Friday, 15 September 2017

...and we thought it was easy in Italy

This was going to be a different sort of LLE - instead of supervising the clinical work, or doing quality assurance, or having a research group - we were bringing a whole DEVELOPMENT TEAM to see just what it was they did. Why we could go back to England, tell of what they were doing in Caltagirone mental health services and Terra Nostra social farm, and have us all wondering 'why can't we do that here?'.

I remember a talk in the last year or so, when - despite the erratic translation - Raffaele Barone and I came to a cosmic agreement about what is needed. And here it is in diagram form:

So off four of us went - once we had got our passports in the right place at the right time - to do some detailed interviews with the key people behind the Sicilian magic. And what did we find? 
...that it is just as hard there as it is here, and to make a thing like that work, it needs a great deal of energy, enthusiasm, willingness to work way beyond the call of duty for a pittance, and taking risks with your capital all the while. A bigger scale maybe, but not unlike what we're doing in GBL after all.

Here's Trevor's notes on it:

The first reaction when I announced at home that I was going to do some work in Sicily was that I was very lucky, but it wasn’t expressed in quite such polite terms. No amount of explanation and protestation that this is not a holiday entirely changes the perception, but of course the reality was somewhat different, with the usual early start, punishing travel conditions and herding around at airports with many other sleep deprived travellers. The programme for the three days of training were also busy enough and structured enough to preclude much leisure time.  However, the company was very good and the journey through from Catania relaxing and the venue when we reached it, a social farm called Terra Nostra, was a haven of seclusion, with beautiful plants and trees, delightful animals and perfect weather.
The development group in their den
From past experience, I have learned to expect the unexpected on working trips to Italy, but I hoped to get an Italian perspective on the therapeutic community and an insight into the somewhat different approach to, and perceptions of, autonomy and recovery for members of this kind of mental health facility. I am also interested in how the relationship between professionals and members is perceived and how much real democracy is possible, partly because some of my colleagues in Italy are suspicious of any discussion of “therapy” in the context of social integration, because of the connotations of the sort of unequal relationships and medicalisation which is prevalent in the psychiatric establishment.
This visit also provided an opportunity to compare how this kind of setting and the way it is set up might affect the experience of members, particularly in relation to the principles of green care. Differences in opportunities for setting up and funding green care facilities were obviously of great interest.
In terms of my own subjective experience, I did expect, because it is a consistent pattern or progression, to have initial doubts about my own role and a perceived need to have my own space. This can easily lead to projections onto others which take a while to unravel and could have been amplified by our rather ambiguous role as observers. However, such feelings were soon dissipated by the openness and warmth of the other participants and the transition to a more secure feeling and sense of belonging wasn’t long in coming.
It was remarked that this was a group of professionals, reasonable people in similar jobs, and it was therefore unsurprising that communal living of short duration caused few stresses or disputes. However, I was surprised by just how open and good humoured the participants were as a group. This must have made the ambiguities of the democratic approach, for example within work tasks, easier to resolve, although there were discussions about the difficulties inherent in an arrangement where nobody was responsible for decision making, or rather, everyone was. There was a tongue in cheek comment that this was anarchic rather than democratic therapy.
It was interesting to see how the community meeting was arranged. Although it was quite structured on paper, with a business-like agenda, the leaders merely stipulated that it should start and end on time and that the chairperson should be whoever ended up sitting in the seat on which the agenda had been placed. Little guidance was given before or during the meeting as to the approach of the chairperson, which resulted in meetings that seemed more like a large group than a community meeting.
One of the most interesting aspects of the trip was the chance to see the set up at Terra Nostra. The challenges faced by anyone wanting to set up a democratic Therapeutic community within a rather inflexible psychiatric system with chronic funding problems are very familiar. Although there are now small grants available from the EU for starting social farms, the aim is to promote traditional farming, and they aren’t targeted at mental health projects. This may have some advantages, but in any case, this particular project was developed by the investment of the personal funds of a dedicated and resourceful professional who realised that seeking funding from the psychiatric and political establishment was just too problematic and involved unacceptable compromises.  However we think the world ideally should be, his success with Terra Nostra is something from which we should derive real inspiration.             

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