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.

Positive Action for Change in Mental Health Services - Part 1

In November last year I attended this one day conference organised by PCCS Books in Nottingham. Two of the keynote speakers – Lucy Johnstone and Sami Timimi – had previously travelled to Powys to speak at a conference organised by our team in March 2014 - Finding Meaning in Psychosis: Early Intervention Services. This conference had highlighted the debate that challenges the validity of ‘mental illness’ diagnosis and raised questions about whether the idea of ‘mental illness’ is useful in driving innovation. However, due to leave I had been unable to attend. So, I was really keen to make the trip across country now to find out more about implementing innovative approaches to mental health distress. And the conference promised not just two but several inspirational speakers.

PCCS Books is an independent mental health publisher dedicated to the demedicalisation of distress, and person-centred, recovery-focused mental health services. The name developed out of a training organisation called ‘Person-Centred Couselling Services’, and at the conference (I think they organise one every couple of years) Director Heather Allan welcomed everyone and set the scene for the day:

“The case for demedicalising mental health services is well rehearsed. The research has been done, the conferences have been held and the intellectual argument all but won. Yet on a day-to-day basis, services continue to operate within the medicalised status quo. One of the aims of this conference will be to look at how we can implement realistic, practical changes in our mental health practice, education and lives, in order to continue the progression from rhetoric to reality.”

Due to limited space I can only touch briefly on the speakers’ presentations with a focus on their practical suggestions for bringing about change in working practice. (Full presentations are available here however).

Lucy Johnstone – Challenging, compromising or colluding? Some thoughts on trying to bring about change in mental health systems

Lucy made regular reference to her own personal situation working as a Consultant Clinical Psychologist at the Royal Glamorgan Hospital for Cwm Taf University Health Board in South Wales. This is the most socially deprived area in the whole of Wales, where 13% of the population are in contact with mental health services. It was a very medicalised service when Lucy arrived.

Lucy has since introduced an approach called “team formulation”. Regular meetings take place involving services in contact with an individual experiencing distress, within Community Mental Health teams, Assertive Outreach teams, rehab services and inpatient wards, to develop an in-depth understanding of that person’s particular difficulties. Staff will then work together to tailor any support to the needs of the individual rather than applying a one-size-fits-all approach. Using a case study of a 17 year old girl hearing hostile voices, Lucy contrasted the medical approach, which resulted in a diagnosis of psychosis/schizophrenia, to the way team formulation drew out the young woman’s story of abuse and bullying over a period of years. The latter approach acknowledges that responses such as hearing voices are survival strategies – “a normal reaction to abnormal circumstances.” 

In Cwm Taf team formulation has spread organically and not aroused much resistance. Lucy explained that her colleagues may not always agree with her approach but they take her stance on board, and some people are shifting away from using diagnostic approaches. The team formulation approach had led to “a change in thinking” and become “part of the culture as a word and a concept.”

“Instead of giving a diagnosis, we need to listen to people’s stories.”

Peter Beresford – From mental health to mad studies: making involvement real

Peter Beresford was introduced as the first “out” mental health service user to become a professor (Professor of Social Policy at Brunel University in London in fact). He spoke knowledgeably about the political background to current mental health service provision, noting politics’ powerful alliance with traditional psychiatry at the expense of those living with mental distress. He believes that “lived experience” is devalued by government, and rather than trying to influence politicians we would be better advised to take the initiative ourselves. Peter’s recommendations included:

• Resisting forced employment and impoverishment.
• Holding on to good participative practice.
• Listening to service users.
• Encouraging service user input in professional training, which has a real impact on service culture.
• Focusing on changing the future for mental health and service users by innovating, by developing our ideas for change and our practice.

Peter also spoke about the value of Mad Studies, and referenced the recent conference Making Sense of Mad Studies which my colleague Anne attended in early October.

“We have to be courageous and rigorous and stop hoping that powerful big voluntary organisations will speak for us.”

Look out for Part 2 of this conference report next week, when I feature the talks of keynote speakers Sami Timimi and Pete Sanders. You can also find out more about the Soteria Network and the British Association for Person-Centred Approach, along with other organisations who attended. Thanks for reading, and let us know your thoughts on these ideas and approaches in the comments box below.