5 different community meetings: Christmas Quiz

What an odd week - five days and five different community meetings in four different TCs.
See if you can work out where each one is...

		type	sector	purpose	no.	feel
Mon		Residential trauma clinic	Private	Monthly information sharing	8+7	Quiet and reserved (except staff)
Tue		Alternative to admission non-residential	NHS	Weekly support and coordination	13+8	Raucous and festive (with Christmas jumpers)
Thurs am		Environmental / ecotherapy	Third	Intensive support: check-in	4+2+2	Warm, welcoming of visitors, and emotionally intense
Thurs pm		Environmental / ecotherapy	Third	Intensive support: check-out	4+2	Appreciative, mindful and settled
Fri		Offender PD tratment	HMP	One of 2x weekly wing meeting	38+4+1	Boundaried, highly organised, with vivid emotional content

Something else is brewing

Peter Cockersell has produced a book (and written most of it himself), called 'Social Exclusion, Compound Trauma and Recovery. Applying psychology, psychotherapy and PIE to homelessness and social exclusion'. Most interesting I think is a lovely clear account of 'compound trauma' - which seems to be a considerable improvement on the much-overused 'complex trauma'.

Here's my blurb for the back cover:

By drawing on modern psychoanalytic thinking, developmental neurobiology and current ideas of therapeutic environments, Cockersell presents the most complex problems in an accessible and engaging way.

And here's a lengthier piece I have written about his work at CHT:

Many things about the new world of social media, artificial intelligence and compliance metrics are a bit bewildering to digital dinosaurs like myself – but there is something else brewing as well. In the midst of all the turmoil that surrounds us, I am hearing different voices from all sorts of directions saying something new. I hear it at professional conferences, at policy meetings, during clinical discussions, in the newspapers and on the radio. There are also many places where people are talking about it – and feeling that it is what is missing – but can’t quite clearly pin down or articulate just what it is. It is the whole area of needing to make relationships the priority. Inspectors and regulators are starting to see that numbers cannot describe some of the most important things about schools, prisons or care homes; commissioners are recognising that complex systems cannot be purchased like cans of beans; professionals are starting to understand that their work is ultimately a bit empty and meaningless unless they consider the relationship that they are working with. Perhaps even politicians and policy-makers will soon realise that top-down command-and-control systems will not get the best out of people. As resources dwindle, and there seems to be little hope for funders to pay for anything more than the bare minimum. But CHT is now forging a new direction, which will not only be more therapeutic and humane than the ‘industrialised’ alternatives, but will be at the cutting edge of the emerging realisation that genuinely therapeutic care is not a luxury, but a necessity. Unless ‘relational practice’ is in place, outcomes will be worse, more people will complain, and the eventual costs will be much higher. From the work we are now doing with our commissioners, perhaps along with the wider crisis in social care provision, things are looking up. The fees we can ask are no longer dropping, and there seems to be increased recognition of the quality of our services, and the way in which we can provide a ‘value-added’ which is significantly more than the similarly-funded routine care services. In the world of therapeutic communities, a similar process is under way. Although few of the traditional residential TCs have survived, the newer adaptations and modified TCs are now bringing the TC philosophy into new areas. Again, CHT is at the forefront of this: the organisation is pioneering relational practice, based on the therapeutic philosophy of TCs, in developing CHT as a provider of a new intensive form of Psychologically Informed Environments (PIEs). It is widely acknowledged, through evaluation and research in the homelessness sector, that this will help us to engage people who would not normally be able to be helped, and provide a therapeutic environment for treatment that would otherwise not be possible.

This work is built on decades of what has been central at CHT. The broad-based understanding of mental distress, including biopsychosocial understanding, the importance of trauma, and the need for a wider frame of reference than either psychiatry or social care can offer, is something that CHT has always proudly asserted and disseminated. We are now entering the next phase of that, and I am confident that we can look forward to a future at the forefront of progressive practice in mental health.

An unexpectedly helpful conference - the start of something?

When I was asked a few months ago to chair a conference on personality disorder and doing an opening talk, I thought it might be worth doing - and agreed. The first draft of the programme they sent me looked quite interesting - not the normal decontextualised and competitive datafest - and I had a few email conversations with a person I didn't know, called Romy, to bring a bit more of a policy / systems / 'relational' angle to it. It was being run by a commercial conference company called Forums and Events, who were a new outfit to me. With the venue overlooking Lord's cricket ground, and its expensive delegate fee, my expectation was that it would be fairly low key and probably mostly appeal to people in grey suits from private hospital groups, who were wanting to set up slick and profitable PD services for their shareholders. In a way, although that's not a milieu that I enjoy, I didn't mind the idea too much - as my intention for the conference was to show that a purely evidence-based and commercial approach misses more than half the point. And maybe the faceless corporates would start to understand that...

But, in fact, I was altogether wrong - and the delegates included a wide range of people from all sorts of organisations, professions and sectors. I counted about 90 of them, including an actor who introduced herself to me afterwards, to wonder how a highly articulate and intelligent friend of hers - who had been badly let down by the NHS system - could 'help the cause'.

But even more than the mixed, enthusiastic and appreciative audience, the almost randomly thrown-together speaker list - with five half hour presentations in the morning and another five in the afternoon - worked like a dream. The morning started with a short explanation of my usual 20-year project timeline for 'PD World' - ending with an exhortation that 'the golden thread' to make it all hang together is 'relational practice'. Here's the prezi: https://tinyurl.com/DanubiusPD. The rest of the morning included four presentations, and discussion slots, all of which made different cases for relational ways of thinking and working. The high point for me was when somebody, during the final discussion panel, so powerfully said "this isn't really just about PD, is it"...

The afternoon - chaired by a good friend and former warden of the PD movement, Conor Duggan - was similarly collaborative and inspiring. I chatted to the person next to me at tea time - and was surprised by how unreservedly positive they were about the whole experience. But this is what normal conferences (in the PD and TC and EE worlds) are like - though they were expecting it to be more like a 'boring old psychiatry one', as they were used to.

The most interesting bit of discussion - which might be a bit arcane for those who don't know the history of people and problems involved - was how the newly appointed commissioner for the NHSE specialist 'Severe Tier 4 PD services', Sarah Skett, is determined to get things done differently. She will be working with Steve Pearce (clinical chair of the reference group) who seems to have been banging his head against a brick wall for several years now. Under her commissioning of NHS England's half of the Offender PD Pathway, following Nick Benefield's diversion of the DSPD funding in that direction, great things have already happened in the criminal justice sector. The recognition of the importance of relational practice - and the underlying principles and values from Enabling Environments - has made over 200 prison and probation units less violent, with prison officers finding meaning in their work and prisoners being recognised as human. They have set up effective and progressive pathways, with research backing, that are lauded by Michael Storr, the head of English Prisons and Probation. Now that Sarah has the brief to look at non-forensic severe PD services which are commissioned in the NHS, let's hope that we can expect to see a similar light-bulb moment in those policy circles. She will have plenty of support from those who have been trying to do the same, with varying levels of learned helplessness, in our various fortresses of locally industrialised and walled-off health services. It could even fit very well with the aspirations for STPs, ACSs and the 5YFV - if we could get rid of the almost meaningless six-tier system.