How exciting and refreshing it was to go to Bristol today and see some of the potential developments with what might be their first ever self-described 'Nano-TC' at Bedminster City Farm. And I thought we were winning the shrinkage game at Slough with our two and a half hour 'micro TC'... (and as for the 'mini-TCs', with a whole day and a half together, they are positively last-but-one decade!
Asa (semi-retired and increasingly grumpy) NHS medical psychotherapist I have a passionate interest in helping people to develop progressive ‘greencare’ interventions for ‘personality disorder’ in group settings. Because of this, I was intrigued to see just what the Bristol gang were up to, particularly as our little social enterprise (Growing Better Lives CIC) won the Royal College of Psychiatrists’ inaugural sustainability award a few years ago, and I had recently presented our Slough work to a Bristol online seminar. It seems that there is a lot of interest in these greencare-TC approaches across the country, and maybe this lot could be getting ahead of the game!
The setting for the service, in the longest-established of Bristol's three city farms, is just excellent – it represents an important and clinically meaningful departure from the usual anonymous and alienating hospital offices and rooms. It also represents a tangible example of what we expect with the forthcoming transformation of mental health services, with the NHSE funding and expectation of preventative services, asset-based community development and third sector partnership - doing mental health really and radically differently. We do a tiny example of this in Slough, but these people have so much opportunity to do it for a whole city – and where better than Bristol, with it’s proud green reputation?
Part of the transformation we all expect is also to do with what some of us are calling ‘relational practice’ – where everybody involved recognises how important ‘the relational field’ is: in terms of risk, recovery, well-being, and suicide prevention. Co-production requires a high order of relational practice, and its central role in the work – and wider systems in the local mental health services – makes me feel that it is fine form. Although there are the usual inter-professional rivalries, I think it is important to always stress the need for a psychiatrist who can work outside a strict biomedical model, and yet have the skills and experience necessary for matters such as deprescribing (specifically for ‘personality disorders’), which will almost certainly become a major part of psychiatrists’ work in years to come, and the huge overlap with physical health.
My only reservation is that this sort of service needs to ‘grow in its own soil’, and establish its identity and relationships - as connected and contributing to, but distinctive from, its parent organisation. This sort of development cannot be manualised or ‘rolled out’ across a large area: it needs to be nurtured and treasured – like a garden or allotment. If done well, many benefits beyond the immediate clinical gains will come.
Unfortunately, these organic and flexible requirements are sometimes against the modern methods of project management and service standardisation, as are now almost universal in the NHS - one of the ghastlier and more dehumanising aspects of 'The New Public Management', I fear. However, there are excellent standards-based quality assurance tools which have been developed at RCPsych – such as the Community of Communities and Enabling Environments - that recognise, measure and accredit the things that accountancy firms can't, and that matter most to real people.