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.

Exploring Mental Health and Trauma: Books To Get Us Thinking ....

Guest Blog by Jane Cooke.

There has been a focus on trauma-oriented work and ‘treatment’ in recent Powys conferences.  You can watch Jacqui Dillon at the Powys Stronger in Partnership conference last year here and you can watch Sami Timimi at the Finding Meaning in Psychosis conference in March 2014 here.

One of my roles in life (when I’m not working within PAVO’s mental health team) is as a counsellor/psychotherapist. I have a trauma-oriented approach which has been reinforced by listening to these speakers and by reading around the subject.

A trauma-oriented approach, as advocated by Sami Timimi, is a gentle way of beginning work that enables a person to feel safe and able to gradually build up a personal sense of control over their own boundaries and in time over responses to events or reminders that can lead to upsetting and overwhelming reactions. Even if a person doesn’t identify trauma as being relevant to them and why they come for therapy, this approach is empowering and helpful anyway. (It is not about forcefully inducing ‘catharsis’, re-living the situation, ‘facing up to it’ or any other similar techniques which can be re-traumatising or even abusive in themselves.)

Sami Timimi is a psychiatrist and a founding member of recently established Council for Evidence-Based Psychiatry.  He believes that working in a trauma-oriented way makes sense for most people who come into contact with mental health services. Much more sense than identifying ‘pathology’, symptoms and ascribing a diagnosis; all of which generally ignore the story, the experience of the person, how it is that they are who they are.

There are two writers who I have found very helpful and their work complements each other. Both Judith Herman and Peter Levine are concerned that people (clients, patients, service users, survivors) gain/regain their own sense of personal power and agency as they recover from their trauma/s.

Peter Levine has written a number of books about trauma. One of his books “Healing Trauma” is a slim self-help book with a CD covering a programme of exercises that anyone can follow to help overcome the neurological ‘holding’ of trauma. It is, he says “for restoring the wisdom of your body”.  He does caution that professional help may still be required. An empowering way of working could be therapist and client working together with the book and exercises, keeping the client in control of the work.

‘Trauma’ is a word we use in everyday speech,  but paradoxically in relation to emotional well-being there is a limited perception that trauma has to relate to major events that are, for example, combat situations, witnessing  extreme violence, being in danger of one’s life or experiencing sexual violence or abuse in childhood or adulthood. However, as Peter Levine says “People, especially children, can be overwhelmed by what we usually think of as common everyday events …The fact is that, over time, a series of seemingly minor mishaps can have a damaging effect on a person. Trauma does not have to stem from a major catastrophe” (his italics).

There is increasing evidence for this. So, for example, bullying, repeatedly not getting your needs for love and positive attention met, feeling fear regularly such as maybe a frightening  walk to school, regular contact with a frightening , threatening teacher or relative; being regularly shamed by powerful people when you are young.  Many things can build up to create a response in the nervous system which then needs to be ‘taught’ to respond to the here and now and to recognise/feel  current sources of support and comfort, including your own capacity  to support and nurture yourself.

Jacqui Dillon (a survivor of childhood sexual abuse) told us how much she had been influenced and empowered by Judith Herman’s book “Trauma and Recovery”. Herman looks at the way in which women’s (and children’s) experiences of violence, fear, captivity (and you can be captive in all senses without the doors being locked) and powerlessness in the domestic and community realm have been seen as variously: natural, bought on by the victim themselves, exaggerated  and overcome-able by normal acts of will. She looks at the way in which their experiences are minimised and belittled.  “Social judgement of chronically traumatized people tends to be extremely harsh” .She also looks at ways of working with people who have experienced trauma. Judith Herman has a framework for recovery from trauma. There has to be in her experience, in sequence (and returned to as often as necessary) Safety, Remembrance and Mourning and Reconnection. This works very well with Peter Levine’s work which in the early stages emphasises ways of achieving an inner sense of safety, and of course actual safety in daily life is essential.

Judith Herman is very clear that therapists need good training and good support, this is work that can be complex and challenging.

There are many books about trauma; I would recommend these two. They are compassionate and well-grounded in research and experience. They are as much for the person recovering from trauma as they are for therapists and other workers.  

Judith Herman’s “Trauma and Recovery provides a radical, community oriented approach to recognising trauma in the lives of women in particular as well as a way of working that can lead to recovery.

Peter Levine’s book is a gentle, practical self-help book (although he does not minimise the need for professional support as well).

Between them they are a very good ‘starter kit’ to this subject whether you are a health professional, or someone who has experienced, is experiencing, trauma – and you could very well, of course, be both.

Trauma and Recovery. Judith Herman.  Pandora  ISBN 978-086358-430-5

Healing Trauma. Peter Levine. Sounds True ISBN 978-1-59179-658-9

Written by Jane Cooke

Member of PAVO Mental Health Team:  jane.cooke@pavo.org.uk

And when not working for PAVO....

Gestalt therapist, ecotherapist  and interpersonal skills trainer.  Jane.cooke@heartfeltwork.co.uk

www.heartfeltwork.co.uk

Unconventional Wisdom: Shaping Services Together Conference, Powys, September 2013 - Adding To The Debate?

2013 Conference Theme: Shaping Mental Health Services Participation

In September 2013, Powys Association of Voluntary Organisations  (PAVO) were involved in running a conference in Powys, one of three events across Wales (you can access all three conference reports here).  The event was funded by Public Health Wales and supported by Welsh Government.  The theme was mental health participation.

PAVO lead on the Powys Stronger in Partnership Participation Network and we are a member of Mental Health Action Wales.  You can find out more about the activities we are involved in and the difference we think we are making here.

You can read a full report (12 pages) from the 2013 Shaping Services Together Conference, Powys, on our website here.  In this blog though I wanted to explain a bit about the ideas underpinning the conference planning in 2013.  I also want to tell you about another free conference that you are invited to on Friday 7th March 2014.
 

Learning From Previous Conferences ...

We first ran an event of this kind (i.e. national participation) in 2012, you can watch a video from this event here and read the conference report here.   Eleanor Longden spoke at this event and her talk continued the debate in Powys that challenges the conventional wisdom underpinning our mental health system.  A wisdom that is founded on the idea of "mental illness". You can read more about this debate in my previous blogs here and you can watch Eleanor talk on ted.com in this link.  

Eleanor Longden is joining us again on 7th March 2014, you can find out more about this here.

 

Thanks to people's willingness to get involved in the 2012 conference and to the feedback we received we were able to learn a lot from this event. 

We used this learning to help us to underpin the  2013 conference planning on two questions:

 

“Should mental health services be shaped by the question what happened to you rather than what’s wrong with you?”  

 

"If so, how can mental health participation influence such a fundamental change to our mainstream mental health services?"

 

As well as asking us to provide more opportunities to explore the de-medicalisation of distress, you also told us that future conferences should include:

"...time for exceptional and inspirational speakers that bring to the debate their own experience of mental distress"

 

... no pressure then! 
 

So A Big Thank You To Jacqui Dillon...

 

Given this we were absolutely delighted when Jacqui Dillon agreed to come to Powys and talk at this conference.  We think that she fitted the bill and luckily you don't have to take my word for it,  you can watch her full talk here.

“Jacqui Dillon is one of the most inspirational speakers I have ever met, thank you for enabling me to be part of today"

Jacqui Dillon is a writer, campaigner, international speaker and trainer.  She is the National Chair in England of the international Hearing Voices Network.  Her talk was entitled "The Personal is Political" and you can download the slides here. 

She began by sharing something of her own story, her experiences and her survival strategies.  Survival strategies such as self-harm, hearing voices, eating "disorder", creativity and resourcefulness.  Survival strategies that are often judged by mainstream wisdom as "symptoms" of "mental illness" rather than a natural and normal response to difficult life experiences.

She then shared her own experience of mental health services which she summarised against 6 themes:

• Pathologised:  "You are ill. Everything that you say and do will be seen as a consequence of your illness."
• Denial:  ‘It never happened’ or ‘It did happen but you will never recover’.
• Medication:  ‘You are resistant and the fact that you don’t want to take medication is evidence that you are ill’ .
• Dependency & Compliance: ‘You must accept the psychiatric diagnosis and medication and we will give you benefits and a bus pass’. 
• Disempowered: ‘You will never recover. You will always have this illness. You won’t be able to work’.
• Passive:  ‘You do not know what is best for you. We know what is best for you’. her own experience of mental distress

Then she talked about finding a new paradigm, which she broke down into 4 main areas:

• 
  Trauma & Recovery
• Understanding Dissociation
• Attachment Theory
• The Personal Is Political 

She shared some of the latest research findings around childhood adversity & psychosis, for example:

• People abused as children are 9.3 times more likely to develop "psychosis"; for those suffering the severest kinds of abuse, the risk rises to 48 times (Janssen et al., 2004).
• People who have endured three kinds of abuse (e.g., sexual, physical, bullying) are at 18-fold higher risk of psychosis, whereas those experiencing five types are 193 more likely to become psychotic (Shevlin et al., 2007).
• People with "psychosis" are three times more likely to have experienced childhood sexual abuse (CSA) than those with other diagnoses, and 15 times more likely to have been abused than non-patients (Bebbington et al., 2004).

She ended her talk by suggesting some answers to the question:  "What is to be done?".  Her ideas can be read in detail on the slides from her talk available here.

I highly recommend watching her talk (just over an hour).  So far over 1,000 people have viewed it and the feedback, not only from the conference but also from people who have watched her talk on youtube, has been incredibly positive.

 Further Information and Videos From Shaping Services Together 2013

Jo Mussen, Vice Chair of Powys Teaching Health Board and their Lead for Mental Health, Chaired the morning, as part of her conference introductions which included a thought provoking reading from the Robert Whitaker book,  Anatomy of an Epidemic.  The extract was entitled “A Modern Plague” and it can be read here

Sian Richards, Welsh Government Strategy Lead, National Mental Health Partnership Board, alongside other partnership members, and David Crepaz-Keay, Head of Empowerment and Social Inclusion, Mental Health Foundation, talked next presenting us with a presentation entitled “Together for Mental Health” that provided the latest information about: 

• The National Mental Health Partnership Board


•  Developing a National Forum for strategic participation in national and local mental health partnership boards 

You can listen to this in full (36 minutes) here.
 
Powys Youth Forum and Clwyd Theatr Cymru developed, planned, led and ran a participatory workshop on the theme: “Wisdom Across All Ages”.  This helped us to begin to explore participation for people of all ages.
 
You can find out more about the conference and read a full conference report (12 pages) here.

Unconventional Wisdom:  The Debate Continues 7th March 2014

Free Conference:  Wales Early Intervention Service Conference:  Finding Meaning in "Psychosis"?

Friday 7th March 2014.  The Pavilion, Llandrindod Wells Powys.  9.30 am for refreshments.  Finish 4.30 pm.   

 

Another chance to join us and find out more about the debate that challenges the conventional wisdom and to explore the question:  “Should mental health services be underpinned by the question what happened to you rather than the question what is wrong with you?”. 

 

Speakers Are:

 

Euan Hails - Clinical Lead Psychosis Services, Hywel Dda Health Board.  Bio to follow.  But to find out more about his work click here.

 

Eleanor Longden - an award-winning postgraduate researcher with a specialist interest in psychosis, trauma, and dissociation. She is a three times TED speaker, a trustee of Intervoice: The International Network for Training, Education, and Research into Hearing Voices and Soteria Network UK, and has lectured and published internationally on promoting creative, person-centred approaches to understanding and recovering from psychosis.  More here.

 

Dr Lucy Johnstone - consultant clinical psychologist and the author of 'Users and abusers of psychiatry' (2nd edition Routledge 2000) and co-editor of 'Formulation in psychology and psychotherapy: making sense of people's problems' (2nd edition Routledge 2013) along with a number of other publications taking a critical perspective on mental health theory and practice.   More here

 

Dr Sami Timimi - Consultant Child and Adolescent Psychiatrist and Director of Medical Education in the National Health Service in Lincolnshire and a Visiting Professor of Child and Adolescent Psychiatry at the University of Lincoln, UK. He writes from a critical psychiatry perspective on topics relating to mental health and has published over a hundred articles and tens of chapters on many subjects including childhood, psychotherapy, behavioural disorders and cross-cultural psychiatry.  More here.

 

This conference is an opportunity to explore:

• how we understand and make sense of these “psychotic” experiences
• best practice in early intervention responses that help people and those close to them cope with these experiences, learn from them and thrive
• the interactions, treatments and ideas that make a positive difference to people’s lives and how we make sure that these are offered with openness and transparency
• interventions and treatments that early intervention services could deliver and how they might continue to develop

Interested in joining us?  To find out more about this conference and to get more detail about how to book, click here or contact the team on pamhinfo@pavo.org.uk, telephone 01686 628 300.