Helene Speyer

Helene Speyer is a consultant psychiatrist and Clinical Associate Professor at the University of Copenhagen, Department of Clinical Medicine. As a senior researcher within the Mental Health Services of the Capital Region of Denmark, her work is grounded in a pluralistic, integrative, and rights-based approach to mental healthcare.

Her professional focus centers on three core areas: addressing physical health inequalities and premature mortality among people living with severe mental illness; developing safe, person-centered strategies for antipsychotic deprescribing; and advancing conceptual competence to foster epistemic humility in clinical practice.

Methodologically, she works across a broad spectrum of approaches, ranging from autoethnographic and qualitative research to randomized controlled trials and causal inference methods. This methodological pluralism enables the exploration of complex psychiatric phenomena from multiple perspectives, honoring both lived experience and empirical rigor. Through research, teaching, and public advocacy, she seeks to reimagine psychiatry as a field rooted in collaboration, justice, and deep respect for lived experience.

Title of the speech

Pluralistic collaboration against institutional injustice

Abstract

Mental health care is facing a profound crisis of stagnation. Despite decades of normal science conducted within predominantly reductive frameworks, meaningful clinical progress has slowed, waiting lists continue to grow, dissatisfaction among service users and clinicians intensifies, and demands for resources exceed system capacity. These patterns point not only to scientific or economic shortcomings but to deeper structural and epistemic limitations in how distress is conceptualised. A central problem is typology overreach, in which the diagnostic system has expanded into an organising principle it was never intended to be.

Typology overreach contributes to injustice. Through recursive feedback across macro, meso, and micro levels, it places responsibility for socially produced conditions onto individuals, narrows interpretive possibilities, and stabilises inequitable patterns of access and response. To move towards justice and equity, we need a new way of understanding human suffering. Pluralism has been proposed as a novel framework for thinking about mental health, recognising that complex problems require more than one perspective. While promising in academic discourse, I introduce here the idea of collaborative pluralism as a form of social innovation capable of intervening in these systemic mechanisms.

Collaborative pluralism is operationalised through a six stage framework that includes threshold recognition, experience naming, explanatory model formation, the articulation of interventional principles, shared deliberation, and expectation alignment. These six stages function as system nodes where stakeholders can meet and contribute different legitimate and potentially incommensurable perspectives without being pushed toward forced consensus. In doing so, the framework acts as a leverage mechanism within a complex adaptive system, offering both a theoretically grounded and practically applicable means of mitigating the processes through which typology overreach reproduces institutional injustice.