Monday, 1 February 2016

Positive Action for Change in Mental Health Services - Part 2

Last week I posted Part 1 of my report on this one-day conference which took place in November 2015 in Nottingham. It was organised by PCCS Books and looked at how services could try and break out of their medicalised approach to supporting people experiencing mental distress. Many of those in the packed audience worked professionally in psychology or psychiatry departments, and it was heartening to note their interest in the overriding theme and sense a real enthusiasm to drive some of these approaches forward in their own teams.

Clinical Psychologist Lucy Johnstone, and Professor Peter Beresford, had spoken passionately about their work in the morning session. This week I cover talks given by the two afternoon keynote speakers, Professor Sami Timimi and author and educator Pete Sanders. I will also touch on the work of organisations like the Soteria Network who attended to spread the word about their developing and ground-breaking work across the UK.

Sami Timimi – Beyond diagnosis: developing an outcome-orientated approach

Sami is the Visiting Professor of Child and Adolescent Psychiatry at the University of Lincoln. He began by focussing on the genuine issue that, despite the growing spend on mental health services on both sides of the Atlantic, there is a corresponding increase in the number of people classified with severe/enduring mental health illnesses.

He went on to describe the commodification of mental distress. Whilst large pharmaceutical companies are frequently attacked for profiteering from “disease” and “mental illness” through their growing sales of medications, Sami pointed out that psychotherapies are equally as vulnerable to this kind of criticism. Brands of psychotherapy compete, claiming they are the best option for a particular problem – producing associated books, courses, conferences and programmes. In this capitalist world of mental health people’s unhappiness is exploited for profit – even during a recession there is no dent in the profit margin of major pharmaceutical companies.

So, what did Sami advocate in these depressing circumstances? He spoke about differentiating between the relationship and the technique used when supporting a patient. If the relationship is primary, the technical aspects have to be slave to the relationship. So… if one patient who is depressed wants Cognitive Behavioural Therapy, the next, though reporting similar symptoms, may want to talk about what happens to them when they experience domestic violence, for example. “Treat each person on their merits – it is harder to turn (treatment) into a commodity as each person has a unique story and a unique model of change.” Sami calls this approach – Outcomes Orientated Approaches to Mental Health Services, and went on to describe in detail how it works in practice in his team’s service provision. This approach “is better at not creating chronic patients. Patients are leaving us.”

Sami closed by imploring people to go to commissioners with evidence of working in a different way – and showing that outcomes can be better. He believes that change really can be influenced at that level.

Pete Sanders – If therapy could be part of positive action for change, what sort of therapy would it be?

Pete is the co-founder of PCCS Books, and has over 30 years’ experience practising as a mental health nurse, counsellor and educator. He introduced his “unbalanced presentation” with a large dose of humour, warning the audience that he wanted it to be a “rude slap in the face for all helping professions!” If there is one thing I took from his talk, and there was no joking intended here: it is the importance of genuine human kindness – of just being nice. As he said - “do not act like an ‘expert’, be your real self as a helper; fallible, vulnerable, imperfect, not knowing any of the answers.”

He asked us what kind of therapy we would want – one “that pretends to provide a systematised treatment, but is really a placebo?” And shared three separate scenarios with mental distress at their heart and asked “what would you do?” Some of the suggestions were basically the actions of a kind-hearted friend or colleague. How many qualifications do you actually need to take someone for a drink after work? To sit and listen to them talk? Pete said that professionals had conned everyone that caring for others is more complicated than it actually is!

“There is no statutory service of natural kindness… Only a proper expert can interpret this chaos and mend the broken brain.”

In 1974, when Pete was a trainee counsellor, there were only five counselling courses in the country, yet now you can “fall over them on the way to the bus stop!” He supports a person-centred approach and is against the medical model.

Pete left us with 11 pointers for “Therapy for positive action for change…” and because I know you can read the whole presentation I shall just quote the one which particularly resonated with me on the day: “therapy that…. understands that the primary healing force is the client themselves, not the person or techniques of the therapist”.

Also attending the conference were various organisations who are working with what we call in our team the “beyond medical” approach.

Soteria Network

Margaret Turner, Secretary of the Soteria Network
The Soteria Network is: “A network of people in the UK promoting the development of drug-free and minimum medication therapeutic environments for people experiencing 'psychosis' or extreme states. We are part of an international movement of service users, survivors, activists, carers and professionals fighting for more humane, non-coercive mental health services.”

British Association for Person-Centred Approach

Bernard Mooney and Sara Callen of the
British Association for Person-Centred Approach
The British Association for the Person-Centred Approach (BAPCA) is: “An organisation that embraces and promotes the person-centred way-of-being: the striving to create relationships based in genuine acceptance and empathic understanding.”

Critical Mental Health Nursing Network

The Critical Mental Health Nursing Network is: “A network of mental health nurses and others who want to think critically about mental health nursing and related issues.”

Working to Recovery

Working to Recovery are “world renowned for their innovative Recovery based practice, training, writing and service designs, working across the world”.

You can find out more about the conference speakers and link to their presentations on the PCCS Books website.

What do you think about these ideas and approaches? Let us know in the comments box below.

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