World Mental Health Day 2022 – Make mental health & well-being for all a global priority

This year we celebrate World Mental Health Day on Monday 10 October. 

The World Federation for Mental Health is the driver behind this important awareness day.

“World Mental Health Day aims to raise awareness in the global community about the critical mental health agendas – with a unifying voice through collaboration with various partners – to take action and to create lasting change through the messages we promote.”

The theme this year is “Make mental health & well-being for all a global priority”.

"The COVID-19 pandemic has created a global crisis for mental health, fuelling short- and long-term stresses and undermining the mental health of millions. Estimates put the rise in both anxiety and depressive disorders at more than 25% during the first year of the pandemic. At the same time, mental health services have been severely disrupted and the treatment gap for mental health conditions has widened."   

World Health Organisation

What can we learn from the rest of the world about good mental health services?

Open Dialogue in Finland

The name Open Dialogue was first used in 1995 to describe two key features of the approach: the use of open family / network meetings and a set of principles for organising the whole psychiatric system that made dialogue possible.

The Open Dialogue approach was originally developed in Western Lapland in Finland by Jaakko Seikkula and colleagues. They wanted to create a crisis service in which families and mental health services worked closely with the person experiencing the crisis and generate better outcomes for patients experiencing psychosis than those resulting from use of antipsychotic medication.

According to the Open Dialogue UK website: “If the family / team can bear the extreme emotion in a crisis situation, and tolerate the uncertainty, in time shared meaning usually emerges and healing / recovery is possible.”

The results of this approach are clear from the statistics – about 75% of those who experienced psychosis return to work or study within 2 years and only about 20% are still taking antipsychotic medication at 2 year follow-up.

As American journalist Robert Whitaker concluded in his book Anatomy of an Epidemic: “Western Lapland in Finland has adopted a form of care for its psychotic patients that has produced astonishingly good long-term outcomes.”

Read more here.

The Italian Trieste mental health model inspired by Franco Basaglia

The mental healthcare model in the port of Trieste, in north east Italy, is based on the theories of the reforming psychiatrist Franco Basaglia. Franco believed that psychiatry in large institutions unfairly ostracised people with mental problems and the area has seen a radical switch to community based care over the years. It is often called a “whole system – whole community” approach.

Basaglia died prematurely in 1980, but his team continued to develop and support his innovative approach to mental health care over the next three decades. The approach includes looking at the whole person and also their social background when considering what support someone needs.

“Historically, Trieste pioneered the shift from relationships based on domination / control to the therapeutic relationship seen as reciprocal, based on rediscovering the whole person.” Roberto Mezzino, MD

“While it is not without controversy, supporters of the Trieste system in Italy and around the world say that it is more humane, more effective, and even economically more viable.”

Political upheavals in recent years have reportedly put the approach at risk and people have organised petitions as recently as 2021 to try and protect the Trieste model.

Read more here.

Norway medication free mental health services

In 2016 regional health authorities in Norway were instructed by health minister Bent Hoie to provide medication-free treatment wards as an option for mental health patients. This followed years of forced treatment and forced isolation in mental health facilities. For some time, there had been considerable debate in Norway about the effectiveness and adverse effects of using antipsychotic medication, and individuals had long campaigned for change. While medication-free treatment is available in some other countries, Norway became the first country in the world to embed it as an option in the state-run mental healthcare system.

Dr Magnus Hald took on the job of running the new drug-free hospital in Tronsko in North Norway. "The idea of evidence-based medicine is difficult within mental health as a whole, although it's of course an aim that we should have. At the same time, we know that diagnoses in psychiatry are just a classification system. Even though you give a person a diagnosis of schizophrenia, you do not see any malfunction in the brain besides what you experience by engaging in a conversation with the person. You cannot see anything on the CT or the MRI images."

Whilst the debate continues in Norway about the pros and cons of medication free treatment, there is more patient choice now and according to research greatly improved trust between people seeking support and their therapists which can result in better outcomes.

Read more here.

Making mental health a priority in Wales – what’s happening now

Young people and mental health

Mental health and wellbeing will be one of the main focuses of the Welsh Youth Parliament over the next two years as the parliament stands up for the issues that matter most to young people in Wales.

Together for Mental Health

Together for Mental Health is a cross-government strategy setting out Welsh Government’s goals for improving mental health and mental health services in Wales. It is the first Mental Health Strategy that covers all ages; children and young people, adults of working age and older people.

This strategy is currently being evaluated nationally, and a new updated strategy will then be produced.

A Powys priority

Until such time as the new Together for Mental Health National Strategy is produced, Powys will continue to drive on its stated priorities. These priorities are identified in this document – T4MH Priorities.

Mental Health is also one of the Big Four health issues facing the county as identified in the Powys Health & Care Strategy. Powys Teaching Health Board says: “We will develop effective services to treat and support people suffering from the four main causes of ill health and premature mortality in Powys (which includes mental health problems).”

If you know of an interesting mental health initiative or approach from somewhere around the globe, we’d love to hear from you. Comment below or send us an email at mentalhealth@pavo.org.uk

Compassionate Mental Health conference, Hereford, November 2019

by Sue Newham

Health & Wellbeing Engagement Officer, PAVO

I went along to this conference with only a vague idea of the content, but being told by my colleagues at Powys Association of Voluntary Organisations that it would introduce me to some new ideas and give me plenty to think about. They were right!

I was asked on arrival if I’d come to do the yoga. I hadn’t, but it was certainly a novel start to the day!

Novelty continued with an opportunity to engage in “Compassion Circles”. Andy Bradley encouraged us to get into threes and listen to each other “with a quiet mind and an awake heart.” Andy’s concern is that our systems, with time pressures and outcomes, can make people feel as if they don’t really matter. Really listening to people can change their feeling of being valued for who they are.

The keynote speaker was Robert Whitaker, author of books about mental health treatment called “The anatomy of an epidemic” and “Mad in America.”

Robert outlined the history of dealing with mental health issues in the USA. He explained that, in the 18th century, the prevailing view and practice was to treat people experiencing mental breakdown as having lost their humanity. Sufferers were treated like animals and subjected to barbaric treatments. At the end of the 18th century, the Quakers set up homes where sufferers were seen as “children of God” and treated with compassion in pleasant surroundings. Records of the day suggest that there was a good rate of recovery following this treatment. In the 1980s, the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders 3 became the standard handbook of psychiatric diagnosis. It heralded a shift towards the disease model of mental health. Whitaker sees this as creating a line between “normal” people and “abnormal” people, where stresses associated with life become illnesses to be treated.

I found myself pondering the role of the American Psychiatric Association and the drugs companies. Is it likely that companies that have seen a 50 fold increase in income from mental health drugs would be open to other ways of treating people without drugs? If drug companies fund the American Psychiatric Association, which apparently they do, is it possible for that organisation to embrace different treatment models?

Early disease models of mental illness seemed to be based on the theory that chemical imbalances within the brain lead to symptoms of illness that can be corrected by medication. Although the theory had been found as inadequate as early as the mid 1980s, it has still continued as an urban myth. This was a shock to me, as before this conference, I too would have said that mental illness was to do with chemical imbalances in the brain.

Robert Whitaker challenged the prevailing disease model as an effective means of treating mental distress. He said that, if the model was correct, overall recovery rates should now be going up as medication successfully treats people’s illnesses. On the contrary, statistics record that 1.1 million people were on long term disability in the USA due to mental illness in 1987. That number is currently around 5 million. There is also evidence that full recovery is more likely amongst unmedicated groups than medicated groups.

Whitaker’s overall message is that the medication model has not achieved the outcomes expected and has failed to produce scientific evidence that it is improving the mental health of the American public. He mentioned several projects that had shown success in non-medical treatment of mental distress: the Soteria project; the Norway Medication Free Inititative; the Open Dialogue's model developed in Finland.

He suggested that we need to change the script, seeing struggles as a part of being human, rather than a sign of illness which may see sufferers relying on medication for the rest of their lives. He advocated social support, listening and giving people a sense of hope. Psychological therapies also have a role to play in helping people work through traumas and distress. 

During another session, I heard from Margaret Jordan about the benefits and practice of Sensorimotor Psychotherapy, which treats people holistically rather than focusing on the brain. A phrase which Margaret used seems to me to be important and worthy of more thought. She said, “Trauma is an action that needs to be completed in order for the symptoms to reduce.”

I observed an Open Dialogue session in which a course participant agreed to talk about a personal experience and we observed how Open Dialogue can help people to work through difficulties they were facing. The practitioners were Yasmin Ishaq and Rai Waddingham. This was an extremely interesting, but in many ways simple intervention, involving taking time with people and those close to them and listening to them. Yasmin is a social worker and psychotherapist and Open Dialogue lead for NHS Kent. This seems like a very positive way that people can be given time, listened to and enabled to process and work through their difficulties.

I enjoyed listening to Ruth Young from Jamie’s Farm talking about residential weeks for troubled young people, which involve real farm work and responsibilities, as well as group times for talking. This is how the website describes the programme, “Jamie’s Farm acts as a catalyst for change, enabling disadvantaged young people to thrive academically, socially and emotionally. We do this through a unique residential experience and rigorous follow-up programme, combining farming, family and therapy.”

So what was my overall impression of the day? As someone with only one year’s experience in the mental health field (in other words, a complete novice) I found it thought provoking! It challenged some views that I had held as facts, without really knowing why.

It shocked me to hear that people with severe mental illness have a reduced life expectancy, often dying between 10 and 25 years before their peers. The World Health Organisation suggests that some physical illness may be exacerbated by antipsychotic and related drugs.

Overall, it left me with a feeling that profits and big business set the agenda for many of the ways we tackle everyday life. I feel that society has a duty to question why things happen as they do and whether, in fact, science is being manipulated for the benefit of those making the most money.

I also feel that better listening and focusing on the whole person could help many people experiencing mental health issues. “Compassionate” sounds like a good word to describe how I’d like to be treated if I was going through trauma and distress.

More Harm Than Good

A couple of weeks ago our guest blogger, Anne Watmough, went along to this London conference - More Harm Than Good: Confronting the Psychiatric Medication Epidemic, organised by the Council for Evidence Based Psychiatry (CEP). The CEP website reports: "Global leaders in the critical psychiatry movement met for a one-day conference to address an urgent public health issue: the iatrogenic harm caused by the over-prescription of psychiatric medications." Anne kindly sent in a review of her experience of the day - read on.

I set out on Thursday the day before the conference at 9 o'clock in the morning and boarded the bus direct to London. My journey took five and a half hours. But I didn't mind as the coach was very comfortable.

I arrived at my small hotel to find my room cosy and spotlessly clean. I had a nice meal that evening at a Moroccan restaurant on King Street.

The next morning I rose early and went out to have a full English breakfast at a nice cafe. Where the chips were delicious. I allowed myself to eat this food because I was a traveller.

Then I took a taxi to Whiteland College, part of Roehampton University, over Hampstead Bridge.

I arrived to an empty auditorium - one of the very first people to get there. Then two women came to sit down beside me. These remarkable women both had sons like myself affected by psychiatry and psychiatric medications.

Amy, a most young looking natural blonde lady despite all of the transgressions her life has held, explained she was prescribed psychiatric medications whilst she was pregnant with her son. He was born handicapped and she has had his lifetime to regret what happened to her when she was most vulnerable and carrying him inside her.

She has devoted her life to caring for him.

The second woman I met was Jemima and she explained how she was fighting for her son who had had a bicycle accident when young. He was left disabled and in a wheelchair. She felt that when he was prescribed psychiatric medication his disabilities were made worse. How horrendous for a woman whose son was disabled for her to watch him become more disabled due to side effects of medication that is supposed to keep him healthy.

I listened to the wonderful speaker Peter Gotzsche and how he is fighting for the rights and care of people like myself. To keep us free!

There were several speakers who were educated renowned men.

But one of the speakers who most impressed me was the renowned American journalist Robert Whitaker. He wrote "Mad in America" and "Anatomy of an Epidemic". He has researched and investigated psychiatry and psychiatric medications. And the drug industry. He has a website - Mad in America - and his work is also on this along with that of other people. The epidemic of labelling and drugging is rife in America and also in Europe. More and more people suffering from normal emotional problems are sent to their GPs who go on to prescribe medications like anti-depresssants or refer them to a bio-psychiatrist. These medications do more harm then good. This award-winning journalist can be found also on YouTube.

The main speaker, and a man I totally am devoted to, was Dr. Peter Breggin. He came through from America on Skype. He couldn't attend because his wife Ginger was unwell and he felt he had to be by her side. He gave his talk and as I expected the audience gave him a rapturous applause.

Then he was up for some questions. I was the first to put up my hand to speak. The sound effects were an issue on that day and at first he couldn't hear me but I managed to speak loud enough and clear enough so my question could get through.

First, and this is the first time I ever had a chance to speak to him, I wanted to tell him I have read his books. "Toxic Psychiatry", "Your Drug May be Your Problem", "Withdrawing off Psychiatric Medications" are just a few of his wonderful writings. I have his latest book in front of me -  "Guilt, Shame and Anxiety" - which I think is his best book yet. My favourite being "The Psychology of Freedom" which he wrote in 1980 when my son was born. Which makes it 35 years old. Somehow my question got through to him despite the sound situation. And he answered me giving me hope about my own current brain damage.

Dr. Breggin has been a psychiatrist working in New York for 61 years. He started at the young age of 18 at Harvard University and went on to train. He never prescribes medication or sends off his patients to be incarcerated. He has never had a suicide on his books.

Which in my opinion makes the man incredibly remarkable.

After the joy of speaking to Dr. Peter the conference went on with the panel and people asking questions.

I am afraid my anger got the better of me on that day although I passionately expressed myself and did keep it in check. It is recorded on YouTube under the title of this article.

My son I feel has been damaged by psychiatric medications. And that they stirred in him mania which he may not have suffered from if given talking therapy which was suited to what ailed him emotionally at the time he was in crisis.

I have been in therapy these past two years and I feel I will never have another psychotic episode.

I became aware at the conference of the wonderful Sandra Breakspeare and her dream of starting up a farm called Chy-Sawel in St. Ives, Cornwall. Chy-Sawel is Cornish for ‘House of Health giving.' Sandra's son is incarcerated as we speak and has been in an institution over these past ten years. Which without a doubt makes this remarkable woman even more amazing.

This is an alternative to medication and is the way forward and will help millions. Anyone interested can find details online. Please do all you can to promote this.

I am also aware of Open Dialogue Therapy which is curing, with a 86% result, people who are suffering from first diagnosed psychosis. This is the way forward also. This nursing approach by psychiatrists and psychologists and trained nurses has been working in Lapland, Finland these past 20 years. It is slowly being introduced to the NHS in this country. Sandra is embodying this into her farm. Which is a non-profit making charity.

Open Dialogue UK is holding a conference next February in London. Anyone who wishes to attend can find details online.

I would say that not only has my therapy been a way forward to recovery for myself but attending this conference has also been life changing.

Simply Google Dr. Peter R Breggin psychiatrist, Robert Whitaker American journalist psychiatry, Open Dialogue Therapy Lapland Finland and Chy Sawel. And you will find these people.

Anne Watmough

Many thanks to Anne for telling us about this interesting day. If you want to find out more, you can watch videos of the event on the CEP YouTube channel.

Some names have been changed to protect the privacy of individuals.

Shaping mental health services: a Powys update

AKA my “Mental Health Awareness Week” blog post! 

At two PAVO events, (in Brecon and Newtown) a couple of weeks ago we invited people in contact with mental health services and those close to them to join us. It was billed as “your opportunity to come and meet your individual representatives, learn what’s new with mental health services across Powys and give your opinions.” I went along to the event in the North and enjoyed a day of debate and information sharing (not to mention some amazing art exhibits and a Laughter Workshop) at the Maesmawr Arts Centre in Caersws.

Freda Lacey, PAVO’s Participation Officer, introduced the day and gave an overview of the mechanisms through which people can feed in their views about mental health services in Powys. Feedback is taken to the Powys Mental Health Planning & Development Partnership run by the health board, also to the National Service Users & Carers Forum, and finally to the National Partnership Board. You can read more about the structure here.

Freda went on to explain that there are currently 5 vacancies on the National Service Users & Carers Forum – opportunities for people in Powys to get involved and help shape future mental health services. If you are interested then please get in touch.

National Partnership Board - behind the scenes

Rhydian Parry from Powys, who has previously written on this blog about his experience as a volunteer on Patients’ Council, is one of four people with lived experience sitting on the National Partnership Board. He spoke enthusiastically to us next about what it’s really like to be a rep at that level.

At a recent NPB meeting Rhydian gave a presentation about a questionnaire around crisis services. He received a good reaction, and crisis services were subsequently discussed at each of the local partnership meetings. Rhydian described this as: “A step forward. Progress.” He and the other reps are often invited to do other things. They recently attended a talking therapies conference in Cardiff. “We are able to speak to reps from all the health board areas and find out the waiting times across Wales. If someone is now waiting 6 months to see a psychotherapist that is good – it used to be a 2 year wait.” Rhydian also spoke about his work with the police around detaining people under a Section 136.

Meriel Richards and Kate van den Ende, the two other Powys reps on the NSUCF, also contributed to the update. Meriel said that “at the last meeting it really felt as if we were part of the forum. It’s chipping away.” Kate added: “It states in legislature that they have to listen to us.” She described the slow process of winning influence. “There is now a good chance to say that this is the way it should be.”

Issues that are raised by the reps can be taken by mental health commissioners at Powys teaching Local Health Board to service providers and further information requested. The reps are clearly making a difference. Even so, it was identified that the task is huge. Someone from the audience said: “like trying to move a mountain with a wheelbarrow and a hand shovel”.

Not everyone likes to attend meetings to have their voice heard. Other suggestions for encouraging people to contribute their opinions included using social media and email, encouraging feedback in GP surgeries, and putting up posters on school noticeboards.

Freda opened up the discussion to ask people attending to tell us what they believed to be the current gaps in services. The key areas were well familiar to us all, and included the long waiting lists for psychological therapies, and the failure of Children & Adolescent Mental Health Services (CAMHS) to meet all young people’s needs. It seemed as if some agencies struggled to signpost people to support services in the voluntary sector. One carer of a young person said: “I would feel empowered if I had the information I need – not completely on my own having to deal with things.”

There was also a real appetite for finding out more and trying alternative approaches (what we have called Beyond Medical) such as the Soteria House promoted by the Soteria Network and the Finnish Open Dialogue approach.

Louisa Kerr updates us

Louisa Kerr, Partnership & Project Support Officer for the Powys Mental Health Planning & Development Partnership, was next welcomed to the event to speak about upcoming priorities for the health board. These include:

- Enhanced Primary Care services;

- Acute Care in the community;

- Repositioning for older people;

- Integration of services.

Louisa is also working on rolling out two other projects – updating the health board website with more information about mental health services, and developing a crisis house in Powys.

Recommissioning of voluntary sector mental health services in Powys

Louisa spoke at length about this process. The Hearts & Minds Strategic Plan – vision for mental health services, commits the voluntary and statutory sectors to work together to achieve the best outcome for individuals. All services are being looked at in line with the strategy. The health board is now seeking equity of services across Powys, which means that to be fair a commissioning process will take place (see the “commissioning cycle” for a diagram showing the nuts and bolts of the process). Formal events are being arranged in the near future, and the health board will engage with "all ages" around services to make them the best that can be commissioned.

In response to questions from the audience, Louisa clarified that “price is not the driver. It is having the best service in place.” The Welsh Government guidelines on tendering will be followed.

Those present went on to express concern about the process which can cause stress for both volunteers and people in receipt of their service. This was acknowledged, and Louisa said she would be going back to speak to the procurement team for clarification on any questions raised. It was also made clear that PAVO (Powys Association of Voluntary Organisations) can be called upon to provide support to voluntary sector agencies around commissioning.

How to be a Two-headed monster
 in Owen's Laughter Workshop!

The discussion could have gone on all day, but a delicious Maesmawr Arts Centre lunch beckoned, followed by a tour of the grounds and the sculpture trail, and an amazing Laughter Workshop with Owen Griffkin. All in all a brilliant day.

Jill Ball (Powys Befrienders) & Glynis Luke
 (PAVO mental health team) on the tour
at Maesmawr Arts Centre, Caersws

What do you think? Would you be interested in finding out more about becoming a “service user & carer rep” for the National Forum? Let us know! Your voice needs to be heard!

Norman Lamb at Brecon & District Mind

Roger Williams MP, Norman Lamb MP and Val Walker, Service Director of Brecon & District Mind

Last Thursday Brecon and District Mind hosted an Open Forum on Mental Health with Norman Lamb MP – Minister of State for Care and Support. The session was facilitated by Roger Williams MP for Brecon & Radnorshire. During the hour-long session many important issues were covered, including changing the health system to put mental health on a parity with physical health, the failings of the system for children and young people, concern around funding for vital third sector services in the community such as Brecon Mind, and the needs of carers. Norman’s talk was followed by a Q&A session with Brecon Mind members.

There is not space to cover the entirety of the Open Forum here in one blog post, so we have highlighted some of the points that Norman made during his visit. 

Disparity between services for mental and physical health

I wanted to say something briefly about my complete passion for mental health. 1 in 4 of us at some stage in our life will experience some form of mental ill health. It may be mild depression or anxiety or it may be something more enduring. Most families are touched by it in some way. Our family very much is. What I talk about is not just because I happen to have a job as the Minister for State responsible for mental health. It is something I really care about. The thing that is quite shocking is the disparity between how people with mental ill health are treated by the system despite the great work of people working within the services. But the system, in my view, discriminates against people with mental ill health. I can talk primarily about my experience in England but I suspect it is not much different to here.

In England if you have suspected cancer and are referred by your GP you have a right to see a specialist within two weeks and a right to start treatment within a month of diagnosis. If you suffer from mental ill health, if you perhaps are a youngster who experiences a first episode of psychosis, you have no such right. There is no such entitlement to access treatment on a timely basis. And I just don’t see how that is right. We know there is a wealth of evidence that if you intervene quickly with a youngster who suffers a first episode of psychosis, you can often rescue that person, you can stop the deterioration of condition and give that person the chance of a good life. 

The Open Forum on mental health

So how unacceptable is it that those people don’t have any right to access evidence-based treatment which we know gives the person the chance of recovery. Particularly in mental health the quicker you intervene the greater chance you have of achieving a good result for that individual and potentially rescue someone from a lifetime of a pretty miserable experience for very many people - out of work on benefits, not enjoying things that the rest of us take forgranted. It costs a fortune to deal with the damage and the effects of negligence on that person. So the moral and economic case for proper investment in mental health is overwhelming. If you make the investment you ultimately end up saving money further down the track as a result. That is the central message that I have been trying to get into government, NHS England and also to apply the moral pressure on organisations locally to take mental health more seriously.

I am on a mission to try and change this (the disparity between physical and mental ill health). So in England we are introducing the first ever waiting time standards for mental health so that if you experience a first episode of psychosis the standard will be that you start your treatment in two weeks from referral by your doctor. We start by saying that 50% of youngsters should be seen within two weeks, and then progressively in subsequent years we want to increase the percentage, but you have to increase the capacity in mental health services to be able to do this.

Increasing Access to Psychological Therapies

Kirsty Williams, Assemby Minister Brecon & Radnorshire 

and Harold Proctor of Powys teaching Health Board

We have also got in England the IAPT programme – Increasing Access to Psychological Therapies. It is fantastic for mental health. For the first time we have rich data, information, evidence about how many people are waiting, how long they waiting and whether they are recovering as a result of their treatment. We can monitor the programme to understand which providers are performing well and which are failing people, where access is very poor. The result of this is that in 2010 300,000 got access to psychological therapies. This year it will hit about 900,000, an increase of three times, so it’s a big advance and a programme that is delivering massive results for people. There are thousands of people that have recovered from depression and anxiety. The evidence is very strong; not only of recovery but that if you invest money you achieve a saving in the long-run. You get people off benefits, you get them back into work, you give people a good life with the chance for self-respect and some dignity.

Crisis care

Crisis care is where the disparity between physical and mental health is probably at its greatest. If you suffer from a physical health problem the system may be under pressure but an ambulance will arrive and you will be taken to an Accident & Emergency department and you will have access to a specialist who understands your condition. If you have a mental health crisis it is completely haphazard what happens to you. And you could end up in a police cell. This is intolerable in a civilised society.

So last February we published the Crisis Care Concordat. We got twenty national organisations to sign up to it. It is the first set of standards for crisis care in mental health that we have ever had. It tells you there that there should be a 24/7 helpline available so you can get access to support any time of day and night. There should be proper liaison psychiatry in hospitals, and in A&E if your problem is a mental health problem you will get access to a specialist. It critically says we should end completely the practice of putting under 18s in police cells and halve the number of adults who end up in in police cells this year compared to two years ago. In my view it should become a “never” event. Parts of England have demonstrated it is possible. They don’t get more money, they have just organised themselves better.

The role of carers and the Open Dialogue approach

I am acutely aware (mental ill health) affects the whole family. It can have a massive impact on other people’s lives. Providing support for the whole family is critically important. There is a very interesting development called Open Dialogue. It is the approach they use in Finland. The whole idea is that it is a recognition that mental health is crucially related to relationships with other people, and to try and deal with someone’s mental ill health in isolation is a mistake. Their whole approach is that when crisis occurs you get the whole family engaged straight away.

It’s absolutely the case that a family trying to cope with mental ill health very often has no idea how to handle it, whether what they do has an adverse or positive effect, whether to be tough with the person or gentle and understanding. Getting the balance right is so often incredibly difficult, so to involve the whole family seems a very attractive approach. There are now four trusts in England that have taken this approach and pooled some money between them to train psychiatrists and other health workers to develop the model in this country and critically to evaluate as they go through.

Transition from children’s to adult services

We have a massive issue with this cliff edge at 18. You get to 18 and are then told children’s services come to an end. You’re suddenly told you’re in adult services. 18 years old is a very difficult age for many people. They are going through real transitions in their own lives, maybe going to university, maybe leaving school, it may be all sorts of teenage angst that you are trying to cope with in your own mind, and to suddenly force a complete change of service seems completely daft. I’m trying to force a move away from a one size fits all date for transition. It’s often “abandonment” to be honest. A service needs to stick with someone if that’s the appropriate thing to do. There are several areas, my own county of Norfolk, where they have a youth service that takes you through to 25. Because it is a youth service it is more attuned to what might be more appropriate for you at that point in your life.

I also think third sector organisations working collaboratively with statutory sector organisations are more subtle and pliable in getting the right response for a youngster. So I think a collaboration between statutory and voluntary sector services works more effectively.

Janet Pardue-Wood, Acting Director of Mind Cymru, meets 

Kirsty Williams AM and Roger Williams MP.

Voluntary sector

My view is that the voluntary sector plays a crucial role. When I was at Gofal earlier they were talking about how they had entered collaborations with some of the health boards around Wales. We have this awful problem of people being put into out-of-area placements, often a long way from home. There is no ambition to give them a better life, they are just hidden away from view at enormous cost to the tax payer, it is an extraordinary outrage really. Their role can be to identify these people and find a mechanism to get them back into community and rebuild their life.

Gofal gave a wonderful example of a woman who was a serious alcoholic whose life was in a complete mess, she had been in secure accommodation. She is now living back in her own home and working in a charity shop three days a week. She contributes to local community efforts, she has a life. It’s fantastic. Three or four years ago no one assumed she was capable of that, she would just have been locked up as a risk or threat to everybody. It does not have to be like that.

Roger Williams rounded off the session by complimenting Brecon & District Mind on the work that they do in their community and thanked them for hosting the Open Forum.

Thank you to Freda Lacey and Brecon & District Mind for providing photographs from the day.

Open Dialogue in Nottingham

“The name Open Dialogue was first used in 1995 to describe two key features of the approach: the use of open family/network meetings and a set of principles for organising the whole psychiatric system that made dialogue possible.” Nottingham Open Dialogue group, September 2013

Back in early September I wrote about the conference I went to in Nottingham – Psychiatry beyond the current paradigm. One of the workshops at the event focussed on an innovative approach to mental distress and crisis work called Open Dialogue, and I promised to write more about it in a future post – so here goes.

Before going to Nottingham I had read briefly about the approach in Robert Whitaker’s book – Anatomy of an Epidemic. “Western Lapland in Finland has adopted a form of care for its psychotic patients that has produced astonishingly good long-term outcomes.” You can read more on Robert’s website here. Robert has subsequently referred to the Open Dialogue approach again in blogs and other writings, quoting it as a clear mandate for change. 

So, what happened at Nottingham? Well, first of all, hour one of the session was absolutely Powerpoint free. That was refreshing in itself. A group of people have been meeting informally in the city to look at what is happening in Finland, and several of them had agreed to lead this workshop. They introduced themselves, and explained that they were considering how Open Dialogue could be put into practice locally. They educate themselves at meetings, having a mailing list of about a hundred, and a core 16 – 18 people attend the meetings regularly. Originally they began as people with “lived experience”, but the group has now expanded to include some professionals “which has changed the dynamics”. 

What followed for the first half of the workshop was a dramatisation and replaying of an actual Open Dialogue meeting which had taken place in Finland some years ago. This was extremely powerful, as for those of us attending it really felt as if we were watching and listening to an actual meeting. The professionals involved listened for a long time without saying anything at all to both the person in distress and the close family members. Eventually, when they did speak, they shared their views amongst themselves and allowed the person and his family to listen in. Further dialogue between the whole group then followed, and throughout the session the sense of absolute crisis seemed to gradually ebb away through use of this continued dialogue. There is no video of the workshop, but if you want a feel read “The Story of Pekka and Maija” on pages 411- 414 of Jaakko Seikkula and Mary E. Olson’s article about the approach.

The second half of the Nottingham workshop was used to explore the Open Dialogue approach in more detail and for this a presentation was used, but again group members took turns to explore the different areas. Some of the key points for me were:

• Psychosis is a temporary, radical disengagement from shared communication practices.
• The need to create safety/trust to allow people to express deep fears.
• Stay with the situation as it is, and allow it to develop (without using specific “tools”).
• The reflection that the team does is in the family meeting.
• Results have been better for those who took no neuroleptic medication or had it at a later point.
• Is the medication for the sake of the individual or for those around them, including the team?

The group reported an 85% recovery rate for psychosis using this approach. So that, rather than a growing number of people going on from psychosis to be labelled as “schizophrenic”, there are actually very few people with this diagnosis in this area of Finland. It is actually disappearing.

A film-maker called Daniel Mackler has produced a number of videos on Open Dialogue, some of which are available on the web. I particularly enjoyed his interview of Jaakko Seikkula, Professor of Psychotherapy in Finland (author of the article quoted above), in which Jaakko states: “All of us could have psychotic problems! Psychosis is an answer to a very difficult life situation.” 

I was truly impressed by what the Nottingham group had found out so far, and how they conveyed their learning at the workshop. You can find further links to documents about Open Dialogue on our new website page here – and thank you to Nottingham Open Dialogue for sending us some of these. What can we do in Powys to bring this innovative approach a little closer to us…? Do you have ideas about this? Let us know by commenting below.

Meanwhile, to finish….  Monica Cassani, “a social worker and … a person whose life was severely ruptured by psychiatric drugs”, created the BeyondMeds blog and posts about the mental health system in the United States, and alternative approaches such as Open Dialogue. This week in the UK the BBC reported on the need for more psychiatric beds – in England…. I’m inclined to agree with Monica’s view that maybe, if the Open Dialogue approach was widely adopted just as has happened in Western Finland, then the psychiatric hospital beds (wherever they are in the world) would lie empty…