Recovery Leeds

The birth of Recovery Leeds; by Recovery Leeds

2011-04-01T03:01:00.006+11:30

I entered the mental health system just over 10 years ago, first as a patient, emphasis on the patience, then a service user and shortly after as a member of staff.

Conditioned by the usual messages welcoming me to a jobless and dysfunctional future, I had become a half being set to fail as both parent and husband. A hungry ghost, haunting my old life, surrounded on all sides by imaginary walls, infecting my surroundings with misery.

" Encompassed on all sides with a thousand dangers, weary faint, trembling with a thousand terrors...I...in a fleshy tomb, am buried above ground."
William Cowper

It is important to stress most of this stigma and negativity came from within. My wife was unfailing in her belief of healing, while others in their silence and empathic expressions only colluded with my own sense of loss, misery and hopelessness, heralding the dawn of an age of severe and enduring illness.

After seeing a long, and I do mean long, series of locum psychiatrists all of whom confirmed my fears, it was during a CPA review that I first heard, spoken by a professional, the language of what I now recognise to be recovery. I was in no state to speak, sobbing so inconsolably those present must have wondered if I even knew what was going on, but this young doctor, Dr Watson, spoke of a return to my normal, of work and life as enjoyable once again. Outwardly I must have seemed unable to hear but inwardly his words gently lifted my face that I would hear them, engendering a sense of hope. The message was understood not in an intellectual sense rather as an experience in my heart, the budding of optimism following words which fell as seeds in my being, watered perhaps by my own tears.

Later after beginning work as a Service User Development Worker within rehabilitation services in Leeds I found echoes of that message in the Psychosocial Interventions training I attended and so I did all I could to understand the concept of what has been labelled recovery. My first Google searches uncovered little; there was information about the Tidal Model together with advice on recovery of a model rocket. I gathered all the information I could and developed my own recovery resource, attaching documents to as many emails I could in the hope of growing the positive message I received on that day and the ensuing positive effect on my sense of hope. I gathered articles which fostered that same sense of optimism by listening with my heart. I then went on to collect items which might be helpful to organisations and the people working within them, those like I now found myself to be, privileged in supporting people with Mental Health challenges.
It was during a visit to my daughters school and reading information produced by their IT department that I realised how easy it would be to set up a blog, this would mean instead of sending people documents I could simply give them the blog address. I went home that evening and within a few short minutes, recoveryleeds was born. It isn’t a blog in the sense of an online journal or diary, more a place to find links and documents. In the body of the blog I have tried to place articles or even phrases which might interest or even inspire others.

Just over a year ago I installed an add-on called Google Analytics, this provides information about how often the site is accessed and from where. Since then the blog has been viewed 2675 times in 83 countries spanning 6 continents. I have no financial investment in people visiting the site only the hope they will find some of the pieces in their jigsaw.

It was suggested I write a short article about my blog for a magazine and I thought it a good idea to post it.

My very best wishes in your recovery and those who you may have the privilege to support. rl

The Way of Transformation

2010-11-15T22:03:00.002+11:30

The man, who, being really on the Way, falls upon hard times in the world will not, as a consequence, turn to that friend who offers him refuge and comfort and encourages his old self to survive. Rather, he will seek out someone who will faithfully and inexorably help him to risk himself, so that he may endure the suffering and pass courageously through it. Only to the extent that man exposes himself over and over again to annihilation, can that which is indestructible arise within him. In this lies the dignity of daring.

Von Durkheim

There is a field

Out beyond ideas of wrongdoing

and rightdoing there is a field.

I'll meet you there.

Rumi

Recovery – pie in the sky or a star?

2010-09-16T18:16:00.000+11:30

Donna Kemp asks who ‘owns recovery’?

Recovery is everyone’s business. It seems to have been the buzz word for the last few years in mental health and is rapidly gathering momentum. Indeed, it appears to be morphing, growing arms and legs, changing its meaning and expanding its territory. Its mental health roots were firmly in the service users’ ground; it was something that service users owned – ‘you know what, despite what I’m going through with mental health services, of being care programme approached up hill and down dale, of being told what my needs are and what services and tablets can do to make me better, regardless of all of this, I can and I will have a life (so up yours!)’. It was empowering and liberating; it actually made sense and generated energy. Energy is contagious, get near it and you too will feel energised with recovery.

Everyone wants a piece of the recovery pie – it’s just so damned good! Mental health services are enchanted, a genuine bona fide tool for engagement, something that service users actually want to be involved with – a promised hope that is not a tablet or a weekly visit, whether you need it or not. Services are smart quickly picked up the new language, the new currency, developing recovery-focused services and offering recovery training. It is truly the age of recovery and the future looks rosy.

But the recovery baton has been taken rather than willingly passed from the user to the service. Yes, service users stay central to their support and care; yes, the ethos of recovery remains strong with collaborative working, but yes, the locus of control has shifted from the individual to the service. Like anything that you nurture and hold dear, to have it taken from you and given back is like the perpetual spare Christmas present, rewrapped and presented back as an original. Disappointed, you act surprised and feign gratitude, but it’s not right, the shine has dulled, it’s lost its energy and appeal.

Services have grabbed the tools from the recovery tool kit (marked ‘service users only’) and sculpted them into service-friendly instruments; paper heavy, but also oddly compatible with an electronic system – kind of – well, it will look better printed off. Take the Mental Health Recovery Star for instance. It’s all the rage, and rightly so. It’s good, it makes sense, it hits the mark, it’s visually pleasing and portable. For all of these reasons, it is fast becoming the tool of choice for measuring outcomes; commissioners are happy, services are happy, maybe even service users are happy at the idea that the ‘Star’ is stealing the show. But, it’s across the board, now everyone should have a recovery star with the outcomes measured regardless. It becomes mandatory, meaning that ultimately recovery is mandatory. You have no choice, you must ultimately recover and we will all be watching. We need you to recover, to show those positive outcomes; that means that you no longer need a service because you met the outcomes.

Congratulations, you just outcomed yourself out of a service. Now that may be great for some individuals, but frankly it fills some people with fear and confusion. The rules have changed, services were always going to be there; to tinker with medications that must be taken; to keep on visiting come rain or shine; to remind people that they are too unwell to work at the moment; that going to the day centre is best. The rules have changed and it’s become time to fly the comfortable mental health nest that was filled with promises of foreverness.

To be clear, the paternalistic tendencies of mental health services are not acceptable. A shift in attitude and practice is evident, welcome and long may it prosper. Recovery-focused work with individuals is the right approach, but I would suggest affording caution to the wholesale use of one specific tool. This would be a move away from individualised service-user-centred care and support. Let mental health practitioners be creative in how they engage with people, give them a selection of tools to use, but remember that any craftsman will tell you that their own hand is their best tool – practitioners are fully capable of working with individuals to develop outcome-based care plans. As for recovery, it’s here to stay, but we need to consider the language and how we use it. It can have a paradoxical effect with some people, there is always the option of being maverick and actually using a term that the person you are working with uses: ‘getting better’ ‘getting back on the horse’ ‘feeling well’ ‘wellbeing’, ‘getting back to normal’; you never know, it could work.

Donna Kemp

Care Programme Approach Development Manager

Leeds Partnerships NHS Foundation Trust

Published in Mental Healt Nursing magazine Aug/Sept 2010 Volume 30 number 4

www.unitetheunion.org/mhna

www.mhpf.org.uk/recoveryStarApproach.asp

Inspirational words of Tagore

2010-09-13T20:07:00.000+11:30

Though known mostly for his poetry, Tagore also wrote novels, essays, short stories, travelogues, dramas, and thousands of songs. Of Tagore's prose, his short stories are perhaps most highly regarded; indeed, he is credited with originating the Bengali-language version of the genre. His works are frequently noted for their rhythmic, optimistic, and lyrical nature. Such stories mostly borrow from deceptively simple subject matter: common people.

Days are coloured bubbles that float upon the surface of fathomless night.

A mind all logic is like a knife all blade. It makes the hand bleed that uses it.

Bigotry tries to keep truth safe in its hand with a grip that kills it.

Do not say, 'It is morning,' and dismiss it with a name of yesterday. See it for the first time as a newborn child that has no name.

Faith is the bird that feels the light when the dawn is still dark.

I have become my own version of an optimist. If I can't make it through one door, I'll go through another door - or I'll make a door. Something terrific will come no matter how dark the present.

Rabindranath Tagore. 7 May 1861 – 7 August 1941

Beyond Belief by Tamasin Archer

2010-05-17T20:51:00.001+11:30

Beyond Belief

Alternative Ways of Working with Delusions, Obsessions and Unusual Experiences

About the book and author

Tamasin Knight's first book Beyond Belief explores ways of helping people who have unusual beliefs. These are beliefs that may be called delusions, obsessions, or another kind of psychopathology.

Psychiatric treatment attempts to remove these beliefs by medication and other methods. The new approach described in Beyond Belief is different. It is about accepting the individual's own reality and assisting them to cope and live with their beliefs.

Beyond Belief explains the new approach in a very readable format.

Many psychological techniques to cope with unusual beliefs are described. These include strategies to reduce fear, strategies to increase coping and problem solving techniques.
Ideal for mental health professionals, service users/survivors and carers.

"Beyond Belief offers us a ground-breaking way of helping people deal with unusual beliefs. In Bradford we have found this publication it to be extremely helpful to service users, workers and as the inspiration for a new self help group. I am sure that this publication will enable more people to benefit from this knowledge and approach and help us change the way we as a society approach beliefs we find unusual." (Rufus May; Clinical Psychologist, Centre for Citizenship and Community Mental Health, Bradford University, England)

Dr Tamasin Knight has degrees in psychology and medicine, she has worked as a doctor in the UK and is currently working in South America. This book describes her research to develop new ways of helping people who have delusions, obsessions or unusual experiences.

Download

Thomas Szasz

2010-03-13T03:46:00.004+11:30

Citizens Commision on Human Rights

Interpersonal Relations in Nursing: A Conceptual Frame of Reference for psychodynamic Nursing: Hildegard E. Peplau

2010-03-12T04:26:00.007+11:30

Modern nursing theorists argue that in the field of Mental Health nursing the model, detailed by Hildegard Peplau, is

still the most appropriate and powerful. Service users and

carers too recognise the style of nursing as the most

benficial and sadly the most lacking.

Dr. Peplau emphasized the nurse-client relationship as the foundation of nursing practice. At the time, her research and emphasis on the give-and-take of nurse-client relationships was seen by many as revolutionary. Peplau went on to form an interpersonal model emphasizing the need for a partnership between nurse and client as opposed to the client passively receiving treatment (and the nurse passively acting out doctor's orders).Peplau was a revolutionary pioneer in the field of modern psychiatric nursing. Her fifty-year nursing career involved prestigious positions and theory development.
Peplau Interpersonal Relations

View more presentations from Ann Sparks.

Clients Perspective

Coatsworth-Puspoky, Forchuk, and Ward-Griffin conducted a study on clients’ perspectives in the nurse-client relationship. Participants in a study were asked about experiences at different stages of the relationship. The research described two relationships that formed the ‘bright side’ and the ‘dark side’. The ‘bright’ relationship involved nurses who validated clients and their feelings. For example, one client tested his trust of the nurse by becoming angry with her and revealing his negative thoughts related to the hospitalization. The client stated, “she’s trying to be quite nice to me…if she’s able to tolerate this occasional venomous attack, which she has done quite well right up to now, it will probably be a very beneficial relationship” (350). The ‘dark’ side of the relationship resulted in the nurse and client moving away from each other. For example, one client stated “the nurses’ general feeling was when someone asks for help, they’re being manipulative and attention seeking” (351). The nurse didn’t recognize the client who has an illness with needs therefore; the clients avoided the nurse and perceived the nurse as avoiding them. One patient reported, “the nurses all stayed in their central station. They didn’t mix with the patients…The only interaction you have with them is medication time” (351). Neither trust nor caring was exchanged so perceptions of mutual avoiding and ignoring resulted. One participant stated, “no one cares. It doesn’t matter. It’s just, they don’t want to hear it. They don’t want to know it; they don’t want to listen” (352). The relationship that developed depended on the nurse’s personality and attitude. These findings bring awareness about the importance of the nurse-client relationship.

Coatsworth-Puspoky, R., C. Forchuk, and C. Ward-Griffin. “Nurse-client processes in
mental health: recipient’s perspectives.” Journal of Psychiatric and Mental
Health Nursing 13 (2006): 347-355. EBSCOHost. McIntyre Lib., UW-Eau
Claire. 12 Nov. 2006

Rethink- Campaigning for Change

2010-02-27T03:57:00.001+11:30

Rethink campaigns for a better quality of life for everyone affected by severe mental illness. They push for national policy change by lobbying people in power on crucial mental health issues, and campaign locally to ensure people can access the help they need.

Please Get involved today.

General Election 2010 Campaign

Lars Martensson and Reverse Psychiatry - From Road To Recovery Speech

2010-01-05T20:54:00.001+11:30

Lars Martensson, 2002

Is recovery possible? Isn’t schizophrenia a chronic, lifelong disease? Yes, in general, at least with the drugs. Almost everybody who gets the diagnosis is stuck both with the diagnosis and the drugs for life. But is recovery possible without the drugs? I will return to that question. But first we will make a trip to the Swedish city of Falun and talk with Goran Andre, a psychiatrist. In the early and mid 1990s he was head of psychiatry in Falun, and responsible for psychiatric services for a population of about 60,000 people. During a four year period 1992 to 1996 all first time psychotic people in this area were taken care of in a novel way that is also practiced, more or less, at some other psychiatric centers in Scandinavia.

Goran describes the four cornerstones of the Falun method a follows:

1. Psychosis is seen as a crisis. A crisis to be overcome.
2. A session with the whole family is arranged within 24 hours.
3. Neuroleptic drugs are avoided. In fact, hardly ever used.
4. Hospitalization is avoided. In fact, hardly ever necessary.

Each one of these principles is contrary to the usual routine in psychiatry. In normal psychiatry a psychotic patient is hospitalized, separated from the family, and finally, after some time, released with maintenance neuroleptic drugs. The family is "educated" to help make sure the patient takes the drugs she "needs." In short, the psychiatry in Falun is an upside down, a contrarian psychiatry, a REVERSE PSYCHIATRY.
What happens in Falun is that the people around the patient, the ”family,” are gathered as soon as possible for a session with the team. The team consists of the psychiatrist, Goran Andre, a psychologist, and two other people. They meet in a living-room type setting. By family is meant whoever is significant in the life of the patient. The experience of the team is that people will come, even if they have to travel from far away.
In this situation, everybody, not only the patient, is filled with anxiety and despair. Together with the team the family gets an increased capacity to contain and solve problems. It is often found that the patient emerges from psychosis during this first family session. The patient is almost always able to return home with the family the same day. If needed, one of the team members may come along home and stay the night with the family.

Psychosis Outcome with Reverse Psychiatry

Now the remarkable outcome. During these four years the Falun team took care of 37 first time psychotic patients. Normally about half of first time psychotic persons get stuck in their psychosis, become chronically psychotic, and get the diagnosis schizophrenia.You do not get that diagnosis right away; you get it after some time when you seem stuck in psychosis. The remarkable outcome is that during these years there was not a single new case of schizophrenia in the Falun area.
In a population of 60,000 people in four years you expect about 30 new cases of psychosis out of which about 15 graduate to schizophrenia. In Falun there were ZERO, instead of 15 cases of schizophrenia. This fact indicates that most, if not all people, who become schizophrenic with normal psychiatry, would overcome the psychosis with the Falun REVERSE PSYCHIATRY. In other words, with the right help at an early stage the development from psychosis to schizophrenia may be prevented.
Since in normal psychiatry most patients would receive neuroleptic drugs, I asked Göran how many of the 37 patients got the drugs. He estimates that perhaps 1/4 of the 37 patients have received a neuroleptic drug some time or times, when, he said “we have thought the drug might be of help."
By 1998 one or two of the 37 patients were taking the drugs. In normal psychiatry, typically about 20 of the 37 patients would be getting neuroleptic drugs at that point in time. In other words, all or almost all of the Falun patients had escaped the usual fate of psychotic patients, the fate of being stuck in the neuroleptic drug trap.
Because GA was chief of psychiatry these years in Falun he was able to ensure that ALL first time psychotic patients were directed to the psychosis team. Thus, there was no selection of patients. Therefore we can be sure that all those 10 or 20 young people in Falun who were destined to become chronic schizophrenics if they had been treated by normal psychiatric methods, were saved from this terrible fate – we can be sure they were among the 37 patients seen by the team.

"We were all wrong!"

You would think these results should have been written up in a proper research paper. Of course. Goran and his team are dedicated professionals, but they are not academic people writing research reports. Obviously, if the academic psychiatric establishment had been truly interested, the continued work of the team would have been protected and the data would have been evaluated and published in the psychiatric literature. I am sorry to say, that did not happen.
The Falun results vindicated views I had presented a decade earlier, in the mid80s, when I argued, among other things, for a legal right to drug free care. Let me quote Loren Mosher, whom you will hear later today. He said

“In psychiatry, the powerful, established gate-keepers - a group composed almost entirely of academic - conservative - psychiatric - research mafiosi - can be relied upon to reject unfashionable research.”

What is true in America is true, also in Sweden.

A senior psychiatrist, my friend, who also knew what made his colleagues tick, said to me in the mid80s: “Lars, you have to realize, if you are right, all they have done all their life is wrong.” When did you hear the people in power admit: “We were all wrong!”

The Problem with Psychiatry and Psychiatrists

What was happening in Falun? Why was there no schizophrenia? Even the members of the team are wondering. Goran told me that "What we are NOT doing may be more important than what we are doing." Ulf Wamming, the psychologist explained: "Never leave a first time psychotic patient alone in a room with a psychiatrist!"

Why? What is it about a psychiatrist that is destructive? What does a psychiatrist do?

Let us think for a moment about what typically goes on between a doctor, the expert, and a patient, the non-expert. The doctor tries to understand what the patient's words suggest about the disease. The doctor has ideas and thoughts that he does not share with the patient. With a psychiatrist, while the patient is talking the doctor is really looking for psychotic symptoms. He has ulterior thoughts. This professional attitude may be OK when the concern is a disease of the body. But it is very problematic with a psychotic person.
Let us compare the relation between doctor and patient with the relation between the mother and the baby at the moment the baby is mentally born by the leap to an outside viewpoint. That leap, we understand, is only possible because of the empathy, dedication, openness, total presence of the mother. There are no ulterior thoughts, no manipulation. This is love. Human consciousness is born in Love.
The task with a psychotic person is, as we noted, similar to the task with a baby. The task is to activate the frontal brain function that underlies human consciousness. When the psychotic person makes the leap to an outside viewpoint through a fully empathic mutual relation with another, at that moment the psychosis is overcome. The person is whole again.
We noted that human beings are programmed to respond appropriately with care and love to a crying baby. But with a crazy adult our spontaneous reaction is not care and love, rather it is withdrawal or anger. The professional attitude is not the answer. The professional attitude is also a kind of withdrawal, a kind of anger management.
If we understand the task that the psychotic person faces in order to become whole again, and if we want to make it possible for him or her to get the faith to dare that vital leap, the recipe is:

Be there, but not aloof and observing, and not intrusive, but fully present with a pure and open mind.

So, what the patient needs is more or less the opposite of what a psychiatrist is trained to give.

Some 20 years ago when I had been giving a speech in Denmark a psychiatrist in the back of the room asked: It is nighttime. I am on duty in the emergency room and I have this very strong, big, violent, psychotic man. Do you say I should not give him a neuroleptic drug?
The answer that came out of my mouth was: “Let us start with the problem, not with the system.” Within the existing system, of course, the psychiatrist may have no alternative.
In our society we expect to do our jobs with a professional attitude and between 9 and 5. Maybe there will be some overtime etc., but still, our involvement is limited. We can do a lot of things this comfortable way. But there are essential tasks that demand more. For example, in wartime we may be expected to risk our lives. If a person is drowning in the river, the only way to save that person may be to jump in and share the danger. If it is my child, or someone else I love, I probably will jump in.
There are tasks for which our system, our way of doing things is inadequate. Doing psychiatry the way we do other kinds of medicine is totally inadequate.

Conclusion

It is an unbearable horrible tragedy when a young person, often a gifted, sensitive, creative young person is drowning in psychosis. Today I have focused on the experience in Falun, but time permitting I could have marshaled much other evidence that most, if not all, these young people can be saved, saved from the psychosis, and saved from the drugs – saved to live the lives they were born to live. They can be saved. Therefore they must be saved. If we understand and face up to the actual problem we will have no patience with the existing system of psychiatry.

Love opens the road to recovery:

Love instills the Faith to dare the vital leap.

Love gives the Hope that the impossible life IS possible, after all.

Road To Recovery
Lars Martensson WebSite

In Memory Of Ian Dawson; Passed Away 15 December 2009 Rest In Peace

2009-12-16T20:53:00.003+11:30

Your fear of death is but the trembling of the shepherd when he stands before the king whose hand is to be laid upon him in honour.

Is the shepherd not joyful beneath his trembling, that he shall wear the mark of the king?

Yet is he not more mindful of his trembling?

For what is it to die but to stand naked in the wind and to melt into the sun?

And what is it to cease breathing, but to free the breath from its restless tides, that it may rise and expand and seek God unencumbered?

Only when you drink from the river of silence shall you indeed sing.

And when you have reached the mountain top, then you shall begin to climb.

And when the earth shall claim your limbs, then shall you truly dance.

Ghibran

The eye; Khalil Ghibran

2009-12-14T20:23:00.005+11:30

Said the Eye one day, “I see beyond these valleys a mountain veiled with blue mist. Is it not beautiful?”

The Ear listened, and after listening intently awhile, said, “But where is any mountain? I do not hear.”

Then the Hand spoke and said, “I am trying in vain to feel it or touch it, and I can find no mountain.”

And the Nose said, “There is no mountain, I cannot smell it.”

Then the Eye turned the other way, and they all began to talk together about the Eye's strange delusion. And they said, “Something must be the matter with the Eye.”

Transpersonal Psychology; Stanislov Grof

2009-12-14T08:11:00.008+11:30

This piece is an extract of a paper called 'A Brief History of Transpersonal Psychology' by Stanislav Grof, M.D.

Psychiatric literature contains numerous articles and books that discuss what would be the most appropriate clinical diagnoses for many of the great figures of spiritual history. St. Anthony has been called schizophrenic, St. John of the Cross labeled “hereditary degenerate,” St. Teresa ofAvila has been dismissed as a severe hysterical psychotic, and Mohammed's mystic al experiences have been attributed to epilepsy. Many other religious and spiritual personages, such as the Buddha, Jesus, Ramakrishna, and Sri Ramana Maharshi have been seen as suffering from psychoses, because of their visionary experiences and “delusions.” Similarly, some traditionally trained anthropologists have argued whether shamans should be diagnosed as schizophrenics, ambulant psychotics, epileptics, or hysterics. The famous psychoanalyst Franz Alexander, known as one of the founders of psychosomatic medicine, wrote a paper in which even Buddhist meditation is described in psychopathological terms and referred to as “artificial catatonia” (Alexander 1931).

While Western psychology and psychiatry describe the ritual and spiritual life of ancient and native cultures in pathological terms, dangerous excesses of the industrial civilization potentially endangering life on the planet have become such integral parts of our life that they seldom attract specific attention of clinicians and researchers and do not receive pathological labels. We witness on a daily basis manifestations of insatiable greed and malignant aggression - plundering of non-renewable resources and turning them into industrial pollution, defiling of natural environment critical for survival by nuclear fallout, toxic chemicals, and massive oil spills, abuse of scientific discoveries in physics, chemistry, and biology for development of weapons of mass destruction, invasion of other countries leading to massacres of civilians and genocide, and designing military operations that would kill millions of people.

The main engineers and protagonists of such detrimental strategies and doomsday scenarios not only walk freely, but are rich and famous, hold powerful positions in society, and receive various honors. By the same token, people who have potentially life-transforming mystical states, episodes of psychospiritual death and rebirth, or past-life experiences end up hospitalized with stigmatizing diagnoses and suppressive psychopharmacological medication. This is what Michael Harner referred to as the ethnocentric bias in judging what is normal and what is pathological.

According to Michael Harner, Western psychiatry and psychology also show a strong cognicentric bias. By this he means that these disciplines formulated their theories on the basis of experiences and observations from ordinary states of consciousness and have systematically avoided or misinterpreted the evidence from non-ordinary states, such as observations from psychedelic therapy, powerful experiential psychotherapies, work with individuals in psychospiritual crises, meditation research, field anthropological studies, or thanatology. The

paradigm-breaking data from these areas of research have been either systematically ignored ormisjudged and misinterpreted because of their fundamental incompatibility with the leading paradigm.

Articles by Stanislav Grof

Skunk ‘poses greatest risk of psychosis’

2009-12-04T08:27:00.000+11:30

RCPsych - Press Release

Embargoed until 01 December 2009

People who smoke skunk, the most potent form of cannabis available in UK, are almost seven times more likely to develop psychotic illnesses like schizophrenia than those who use traditional hash, according to new research.

The study, published in the December issue of the British Journal of Psychiatry, was carried out by psychiatrists and researchers at the Institute of Psychiatry, King’s College London (KCL).

The team collected information on cannabis use from 280 people attending South London & Maudsley NHS Foundation Trust with their first episode of psychosis. A control group of 174 healthy people from the local area was also studied.

There was no significant difference between the two groups in whether they had ever used cannabis, or their age at first use. However, the patients with psychosis were twice as likely to have used cannabis for longer than five years, and over six times more likely to use it every day.

Moreover, among those who had used cannabis, patients with psychosis were almost seven times more likely to use skunk than the control subjects.

Psychiatrist and lead researcher Dr Marta Di Forti said: “Patients experiencing their first episode of psychosis were not more likely to have ever taken cannabis or to have started doing so earlier than the control group. However, psychosis was associated with more frequent and longer use of cannabis. Our most striking finding is that patients with a first episode of psychosis preferentially used high-potency cannabis preparations of the skunk variety.”

The researchers believe the high level of delta-9 tetrahydrocannabinol (Δ9-THC) found in skunk is to blame.

The two main constituents of cannabis are Δ9-THC and cannabidiol. Δ9-THC is the main psychoactive ingredient, and in experiments has been shown to produce psychotic symptoms such as hallucinations and delusions. Cannabidiol does not induce these symptoms and seems to have anti-psychotic properties – possibly counteracting the effects of THC.

In south-east London, where the study was carried out, the skunk variety of cannabis contains 12-18% Δ9-THC and less than 1.5% cannabidiol. In contrast, resin (hash), which was preferred by cannabis users in the study’s control group, has an average Δ9-THC of 3.4% and a similar proportion of cannabidiol.

Dr Di Forti concluded: “Our study is the first to demonstrate that the risk of psychosis is much greater among people who are frequent cannabis users, especially among those using skunk, rather than among occasional users of traditional hash. It is not surprising that those who use skunk daily have the highest risk of all, because skunk has the highest concentration of Δ9-THC and a relative lack of cannabidiol with its protective effect.”

She added: “Unfortunately, skunk is displacing traditional cannabis preparations in many countries, and the availability of skunk on the UK ‘street’ market has steadily increased over the past six years. Public education about the risks of heavy use of high-potency cannabis is vital.”

The study was funded by the Maudsley Charitable Fund and the National Institute for Health Research specialist Biomedical Research Centre for Mental Health at South London & Maudsley NHS Foundation Trust and KCL.

For further information, please contact Liz Fox or Deborah Hart in the Communications Department.
Telephone: 020 7235 2351 Extensions. 298 or 127

E-mail: efox@rcpsych.ac.uk or dhart@rcpsych.ac.uk

References:

Di Forti M, Morgan C, Dazzan P, Pariante C, Mondelli V, Reis Marques T, Handley R, Luzi S, Russo M, Paparelli A, Butt A, Stilo SA, Wiffen B, Powell J and Murray RM (2009) High-potency cannabis and the risk of psychosis, British Journal of Psychiatry, 195: 488-491

Spiritual Emergence and Spiritual Emergency

2009-12-02T04:24:00.002+11:30

There is a great deal already written by wiser souls than mine. I wish only to introduce the subject and act as a sign post to the rich veins of information already available. I found this on a Royal College of Psychiatry page which is brimming with links to mental health and spirituality. Click here

‘‘Spiritual Emergency’ – a useful explanatory model?’

A Literature Review and Discussion paper
Dr. Patte Randal and Dr. Nick Argyle

When spiritual development is gradual and occurs in a context which can support the personal changes in worldview that it brings, there should be no crisis of transition. When it is sudden, or the higher stage is experienced intermittently there can be uncertainty or crisis. In this context, Grof and Grof [35, 36] write about spiritual development using the term "spiritual emergence". By this, they mean "the movement of an individual to a more expanded way of being that involves enhanced emotional and psychosomatic health, greater freedom of personal choices, and a sense of deeper connection with other people, nature, and the cosmos". They go on to make a distinction between this natural process, and a more difficult and sometimes traumatic experience, ".When spiritual emergence is very rapid and dramatic, however, this natural process can become a crisis, and a spiritual emergence becomes a 'spiritual emergency'". Episodes of this kind have been described in the sacred literature of all ages as a result of meditative practices and are signposts of the mystical path.

Recovery from psychosis and care for spiritual emergency

In a psychosis formulated as a spiritual emergency best care will both use the spiritual sphere to speed recovery and avoid iatrogenic damage. There are some similarities to general crisis intervention that sees crisis as a time of opportunity. Psychosis appropriately framed as "spiritual emergency" can be seen as an opportunity for further personal growth, if responded to in appropriate ways.

Treatment of spiritual emergency is supportive, does not usually involve medication (other than occasional use of a minor tranquilliser or hypnotic to ensure sleep if necessary). Care is usually undertaken by people who have a transpersonal understanding and some experience themselves of these phenomena. It involves "being with" the person, usually in a tranquil environment, doing everyday things to help "ground" the person. Reception of the altered state is characterized by trust rather than fear, with the expectation that healthy, natural resolution will occur in time, with a beneficial outcome in terms of personal growth. Sometimes constant supervision can be necessary to help prompt care of basic needs, such as eating and drinking, if these are being neglected. Cessation of intense spiritual practices at this time is usually recommended, but prayer support may be offered. Explanation of the psychotic experience in terms of the spiritual domain is helpful. The person is supported in expressing the content of their inner world at their own pace, and when
appropriate, the psychospiritual roots of the problem can be addressed. For this type of care to become available within general mental health services, clearly appropriate staff selection and training would be required [65, 66].

The danger for people being diagnosed as having a serious form of psychotic disorder is that they will be subjected to perhaps unnecessary, suppressive antipsychotic medication, with its potentially serious side effects. If psychosis can be seen as "a state of aberrant salience", and a central role of dopamine is to mediate the "salience" of environmental events [67] it may be that the "salience" of the experience of spiritual emergency is inappropriately suppressed by dopamine blockade. In addition, there may be the social isolation, stigmatisation and self-stigmatisation associated with the label of mental illness. This may leave the person not only with the need to integrate the spiritual emergency experience without a context in which to understand it, but also having to recover from the trauma of these consequences.

On the other hand there are risks associated with not treating psychosis with medication soon enough related to on-going distress, potentially unwise or dangerous behaviour, and effect on prognosis. Current best practice recommends early use of antipsychotics for all acute psychosis in an attempt to prevent the deteriorating pattern of chronicity [68]. With the burgeoning of early intervention programmes this balance of risks is an aspect which needs urgent attention. The concept of spiritual emergency is a potentially useful explanatory model which might assist in the recovery process because it is normalising and not stigmatising. It remains unclear how large the sub-group of patients is for whom this explanatory model, and an approach which supports spiritual development and understanding of the psychotic phenomena in this light, might be more useful either in the acute management phase or recovery phase. Further research is recommended in order to assess whether the notion of spiritual emergency might have diagnostic utility in improving clinical outcome for this sub-group and how cases can be identified in terms of past history, phenomenology, continuity with prior spiritual life, and personal explanatory model. To what extent spiritual emergency may be 1) a separate diagnosis strongly related to causal factors and best treatment or 2) an explanatory model that is useful for some people recovering from psychosis, regardless of cause, which can be included along with other treatment approaches, are important questions to be answered.

35. Grof C, Grof S. The Stormy Search for the Self - A Guide to Personal Growth through Transformational Crisis. New York: Jeremy P Tarcher, 1990.
36. Grof S. Spiritual Emergency. When Personal Transformation becomes a crisis. Los Angeles: Jeremy P. Tarcher, 1989.
65. Nelson J. E. Healing the split: Integrating spirit into our understanding of the mentally ill (Revised ed.). New York: State University of New York, 1994.
66. Grof S. Psychology of the Future. Albany, New York: State University Press, 2000.
68. Remington G; Kapur S, Zipursky RB. Pharmacotherapy of first-episode schizophrenia. British Journal of Psychiatry 1998; 172 (Suppl. 33), 66-70.

Spiritual Emergency
Spiritual Crisis Network
Spiritual Emergency Resource Centre
Spiritual Emergence
'Psychosis or Spiritual Emergence?
Spiritual Competency Resource Centre

Dial House: Celebrating 10 Years.

2009-11-19T20:58:00.008+11:30

Dial House is a place of sanctuary open 6pm–2am Friday-Sunday. Visitors can access when they are in crisis. They can telephone to request a visit, or turn up at the door 6pm–10.30pm. We currently have 60–100 visits each month.
Visitors can use the house as time out from a difficult situation or a home environment where they may feel unsafe or that may exacerbate their difficulties. Visitors can relax in a homely environment and can also gain one to one support from the team of Crisis Support Workers.
At Dial House we have a family room, so parents in crisis can bring children with them. We also transport visitors to and from the house by taxi, to make their journey safe and comfortable.

History of the Organisation

The Leeds Survivor Led Crisis Service was set up in 1999 by a group of service users, who had campaigned for five years to develop the service. Initially, the service was run in partnership with Social Services, becoming a registered charity in 2001. The service was set up to be a place of sanctuary, which was an alternative to hospital admission and statutory services for people in acute mental health crisis. The service was established, and continues to be governed and managed, by people with direct experience of mental health problems. We have our own unique perspectives on what it feels like to be in crisis and what helps and does not help. We have developed our service based on this knowledge and experience, while responding to the needs articulated by our visitors and callers.
We are part of a network of mental health services in Leeds. We liaise with and undertake joint work with other services, while maintaining our identity as an innovative, service user led voluntary sector organisation.

Philosophy of the Leeds Survivor Led Crisis Service

Each individual has their own experience of crisis. The causes and impact of crisis will be different for each person. We believe that people are expert in knowing their own situations and with the right kind of attention and support can find their own solutions.

Our definition of crisis is…

People have told us that some of the characteristics of crisis are:

An overwhelming experience

More than the person can deal with

Not one’s normality

Usually intolerable

Highly stressful

Having nowhere to turn

Having exhausted all one’s coping strategies.

Crisis is sometimes described as a time of change or a turning point in one’s life: a period of breakthrough or breakdown.

Crisis can be a liberating or learning experience.

People in crisis should have a range of choices for dealing with a crisis. Our services may be used as an alternative to statutory services, or may complement involvement in mainstream services. We believe that to deal with a crisis, a person must feel safe, listened to, and connected to other people.We want to know about the person, not the label they have been given.People in crisis are not essentially different from anyone else and everyone in his or her life will experience crisis at one time or another.
We recognise that the city of Leeds is made up of many different groups, traditions and cultures. We respect and are responsive to the fact that social factors in a person's life shape both their understanding of crisis and their way of dealing with crisis. We also recognise that deprivation and oppression not only impact on people's ability to cope with distress, but can be the cause of distress.

Therapeutic Approach of Leeds Survivor Led Crisis Service

The paid staff within the organisation are qualified or qualifying counsellors, or receive training in the Person Centred Approach. This is the primary therapeutic approach we use.

The key principles of this are:
The person providing support demonstrates empathy, congruence and unconditional positive regard towards the client

A belief in the actualisation tendency – that is, a belief that people do the best they can in the circumstances they are in and have an inherent tendency to try to achieve their full potential

The principle of non directivity. Work is led by the client, in the belief that they have the resources within themselves to find their own solutions.

We also draw on other therapeutic approaches, such as Solution Focused Brief Therapy. We provide a compassionate, respectful, empathic and consistent service, with the aim of supporting visitors to identify their own solutions to their difficulties.

Within both Dial House and Connect, we work with people in acute states of crisis. Many of our visitors are suicidal and/or self harm and we are skilled and experienced within these areas of work. Over the time we have been open, we have successfully worked with people who have been excluded from other services, or who other services have been unable to engage.

Refuge (by Hans-Werner Sahm)

10 years on Leeds Survivor Leed Crisis Service has grown from strength to strength and has a very special place in the hearts of those who visit and work there. It stands as an ideal that should one day be available to all regardless of postcode, the present manager Fiona Venner travels the UK giving lectures on the unique philosophy and practice of Dial House. The project has been awarded several highly prized awards including being the winner of the Gaurdian Public Sevice Award in 2006.

For more details contact survivor.led@lslcs.org.uk
0113 260 9328

Here is the article in the Guardian newspaper about Leeds Survivor Led Crisis Services Public Services Award.

06 Dec 2006: The Guardian

Public services award: The client knows best

Innovation and progress, customer service winner: Leeds Survivor Led Crisis Service This user-led service offers a non-residental safe house for people experiencing a mental health crisis.

Andrew Cole reports:

Everyone who turns up at the door of the Leeds Survivor Led Crisis Service on the outskirts of the city has one thing in common: they are at the end of their tether. All will be facing acute mental crisis, ranging from attempted suicide to self-harm and family break-up. And most will already be feeling bruised by their experiences of the statutory services.
What they find at the crisis service is very different. For a start, nearly all the managers, frontline staff and volunteers have experienced mental health problems themselves. Just as importantly, the therapeutic approach they follow is based on the radical notion that the users know what's best for them.
The principle tenets of this philosophy are "unconditional positive regard", "actualisation" and "non-directivity". But, says project manager Fiona Venner, this simply means treating people with warmth, kindness and honesty. "Rather than telling people what to do or giving advice or saying 'I'm the expert', it's very much about supporting people to bring out and develop their inner resources. People ultimately know what's best for them."

So clients will be offered one-to-one support from the team of crisis support workers. They can also take part in the weekly group sessions. But if they simply want to listen to music, have a bath or make a meal in the adjoining kitchen, that's fine too.

"We give people a lot of freedom and choice. Many of the people have not always had a lot of experience of feeling in control in their lives." Venner says.

This freedom even extends to accepting individuals' self-harming, which the team see as a coping mechanism in the face of unbearable distress. Nevertheless, there is a limit to the permissive approach. If someone is judged to be at real risk of suicide, the team will intervene, as they will if they learn about adult or child abuse. But this only happens rarely.

Between 30% and 50% of all clients who come to the service are suicidal, and many have actually tried to take their lives. "But if someone is here, there's always hope," says Venner. "Part of them might want to die, but part of them wants to live and that's the part that's with us."

The service was set up in 1999 as a result of a campaign by users to find an alternative to hospital for people in acute mental health crisis. After initially working in partnership with social services it became an independent charity in 2001, but is still largely funded by the local health trust and social services.

In the last year the numbers attending the service have shot up from fewer than 250 to around 1,000, mainly as a result of the decision to extend the opening hours - now from 6pm to 2am between Friday and Sunday. The service provides a well-used telephone helpline every night from 6pm-10.30pm. There is also a family room for parents in crisis and users are offered a taxi service if required. Importantly, everyone comes of their own volition. Most self-refer, though a few are referred by GPs, A&E or specialist services such as the city's crisis resolution team.

The pattern of attendance varies hugely. Many have very chaotic lives and will return again and again before moving on. Others will turn up once and that will be enough. Sadly, high demand means many have to be turned away, so visitors are prioritised according to their level of desperation and isolation. "If they're in a hostel or have friends or family, they may be safer than someone who's completely on their own. But," Venner adds, "there is a huge amount of unmet need."

She has no doubt the service has kept many people out of hospital and gives them safety and sanctuary when they are at their lowest ebb. "People often say to us: I would be dead if you hadn't been there," she observes.

Despite the volatile nature of many people's problems, there has not been a single violent incident in the service's seven-year history, says Venner. "People love the service and are very respectful of it and don't want to jeopardise it. The fact that we provide genuine kindness, warmth, affection and respect seems to mark us out as different from other services."

Dial House; A bit of Backgrounnd to the building.

2000 A view of Dial House built in 1720 and altered in 1755. The name Dial means a new turnpike, Halton Dial, on the road known as, the road to York. It is thought that the timbers in the roof of Dial House, which are the original, were from a sailing ship. The front elevation has the attractive variations in colour and tone of hand-moulded bricks. The house is on three storeys with elegant venetian windows at ground and first floor level. At the present, Dial House is operating as a safe house for local people experiencing a crisis in mental health. Dial House became a Grade III building in 1951.

Form; Leodis, A photographic archive of Leeds.

Diagnoses are psychiatry's star signs. Let's listen more and drug people less

2009-11-17T02:00:00.006+11:30

The biological approach to treating mental illness has been a lamentable failure. We must focus on a patient as a person.
Surveying the history of psychiatry, the medical historian Edward Shorter remarked: "If there is one central intellectual reality at the end of the 20th century, it is that the biological approach to psychiatry – treating mental illness as a genetically influenced disorder of the brain chemistry – has been a smashing success."
Far from being a success, there is compelling evidence that the biological approach has been a lamentable failure. Whereas last century saw dramatic improvements in the survival rates of patients suffering from heart diseases and cancer, so far as we can tell, outcomes for patients suffering from the severest forms of psychiatric disorder – the psychoses (disorders in which the patient experiences hallucinations or delusions, usually resulting in a diagnosis of schizophrenia or bipolar disorder) – have hardly changed since the Victorian period. Poor countries without well-resourced psychiatric services seem to do at least as well as the developed world. Therefore, although the perception is often different, there is little evidence that modern psychiatric services have had a global, positive impact on mental health.
At the beginning of the 21st century a new picture of severe mental illness is emerging, which shows that the genetically determined brain disease paradigm is not only ineffective but scientifically flawed. First, it seems that diagnoses such as schizophrenia and bipolar disorder do not identify discrete conditions analogous to, say, appendicitis or tuberculosis. Patients with a mixture of bipolar and schizophrenia symptoms are at least as common as patients who fit one or other diagnosis. The concept of schizophrenia is so broad that two patients can share the diagnosis while having no symptoms in common.
In the case of both types of symptoms, there appear to be many people whose experiences place them on the borderline between health and illness, so that we can think of a spectrum running from ordinariness, through eccentricity and creative thinking, to full-blown psychiatric disorder. Research has also shown that psychiatric diagnoses are poor predictors of response to treatment, giving little indication of which patients will respond to which drugs. They are therefore hardly more meaningful than star signs – another diagnostic system that is supposed to tell us something about ourselves and what will happen in the future, and which is widely embraced despite no evidence of its usefulness.
When new methods of molecular genetics have been used to study psychiatric patients, no genes of major effect have been found. The latest evidence suggests that many genes – possibly thousands – each make a tiny contribution to vulnerability to psychiatric disorder, and that these effects are highly non-specific (the same genes are implicated in patients with different diagnoses).
Some findings that were announced with enormous fanfare have not been replicated in subsequent studies. Much, for instance, has been made of the discovery of a variant of the 5-HTTLPR gene, which appears to make people liable to depression if they are exposed to unpleasant life events. A recently published analysis of the data available on this gene found no evidence that it directly causes depression, or that it makes people vulnerable to depression. However, it was found that negative life events had a direct impact on mood: as our mothers could have told us, bad things tend to make us miserable.
This last observation is consistent with other evidence that life experiences shape even the most severe forms of mental illness. Migrants have at least a four times greater risk of psychosis than other groups, and this effect is most pronounced if they live in areas in which they are in a minority. Early separation from parents has also been shown to increase the risk of psychosis, as have growing up in an urban environment and chronic bullying.
Many studies have also reported an association between trauma in early life and psychosis. These effects are large: one recent study estimated that individuals who had been sexually abused in childhood were 12 times more likely than others to suffer from serious mental illness, and another calculated that the population-attributable risk of a diagnosis of schizophrenia associated with an inner-city childhood was 15% (that is, there would be 15% fewer cases if we all grew up in the countryside). The risk associated with having a parent with the diagnosis is 7% (ie, there would be 7% fewer cases if patients stopped having children).
These effects are understandable in the light of psychological research. For example, early trauma seems to disrupt the process by which we distinguish between our own thoughts and our perceptions, leading to a specific risk of hallucinations. Disruption of early relationships with caregivers, coupled with victimisation, create a tendency to mistrust others and to anticipate threats, leading to paranoid delusions.
The cruel and ineffective treatments that characterised psychiatry in the mid-20th century – for instance, prefrontal leucotomy and insulin coma therapy – would not have been accepted had psychiatrists not been in thrall to the idea that mental illnesses are genetically determined brain diseases. Today, although mental health professionals are usually much more compassionate than in those dark times, psychiatric services continue to see their primary objective as ensuring that patients take their medication.
Legislation has been introduced allowing doctors to coerce patients to take their drugs with threats of a return to hospital if they do not comply. Patients often find that their own understandings of their troubles are ignored. A study of psychiatrists in London found that, when patients asked questions about the meaning of their experiences, the doctors typically changed the subject.
Meanwhile, research on the biology of severe mental illness continues to be prioritised over social and psychological research. Biological investigations into psychosis currently outnumber those on environmental factors by at least five to one, and are much more generously funded by the UK's Medical Research Council. To date, about 30 trials of cognitive therapy for psychosis have been completed; by comparison, in the period 2001-3, nearly 400 drug trials were published in the five leading American psychiatric journals. There is therefore an urgent need to develop a less drug-based, more person-centred approach to understanding and treating mental illness, which builds on the recent scientific findings and which takes the experiences of patients seriously.

By Richard Bentall
guardian.co.uk, Monday 31 August 2009

How I became a Madman

2009-06-08T08:20:00.008+11:30

You ask me how I became a madman.

It happened thus:

One day, long before many gods were born, I woke from a deep sleep and found all my masks were stolen

-- the seven masks I have fashioned and worn in seven lives --

I ran maskless through the crowded streets shouting, "Thieves, thieves, the cursed thieves."
Men and women laughed at me and some ran to their houses in fear of me.
And when I reached the market place, a youth standing on a house-top cried, "He is a madman." I looked up to behold him; the sun kissed my own naked face for the first time. For the first time the sun kissed my own naked face and my soul was inflamed with love for the sun, and I wanted my masks no more. And as if in a trance I cried, "Blessed, blessed are the thieves who stole my masks."

Thus I became a madman.

And I have found both freedom and safety in my madness; the freedom of loneliness and the safety from being understood, for those who understand us enslave something in us.
But let me not be too proud of my safety. Even a Thief in a jail is safe from another thief.

Khalil Gibran

Recovery and the Symphony for a Sea Bird

2009-04-09T20:01:00.013+11:30

In 1988 Deegan stated that recovery is about

‘…moving away from professional definitions towards self determination.’

Symphony for a seabird

You cannot put a big load in a small bag,
nor can you with a short rope,
draw water from a deep well.

Have you not heard how a bird
from the sea was blown inshore
and landed outside the capital of Lu?

The prince ordered a solemn reception,
offered wine to the seabird
in the Sacred precinct,
called for musicians to play
the compositions of Shun,
slaughtered cattle to nourish it.
Dazed with symphonies,
the unhappy seabird died of despair.

How should you treat a bird?
As yourself or as a bird?
Ought not a bird to nest in deep woodland
or fly over meadow and marsh?
Ought it not to swim on river and pond,
feed on eels and fish,
fly in formation with other waterfowl,
and rest in the reeds?

Bad enough for a seabird to be surrounded by men
and frightened by their voices!
That was not enough!
They killed it with music!

Water is for fish, and air for man.
Natures differ, and needs with them.
Hence the wise men of old
did not lay down
one measure for all.

Chaung Tsu

The NHS Duty to Involve (Section 242 of the Health and Social Care Act)

2009-01-24T23:04:00.021+11:30

Our NHS, our future, Leading local change
one of Lord Darzi’s reports tells people:

“You will be involved. The local NHS will involve patients, their carers, the public and other key partners. Those affected by proposed changes will have a chance to have their say and offer their contribution.”
Section 242 of the consolidated NHS Act 2006 places a duty on NHS trusts, primary care trusts and strategic health authorities to make arrangements to involve patients and the public in service planning and operation, and in the development of proposals for changes.

This duty is supported by the guidance;

Real involvement: working with people to improve healthcare
Chapter 2 Public involvement and consultation
242 Public involvement and consultation

(1) This section applies to—
(a) Strategic Health Authorities,
(b) Primary Care Trusts,
(c) NHS trusts, and
(d) NHS foundation trusts.

(2) Each body to which this section applies must make arrangements with a view to securing, as respects health services for which it is responsible, that persons to whom those services are being or may be provided are, directly or through representatives, involved in and consulted on—
(a) the planning of the provision of those services,
(b) the development and consideration of proposals for changes in the way those services are provided, and
(c) decisions to be made by that body affecting the operation of those services.
(3) For the purposes of this section a body is responsible for health services—
(a) if the body provides or will provide those services to individuals, or
(b) if another person provides, or will provide, those services to individuals

(i) at that body’s direction,
(ii) on its behalf, or
(iii) in accordance with an agreement or arrangements made by that body with that other person,
and references in this section to the provision of services include references to the provision of services jointly with another person.
(4) Subsection (5) applies to health services for which a Strategic Health Authority is not responsible by virtue of subsection (3), but which are or will be provided to individuals in the area of the Strategic Health Authority, and for which—
(a) a Primary Care Trust any part of whose area falls within the Strategic Health Authority’s area, or
(b) an NHS trust which provides services at or from a hospital or other establishment or facility which falls within the Strategic Health Authority’s area,
is responsible by virtue of subsection (3).
(5) A Strategic Health Authority may give directions to Primary Care Trusts falling within paragraph (a) of subsection (4), and NHS trusts falling within paragraph (b) of that subsection, as to the arrangements which they are to make under subsection (2) in relation to health services to which this subsection applies.

Patients to get more say in NHS services
Thursday 30 October 2008 16:33 Department of Health (National)

The Department of Health today urged Primary Care Trusts (PCTs) to engage better with patients and the public in developing plans and making decisions about local health services.
New guidance, published today, will help the public have more say in decisions made by their PCT, enabling them to shape local health services.
The strengthened 'Duty to Involve' guidance will also make feedback on public consultations more transparent and accessible.
This follows on from Lord Darzi's review of the NHS earlier this year in which he recommended that any changes to NHS services should be transparent, locally-led and for the benefit of patients.
Today's guidance 'Real Involvement' is being issued to help PCTs and other NHS organisations understand changes to the Duty, and also to offer practical advice on how to put local people at the heart of service changes.
Increased patient involvement will enable local NHS organisations to put patients' wishes first and give staff the freedom to respond and deliver safer, more personalised care. Developing NHS services in partnership with the public and staff plays an important role in creating a modern NHS which meets the changing needs of the population both nationally and locally.

Health Minister Ann Keen said,

"Feedback from patients is one of the most powerful tools available to the NHS to help improve services which is why the Duty to Involve has been strengthened. The NHS is a public service so it is only right that the public should have their say on how the service is shaped.
"Helping local NHS organisations to understand and act upon the Duty is essential to making the most of this feedback which is why we have produced this guidance to help them involve patients effectively."

The new Duty to Involve is also expected to be included in the NHS Constitution due to come into force next year. The Duty will take effect next month but will be included as one of the existing rights set out in the Constitution - to make it easy for patients to find all their rights in one place. The Duty is one of several ways the public can have their say on NHS services including Local Involvement Networks, the Patient Liaison Service and complaints channels and feedback is always encouraged to make sure services are meeting patients' needs.
The guidance will be published on the Department of Health website and letters will be sent to chief executives across the NHS to raise awareness of the changes to the Duty. Materials such as leaflets and presentations will also be provided to help spread the guidance through local NHS organisations and regional briefings will be provided to help with understanding and implementing the guidance.
Notes to editors: 1. For further information please contact the Department of Health press office on 020 7210 5221 2. The Duty to involve was first introduced in 2003 in response to members of the public who were interested in having more say over their local NHS. 3. 'Real Involvement' can be downloaded from : http://www.dh.gov.uk/publications 4. The strengthened Duty to Involve came from the Local Government and Public Involvement in Health Act 2007 5. Case studies of best practice in the Duty to Involve are available on request

Misconceptions about ‘involvement’

Pre-consultation - sometimes used to describe involvement activity that happens early.
It suggests that another form of involvement activity precedes a consultation and that these activities do not have the same importance as a consultation.
This is a misconception that causes confusion as to the level of consultation required – section 242(1B) requires NHS organisations to make arrangements to involve users, whether by being consulted, provided with information or in other ways.
The duty covers a range of activities from providing information to large public consultations

Formal consultation – a term sometimes used to describe the statutory requirement imposed on NHS organisations by the Local Authority Regulations 2002 that require NHS organisations to consult with overview and scrutiny committees (OSCs) when considering a proposal that constitutes a substantial variation or development in the provision of a service.

The duty to involve users is also ‘formal’ as it is a legal requirement, NHS organisation must involve users where section 242(1B) requires them to do so, irrespective of whether the OSC is consulted or not.

Specific commissioning situations

•S242 applies to PCTs for which the 10 specialised commissioning groups (SCGs) act as formal joint committees in commissioning specialised services across the area of the PCT.
•Each PCT that is a member of an SCG retains responsibility for its statutory functions - which include the duty to involve.
•S242 applies to any SHA that commissions services – currently London SHA is responsible for all nationally commissioned services.

The Duty to Involve supersedes;
Strengthening accountability - involving patients and the public: policy guidance

The NHS Constitution
makes it clear to patients that they have a legal right to be involved in planning and developing services provided by the NHS.

The NHS Centre For Involvement

Time To Change

2009-01-22T03:28:00.010+11:30

We have a dream that one day it will be possible to talk openly about mental health problems to friends, neighbours and colleagues without fear of being devalued and excluded and without attracting those delicate 'changes of subject' that indicate that such issues should be kept firmly behind closed doors.

We have a dream that one day derogatory and pejorative descriptions of people with mental health problems - and use of 'nutter', 'mental' 'schizophrenic' etc as terms of derision and abuse - will be as unacceptable as derogatory racist language.

We have a dream that people with mental health problems will be able to talk of their experiences, dreams and aspirations without these being ignored and written off as unrealistic, lacking in insight, or the ramblings of a deranged mind.

Taken From Repper and Perkins' Social Inclusion and Recovery'

From their website

Stigma and discrimination still have a huge impact on the lives of people with mental health problems, even though one in four people will experience a problem at some time in their lives.

It’s time to tackle this last great taboo.

Over the last decade, there have been huge advances in our understanding and treatment of mental health problems and increased investment in services. We are moving closer to a society where recovering a full and meaningful life from mental health problems is the norm rather than the exception.

However, there remains one massive barrier – discrimination.

People with mental health problems consistently identify discrimination as one of their biggest issues and almost nine out of ten people affected by mental health problems have experienced discrimination.

Attitudes need changing

Until now, England has lacked a long-term campaign to raise public awareness about good mental health, counter pervasive negative stereotypes and challenge discrimination.
Despite attitudes about sexuality, ethnicity and other similar issues improving, research shows that prejudice against people with mental health problems is actually increasing.
But there is a climate for change. The government has recognised the impact of stigma and that public attitudes are not improving.

Setting standards

New Zealand and Scotland have set the standards internationally for public anti-stigma campaigns, while the research community has been contributing to a growing knowledge base of what works.
In England there have been relatively small-scale, piecemeal attempts to challenge the stigma and discrimination around mental health. But there has not been one coordinated, long-term, well-funded approach to combating stigma, with the reach and expertise to really make a difference.
That is why Mental Health Media, Mind, Rethink and the Institute of Psychiatry have come together as Time to Change, to combine their knowledge and expertise in the biggest ever England-wide attempt to end the discrimination around mental health.
Our funders have recognised the importance of this issue, and it is the English public, through the National Lottery Fund and Comic Relief, who have made this vital work possible.

Click here to download their brochure.

Click here to order Social Inclusion and Recovery

Click here to find out more about shift

2009-01-21T01:07:00.031+11:30

What is stigma?

1. a mark of disgrace or infamy; a stain or reproach, as on one's reputation.

2. a mental or physical mark that is characteristic of a defect or disease: the stigmata of leprosy.

3. Archaic. a mark made by a branding iron on the skin of a criminal or slave.

From dictionary.com

In Ancient Greece bodily signs or ‘stigmata’ were cut and burnt onto people’s bodies to mark them as different. People with mental disorders are no longer physically mutilated, but critical or derogatory attitudes can be just as damaging to them. You only have to open a newspaper, switch on the TV or go to the cinema to spot such attitudes. While the media isn’t wholly to blame for negative perceptions, every time a programme, article or film portrays a stereotype or fails to clear up a misunderstanding about a mental disorder, it helps to perpetuate the myths. From RCPSYCH

"Help kill the stigma" Adam Ant.

Adam is a keen supporter of the RCPSYCH's anti-stigma campaign and wants more famous people to talk openly about their experiences of mental health problems. Adam recently featured in a Channel 4 documentary in which he talks openly about his manic depression and being stalked. So please watch this space and support Adam in campaigning against discrimination and stigma.

2008-11-11T09:35:00.003+11:30

"Close the Language door

And open the Love window.

The Moon won't use the door

Only the window"

Rumi

2008-10-25T08:10:00.007+11:30

Soteria and Other Alternatives to Acute Psychiatric Hospitalization

THE JOURNAL OF NERVOUS AND MENTAL DISEASE 187:142-149, 1999

A Personal and Professional Review

LOREN R MOSHER, M.D.

http://www.moshersoteria.com/soteri.htm

In 1961, while serving as a medical intern, knowing I was soon to embark on a career as a psychiatrist, I suffered what retrospectively could be labeled an existential crisis. For the first time I experienced the responsibility of caring for persons who would soon die-and I was powerless to do anything about it-except to try to understand their experience of it. They frequently expressed how helpless and depersonalized they felt, "I'm just the one with lung cancer" or "Why can't you do something so I can breathe-- drowning" or "All this place has done is to make me into a nobody-you can't do anything for me so you steer clear." For the first time I faced my own mortality and with it the degrading, dehumanizing and helplessness of the process that could accompany it-particularly if I had the misfortune of being in a hospital like the one in which I worked.

Previous intensive psychotherapy as a medical student had obviously not prepared me to face mortality compounded by the degradation ceremonies I presided over within the institution. As a sometime intellectual, I sought help with my conundrum in the library. Rollo May's Existence (1958) was the beginning of a quest for an intellectual foundation for the depth of what I was experiencing personally. With the help of May's book and an existential analytic tutor (Dr. Ludwig Lefebre), I studied the writings of a number of the phenomenologic/existential thinkers (e.g., Allers, 1961; Boss, 1963; Hegel, 1967; Husserl, 1967; Sartre, 1956; Tillich, 1952; and others) in greater depth. I concluded that their open minded, noncategorizing, no preconceptions approach was a breath of fresh air in the era of rationalistic theory driven approaches (such as psychoanalysis) to disturbed and disturbing persons.

So, I brought to my psychiatric residency a phenomenology-based "what you see is what you've got" bias to my interactions with patients and a sensitivity to the issues of a degradation and power especially as embodied in conventional institutional practices. The good mentors (e.g., Drs. Elvin Semrad and Norman Paul) in my psychiatric training taught me how to listen and attempt to find meaning in the distorted communications of my patients and their families (in 1962!) by doing my best to put my feet into their shoes. Harry Stack Sullivan (1962) and the double bind theory (Bateson et al., 1956) provided intellectual support. I also learned how to ask and look for answers to questions of interest from research gods (e.g., Dr. Martin Orne). On the other hand, the institution itself gave me master classes in the art of the "total institution" (Goffman, 1961); authoritarianism, the degradation ceremony, the induction and perpetuation of powerlessness, unnecessary dependency, labeling, and the primacy of institutional needs over those of the persons it was ostensibly there to serve-the patients. These institutional lessons were not part of the training program. In fact, my efforts to be helpful to my patients were interrupted by these institutional needs. When brought up they were denied, rationalized, or simply invalidated, "You're just a resident and aren't yet able to understand why these processes are not as you see them." From a series of such experiences, I began to believe that psychiatric hospitals were not usually very good places in which to be insane.

Although the Thorazine assault troops (Smith, Klein, and French's own terminology for its 1956 charge to the company's detail men--see BradenJohnson [1990]) had already successfully done their job --selling the neuroleptics -- never became a true believer in the "magic bullet" attribution commonly ascribed the neuroleptic drugs. Despite being trained by psychopharmacologic icons (e.g., Dr. Gerald Klerman), I somehow never found a Lazarus among those I treated with the major tranquilizers. Again, my experience led me to question the emerging psychopharmacologic domination of the treatment of very disturbed and disturbing persons. Actually those persons seemed to appreciate my sometimes clumsy attempts to understand them and their lives. Because I hadn't found a large role for drugs in the helping process, I was led to believe more in interpersonal than neuroleptic "cures." I did worry about what went on in the 164 hours a week when my patients were not with me -- was the rest of their world trying to understand and relate meaningfully to them?

So, as a career unfolded, the questioning of conventional wisdom remained part of me, albeit not always acted upon in a way that would bring undue attention and consequent retribution. To interests in the meaningfulness of madness, understanding families, and the conduct of research, I added one from my institutional experience; if places called hospitals were not good for disturbed and disturbing behavior, what kinds of social environments were? In 1966-1967, this interest was nourished by R.D. Laing and his colleagues in the Philadelphia Association's Kingsley Hall in London. The deconstruction of madness and the madhouse that took place there generated ideas about how a community-based, supportive, protective, normalizing environment might facilitate reintegration of psychologically disintegrated persons without artificial institutional disruptions of the process. This, combined with my existential/phenomenologic- psychotherapy and anti-neuroleptic drug biases resulted, in 1969-1971, in the design and implementation of the Soteria Research Project. Soteria is a Greek word meaning salvation or deliverance. In addition to my interests, the project included ideas from the era of "moral treatment" in American psychiatry (Bockhoven, 1963), Sullivan's (1962) interpersonal theory and his specially designed milieu for persons with schizophrenia at Sheppard and Enoch Pratt Hospital in the 1920s, labeling theory (Scheff, 1966), intensive individual therapy based on Jungian theory (Perry, 1974) and Freudian psychoanalysis (Fromm-Reichman, 1948; Searles, 1965), the notion of growth from psychosis (Laing, 1967; Menninger, 1959), and examples of community-based treatment such as the Fairweather Lodges (Fairweather et al., 1969).

Important Therapeutic Ingredients

Descriptively, the therapeutic ingredients of these residential alternatives, ones that clearly distinguish them from psychiatric hospitals, in the order they are likely to be experienced by a newly admitted client, are:

1) The setting is indistinguishable from other residences in the community, and it interacts with its community.

2) The facility is small, with space for no more than 10 persons to sleep (6 to 8 clients, 2 staff). It is experienced as home-like. Admission procedures are informal and individualized, based on the client's ability to participate meaningfully.

3) A primary task of the staff is to understand the immediate circumstances and relevant background that precipitated the crisis necessitating admission. It is anticipated this will lead to a relationship based on shared knowledge that will, in turn, enable staff to put themselves into the client's shoes. Thus, they will share the client's perception of their social context and what needs to change to enable them to return to it. The relative paucity of paperwork allows time for the interaction necessary to form a relationship.

4) Within this relationship the client will find staff carrying out multiple roles: companion, advocate, case worker, and therapist-although no therapeutic sessions are held in the house. Staff have the authority to make, in conjunction with the client, and be responsible for, on-the-spot decisions. Staff are mostly in their mid-20s, college graduates, selected on the basis of their interest in working in this special setting with a clientele in psychotic crisis. Most use the work as a transitional step on their way to advanced mentalhealth-related degrees. They are usually psychologically tough, tolerant, and flexible and come from lower middle class families with a "Problem" member. (Hirschfeld et al., 1977; Mosher et al., 1973, 1992) In contrast to psychiatric ward staff, they are trained and closely supervised in the adoption and validation of the clients' perceptions. Problem solving and supervision focused on relational difficulties (e.g., "transference" and "counter-transference") that they are experiencing is available from fellow staff, onsite program directors, and the consulting psychiatrists (these last two will be less obvious to clients). Note that the M.D.s are not in charge of the program.

5) Staff is trained to prevent unnecessary dependency and, insofar as possible, maintain autonomous decision making on the part of clients. They also encourage clients to stay in contact with their usual treatment and social networks. Clients frequently remark on how different the experience is from that of a hospitalization. This process may result in clients reporting they feel in control and a sense of security. They also experience a continued connectedness to their usual social environments.

6) Access and departure, both initially and subsequently, is made as easy as possible. Short of official readmission, there is an open social system through which clients can continue their connection to the program in nearly any way they choose; phone-in for support, information or advice, drop-in visits (usually at dinner time), or arranged time with someone with whom they had an especially important relationship. All former clients are invited back to an organized activity one evening a week.

Pasted from <http://www.moshersoteria.com/soteri.htm>

Letter of Resignation from the American Psychiatric Association

http://www.moshersoteria.com/resig.htm>

Treatment of Acute Psychosis without Neuroleptics: Two-Year Outcomes From the Soteria Project JOHN R. BOLA, PH.D.,1 and LOREN R. MOSHER, M.D.2

http://www.moshersoteria.com/bola.pdf

Soteria and Other Alternatives to Acute Psychiatric Hospitalization
A Personal and Professional Review
LOREN R MOSHER, M.D.2
http://www.moshersoteria.com/soteri.htm>

2008-09-20T03:20:00.035+11:30

To a wordly man a God intoxicated man will appear mad

The Wise King

Once there ruled in the distant city of Wirani a king who was both mighty and wise. And he was feared for his might and loved for his wisdom. Now, in the heart of that city was a well, whose water was cool and crystalline, from which all the inhabitants drank, even the king and his courtiers; for there was no other well. One night when all were asleep, a witch entered the city, and poured seven drops of strange liquid into the well, and said, "From this hour he who drinks this water shall become mad." Next morning all the inhabitants, save the king and his lord chamberlain, drank from the well and became mad, even as the witch had foretold. And during that day the people in the narrow streets and in the market places did naught but whisper to one another, "The king is mad. Our king and his lord chamberlain have lost their reason. Surely we cannot be ruled by a mad king. We must dethrone him." That evening the king ordered a golden goblet to be filled from the well. And when it was brought to him he drank deeply, and gave it to his lord chamberlain to drink. And there was great rejoicing in that distant city of Wirani, because its king and its lord chamberlain had regained their reason.

By Khalil Gibran http://leb.net/~mira/

Pain

Your pain is the breaking of the shell that encloses your understanding.
Even as the stone of the fruit must break, that its heart may stand in the sun, so must you know pain.
And could you keep your heart in wonder at the daily miracles of your life, your pain would not seem less wondrous than your joy;
And you would accept the seasons of your heart, even as you have always accepted the seasons that pass over your fields.
And you would watch with serenity through the winters of your grief.
Much of your pain is self-chosen.
It is the bitter potion by which the physician within you heals your sick self.
Therefore trust the physician, and drink his remedy in silence and tranquillity:
For his hand, though heavy and hard, is guided by the tender hand of the Unseen,
And the cup he brings, though it burn your lips, has been fashioned of the clay which the Potter has moistened with His own sacred tears.

2008-09-13T05:07:00.013+11:30

Love Itself

The light came through the window,

Straight from the sun above,

And so inside my little room

There plunged the rays of Love.

In streams of light I clearly saw

The dust you seldom see,

Out of which the Nameless makes

A Name for one like me.

I’ll try to say a little more:

Love went on and on

Until it reached an open door –

Then Love Itself

Love Itself was gone.

All busy in the sunlight

The flecks did float and dance,

And I was tumbled up with them

In formless circumstance.

I’ll try to say a little more:

Love went on and on

Until it reached an open door –

Then Love Itself

Love Itself was gone.

Then I came back from where I’d been.

My room, it looked the same –

But there was nothing left between

The Nameless and the Name.

All busy in the sunlight

The flecks did float and dance,

And I was tumbled up with them

In formless circumstance.

I’ll try to say a little more:

Love went on and on

Until it reached an open door –

Then Love itself,

Love Itself was gone.Love Itself was gone.

L. Cohen

Redefining hearing voices

2008-05-19T06:40:00.014+11:30

"If you talk to God, you are praying; If God talks to you, you have schizophrenia.If the dead talk to you, you are a spiritualist; If God talks to you, you are a schizophrenic."

--The Second Sin, by Thomas Szasz,

If it was not for social psychiatrist Professor Marius Romme, visiting professor of the University of Central England, the Hearing Voices Network may never have been founded. He describes why he believes hearing voices – or auditory hallucinations – is not necessarily symptomatic of an illness.- based on a speech given at the launch of The Hearing Voices Network, in the summer of 2000.

"Hearing voices in itself is not a symptom of an illness, but is apparent in 2 - 3 % of the population. One in three becomes a psychiatric patient - but two in three can cope well and are in no need of psychiatric care and no diagnosis can be given because 2/3 are quite healthy and well functioning.
There are in our society more people hearing voices who never became psychiatric patients than there are people who hear voices and become psychiatric patients.
The difference between patients hearing voices, and non-patients hearing voices, is their relationship with the voices. Those who never became patients accepted their voices and use them as advisers.
In patients, however, voices are not accepted and seen as evil-messengers.

Don’t kill the messenger

They are messengers and they have a message. They are related to sincere problems that occurred in the person’s life and they tell us about those problems. Therefore it is not wise to kill the messenger. Instead of not-listening to the message we should look how to help and sustain the person in solving their problems. (It is like it has been in many wars and conflicts in ancient times already, where the messengers were killed when a message was not welcome).
Research shows also that hearing voices in itself is not related to the illness of schizophrenia. In population research only 16% of the whole group of voice hearers can be diagnosed with schizophrenia.
Also, therefore, it is not right to identify hearing voices as an illness. Psychiatry in our western culture, however, tends unjustly to identify hearing voices with schizophrenia. Going to a psychiatrist with hearing voices gives you an 80% chance of getting a diagnosis of schizophrenia.
However, when you identify hearing voices with illness and try to kill the voices with neuroleptic medication, you just miss the personal problems that lay at the roots of hearing voices - and you will not help the person solving those problems. You just make a chronic patient.

Handicap

Many patients rightly realize that their experience of hearing voices is wrongly interpreted as a symptom of an illness of schizophrenia. Many patients also rightly feel that it is a handicap that they are not allowed to talk about their voices in psychiatry on fully unjustified grounds.
Many patients also are unjustly treated with high doses of neuroleptics which becomes a drawback to their development and their possibility to take their lives in their own hands.
Therefore many voice hearers are glad that there is an opportunity created by the National Hearing Voices Network, where their experience is recognized and accepted as real. Where the possibilities are available to talk about this experience and be appreciated for it.

Groups

In these groups of voice hearers people can learn form each-other about coping with their voices and they can support each other in their battle to stop being discriminated against. I do not deny that there exists a pattern of behaviour and experience that can be categorized as "schizophrenia.
The question, however, is how this pattern of behaviour and experience has developed in the diagnosed individual. We know quite a few people who, when they first heard voices, were not able to cope with their voices and developed a range of secondary reactions that mimic the whole range of schizophrenic behaviour and therefore were diagnosed as such.
But when they started to listen to their voices and recognise their problems and were able to learn to cope with their problems they were also able to cope with their voices and the full range of reactions diminished or vanished.

Help

Therefore everyone who hears voices and has troubles with them, should be given the opportunity to assess the relationship of the voices. Their life experiences should be assessed for the reasons for hearing voices, before they become diagnosed and are treated for an illness instead of being helped with their problems.
The negative attitude of our society and our psychiatric services towards hearing voices and schizophrenia should be scrutinized. As long as that is not the case HVN offers a unique opportunity for voice hearers to scrutinize their own victim status and help each other to overcome the negative attitude of the society the consequences of discrimination related to it.

Prognosis

The prognosis of hearing voices is more positive than generally is perceived. In Sandra Escher's research with children hearing voices she followed 82 children over a period of four years. In that period 64% of the children’s voices disappeared congruently with learning to cope with emotions and becoming less stressed.
In children with whom the voices were psychiatrised and made a part of an illness and not given proper attention, voices did not vanish, but became worse, the development of those children was delayed.
Normalising the experience within the family was of help to children and parents who became able to support the child with existing problems. While the illness concept estranges parents and children, makes them afraid and introduces a fatal outlook on the future of a life-time illness.
Therefore the HVN is of such importance and should expand its activities in training professionals to react differently with voices and voice hearers to support each-other instead of deny their experience and try to kill it. To develop actions that will end the social taboo.
As long as there exist a social taboo against voices psychiatry will keep up his role as custodian of this taboo. Because that is what psychiatry is set up for, to watch over societies interests in mental health affairs. In itself this is an adequate role when it is done rightly and effectively, which is at the moment not the case as far as voice hearing is concerned. Taken from psychminded

Helping children who hear voices

hearing voices can be triggered by stressful events, such as child abuse

Hearing voices when you are a child may be a temporary condition whose symptoms lessen with age if they are sensitively handled, according to new research.
Dutch researchers studying 80 children over a four-year period found that if hearing voices was treated as relatively "normal" and not strange or frightening, symptoms were likely to lessen.
The researchers Sandra Escher, Marius Romme and Alex Buiks are half-way through their study and will present their findings at mental health charity Mind's annual conference on Tuesday.
There have been few previous studies of children who hear voices, but only one has looked at the condition over a period of time.
It suggested that the severity of the disturbance caused by hearing voices worsened as the child got older.
However, the Dutch study says children in the second year of the research were more likely to have fewer symptoms and to need less psychiatric treatment.
The children are aged eight to 18.

Stress

The researchers said many of the voice-hearing experiences were triggered by stressful circumstances, such as sexual abuse, moving home or bereavement.
They believe that understanding the cause of the condition and dealing with it sensitively can reduce the symptoms dramatically.
They say the key to reducing symptoms appears to lie in whether the child and his or her parents try to "normalise" the condition and not make it seem frightening or strange.
According to Mind, 2% of children in all age groups hear voices, although there is very little research on the subject.

Accepting voices

It has traditionally been thought that hearing voices was a symptom of schizophrenia. Patients are usually prescribed tranquillisers.
However, Marius Romme, professor of social psychiatry at the University of Limburg, Maastricht, says: "We must accept that the voices exist. We must also accept that we cannot change the voices. They are not curable, just as you cannot cure left-handedness or homosexuality - human variations are not open to cure - only to coping.
"Therefore to assist people to cope we should not give them therapy that does not work. We should let people decide for themselves what helps or not. It takes time for people to accept that hearing voices is something that belongs to them."
He believes people who hear voices need to understand their condition and see it in a positive way.
Taken From BBC News on line

More For Voice Hearers;
Hearing Voices Network
Intervoice
Hearing Voices Network USA

Accepting voices is By Marius Romme, Sandra Escher

MIND Publications, pp 258 ISBN 1-874690-13-8

Resilience: Emotional Intelligence

2008-02-25T07:25:00.009+11:30

There are real health and wellness benefits for being resilient. It's something worth striving for, if you aren't already that way.

Importantly, resilience is a learnable skill.

Most anyone can become more emotionally resilient if they work at it.
Growing in emotional resilience requires that you work towards greater self-knowledge. It is important, for example, that you learn to identify how you react in emotional situations. Becoming aware of how you react when stressed helps you gain better control over those reactions. A good framework to help guide you towards becoming more aware of your emotions is something called Emotional Intelligence.
The term 'Emotional Intelligence' was coined by psychologists John Mayer and Peter Salovey in 1990. It can be defined as your ability to use your emotions intelligently and appropriately in different situations, combined with your ability to use emotions to make yourself more intelligent overall. Emotionally intelligent people are able to accurately recognize and comprehend emotion, both in themselves and in others, to appropriately express emotion, and to be able to control their own emotion so as to facilitate their own emotional, intellectual and spiritual growth. In short, emotionally intelligent people intentionally use their thinking and behaviour to guide their emotions rather than letting their emotions dictate their thinking and behaviour. People who are highly emotionally intelligent tend to also be highly emotionally resilient.
In order to become more emotionally intelligent, it is necessary to develop the following five skill domains:

§ Self-awareness. Self-awareness involves your ability to recognize feelings while they are happening.

§ Emotional management. Emotional management involves your ability to control the feelings you express so that they remain appropriate to a given situation. Becoming skillful at emotional management requires that you cultivate skills such as maintaining perspective, being able to calm yourself down, and being able to shake off out-of-control grumpiness, anxiety, or sadness.

§ Self-motivation. Self-motivation involves your ability to keep your actions goal-directed even when distracted by emotions. Self-motivation necessarily includes being able to delay gratification, and avoid acting in impulsive ways.

§ Empathy. Empathy involves your ability to notice and correctly interpret the needs and wants of other people. Empathy is the characteristic that leads to altruism, which is your willingness put the needs of others ahead of your own needs.

§ Relationship Management. Relationship management involves your ability to anticipate, understand, and appropriately respond to the emotions of others. It is closely related to empathy.

These various skills work together form the basis of emotionally intelligent behaviour.
People come to the challenge of emotional intelligence with different strengths and weaknesses. Where some find it easy to develop self-awareness and empathy, others have a difficult time, or don't easily recognize the need. Luckily, emotional intelligence (likewise emotional resilience) is something that can be cultivated and developed. You have the ability to learn how to better work with emotions so as to improve your mental, physical, and social health.

From mentalhelp.net

Top Ten Suggestions to improve emotional intellegence.

1. Become emotionally literate.

Label your feelings, rather than labeling people or situations.

"I feel impatient." vs "This is ridiculous." I feel hurt and bitter". vs. "You are an insensitive jerk."
"I feel afraid." vs. "You are driving like a idiot."

2. Distinguish between thoughts and feelings.

Thoughts: I feel like...& I feel as if.... & I feel that

Feelings: I feel: (feeling word)

3. Take more responsibility for your feelings.

"I feel jealous." vs. "You are making me jealous."

4. Use your feelings to help them make decisions.

"How will I feel if I do this?" "How will I feel if I don't"

5. Show

respect for other people's feelings.

Ask "How will you feel if I do this?" "How will you feel if I don't."

6. Feel energized, not angry.

Use what others call "

anger" to help feel energized to take productive action.

7. Validate other people's feelings.

Show

empathy, understanding, and acceptance of other people's feelings.

8. Practice getting a positive value from emotions.

Ask yourself: "How do I feel?" and "What would help me feel better?"

Ask others "How do you feel?" and "What would help you feel better?"

9. Don't advise, command, control, criticize, judge or lecture to others.

Instead, try to just

listen with empathy and non-judgment.

10. Avoid people who

invalidate you.

While this is not always possible, at least try to spend less time with them, or try not to let them have psychological power over you.

First, thanks to Stephen Covey for the title idea. Second, these 10 habits are based on a mixture of my defintion of EQ and the more academic definition of emotional intelligence offered by John Mayer and his research colleagues.

Developing Your EQ - Summary and Suggestions

Use three word sentences beginning with "I feel"

Start labeling feelings; stop labeling people & situations

Analyze your own feelings rather than the action or motives of other people

Ask others how they feel -- on scale of 0-10

Make time to reflect on your feelings

Identify your fears and desires

Identify your UEN's (Unmet Emotional Needs)

Express your feelings - find out who cares - spend time with them

Develop the courage to follow your own feelings

From

Eqi.org

Applied EI

Emotional intelligence test

Emotional processing.org

Emotional Literacy

RISK

2008-01-30T05:41:00.000+11:30

To laugh is to risk appearing the fool.

To weep is to risk appearing sentimental.

To reach for another is to risk involvement.

To expose your feelings is to risk exposing your true self.

To place your ideas, your dreams before a crowd is to risk their loss.

To love is to risk not being loved in return.

To live is to risk dying.

To believe is to risk despair.

To try is to risk failure.

But risks must be taken, because the greatest hazard in life is to risk nothing.

The person who risks nothing does nothing, has nothing, is nothing.

They may avoid suffering and sorrow, but they cannot learn, feel, change, grow, love, live. Chained by their attitudes they are slaves; they have forfeited their freedom.

Only a person who risks is free.

- Unknown

Exposure to uncertain change, most often used with a negative connotation of adverse change.

www.info-forex.com/glossary.htm

The potential for realization of unwanted negative consequences or events.

www.uoguelph.ca/GTI/urbanpst/glossn_z.htm

There is a growing emphasis given toward positive risk taking, as evidenced by point nine of the ten essential shared capabilities. Are we as service providers being governed by the definitions of risk listed above instead of seeing risk as a route for re-engagement in life?

Working with risk:

a shift from risk avoidance to risk-sharing
Deegan’s rallying call that ‘professionals must
embrace the concept of the dignity of risk, and the
right to failure if they are to be supportive of us’
(Deegan, 1996) seems completely at odds with the
risk-averse climate in which we live and work,
where, for instance, patients often have to be
medically ‘vetted’ before an occupational therapist
can take them for a cycle ride. And yet risk is
inevitable, and healthy. We begin to take risks with
our first few steps in life, and without risk there is
no progress or development.
For psychiatrists, stopping a patient’s medication
can represent the risks that epitomise the tensions
involved in implementing a recovery model. Failing
to distinguishing between a temporary exacerbation
of symptoms due to medication reduction and a
genuine relapse carries the possibility of reinforcing
the belief that medication needs to be lifelong. May
(2004) describes his experience of medication as
intolerable, especially as, for him, the ‘psychic indifference’
towards psychotic symptoms carried over
into every aspect of life. He went into hiding from
family and services for weeks and experienced what
he describes as a withdrawal syndrome that was
quite different in quality from previous episodes of
psychosis and that resolved spontaneously. He subsequently
took a psychology degree and trained as
a clinical psychologist. He has remained medicationfree
ever since and has become a highly respected
witness and advocate for recovery. A single story
cannot support ‘non-compliance’ as a route to
recovery, but if an individual is determined to stop
medication, a recovery-oriented approach should
aim to negotiate a phased reduction, during which
contact and relationship is maintained, reducing
the risk of relapse through awareness of early signs
and enabling both patient and prescriber to learn
from the experience.

From;The rediscovery of recovery: open to all
Glenn Roberts & Paul Wolfson

Definitions of risk on the Web:
hazard: a source of danger; a possibility of incurring loss or misfortune; "drinking alcohol is a health hazard"
a venture undertaken without regard to possible loss or injury; "he saw the rewards but not the risks of crime"; "there was a danger he would do the wrong thing"
expose to a chance of loss or damage; "We risked losing a lot of money in this venture"; "Why risk your life?";

Risk is a concept that denotes a potential negative impact to an asset or some characteristic of value that may arise from some present process or future event. In everyday usage, "risk" is often used synonymously with the probability of a known loss. ...en.wikipedia.org/wiki/Risk

Risk is a 2007 Bollywood movie directed by Vishram Sawant. It stars Randeep Hooda, Vinod Khanna and Tanushree Dutta in the lead role. The movie is based on the Mumbai underworld. ...en.wikipedia.org/wiki/Risk (film)

Risk is a commercial strategic board game, produced by Parker Brothers (now a division of Hasbro). It was invented in the early 1950s by French movie director Albert Lamorisse. It was originally released in 1957, as La Conquête du Monde (The Conquest of the World), in France. en.wikipedia.org/wiki/Risk (game)

Risk is an album by the metal band Megadeth released in 1999. It is generally regarded as Megadeth's musical low point by both fans and Dave Mustaine alike, and is the last original Megadeth release to feature virtuoso guitarist Marty Friedman. ...en.wikipedia.org/wiki/Risk (album)

Risk is a science fiction short story by Isaac Asimov, first published in the May 1955 issue of Astounding Science Fiction, and reprinted in the collections The Rest of the Robots (1964) and The Complete Robot (1982). en.wikipedia.org/wiki/Risk (Asimov)

Risk is a comic book character appearing in publications from DC Comics. en.wikipedia.org/wiki/Risk (comics)

The Art of Resilience

2007-12-16T05:09:00.000+11:30

Think you're a prisoner of a troubled childhood? Think again. You need not go through the rest of your life as an emotional cripple. It is possible to bounce back from adversity and go on to live a healthy, fulfilling life. In fact, more people do it than you may think.
Resilience may be an art, the ultimate art of living, but is has recently been subjected to the scrutiny of science. This much is known so far. At the heart of resilience is a belief in oneself -- yet also a belief in something larger than oneself.
Resilient people do not let adversity define them. They find resilience by moving towards a goal beyond themselves, transcending pain and grief by perceiving bad times as a temporary state of affairs.
Experts argue among themselves about how much of resilience is genetic. People do seem to differ in their inborn ability to handle life's stresses. But resilience can also be cultivated. It's possible to strengthen your inner self and your belief in yourself, to define yourself as capable and competent. It's possible to fortify your psyche. It's possible to develop a sense of mastery.
And it's definitely necessary to go back and reinterpret past events to find the strengths you have probably had within all along. Some evidence shows that it's not really until adulthood that people begin to surmount the difficulties of childhood and to rebuild their lives.
One problem is, there are elements of our culture that glorify frailty, says Washington, D.C. psychiatrist Steven Wolin, M.D. There is a whole industry that would turn you into a victim by having you dwell on the traumas in your life. In reality you have considerable capacity for strength, although you might not be wholly aware of it.
Sometimes it is easier to be a victim; talking about how other people make you do what you do removes the obligation to change. And sympathy can feel sweet; talk of resilience can make some feel that no one is really appreciating exactly how much they have suffered.
Wolin defines resiliency as the capacity to rise above adversity -- sometimes the terrible adversity of outright violence, molestation or war -- and forge lasting strengths in the struggle. It is the means by which children of troubled families are not immobilized by hardship but rebound from it, learn to protect themselves and emerge as strong adults, able to lead gratifying lives.
Resilient people don't walk between the raindrops; they have scars to show for their experience. They struggle -- but keep functioning anyway. Resilience is not the ability to escape unharmed.

It is not about magic.

Most people mistakenly operate on what Wolin calls "the damage model," a false belief about the way disease is transmitted. It basically says that if your family is having trouble, the chances are high that you will suffer lasting emotional disturbances. It's a prophecy of doom.
Wolin offers survivors of troubled families a more balanced perspective about their past, based on 20 years of his own research on adult children of alcoholics. Most of them, he has found, do not repeat their parents' drinking patterns. The same is true of adults who have survived families troubled by mental illness, chronic marital disputes, racial discrimination and poverty.
The ground-breaking resilience research of sociologist Emmy Werner, Ph.D., of the University of California, showed that even at the time about a third of kids never seemed to be affected by the grinding poverty, alcoholism and abuse in the homes they grew up in. Of the remaining two-thirds, many were troubled as teens, typically turning to petty crime. But by the time they reached their 30s and 40s, they had pulled themselves together, determined to not repeat their parents' lives.
A troubled family can indeed inflict considerable harm on its children, but resilient people are challenged by such troubles to experiment and respond actively and creatively. Their pre-emptive responses to adversity, repeated over time, become incorporated into their inner selves as lasting strengths.
To the degree that it is learned, resilience seems to develop out of the challenge to maintain self-esteem. Troubled families make their children feel powerless and bad about themselves. Resilience is the capacity for a person to maintain self-esteem despite the powerful influence of the parents.
It is also possible to be hurt and to rebound at the same time. We human beings are complex enough psychologically to accommodate the two. What the resilient do is refrain from blaming themselves for what has gone wrong. In the language of psychology, they externalize blame. And they internalize success; they take responsibility for what goes right in their lives.
One way they do this, Wolin has found, is to maintain independence. Survivors draw boundaries between themselves and troubled parents; they keep their emotional distance while satisfying the demands of conscience. Resilient children often hang out with families of untroubled peers. As adults, the resilient children of alcoholics marry into stable, loving families with whom they spend a great deal of time.
Survivors cultivate insight, the mental habit of asking themselves penetrating questions and giving honest answers. They also take the initiative. They take charge of problems, stretching and testing themselves.
But they don't do all the work alone. One of the cardinal findings of resilience research is that those who lacked strong family support systems growing up sought and received help from others--a teacher, a neighbor, the parents of peers or, eventually, a spouse. They were not afraid to talk about the hard times they were having to someone who cared for their well-being.
Relationships foster resilience, Wolin contends. Resilient people do the active give-and-take work necessary to derive emotional gratification from others.
Reframing is at the heart of resilience. It is a way of shifting focus from the cup half empty to the cup half full. Wolin accords it a central role in "survivor's pride." He tells the story of a patient, a woman who felt helpless. She had been whipped by her father throughout childhood any time he felt challenged. Wolin instead encouraged her to see herself as smart, an accomplished strategist. She had eventually learned to recognize her father's moods and respond to them.
There are lessons in her tale for everyone, Wolin insists. You re-examine your life story to see how heroic your acts were as a child. You go back to an incident, find the strengths, and build self-esteem from the achievement.
Psychologist Edith Grotberg, Ph.D., believes that everyone needs reminders of the strengths they have. She urges people to cultivate resilience by thinking along three lines:

* I HAVE: strong relationships, structure, rules at home, role models; these are external supports that are provided;

* I AM: a person who has hope and faith, cares about others, is proud of myself; these are inner strengths that can be developed;

* I CAN: communicate, solve problems, gauge the temperament of others, seek good relationships--all interpersonal and problem-solving skills that are acquired.

(Brigid Daniel & Sally Wassell – Assessing & Promoting Resilience in Vulnerable Children)

Leading psychiatrist turns down OBE

2007-11-30T05:02:00.000+11:30

Leading psychiatrist turns down OBE in protest at "deeply flawed" mental health bill
May 17, 2007by Adam James

An eminent psychiatrist has turned down a Queen’s honour in protest at the government’s “deeply flawed” plans to extend compulsory powers of detention over the mentally ill.
Dr Suman Fernando, one of the country’s leading psychiatrists on mental health and race, was told last week by Downing Street that he had been nominated for an OBE for his “services to black and minority ethnic mental healthcare.”
But Dr Fernando has publicly rejected the honour, accusing NHS mental health services of being institutionally racist and fearing law changes proposed in a mental heath bill going through parliament would fail to address the disproportionate rate that black people are admitted to and detained in psychiatric hospitals.
Healthcare Commission statistics reveal that black people are three times more likely than white people to be compulsory detained in psychiatric hospital.In 2003 an independent inquiry into the death of black Rastafarian David Bennett in the Norvic psychiatric clinic in Norwich highlighted a "festering abscess of institutionalised racism" in NHS mental health services. The government is now almost half way through a five-year action plan - Delivering Race Equality In Mental Health Care – set up in response to the inquiry and which aims to end anti-discriminatory practice in mental health services.
However, Dr Fernando says the mental health bill, which this week completed its committee stage in the House of Commons, gives doctors further powers to compulsory detain patients and will exacerbate the discrimination of black and ethnic minority people.Dr Fernando, a former Mental Health Commission inspector of psychiatric wards, wrote this week in a letter to Blair that he "cannot possibly accept it [OBE] while the government is pursuing its present policy regarding mental health legislation…the government bill currently before parliament is deeply flawed.”
He added: “What seems most strange is that the government say they want to recognise my services to black and minority healthcare at a time when they are trying to push through legislation that would make things worse for black people caught up in the mental health system.”
Dr Fernando believes that “at the very least” the bill should have a set of principles written into it to ensure that anti-discriminatory mental health practice is legally binding. Health Secretary Patricia Hewitt has rejected this, but said such principles could be included in a code of practice.
Dr Fernando, a psychiatrist with 23 years experience and now visiting professor in applied social sciences at London Metropolitan University, is also angry that ministers “have not taken any notice” of a raft of other concerns aired by himself, other mental health professionals and law groups during a series of consultations over the bill. Critics fear the bill, which is a series of amendments to present law, threatens civil liberties and would lead to people being detained without therapeutic benefit."My plea to government is to withdraw the bill as it stands today and get back into a consultation mode,” Dr Fernando wrote in his rejection letter which he has also sent to the prime-minister-in-waiting Gordon Brown.
The government says the bill is a suitable balance between patient rights and protecting the public from dangerous people with a mental health diagnosis.
Dr Fernando worked as an NHS psychiatrist from 1970 to 1993, and has held a string of clinical and academic posts specialising in race and mental health.
From 1994 to 2001 he was vice chair of the Transcultural Psychiatry Special Interest group of the Royal College of Psychiatrists, and from 1989 to 1991 he served as a British representative on the World Psychiatric Association’s executive committee of transcultural psychiatry.
It is convention that those rejecting honours should do so privately. But Fernando’s decision follows that of poet Benjamin Zephaniah who in 2003 openly dismissed his award as a legacy of colonialism.
A Downing Street spokeswoman said she could not confirm or deny whether Dr Fernando had been nominated for an OBE, and was unable to add any further comments.

* Suman Fernando's letter to Tony Blair (pdf)*

Suman Fernando’s website: http://www.sumanfernando.co

* This news story first appeared in a shorter version at guardian.co.uk

Rufus May on cannabis

2007-11-27T07:40:00.000+11:30

I smoked cannabis. I went mad. But life's not that simple

Published in Independent on Sunday, The, Jul 29, 2007 by Rufus May

As the review published in The Lancet last week confirmed, studies have been finding an association between cannabis and psychotic experiences for the past 30 years. The reviewers looked at 35 studies and suggested that cannabis users have a 40 per cent increased chance of having psychotic experiences. They also say that 14 per cent of psychotic problems in the United Kingdom could be linked to cannabis use. But not all the evidence supports a simplistic causal link. For example, while the use of cannabis has gone up steadily over the past 30 years, the incidence of psychotic diagnoses has not. Yet the research coming out of the Institute of Psychiatry and this latest review from Bristol and Cardiff universities is putting growing pressure on the Government to reconsider its classification of cannabis as a class C drug.

Cause and effect are difficult to unravel. Are people with a tendency to hear voices or suffer from paranoia attracted to using cannabis to calm themselves or is the drug increasing the risk of these experiences? Perhaps both processes are happening. In my experience, both as a user and as a psychologist, cannabis can be both a tonic and a poison. Ultimately, like all drugs, it brings problems, but demonising it will not help.

At the age of 15 and 16 I smoked cannabis pretty heavily. It helped me escape the boredom of school life and fractious relations with my parents. It also helped me bury deeper anxieties about impending adulthood and my identity. I fell in love with the idea that this illicit weed could bring me serenity on a daily basis. Its forbidden status made me feel rebellious and cool. I became addicted to the ceremonious ritual of sticking the papers together and building the spliff that I hoped would transport my mind to a more peaceful place. But life has taught me that if you suppress things sooner or later they come back to haunt you. By the age of 18, I was drug free, trying to get over my first girlfriend leaving me and struggling to find a decent job. Instead of getting depressed, I slowly drifted into a dreamlike reality where I was spied upon and felt I had special spiritual powers. It culminated in being treated psychiatrically for a year and being given the rather unhelpful tag of schizophrenic. My recovery has involved largely steering clear of cannabis and finding more healthy ways to relax and stay calm and centred.

In my work, I help others who have developed psychotic experiences. Many of us choose to avoid using cannabis, but some feel it is helpful in dealing with anxiety and the side effects of the medication they are prescribed. My impression is that some people - and I would include myself in this category - do have a particular sensitivity to cannabis and need to be cautious with it. But I also feel there is a political agenda behind the current "blame the weed for mental illness" campaign. Psychiatrists such as Robin Murray and others spent many years in the 1990s - described as "the decade of the brain" - trying to find a biological and genetic cause for psychosis, but with little success. The latest focus on cannabis can be viewed as the dying gasp of the "blame the brain" brigade who seek to justify a biological approach to madness.
Such an emphasis on chemical causes suits the pharmaceutical industry and obscures the bigger truth that mental distress is caused by emotional traumas and troubles. People who react badly to cannabis but continue to use it are trying to suppress feelings such as anger, guilt and loneliness. It is the social situations that lie behind these emotions that we really need to understand and address.

Rufus May, a clinical psychologist, works with Bradford's Assertive Outreach team
Copyright 2007 Independent Newspapers UK Limited. All rights owned or operated by The Independent.Provided by ProQuest Information and Learning Company. All rights Reserved.

CASL; Campaign for the Abolition of the schizophrenia lable

2007-11-24T18:25:00.000+11:30

Campaign for Abolition of the Schizophrenia Label

Introducing CASLThe Campaign for Abolition of the Schizophrenia Label

Paul Hammersley and Terence McLaughlin

The idea that schizophrenia can viewed as a specific, genetically determined, biologically driven, brain disease has been based on bad science and social control since its inception. If the scientific argument against `schizophrenia' is judged to be won, it remains to take the evidence to the people, to explain and develop the alternatives in the full light of day. This is why the campaign is led by Asylum, the magazine for democratic psychiatry, psychology, education and community development. We believe the time is fully ripe for a paradigm shift across the field of mental distress and that the alternative knowledges and resources are now in place to mobilise for change. No more will we view the scandal where intelligent persons are expected to accept discredited diagnoses for fear of being labelled as `lacking in insight' and having treatment forced on them.
Read (2004) lists a fundamental dissatisfaction with the concept of schizophrenia as an illness that can be traced back over 80 years. More recently Bentall (1990, 2003), and Boyle (1990) have published elegant, well researched arguments clearly demonstrating that the concept of schizophrenia is neither valid nor reliable. Despite this, mainstream psychiatry continues to perpetuate the myth that when talking about ‘schizophrenia' we are discussing something that actually exists. For example, the opening statement of the NIMH public information website in the USA reads as follows:
“Schizophrenia is a chronic and severe disabling brain disease”
As Read (2004) points out, such an opinion is common in psychiatric textbooks and drug company pamphlets.
The CASL campaign is driven by two central factors:
1) The concept of schizophrenia is unscientific and has outlived any usefulness it may once have claimed.
2) The label schizophrenia is extremely damaging to those to whom it is applied.
ReliabilityFor a diagnosis to have any clinical utility it must be reliable. That is to say there must be consistency in how individuals are diagnosed. There is no evidence that this has ever been the case with schizophrenia. Read (2004), has illustrated how it is possible for 15 individuals with nothing in common to be gathered together in one room and ALL be diagnosed with schizophrenia. Test- retest analysis is as low as 37% and in 1970 when 194 British and 134 American psychiatrists were asked to provide a diagnosis on the basis of a case description, 69% of the Americans diagnosed schizophrenia whilst only 2% of the British did so. There is no definitive evidence to suggest that the reliability of the diagnosis has improved since that date.
ValidityAn unreliable diagnosis cannot by definition be valid. However it is worth pointing out quite how poorly the diagnosis of schizophrenia performs in terms of validity. Firstly, a diagnosis of schizophrenia tells us nothing about cause. Biological research into cause offers little more than a series of dead ends (Bentall 2003, Read 2004), and the significance of genetic inheritance in schizophrenia has been vastly overstated and is seriously methodologically flawed (Joseph 2004). Secondly, a diagnosis of schizophrenia tells us nothing about prevalence rates. It is often blandly asserted that schizophrenia has a prevalence rate of 1% in all societies. This is not true; there is a wide disparity of prevalence between rural and urban environments and different research has shown prevalence rates of between 0.33 and 15%. In addition a diagnosis of schizophrenia tells us little about the course of the illness. Kraepelin initially suggested that schizophrenia was a chronic deteriorating condition in all cases. We now know that all outcomes are possible from chronicity to complete recovery. Interestingly Marius Romme, the Dutch Psychiatrist, has argued that those most likely to make a complete recovery are individuals who reject or drop out of the psychiatric system.
StigmaTo be labelled ‘a schizophrenic' is one of the most devastating things that can happen to anyone. This label implies dangerousness, unpredictability, chronic illness, inability to work or function at any level and a lifelong need for medication that will often be ineffective (Whitaker 2005), but will usually cause unpleasant side effects. To champion the idea that schizophrenia is an illness just like any other (sometimes referred to as mental health literacy) makes the situation worse, in that it has been shown to increase amongst other things mistrust and a desire for social distance.
Sincere attempts have been made to rescue the word for humanity (Jenner et al., 1993) yet we have had to conclude that the continuation of the concept serves only the greed of Big Pharma in the pursuit of producing yet more `magic bullets' The desire of our campaign to place the label ‘schizophrenia' into the diagnostic dustbin, in which it most certainly belongs, is not based solely on the poor science that surrounds it but also on the immense damage that this label can bring about. A single word can ruin a life as surely as any bullet and schizophrenia is just such a word.
Japan abolishes schizophrenia?There is hope. In 2002 in order to remove the stigma and prejudice associated with the term schizophrenia, The Japanese Society of Psychiatry and Neurology renamed the condition. Their reasons were that the old term ‘Seishin Buntreyso Byo' (mind- split disease) was ambiguous, had purely negative connotations and was in part related to the inhumane treatment of most people who carried the diagnosis (Sato 2006). The new term is ‘Togo Shitcho Sho' (Integration disorder). It is defined not as a specific illness, but as a syndrome based on a stress vulnerability model, with many different causes, symptoms and outcomes. This change was brought about largely by lobbying from service users and family groups, and has been welcomed by service users and families alike.
AlternativesAlternatives already exist. Given the high levels of trauma in the lives of individuals who experience psychosis (Read et al 2004, Hammersley et al 2003) Professor Marius Romme in The Netherlands has for a number of years called for a new diagnostic category of post-traumatic psychosis. Colin Ross in the United States has made a similar call for a category of Dissociative Psychosis.
Yet alternatives also exist outside the language of psychopathology (Parker et al, 1995; Romme and Escher, 2000). In recognising the role of language and being prepared to make a practical deconstruction of what it produces (in this case forms of pathology) is taking one step in enabling communities, through self help networks, to regain control and ownership of human experience. Romme and Escher have remained particularly faithful to the contribution of knowledge of `experts by experience' and we remain firmly convinced that the future health of communities lies largely in the hands of organisations like the Hearing Voices Network and new initiatives like the Paranoia Network and depressiondialogues. The hope and promise of radical change is not something to be relegated wistfully to a bygone age but is firmly on the agenda today (McLaughlin, 2003). Furthermore growing alongside CASTL is a widespread enthusiasm to form a European Association for Democratic Psychiatry as the mechanism to bring about decisive change in public policy, media activity and social attitudes.
The CASL campaign began as collaboration between The COPE Initiative at the University of Manchester , the Hearing Voices Network and supporters of Asylum magazine (Asylum Associates). We are working to build a broad coalition of service users groups and like minded professionals, with the aim of bringing a more coherent and humane diagnostic system to service users worldwide. Yet it is more than that. We are looking to a future when we can talk less of the associations for democratic psychiatry and more of the International Association for Democratic Communities.
JOIN TODAYContact casl@asylumonline.net
ReferencesBentall, R.P. (1990). Reconstructing schizophrenia. London : Routledge.Bentall, R.P. (2003). Madness Explained. Allen Lane . Penguin Books.Boyle, M. Schizophrenia: A Scientific delusion. London : Routledge. UK .Jenner, F.A., Monteiro, A. C. D., Zagallo-Cardoso, J. A. and Cunha-Oliveira, J. A. (1993) Schizophrenia: A Disease or Some Ways of Being Human. Sheffield : Sheffield UP.Joseph, J. The Gene Illusion: Genetic Research in Psychiatry and Psychology under the Microscope. Ross-on-Wye. PCCS Books.Hammersley, P.A., Dias, A., Todd, G., Bowen Jones, K., Reiley, B Bentall, R.P. (2002). Childhood trauma and hallucinations in bipolar affective disorder: A preliminary investigation. British Journal of Psychiatry, 182, 543-547.McLaughlin, T. (2003) `The view from democratic psychiatry.' European Journal of Psychotherapy, Counselling and Health 6(1) 63-66.Parker, I, Georgaca, E, Harper, D, McLaughlin, T and Stowell Smith, M (1995) Deconstructing Psychopathology London : Sage .Read, J, Mosher, L.R. & Bentall, R.P. (2004). Models of Madness. ISPS Publications.Romme, M. and Escher, S. (2000) Making Sense of Voices: a guide for mental health professionals working with voice-hearers. London : MindSato, M. (2006). Renaming schizophrenia: A Japanese Perspective. World Psychiatry, Feb, 5, 1, 53-55.Whitacker, R. (2004). The case against anti-psychotic drugs: a 50-year history of doing more harm than good. Medical Hypotheses, 62, 5-13
FIRST COMMENTS
Marius Romme Emeritus Professor of Social Psychiatry:
"We have known for quite some time that the concept of schizophrenia has no scientific validity. We now however have an alternative which is more helpful. It is time to challenge the old concept and leave it behind.
The old concept is harmful because, it is impossible to solve the problems of the patient diagnosed with this illness. We now not only know that the symptoms exist and the illness does not, but we now know more about where the symptoms come from. It is a false suggestion that the symptoms are the result of an underlying illness. The symptoms are partly a reaction to serious problems in the life of the person and partly a reaction towards other symptoms. Therefore attention should be given to the reality for the patient of his /her complaints and the background for each of them should be explored. Only then do we discover what the problems for the patient are, and only then we might be able to help solve those problems. When for example hearing voices is the complaint related to a serious problem in the person's life and the explanation of the person is that it is the voice of God, this can be a reaction on hearing that voice as an explanation. This in itself is not a symptom but a reaction to the strange overwhelming voice often with the metaphoric meaning of a needed spiritual power or a father figure, wanted or feared".

Jacqui Dillon National Chair of the Hearing Voices Network
'In our experience, gained through more than 15 years running a national network, listening to people who hear voices, many of them living with a diagnosis of schizophrenia; it is clear that there is a definite link between traumatic life events and psychosis. On a daily basis, we hear terrible stories of sexual, emotional and physical abuse, and the impact of racism, poverty, neglect and stigma on peoples' lives. We do not seek to reduce people to a set of symptoms that we wish to suppress and control with medication. We show respect for the reality of the trauma they have endured and bear witness to the suffering they have experienced. We honour peoples' resilience and capacity to survive, often against the odds. The reduction of peoples distressing life experiences into a diagnosis of schizophrenia means that they are condemned to lives dulled by drugs and blighted by stigma and offered no opportunity to make sense of their experiences. Their routes to recovery are hindered. Rather than pathologising individuals, we have a collective responsibility to people who have experienced abuse, to acknowledge the reality and impact of those experiences and to support them to get the help they need. Abuse thrives in secrecy. We must expose the truth and not perpetuate injustice further; otherwise today's child abuse victims become tomorrow's psychiatric patients."

Campaign for the Abolition of Schizophrenia LabelBy Dr. Terry Lynch, GP and psychotherapist, Limerick , Ireland . Lynch, Terry (2004) Beyond Prozac: Healing Mental Distress, Ross-on-Wye, PCCS Books.
In our modern 21 st century, access to information has never been easier at any time in the history of the world. Yet, some aspects of life remain very poorly understood. One glaring example of this is the degree to which the general public understand – or more accurately, misunderstand – so-called ‘mental illness', and ‘schizophrenia' in particular.
The term ‘schizophrenia' needs to be abolished for a number of reasons. The so-called ‘illness' which the term is purported to represent is a gross misinterpretation of the experience of people so labelled. The schizophrenia label encourages the ongoing ignoring of key issues which are virtually always present in the life experience of people who receive this label. For example, issues such as great trauma in their lives; terror; immense loss of autonomy and of their sense of Self; overwhelm; powerlessness; immense emotional pain; intense isolation.
The term ‘schizophrenia' is taken to mean that a person who experiences certain experiences (such as hearing voices, becoming paranoid, experiencing ‘delusions', withdrawing to a major degree) is fundamentally abnormal; crazy; clearly and obviously suffering from a major illness, which we have come to call ‘schizophrenia'.
This interpretation is incorrect. Many mental health care workers who take the time to listen intently and work collaboratively with people who go through these experiences come to realise that, far from being abnormal or crazy, these experiences make sense in the context of the person's sense of Self, their experiences, and their life. By rejecting and dismissing the experiences, we also reject and dismiss the individual who is experiencing these.
The term ‘schizophrenia' has been taken a step further into inaccuracy and misinterpretation. The term is now widely seen as synonymous with the presence of a biological abnormality within the person's brain. This view has been enthusiastically promoted within some quarters, despite the reality that no consistent, reliable, or durable biological abnormalities have been identified, and in spite of the reality that the ‘diagnosis' is always, always made without reference to any tests, because there are no biological tests for this ‘condition'. This gross misrepresentation (ie that ‘schizophrenia' is known to be a biological illness) is used to justify the long-term (often life-long) use of mood-altering substances (often inaccurately referred to as antipsychotics) as the primary ‘treatment' of this ‘illness'.
The upshot of this worped logic and bad science is that recovery rates from ‘schizophrenia' in modern westernised societies trails well behind that in underdeveloped countries, according to World Health Organisation studies. The misguided obsession with imagined biological abnormalities over several decades has had the effect of reducing the attention on and research into psychological, social, human approaches to helping people get their lives back on track. There are many, many people – some of whom spoke at the Hearing Voices Network Annual Conference 2006) – whose recovery (from the traumatic experiences which caused their experiences of hearing voices, paranoia, etc) was impaired, and/or blocked by the preoccupation with the diagnosis of ‘schizophrenia' and its supposed ‘treatment' rather than working collaboratively with the person to explore the distress, seek to ascertain what may lie behind the distress, and with compassion, gentleness and caring, help the person to resolve their pain and move on with their life.
So-called ‘mental illness', including ‘schizophrenia', is one of the last remaining unrecognised apartheids left in our society. Well intentioned intervention is not necessarily effective intervention, and because it is well-intentioned, and provided by society's appointed experts, it can be even more damaging, subtle and pervasive.
Abolishing the label ‘schizophrenia' is an important step towards reversing the enormous travesty of natural justice which has existed in this area for decades. Not having a label, a ‘box' to put people into, will facilitate the development of more humane, healing, collaborative working relationships between all concerned, including the experiencer and those who care, love, and work with them.

A Carer's View of Schizophrenia
Some people like the term ‘schizophrenia'. The diagnosis does enable some service users to access benefits they might otherwise not, so they may find it useful. Some psychiatrists like to have a simple label they can use to describe people who otherwise have a confusing and diverse range of inconsistent symptoms; it suggests that they recognise these behaviours. In so doing, it enables them to ignore and discount the history and traumas of the service user, and all aspects of his or her life since everything is dismissed as ‘psychosis' and ‘fantasy'. Some families think initially but mistakenly that if there's a ‘diagnosis', it represents a well-defined situation for which a genuine treatment and route to recovery is known, as happens with other health problems. So, initially, there may be brief relief with the diagnosis. However, this does not last. All affected families are horrified when the label ‘schizophrenia' is soon attended by another damning label, that of ‘severe and enduring mental health problem', yet despite this devastating prospect, they are urged NOT to give up hope as this is important to their relative's recovery.
In practice, most families continue to hold the hope of recovery, and to work unstintingly for their family member's support with absolute dedication sometimes for decades and often despite the unsupportive disinterest, and sometimes outright hostility and inhumanity, of many staff. The family often hold the flame which helps and inspires the service user throughout his illness. This is called LOVE, and it is discounted and dismissed by the services and the NHS obsessed as it is with regulations and procedures.
The government has ‘recovery' as its goal though how to reconcile ‘recovery' with the ‘severe and enduring' label is a contradiction neither explored nor explained, and the treatment offered continues to be the same drugs.
As carers begin to search for information, they meet other carers and families; they come to know service users also diagnosed with ‘schizophrenia' who have been maintained on drugs for decades and whose lives, along with those of their families, are slipping by in poor or no quality, stigmatised, rejected, isolated and dumped by mainstream society.
Soon, the vast range of symptoms and histories included in the umbrella diagnosis ‘schizophrenia' is apparent and it is inconceivable to everyone except the psychiatrist that all these people could, or should, have the same diagnosis or the same treatment. By relying almost entirely on drugs, other therapies of proven value are ignored, often not even mentioned. When carers / families want to discuss other options with the psychiatrist, their request is usually refused or ignored. So, if you're in the right place with more forward thinking and humane approaches available, your service user family member can access empathic therapies, taking into consideration his/her specific history and experiences with understanding and allowing him/her to process them then move on with improved chance of recovery. But, if you are not in an enlightened area, you are supposed to accept the total devastation of your family meekly and without question.
‘Schizophrenia' was coined nearly a century ago. No other branch of medicine continues to rely on the faltering first footsteps taken so long ago. It is time it was abandoned so that service users can be treated individually, have their symptoms and histories properly addressed so they can recover proper control of their lives. Once schizophrenia has been abandoned as a concept, the medicalisation of mental illness and the domination of the drug companies is no longer acceptable. This is not recovery; it is sedation and containment using a chemical cosh lobotomy. Service users need appropriate individualised support, so that the 80% recovery rates achieved in the developing World can be seen here instead of the 20% we have currently. A recent comment by an enlightened psychiatrist was to the effect that the service user was in charge of his own recovery, but the psychiatrist supported his/her journey properly so that it was ordered and (s)he was not overwhelmed in the process.
Best wishesJudith Varley

Mary BoyleUniversity of East London
The claim that there exists a biologically based diagnosable disorder called schizophrenia has been the focus of intense and persistent criticism and been shown to be scientifically bankrupt. But the label is also morally problematic. It is imposed on people in the absence of any evidence base and used without their informed consent (informed that is, of the controversies surrounding it). The label also appears to justify drugs as the major intervention as well as a vast and very unsuccessful research programme searching for biological and genetic causes.
But schizophrenia is much more than a label. Behind it lies the medical model – the claim that emotional distress and problem behaviour are pathological symptoms of illness or disorder rather than meaningful responses to serious problems and adversity in people's lives and relationships. The public know (often from their own experience) that people become distressed because of what is happening in their lives. This understanding, however, may be stretched in the case of the bizarre seeming experiences and behaviour which are labelled as schizophrenia and which, we are told, are outside the range of our understanding of ‘ordinary', everyday behaviour and experiences, hence the invoking of a brain disease to account for them. Yet instead of leading us to the conclusion that ‘mental illness is an illness like any other', the evidence points in a quite different direction – that schizophrenic behaviours and experiences are ‘behaviours and experiences like any other' – understandable in the same terms as we understand ‘ordinary' behaviour and meaningful in the context of peoples lives. If we acknowledge this, then we enter a world of ideas and possibilities entirely different from and far more constructive in terms of helping people, than those created through claims about schizophrenia as a brain disease.
Claims about illness and brain disease have been so persistent and plausible not just because psychotic behaviour and experience may indeed be difficult to understand but also because schizophrenia research is so often presented in ways which systematically obscure evidence against it (see http://www.critpsynet.freeuk.com/Boyle.htmfor many examples of this). Not only that, but service users, the public and professionals are rarely presented with alternatives so that ‘schizophrenia as brain disorder' seems all the more plausible simply because there appears to be no other way of thinking.
It is exactly because schizophrenia is not just a descriptive label but an entire way of thinking about people that we need to be alert to the danger that it will be replaced with an equally problematic label leaving intact the language and assumptions of symptoms and illness on which it is based. Indeed the label ‘dopamine disregulation disorder' (which does exactly this) has already been suggested, focussing, again, on what is supposedly going on in people's brains rather than their lives and implying that drugs are still the preferred intervention. What is being called for instead (and is already available) is not simply a different label but entirely different ways of thinking about those psychological experiences and behaviours which have been mislabelled and misunderstood as symptoms of schizophrenia.

Lucy JohnstoneAcademic Director
Bristol Clinical Psychology DoctorateAuthor 'Users and abusers of psychiatry', Routedge 2000.
We have known for a long time that the term 'schizophrenia' is scientifically meaningless. It is not actually a 'diagnosis' in a medical sense, since it is not based on bodily symptoms or signs. Instead, the criteria consist of a ragbag of social judgements about people's thoughts, feelings and behaviour - experiences which actually make sense in the context of people's histories of abuse and deprivation. The people who are so labelled may well have difficulties and be in urgent need of help, but this is not the way to help them.
We used to be convinced that disturbed or disturbing behaviour could be explained by the presence of 'evil spirits'. No one could actually see them, but we knew they were there. We are equally convinced today by the explanation that distressed people are, in effect, possessed by 'schizophrenia'. No one can detect the 'biochemical imbalance' or the 'genetic vulnerability' that is meant to underlie it, but we know the 'illness' is lurking in there somewhere. We know that the reason people suffer 'delusions' is because they have 'schizophrenia'. And how do we know they have 'schizophrenia'? Because they have 'delusions', of course!
Strip away the pseudo-scientific rhetoric and it is obvious where the real delusion lies. Believing in this 'illness' has powerful benefits for professionals and drug companies, and indeed for society at large, which has found it very convenient to conceal the effects of widespread damage and abuse under this ever-flexible label. Perhaps this is why we have failed to draw the moral from the pile of research indicating that this kind of breakdown has a far better outcome in non-industrialised countries that have not come under the influence of Western psychiatry.The people who lose out, of course, are the 'patients' or service users, for whom the diagnosis is often an introduction into a lifetime of dependence on psychiatric services and toxic drugs, alienated from mainstream society by fear and stigma. They would do far better in a village in rural India or Africa . Perhaps this also explains why we have failed to follow more enlightened examples from our own history - moral management, therapeutic communities and so on - or from places like Scandinavia which are moving well away from diagnosis and medication as first-line interventions.
'Diagnosing' someone with 'schizophrenia' is one of the most damaging things one human being can do to another. Re-defining someone's reality for them is the most insidious and the most devastating form of power we can use. It may be done with the best of intentions, but it is wrong. We now have a chance to put some of this right, by abolishing the label - not to replace it with another fake-medical term, but instead to work with individuals towards a true understanding of how and why they come to experience extreme forms of emotional distress.

This article came from the Asylum on line web site http://www.asylumonline.net/
Contact casl@asylumonline.net
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2007-11-23T07:25:00.000+11:30

TO BE A MENTAL PATIENT

Raymond Depardon... Untitled (from the series San Clemente, a mental asylum in San Clemente near Venice, 1982). From the exhibit To Die So As To Leave The Hell

To be a mental patient is to be stigmatized, to be ostracized, socialized, patronized, psychiatrized.
To be a mental patient is to have everyone controlling your life but you. You're watched by your shrink, your social worker, your friends, your family. And then you're diagnosed as paranoid.
To be a mental patient is to live with the constant threat and possibility of being locked up at any time, for almost any reason.
To be a mental patient is to live on $82 a month in food stamps, which won't let you buy Kleenex to dry your tears. And to watch your shrink come back to his office from lunch, driving a Mercedes Benz.
To be a mental patient is to take drugs that dull your mind, deaden your senses, make you jitter and drool and then you take more drugs to lessen the "side effects."
To be a mental patient is to apply for jobs and lie about the last few months or years, because you've been in the hospital, and then you don't get the job anyway because you're a mental patient. To be a mental patient is not to matter.
To be a mental patient is never to be taken seriously.
To be a mental patient is to be a resident of a ghetto, surrounded by other mental patients who are as scared and hungry and bored and broke as you are.
To be a mental patient is to watch TV and see how violent and dangerous anddumb and incompetent and crazy you are.
To be a mental patient is to be a statistic.
To be a mental patient is to wear a label, and that label never goes away, a label that says little about what you are and even less about who you are.
To be a mental patient is to never to say what you mean, but to sound like you mean what you say.
To be a mental patient is to tell your psychiatrist he's helping you , even if he is not.
To be a mental patient is to act glad when you're sad and calm when you're mad, and to always be "appropriate."
To be a mental patient is to participate in stupid groups that call themselves therapy. Music isn't music, its therapy; volleyball isn't sport, it's therapy; sewing is therapy; washing dishes is therapy. Even the air you breathe is therapy and that's called "the milieu."
To be a mental patient is not to die, even if you want to -- and not cry, and not hurt, and not be scared, and not be angry, and not be vulnerable, and not to laugh to loud -- because, if you do, you only prove that you are a mental patient even if you are not.
And so you become a no-thing, in a no-world, and you are not.

Rae Unzicker © 1984

But things have changed, haven`t they?

© Sven Torfinn, 2002 An isolation cell in a psychiatric hospital in Freetown, Sierra Leone. In this hospital are a lot of young boys who have a serious mental problems caused by years of civil war.

What qualities do you value in Mental Health Staff

2007-11-21T20:33:00.000+11:30

In 2001, the Workforce Action Team [WAT], set up to consider the workforce implications of the Mental Health National Health Service Framework, [MHNSF] and the NHS Plan [NHSP], commissioned and received two pieces of work: the Capable Practitioner Framework [CPF] and the Mapping of Mental Health Education and Training in England.

The shift in culture in services towards Choice, person-centeredness and mental health promotion is a key imperative. People who use services and their families continue to report not being listened to, being marginal to assessment and care planning and being rendered helpless rather than helped by service use. Tragic events, evidenced by the Bennett inquiry, illustrate that there is a significant need to ensure that all staff have training in what is described here as the Essential Shared Capabilities [ESC].

The Aim of the ESC is to set out the shared or common capabilities that all staff working in mental health services should achieve as a minimum as part of their pre-qualifying training. Thus the ESC should form part of the basic building blocks for all mental health staff whether they be professionally qualified or not and whether they work in the NHS or social care field or the statutory and private and voluntary sector.

In 2003, a national steering group was established to guide the development of the ESC (see Appendix C). The ESC were developed through consultation with service users, carers, managers, academics and practitioners. To facilitate this process, a number of focus groups were held across England in order to sample opinion and seek feedback. In the main, they have what might be termed an "outward focus" and are explicitly and deliberately centred upon the needs of service users and carers.

The Ten Essential Shared Capabilities for Mental Health Practice.

1.Working in Partnership. Developing and maintaining constructive working relationships with service users, carers, families, colleagues, lay people and wider community networks. Working positively with any tensions created by conflicts of interest or aspiration that may arise between the partners in care.

2.Respecting Diversity. Working in partnership with service users, carers, families and colleagues toprovide care and interventions that not only make a positive difference but also do so in ways thatrespect and value diversity including age, race, culture, disability, gender, spirituality and sexuality.

3.Practising Ethically. Recognising the rights and aspirations of service users and their families,acknowledging power differentials and minimising them whenever possible. Providing treatment andcare that is accountable to service users and carers within the boundaries prescribed by national(professional), legal and local codes of ethical practice.

4.Challenging Inequality. Addressing the causes and consequences of stigma, discrimination, social inequality and exclusion on service users, carers and mental health services. Creating, developing or maintaining valued social roles for people in the communities they come from.

5.Promoting Recovery. Working in partnership to provide care and treatment that enables service users and carers to tackle mental health problems with hope and optimism and to work towards a valued lifestyle within and beyond the limits of any mental health problem.

6.Identifying People’s Needs and Strengths. Working in partnership to gather information to agreehealth and social care needs in the context of the preferred lifestyle and aspirations of service userstheir families, carers and friends.

7.Providing Service User Centred Care. Negotiating achievable and meaningful goals; primarily from the perspective of service users and their families. Influencing and seeking the means to achieve these goals and clarifying the responsibilities of the people who will provide any help that is needed, including systematically evaluating outcomes and achievements.

8.Making a Difference. Facilitating access to and delivering the best quality, evidence-based, values-based health and social care interventions to meet the needs and aspirations of service users and their families and carers.

9.Promoting Safety and Positive Risk Taking. Empowering the person to decide the level of risk they are prepared to take with their health and safety. This includes working with the tension between promoting safety and positive risk taking, including assessing and dealing with possible risks for service users, carers, family members, and the wider public.

10.Personal Development and Learning. Keeping up-to-date with changes in practice and participating in life-long learning, personal and professional development for one’s self and colleagues through supervision, appraisal and reflective practice.

* 'Focusing on the core significane of hope and optimism. Being met with hope and optimism, especially at the initial contact, is of central significance in many people’s accounts of recovery, and ‘offering help, treatment and care in an atmosphere of hope and optimism’ is the first and overarching principle in the NICE clinical guidelines (National Institute for Clinical Excellence, 2002: 1.1.1.1). This has implications for staff selection and training to enable them to foster hope-inspiring relationships (Box 3) and exhibit recovery competencies (see Box 5).

Box 3 Dimensions of hope-inspiring relationships
(from Repper & Perkins, 2003)
1 Valuing people as human beings
2 Acceptance and understanding
3 Believing in the person’s abilities and
potential
4 Attending to people’s priorities and
interests
5 Accepting failures and setbacks as part of
the recovery process
6 Accepting that the future is uncertain
7 Finding ways of sustaining our own hope
and guarding against despair
8 Accepting that we must learn and benefit
from experience

Box 5 New Zealand guidelines on recovery competencies for mental health workers (adapted from
O’Hagan, 2001, with permission)
A competent mental health worker:
1 understands recovery principles and experiences in the national and international contexts
2 recognises and supports the personal resourcefulness of people with mental illness
3 understands and accommodates the diverse views on mental illness, treatments, services and recovery
4 has the self-awareness and skills to communicate respectfully and develop good relationships with
service users
5 understands and actively protects service users’ rights
6 understands discrimination and social exclusion, its impact on service users and how to reduce it
7 acknowledges different cultures and knows how to provide a service in partnership with them
8 has comprehensive knowledge of community services and resources and actively supports service
users in accessing them
9 has knowledge of the service-user movement and is able to support its participation in services
10 has knowledge of family perspectives and is able to support the family’s participation in services. `*

*Taken form The rediscovery of recovery: open to all
Glenn Roberts & Paul Wolfson

NIMHE 10 Essential Shared Capabilities
Capable Practitioner Framework

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