaps, the implementation and use of OD can be expanded to meet the growing demand and interest in this approach in the Spanish context.

La condición del diálogo. Saberes profanos y nuevos contextos del decir / Conditions for dialogue: lay knowledge and new speech contexts

A la luz del amplio crecimiento de colectivos, entidades y federaciones que se definen como "en primera persona", la intención aquí es problematizar la cuestión de los llamados saberes profanos, su contexto y sus circunstancias de expresión y desarrollo, así como los obstáculos y dificultades a la hora de adquirir un estatus socialmente legitimado. Cuando hablamos de saberes profanos, hacemos referencia a aquel conocimiento y elaboración conceptual que deriva de la experiencia subjetiva del sufrimiento psíquico/emocional/social. Un saber que frecuentemente corre el riesgo de ser un "punto ciego" para la mirada experta, pero que, de diversas maneras, actúa y emerge como elemento constitutivo de las estrategias de supervivencia y autoatención en los sujetos de la locura. Un saber que busca ser reconocido, acogido, y que se presenta como un elemento clave a la hora de habilitar las condiciones del diálogo en el ámbito de la reflexión sobre el sufrimiento y la construcción de los itinerarios hacia un mejor estar

In light of the broad growth of collectives, entities and federations that are defined as "in the first person", the intention here is to problematize the question of the so-called profane or lay knowledge, its contexts and circumstances of expression and development, as well as its obstacles and difficulties to acquire a socially legitimized status. When we talk about profane knowledge, we refer to that conceptual elaboration that derives from the subjective experience of the psychic/emotional/social suffering. This knowledge frequently runs the risk of being a "blind spot" for the expert look, but, in various ways, acts and emerges as a constitutive element of survival strategies and self-care in the subjects of the so-called madness. This knowledge seeks to be accepted, recognized, and is presented as a key element when it comes to enabling the conditions of dialogue in the field of reflection on suffering and the construction of itineraries towards better living

E se nós fossemos Jacques Rivière? / What if we were Jacques Rivière? / ¿Y si fuésemos Jacques Rivière?

A relação epistolar entre Antonin Artaud e seu editor, Jacques Rivière, sugere neste artigo a possibilidade de uma outra maneira de se relacionar com a chamada loucura. Propõe uma visão que permite um freio para a patologização constante das identidades sociais no campo da saúde mental. Para Rivière, Artaud era antes poeta do que louco; escritor antes que sujeito da loucura, e a partir daí o interpela, o acompanha. O editor aparece, então, como um tipo de gentil provocador, um hipocrático literário, um gerador de novos contextos de possibilidades, de canais para o fluir criativo de Artaud. E foi precisamente esse fluir acompanhado, o que mais tarde permitiria ao poeta francés, conseguir uma relativa recuperação. O artigo é apresentado como um breve ensaio teórico a partir do qual propõe a possível exploração de outras formas de se relacionar com a questão do sofrimento psíquico e da saúde mental. (AU)

We posit in this article that the epistolary relationship between Antonin Artaud and his publisher, Jacques Rivière, suggests the possibility of another way of relating to so-called madness. It proposes a view that enables a halt to the ceaseless pathologization of social identities in the field of mental health. For Rivière, Artaud was a poet rather than a madman, a writer rather than a subject of madness, and with that outlook he challenges him and attends to him. The publisher emerges as a gentle provocateur, a literary Hippocrates, an instigator of new contexts of possibilities for Artaud's creative flow. And it is precisely this ministered attention to flow which would later allow the poet to effectuate a certain recovery. The article is a brief theoretical essay which seeks to propose the possibilities of exploring other ways of linking with and relating to the question of psychic suffering and mental health. (AU)

La relación epistolar entre Antonin Artaud y quien fuera su editor, Jacques Rivière, nos sugiere en este artículo la posibilidad de una otra manera de vincularse con la denominada locura. Nos propone una mirada que habilita un freno a la constante patologización de las identidades sociales en el campo de la salud mental. Para Rivière, Artaud era antes poeta que loco; escritor que sujeto del trastorno, y desde allí lo interpela, lo acompaña. El editor aparece como una suerte de amable provocador, un hipocrático literario, generador de nuevos contextos de posibilidades para el fluir creativo de Artaud. Y fue precisamente ese fluir acompañado lo que le permitiría más tarde al poeta alcanzar una cierta recuperación. El artículo se presenta como un breve ensayo teórico desde donde proponer la exploración posible de otras maneras de relacionarse con la cuestión del sufrimiento psíquico y la salud mental. (AU)

[Less well-established forms of knowledge: new positionings in the field of collective mental health]. / Un saber menos dado: nuevos posicionamientos en el campo de la salud mental colectiva.

Collective health is a paradigm with a long history in Latin America. Similarly, collective mental health has had an interesting development in certain Latin American countries, even acting to stimulate psychiatric reform. However, both paradigms appear to be encapsulated in specific times and places, among other reasons because of a hegemonic global-scale epistemology that, by imposing a naturalized model of truth, denies other forms of knowledge the opportunity to question not only already-established disease categories, treatment protocols and health policies, but the established order itself. In this article, we reflect on the power of ethnography, as both a form of knowledge and a social relation in itself, to broaden the space available for a possible field of collective health in a context where it is still incipient: Europe. The ethnographic point of view allows us to rethink that which is already accepted, creating permeability in entrenched practices and opening up surprising new possibilities.

Un saber menos dado: nuevos posicionamientos en el campo de la salud mental colectiva / Less well-established forms of knowledge: new positionings in the field of collective mental health

RESUMEN La salud colectiva es ya un paradigma de largo recorrido en América Latina. La salud mental colectiva, por su parte, ha tenido un desarrollo relevante en algunos países latinoamericanos, e incluso ha actuado como estímulo para la reforma psiquiátrica en estos países. Sin embargo, ambas aparecen encapsuladas en un tiempo y territorio, entre otras cosas, por la hegemonía de una epistemología-mundo que, mientras ha impuesto un modelo naturalizado de verdad, ha negado la posibilidad de que otros saberes discutan sobre aquello ya ordenado (nosologías, protocolos, políticas, etc.), y menos aún sobre el propio ordenamiento. En este artículo reflexionamos sobre el poder de la etnografía, en tanto forma de conocimiento y relación social en sí misma, para ensanchar los espacios para una salud colectiva posible en un contexto donde aún es incipiente: Europa. La idea es que el punto de vista etnográfico facilita repensar lo ya dado, creando permeabilidad en las prácticas ya sedimentadas, así como nuevas ventanas de asombro.

ABSTRACT Collective health is a paradigm with a long history in Latin America. Similarly, collective mental health has had an interesting development in certain Latin American countries, even acting to stimulate psychiatric reform. However, both paradigms appear to be encapsulated in specific times and places, among other reasons because of a hegemonic global-scale epistemology that, by imposing a naturalized model of truth, denies other forms of knowledge the opportunity to question not only already-established disease categories, treatment protocols and health policies, but the established order itself. In this article, we reflect on the power of ethnography, as both a form of knowledge and a social relation in itself, to broaden the space available for a possible field of collective health in a context where it is still incipient: Europe. The ethnographic point of view allows us to rethink that which is already accepted, creating permeability in entrenched practices and opening up surprising new possibilities.

Self-care strategies for emotional distress among young adults in Catalonia: a qualitative study.

BACKGROUND: Emotional distress is common in adolescence, and self-care strategies are frequently preferred to address it. The aim of this article is to analyze the self-care strategies among adolescents and young people diagnosed with depression or with self-perceived depressive distress in Catalonia using a qualitative design. METHODS: We analyzed the self-care strategies of 105 young people (17-21 years of age) in Catalonia who had participated in a national survey on adolescents. The sample was divided into thirds, with 37 who had a previous diagnosis of depression, 33 who had self-perceived emotional distress, and 35 controls. The participants' narratives on self-care strategies for emotional distress were elicited through in-depth semi-structured interviews. The data were managed using ATLAS-Ti 6.5 software18. We applied hermeneutic theory and the ethnographic method to analyze the interviews. RESULTS: The ten self-care strategies identified in the analysis were grouped into four areas covering the various pathways the young people followed according to whether they had a diagnosis of depression or their depressive distress was self-perceived. The young people feel responsible for their emotional distress and consider that they are capable of resolving it through their own resources. Their strategies ranged from their individuality to sociability expressed through their relationships with others, membership of groups or other self-care strategies (relaxation, meditation, naturopathy, etc.). CONCLUSIONS: The study results highlight the importance of sensitivity in considering young people's self-care strategies as another option in the care of emotional distress.

Non-professional-help-seeking among young people with depression: a qualitative study.

BACKGROUND: Adolescents and young adults often suffer from depression, but tend to avoid seeking professional help. The aim of this study was to explore the reasons for non-professional-help-seeking in a sample of young adults resident in Catalonia with depressive symptoms through a qualitative study. In addition, the subjects were invited to offer their recommendations for making mental health care services more accessible. METHODS: We recruited 105 young persons (17-21 years of age) who had participated in a national survey on adolescents. The sample was divided into thirds, with 37 who had a previous diagnosis of depression, 33 who had self-perceived emotional distress, and 35 controls. The participants were interviewed in depth about their reasons for avoiding professional mental health care services, and the interview results were analyzed using both qualitative and cultural domain techniques and corroborated through comparison with the results of three focus groups. RESULTS: Participants' reasons for avoidance varied both by gender and according to prior experience with health services. Male study participants and female controls mainly understood depressive symptoms as normal and therefore not requiring treatment. Female participants with self-perceived distress were more likely to cite problems of access to treatment and fear of speaking to an unknown person about their problems. Females with a diagnosis expressed lack of trust in the benefits of treatment and fear of the social consequences of help-seeking. In their recommendations for best practices, the study participants suggested educational initiatives, as well as changes in the organization of mental health care services. CONCLUSIONS: A better understanding of the views of young people and a greater effort to involve them as active participants is important for facilitating help-seeking in this age group, and for adapting mental health care services to adolescent users and their social context.

[Smoking as a form of self-medication for depression or anxiety in young adults: results of a mixed-methods study]. / El consumo de tabaco como automedicación de depresión/ansiedad entre los jóvenes: resultados de un estudio con método mixto.

Tobacco use and mental health problems in the depression/anxiety spectrum often begin in adolescence as co-occurring phenomena. Epidemiologically, the relationship between them is bidirectional, but in the case of young people it appears to be explained best by the unidirectional self-medication hypothesis. The aim of this study is to explore the relationship between tobacco use, symptoms of depression or anxiety, and the perception of adolescents and young adults concerning tobacco use as a form of self-medication. A sample of 105 young people between the ages of 17 and 21 years was selected from a longitudinal sociological study to create three groups of participants: 1) subjects with a previous diagnosis of depression or anxiety; 2) subjects with self-perceived but undiagnosed distress compatible with depression or anxiety; 3) and a group of control. A mixed quantitative/qualitative questionnaire on substance consumption was administered, as well as the BDI-II depression scale, the GHQ anxiety and depression scales, and the MISS (Mannheim Interview on Social Support) scale. The final results show that the subjects experiencing symptoms of depression or anxiety in adolescence start smoking later than subjects in the control group, and those who smoke give self-medication as the main reason for doing so. The association between habitual tobacco use and BDI scores for depression was not statistically significant for the sample as a whole, only for the male participants (OR: 6,22, IC 95%, 1,06-36,21, p=.042). Anti-smoking campaigns targeting young people should take into consideration their use of tobacco as a form of self-medication for emotional distress.

El consumo de tabaco como automedicación de depresión/ansiedad entre los jóvenes: resultados de un estudio con método mixto / Smoking as a form of self-medication for depression or anxiety in young adults: results of a mixed-methods study

El consumo de tabaco y los problemas de salud mental de tipo depresivo/ansioso son dos fenómenos que suelen iniciarse en la adolescencia y juventud con cierta co-ocurrencia. Ambos fenómenos guardan una relación bidireccional que, en el caso de los jóvenes, la hipótesis de automedicación parece explicar de forma más exhaustiva que otras opciones. El objetivo de este estudio es explorar la relación entre consumo de tabaco, síntomas de depresión y ansiedad y percepción de los jóvenes sobre el uso del tabaco como forma de automedicación. Para ello se seleccionaron 105 jóvenes (17-21 años) de un estudio sociológico longitudinal previo considerando tres grupos de participantes: 1) sujetos con diagnóstico de depresión/ansiedad en anteriores oleadas, 2) sujetos con malestar depresivo/ ansioso autopercibido y sin diagnóstico previo y 3) sujetos control. Se aplicó un cuestionario mixto cuantitativo/cualitativo de consumo de substancias y las escalas BDI-II de depresión y GHQ en su cribado de ansiedad-depresión, así como la escala MISS (Mannheim Interview on Social Support). Los resultados indican que los sujetos afectados por síntomas de depresión/ansiedad en la adolescencia se inician más tarde en el consumo de cigarrillos, pero los que son fumadores alegan principalmente como motivo la automedicación. La asociación entre consumo habitual de tabaco y niveles de depresión de la escala BDI no fue significativa para la muestra general, pero sí para los jóvenes varones (OR: 6,22, IC95%, 1,06-36,21, p=.042). Las iniciativas antitabáquicas dirigidas a los jóvenes deben considerar los problemas de malestar emocional y el consumo de tabaco como forma de automedicación

Tobacco use and mental health problems in the depression/anxiety spectrum often begin in adolescence as co-occurring phenomena. Epidemiologically, the relationship between them is bidirectional, but in the case of young people it appears to be explained best by the unidirectional self-medication hypothesis. The aim of this study is to explore the relationship between tobacco use, symptoms of depression or anxiety, and the perception of adolescents and young adults concerning tobacco use as a form of self-medication. A sample of 105 young people between the ages of 17 and 21 years was selected from a longitudinal sociological study to create three groups of participants: 1) subjects with a previous diagnosis of depression or anxiety; 2) subjects with self-perceived but undiagnosed distress compatible with depression or anxiety; 3) and a group of control. A mixed quantitative/qualitative questionnaire on substance consumption was administered, as well as the BDI-II depression scale, the GHQ anxiety and depression scales, and the MISS (Mannheim Interview on Social Support) scale. The final results show that the subjects experiencing symptoms of depression or anxiety in adolescence start smoking later than subjects in the control group, and those who smoke give selfmedication as the main reason for doing so. The association between habitual tobacco use and BDI scores for depression was not statistically significant for the sample as a whole, only for the male participants (OR: 6,22, IC95%, 1,06-36,21, p=.042). Anti-smoking campaigns targeting young people should take into consideration their use of tobacco as a form of self-medication for emotional distress