Just why don't they get it?

A busy fortnight of meetings, with three last week all about local matters, then three this week all with people from further afield. This blog entry will try to illustrate that all the hope seems to be 'out there' and not 'back here'.
In the interests of fairness, anonymity and not to mention self-preservation - all names and distinguishing features have been fictionalised...

LAST WEEK

Week 1: meeting 1 - senior manager, Craig O'Reilly...
GS      There's a great variety of good things going on out there
Co'R   We need just six types of complex needs service elements
GS      If only we could do mental health differently
Co'R   Tell that to the commissioners, not to me
GS      We have been cut to less than half the staff we had 3y ago
Co'R   And there's worse to come - we have to cut £4m

Week 1: meeting 2 - less senior manager, Barry Southmore and even less senior manager, Mikey Davidson...
GS      There are great opportunities here to do it better
BS       Do you know about the organisations' strategic plan?
GS       But this is about implementing government policy
MD      Don't threaten me
GS       So we need to shut services then
BS+MD No comment

Week 1: meeting 3 - local manager, Maria Freeman and GP commissioner, Raheed Gursha
GS       There are great opportunities here to do it better
RG       But we do need to treat people with proper illnesses
GS       There are excellent things going on elsewhere in the country
MF      Let's include some of these ideas in our shortlist of how to improve local services
RG       OK, maybe
GS       Good - but we will have to start about doing things very differently
MF+RG There's a lot more meetings before we can decide

THIS WEEK

Week 2: meeting 1 - national campaign coordinator, Smita Chatterji
GS       What do you think of our idea for expanding greencare access for severely affected MH populations?
SC       It's just what should be happening, what's the problem?
GS       We've been stopped from doing it by the NHS managers.
SC       Find a friendly local councillor - they should love it. Failing that, an MP. It is what the CCGs should be commissioning nowadays.

Week 2: meeting 2 - national commissioner, Dick Wenniford
DW      Why don't you give up trying with that lot? You have been banging your head against a brick wall for many years now.
GS        Because I believe in it, live here, and am very loyal to my own area - and once they realise, it will actually save them money and give a better service
DW      You may kill yourself in the effort.
GS        But there's a chance it may just get better - we're having a new chief executive soon
DW      Can we help from the centre?
GS        Probably not.

Week 2: meeting 3 - international conference with famous keynote speaker (KN) and subsequent tea party with Sicilian colleagues (SC)
KN       Yes we agree about most things, and there's not much hope that the Government has 'got it', in the way we need things to be - like epistemics
GS        Just why don't they get it?
KN       Good question...
SC        Are you residential?
GS        No - the community is in the head - not the buildings or the leader or the staff.
SC        That is so obvious and so cheap. Why are there not many more of them?
GS        Hard to say. Just why don't they get it?

The Return of the Yurt

Since last years' twin disasters (both consequences of rapacious market managerialism of public services), 'Growing Better Lives' hasn't been doing so - and the poor old yurt itself was homeless, until we suffered our third disaster - collapse and breakage of many of the ribs which support the crown. As time passed, even the success of our launch party (personality disorder dog show and all) faded into a vague disappointment that nobody with any relevant influence had come along to support it.

Triple disasters
1
Being ever-more organised as secretive and mistrustful businesses, NHS Foundation Trusts (aka hospitals) cannot get their corporate head around concepts like sharing, cooperation, informal relationships and the common good. So we were forbidden by Berkshire Healthcare Foundation Trust from allowing NHS registered patients from also enjoying the greencare facilities of the yurt, therapeutic horticulture, fresh air and contact with nature as part of their treatment programme. The therapy programme continued in the public, antiseptic, noisy and unwelcoming corridors of Wexham Park Hospital.

a therapeutic environment?

2
Being desperately short of revenue, in the most deprived and ethnically diverse corner of the Thames Valley, Slough Borough Council had to sell land to make ends meet. At the top of the list of uneconomic plots of land that would be readily developed for private housing was Wexham Nursery. An oasis off the busy B416, with friendly staff and lots of sheltered work for those with learning disabilities, they diligently grew all the bedding plants for Slough's roundabouts, cherished their memories of winning Chelsea medals in years gone by, and ran a small and other-worldly garden centre. Our plot, and the 'magic garden' that had been established behind it, were turned over to the diggers and developers - but the situation was very much sadder for the people who had put all their working lives and care into something of beauty that was no longer valued.

Bedding plants £1 - everything must go

3
It was always ambitious to try assembling the thing between Christmas and New Year - but we managed it, although the cotton lining was too wet to fit - and we didn't have time to fit the five felt sections with their cat's cradle of nylon cords. However, we got the canvas over the thing, to at least protect the wooden structure until we could find a weekend day to put all three layers on it. But the weather was not kind to us: ripping winds loosened the canvas, and shook the trellises, ribs and crown to their foundations. Then came the snow. Unfortunately, the canvas cover, though loose, was still roughly in place when the blizzards hit. And that sturdy cover provided a 21 foot diameter circle to comfortably accommodate about 5 inches of snow. Which, on a weakened structure suddenly made the elegantly convex roof into an inelegant concave wreck. With about 20 of the 72 ribs snapped in the process.

Convex version

Concave version

Recovery
Tucked between a totem pole and a life-sized stuffed buffalo, we now have a perfect size circle amid trees, work areas, a large pond and a large log cabin - with kitchen, classrooms and office. It hardly matters that we're on the site of a major electricity substation, a whisker's distance from the M25 and only a few miles from Heathrow.
Our hosts - a mostly educational greencare project who are part of the Thames Valley Groundworks organisation - seem faintly amused at our comings and goings - but helped us enormously by rescuing and tidying up all the parts of the collapsed heap of wood and canvas - and sorting them all  into intact and broken; they are now also helping us to devise horticulture programmes, and marketing them for the last phase of our EcoMinds grant, and running the activities with us.
The Yurt Workshop soon provided us with replacement ribs and shipped them over from Spain, and a flicker of interest was reignited from the good people who had suffered the privations of winter 2010 with us. So, on the hottest day yet of the year, we sat around all morning talking and scheming - and then got down to the serious construction business. Trellis - easy; ribs and crown - a bit trickier until we made sure we had the trellis arranged in a perfect circle; cotton lining - much easier for being dry; felt layer - quite a tangle of odd bits of string needed to hold it up, but secure eventually; canvas cover - went up like magic, poked into place by three of us with spare rib poles. The only remaining problems are that we need to stake it all down and find or replace the missing nylon webbing girdles, and plane the door slightly so that it fits again - presumably having become a bit warped by all the bad fortune and unfavourable climate it has suffered. A bit like us really.

Heaven or hell?

A weekend in the countryside, at a rural study centre on an organic farm, supplied with all the good fresh food, drink and treats we could ever need; sleeping in bedrooms in a lovely old Tudor farmhouse (was later converted into a Jacobean mansion), all beautifully restored and maintained; in easy distance of London, for a relaxing and stimulating weekend with about twenty like-minded people. With fresh air in abundance, walks across the Low Weald of Kent on the doorstep, peace, quiet and tranquillity. An almost unique chance to escape from the pressures and hectic pace of day-to-day life. Even more, chance to work with others in an authentic and unique way, and feel connected to the natural world - and each other - in a wonderful peaceful environment. 

...OR...

Isolated without TV or even a mobile phone signal, thrown together with a whole group of strangers and very little structure or explanation of what everybody is there for.  A kitchen and fridge full of food, with which we are expected to feed ourselves for the best part of three days - and to cap it all ...the group meetings! The large groups at the beginning and end of each day where we have to decide what to do together and what we make of it all, and the small groups - about seven or eight people (including 'conductors') where we are expected to tell of our innermost feelings in front of people we will probably never see again. Uncertainty, anxiety, painful thoughts and feelings. You must be mad to want to go on a course like this.

Heaven or hell? You choose! 
And you're welcome to come on the next one, November 14-16, either way.

Since 1995, 'Living-Learning Experiences' have taken place for a weekend every May and three midweek days every November. Ostensibly to train mental health practitioners in the advanced use of certain types of group psychotherapy, they are usually experienced as something rather more significant than a run-of-the mill skills course.

The one which finished yesterday was particularly interesting for its cultural mix: the conductors of the small groups were from Italy and South America, and participants came from India, Ireland and Yorkshire - as well as the rest of England.

ETHNOGRAPHIC ANALYSIS:

Rawlings B (2005)

The Temporary Therapeutic Community: a qualitative evaluation of an ATC Training Weekend. 

Therapeutic Communities 26 (1) 6-18

Sacked?

With great sadness, I have to report that I think all the dreams that Yousuf and I were having for really good biopsychosocial medicine, for the mentally wounded people of Kabul, might be turning to dust. And I just don't have any idea why - can't get hold of anybody to clarify the situation, and seem to be wanted over there no more. 

I had been a bit worried since the middle of August, as I knew Yousuf would have been back from his family holiday is Dubai - and had had no reply from him. In the time since my arrival back from Kabul, I had been recruiting potential trainers to go over with me for the next three planned visits - and there had been an excellent response from ex-service users from therapeutic community programmes who were willing to volunteer to come over as training assistants, and help explain the model of intensive 'user-partnership' and 'integrated psychosocial' therapy that we wanted to get going. As the intention was to use my personal fees from the project for their air fares and expenses, we could only stretch to two per visit, including the co-trainers.

In fact, many more than this came forward - and I was immediately set the task of selecting the 'best of a good bunch' for accompanying me to deliver the agreed training programme. And as I knew several of them personally or professionally, from our therapy and greencare in the Thames Valley, I did not want to be seen to be biased in choosing between people (all of whom seemed very well-motivated and capable). So I decided to ask each of them to write half a page on why they wanted to do this volunteering, and what they thought would make them good at it. From sitting on the panel in dozens of NHS interviews over the years, the questions weren't exactly hard to come up with!

So that I would get the choices made quickly, and be able to get the best value air-fares for the planned September visit, I asked for a very tight deadline. And everybody responded almost immediately - with some marvellous and inspiring pieces of prose. This was becoming an even more exciting project! And more so, because I had no trouble in also recruiting a journalist, business consultant and researcher to come on the future visits - some of whom would be able to find their own funding, and all of whom would be able to then do work that could sustain and develop the project beyond its current planned ending date. And another Kabul-trained psychiatrist working in Oxford wanted to discuss whether he could help too. This lot will really help the project, I was thinking  - about a dozen highly experienced volunteers more than they were expecting!

So I assembled all the applications into a spreadsheet and sent it off to Yousuf, with a few demographic variables, asking him to rank the applicants so that I could get back to them and make all the practical arrangements (which would have been quite complicated - including visas, insurance, induction, preparation, accommodation and security arrangements) in good time.

One week - no reply. Oh well, he's still on holiday maybe. Two weeks: probably got a backlog of emails to sort out. I'll send a reminder email. I think that was also the week the British Council over there was attacked - so a bit of non-specific worry about the security situation: I wonder if they are stopping all but absolutely essential movements. Three weeks: he's probably just very busy with all the work going on in Kabul, but I'll send a note to the London office just to check all's well. Four weeks: no reply from London or Yousuf - starting to get concerned now. Nothing relevant I could find on the web. Send a 'worried' and supportive email to Yousuf. A colleague over here, who knows Afghanistan quite well, though it would just be normal delay and bureaucracy - so I sat tight for a bit longer.

Then, a few days ago now, I received an odd communication by email from the US offices of the NGO. It was an email asking me to acknowledge receipt of a letter from the impressive manager who had started as Country Director for the NGO just before my July visit - and who seemed to be really invigorating the project with determined leadership (which, from stories I heard, had been in rather short supply on the managerial side, until then). The letter a blurred monochrome pdf which was all of two sentences long, on their headed notepaper, saying my services were no longer needed after a budget realignment. Not even a 'thank you'!

I acknowledged it - with a rather intemperate 'what the hell is going on'-type email to the California office, which got a very speedy receipt and thanks (thanks for your acknowledgement, that is). But no more explanation of what was going on. I informed all the volunteers that it looked like we weren't wanted over there any more, and got some heartwarming messages back. The colleague who knows a bit about Afghanistan and NGOs wasn't at all surprised, and said this sort of thing happens all the time -and really shows what a self-serving shower some of the NGOs are.

So that's where we are at the moment. Although obviously disappointed, I am hopeful that the energy and commitment people felt in coming forward will still be used - though maybe not through this NGO or this project. And it may need a lot of work to get back to where were were.

I have some dark thoughts about NGOs in general, as well as the sort of rumours, mischief and anti-group process that might have been marshalled - but I had better not air them here until I have found out more about what is actually happening. I feel very sorry for Yousuf - I imagine that he is very unhappy that the project has been scaled back in this way, and has probably been asked not to get in contact with me. I think back to how proudly he introduced me to his Kabul colleagues as one of his own teachers - and how honoured I felt by that. And, then, how humiliating it must feel to be unable to even be allowed to explain it to me. But these are my mere fantasies, at this stage. But oh, how we are told that people enjoy such freedom in corporate America, indeed!

In the next week, I shall send friendly individual emails to all the people I know in the organisation, and report my progress here in the blog. I shall also ask why I haven't been paid yet! Watch this space - the story is not over yet...

Media Land

Since my last entry here, life has returned to normal: valuable times with service users, grim times with NHS managers, busy times with a family growing up and leaving home, and a little bit of green time with a brilliant holiday read called "Sustainable Energy - without the hot air" and down at the yurt. Which, although randomly overgrown with everything from thistles to orchids, is looking wonderfully rustic in the midst of a town-of-ugly-repute - and producing great runner beans, courgettes and soft fruit. It reminds me of a couple of greencare principles: a weed is just a plant in the wrong place, and there's no such thing as bad weather, just wrong clothing. Which reminds me of my summer holidays, in a very beautiful part of England where the Pennines start, but for which I very definitely had the wrong clothing (though it was warm and sunny when we left Berkshire, honestly!).

In a town of ugly repute...

My dear employers, Berkshire Healthcare Foundation Trust (who now deliver all mental health and community services right across 'The Royal County'), had been beavering away on my behalf while I had been away on my hols. At Yousuf's suggestion, I had let them know that this blog was 'out there'. Their diligent PR department had done good work, and alerted BBC Radio Berkshire to the fact. So on my return, I had a few emails asking me to contact their newsroom. Could it really be that so little of interest is happening in Berkshire that they want to talk to a random psychiatrist about helping a foreign colleague? Well yes, they were interested in my tale - and the first phone call to them left me feeling quite excited that this was interesting stuff. And - though it would be touch-and-go whether I'd get to my groups in time, they provisionally booked me into the Andrew Peach Breakfast Show for Tuesday. I'd heard Andrew Peach a few times, quite liked his style, and thought it would be nice to meet him - but my excitement was squashed when I later got an email saying 'sorry, we can't fit you in. We might get back to you'. Don't call us we'll call you. Oh well, maybe somebody in Chapel Row has a new insight about Kate before she knew you-know-who.

But then they did get back to me - and a wonderfully engaging young media type, called Tom, phoned me and asked if he could ask me a couple of test questions and record them for the show. Wow - so this is what fame was like! I then spoke to somebody very helpful who explained that they wanted me to do TWO spots on the Wednesday morning breakfast show - a quick one, like a taster, at 0820, then a longer chat at 0915. I tried to get out of it by saying that I wasn't media-friendly and I'm not very good at this sort of thing - but then I thought of Yousuf and all he's doing for his devastated home town, and how he had asked me to get all the publicity for the project that I could once I got back home. They promised me that it wouldn't be at all like a grilling from J Paxman, so I said yes. They emailed me a map of where to go and asked me to be there for 0810 so I had 'time to relax' before I was on air (as if!).

The family were not impressed with the fact I'd need the car - as a few boyfriend/girlfriend/sleepover arrangements would need changing - and I set my alarm for quite a lot earlier than I needed. So when it went off I sat up in bed for a few minutes and wondered what on earth I had to say that was worth saying, then made myself a strong coffee. In the car, I decided to write myself a list of  three essential points that I wanted to get across. I did one per red traffic light, and I got to eight by the time I was in Caversham, near BBC Berkshire. Forgoing my usual fix of James Naughtie, I tuned into 104FM to hear all about the lastest advice against having caesarian sections, and listener's responses. Now why on earth would those listeners want to hear anything at all about sorts of therapy that none of them have ever heard about in far away bits of the world that none of them would ever be likely to go to?

The directions were odd, and had a space warp included - I know Caversham fairly well, but have never really known how to get into the enormous and palatial BBC estate there (most of which I understood is their main British listening station for all overseas broadcasting). I tried about three wrong turnings before finding the right one - after asking a local, who seemed surreal in her friendly coolness. Security was impressive - enormous folding road ramps that were only lowered when they had checked you on the list, and then a long drive between well-manicured lawns to a visitors car park. As I parked I thought "I expect they need this sort of thing in Tripoli at the moment, but why CAVERSHAM???".

The BBC's palace in Caversham (the nice side of the river from Reading)

The laid back receptionist pointed me to the seats in the waiting area - it was about 0800, and fairly quiet. But the whole area was what you would expect of a rather distinguished and long-established private mega-multinational, not the dear old Aunty BBC - public servant that she is. With a high-ceiling, classical columns, graceful arches, whole wall screens of News24, extremely funky computer hot-desks, nests of comfy chairs and emotionally intelligent management advice on the notice boards - this was very different from the NHS (or indeed Kabul MH Hospital).

Tom came to find me at 0810, as planned - and I found out that Tom is a first year journalism student at Cardiff who is there on a week's work experience. He enthusiastically told me that they had used a short sound clip from the phone interview (that he did with me the day before) at 0710 to trail my interview. Even more wow - this is really what it's like to be a star! And what a great work experience for him, we agreed (OK, maybe I was getting a bit carried away by now...). But he certainly had that 'put you at ease' thing, and we chatted quite easily while sitting on the producers' room sofa watching the studio through the one-way mirror - just like a good family therapy set up, I thought. The producer was soon to go on maternity leave, and not entirely comfortable with all the chat about why people had emergency C-sections. But the screens relentlessly showed progress of the show - and as it edged towards my time I was led into the studio, sat with two multicoloured microphones across a table from the presenter - James Cannon - who was standing in for the day for Andrew Peach. But I was impressed with the smoothness and flow of the whole thing, and particularly how James was so natural with it all - but I suppose that's his job. I think he's probably what I'd call a 'butch and hunky' DJ rather than a 'warm and fluffy' one - but that is in no way to detract from his professionalism.

Warm and fluffy?

Butch and hunky?

Just before my slot, he turned off the speakers and was talking normally - until I realised it was to thousands and thousands of people out there, and he was starting to talk to me.

I forget the rest, but don't think I said anything too bad.

When I checked my list, I think I'd covered two of my eight points, and I was going back in for more in about three quarters of an hour. So I was given a cup of BBC coffee and did some work in the canteen. Which was well-populated and rather plush; some of its patrons spoke in american accents and I could quite imagine them with those curly wires going from their ears under their collars. Spooks? Who knows, I certainly don't - but then I reckoned it could explain why the BBC needs such exquisite surroundings for their international listening station, and how they can afford to live in a palace!

Round two felt a bit more under control, and started straight after Diana Ross, on the dot of 0915, though I got the feeling that I went off into long chatty rambles that were rather off the point. But James seemed perfectly cool with it, asked good questions to keep me in my comfort zone, and rounded off nicely when our time was up. I had managed to squeeze in six out of my eight points.

Now I wanted more!

A very friendly and helpful editor from the newsroom took me out, and said that they may be interested in doing more on this 'story'. She wondered if one of their journalists might be able to come with me on my next trip: it could make great radio, she said. I enthused about how much Yousuf would appreciate that, and how it might help the long-term future an sustainability of the project. Yet more wow. I left with a spring in my step, and drove back into the normal world of Reading's late rush hour traffic jams.