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.

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…

Top mental health books: Part 1

I've been on holiday this week - the plan was to sow all my veg for the coming season. But it's been so cold that not a single seed has gone in!

So, plan B. Reading. I asked my colleague Laura (she is much more well-read than me!) to recommend some of her favourite mental health books - which she has. And then I thought - it would be good to share them with a wider audience. So, here it is, the first of an occasional series of top reads on mental health:

Living with Voices: 50 Stories of Recovery 
Published by PCCS books in association with Birmingham City University. There is a range of contributors, including Professor Marius Romme, Dr Sandra Escher, Jacqui Dillon and Professor Merwyn Morris. 
Laura says: I think this is a great book, I couldn’t put it down. It gives so much insight into people's experiences and in my opinion shows how questionable the level of medicalisation that we do around these behaviours, thoughts and emotions is (i.e. the view of voice hearing as a sypmtom of mental illness). A bit like your grief post - the people’s stories in this book tell us about personal trauma and stress and in my opinion their very human responses (e.g. hearing voices) to these adversities rather than a symptom of an illness.

Thinking About Suicide: Contemplating and comprehending the urge to die 
By David Webb, published by PCCS books. 
The author completed the world’s first PhD on suicide by someone who has attempted it. 
Laura says: I found this book really interesting and it really made me question just how dangerous some of our knee jerk responses to people talking about wanting to die might be. It also made me think more deeply about responsibility and confidentiality. Could our reactions (i.e. individuals and services) and actions (e.g. sectioning, treatments) stop people from being able to openly and honestly talk about their feelings of wanting to die? How valuable is it for people considering suicide to be able to talk about these feelings without fear of what others might do in response? 

The Myth of Mental Illness by Thomas Szasz and Szasz under Fire edited by Jeffery A Schaler
Published by Harper Collins and Open Court Publishing respectively. 
Thomas Szasz was a psychiatrist and academic who criticised the medical approach to treating mental distress. 
Laura says: I can honestly say that Thomas Szasz changed my life by changing my ideas. When I first read The Myth of Mental Illness I found it hard going, his views were so alien to everything I had ever understood about mental illness since my first experiences of psychiatry in my early teens. Szasz’s ideas challenged everything. My issues with the book are not though a reflection on his writing, he is one of the most clear and logical authors I have every come across.  As I read other books about these ideas my understanding became clearer and I particularly found the book Szasz Under Fire useful.

Anatomy of an Epidemic
By Robert Whitaker, published by Broadway Books. 
This award-winning journalist explores why with every passing year so many more Americans are labelled as "mentally ill", and considers whether the increasing use of psychiatric medicines could be contributing to this rise. 
Laura says: Robert Whitaker would be a must for me. I cannot recommend this highly enough.

Trauma - From Lockerbie to 7/7: How trauma affects our minds and how we fight back
By Gordon Turnbull and published by Bantam Press.
Laura says: This book was my introduction to the subject of post traumatic stress disorder in any detail and I became interested in the similarities between this diagnosis and other "mental illness" diagnosis. I also found it fascinating to read the journey of PTSD as a "mental illness" diagnosis in and out (and in again) of the Diagnostic and Statistical Manual of Mental Disorders (DSM). Gordon’s use of people’s live experiences alongside his own clinical knowledge journey are really thought provoking. His insight into why two people might experience the same external trauma and yet respond and cope very differently is also in my opinion very relevant to our wider understanding of mental health.

So, this should get us started! We'll post again in future with more recommended reads, and also include some fiction works.  In the mean time we will be ordering copies of these books at our local Powys libraries, so if you want to get hold of a copy why not get in touch with your library, details of which you can find here.

If you have any reading recommendations that you think we should share then please do get in touch.
Happy reading from all at Powys Mental Health!

PS: for those still troubled about the gardening... you could always try Cold Climate Gardening by Lewis Hill....