Sunday, 10 June 2012

The trouble with therapeutic communities…

Is that, although ahead of the game in so many ways, they’re just a bit slow in cottoning on to what you need to do to survive. And unless they do survive in some recognisable form, the radical core of what they do differently (quality of relationships, basically, though nobody has ever described it well enough to catch fire) will be lost. The crown jewels will be dismantled and used in all sorts of other settings – being very pretty, maybe, but losing the beauty and power of ‘the whole thing’.

Where new ideas for mental health come from

But I have just heard of a plan – from that modern-day foundry of mental health ideas which is Nottingham’s Institute of Mental Health (IMH) – that would truly blow Maxwell Jones’ socks off. Here it is – just floated to the local mental health services there, by Nick Manning (who is Director of IMH):

there should be a ‘peer workers’ management buy-out, rather than just peer support, so that peer workers managed the service and ‘contracted in’ just those types of staff they wanted for the service

I have sent a half-serious reply to Nick Manning that we’re all set and ready to go: we have an established TC in the NHS, a Community Interest Company social enterprise with a current lottery grant for greencare, and an active group of service users, some of whom will soon finish the main phase of their intensive therapy programme, who are well-versed in therapeutic empowerment – as well as being energetic, resourceful and committed.  Not to mention being utterly committed to making real changes for themselves, desperate to escape the ‘benefits trap’, angry with many aspects of the mainstream MH system, and determined to get a life worth living for themselves.

Where new ideas for mental health go to?

But, probably because I’m a psychiatrist, and not a service user or a manager, it’s unlikely that I’d get an idea like this over the first hurdle – especially as I have had such a spectacularly unsuccessful history of innovation in dear old Berkshire since 2002. I’m meeting Nick next week and I expect he will gently tell me to stop flogging a dead horse – things they do in Nottingham just wouldn’t work in the affluent South East (like Slough!)

But – what about if we get a small team of interested service users together? With a really good idea for taking the pressure off the statutory services and doing it better themselves? Almost like a group version of personalised budgets. And how about ‘employ your own therapists’ as an alternative to ‘payment by results’?

Although I expect it is very unlikely to happen, I’d be first to apply when they advertise for their own psychiatrist…

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