Getting ready

Hello, green care friends and colleagues


I have just got back from Slough (yes – on a Saturday!) having done two
hours heavy digging. Unfortunately, probably because it’s half term, nobody
else I asked could make it – and our two teenage boys at home refused to get
out of bed (also because it’s half term). But they have promised to come
next week if I buy them a kebab...


But I’m putting a call out for everybody to muck in next week – and I think
we should be able to get to the penultimate stage - before putting the final
layer of the floor down. The big tent itself is meant to be arriving the
following week...


I have done quite a lot of web research about what we need for this cob floor,
Here's the soil analyses I did:

And here’s my recipe for what I think we need to do:

Because of the staff shortage today ;-) I didn't quite manage to complete the
hole before the nursery closed – but I did get at least a third (maybe a
half) of it dug out. David did the position and circle the other day, so I
started by digging a small trench all the way round – diameter exactly that
of the yurt (21’), then digging down to 4” everywhere. But as I say, I
didn’t manage everywhere – and I didn’t do any stamping down. It was still
about 30 wheelbarrows full to shift – which makes me realise that there’s
more to this Green Care than I first thought – and I expect to be a bit
stiff tomorrow. It would be good if we could get the whole hole (ie 4” deep,
21’ diamerter) dug by next weekend – so I will ask the 3-day programme on
Monday, and the Thursday group if they are willing to help. No promises,
though!


But next weekend needs to be the ‘big floor-laying day’ – so please come if
you can. The nursery is only open on Saturdays between 10am and 4pm, so I
think we should get started as soon after 10 o’clock as people can arrive.
Again, I will invite both groups and the few other people who have come
along so far to join us – but 6 to 8 energetic people would probably get us
one stage away from being ready to erect the yurt itself. Which is where we
need to be by then... I will buy everybody who comes along lunch in the pub
nearby (and later ask the board if I can claim it back on expenses!). The
place is Wexham Nursery, http://www.slough.gov.uk/services/1016.aspx, and
the address is Wexham Nursery, Wexham Road, Slough, SL2 4HE – about 200yds
from the hospital entrance going towards the town centre – but ring me if
you want more directions.


I have ordered a few things to arrive on Monday afternoon – when David and
SEEDS are there (and maybe us from the 3-day programme for an hour or so):

·         3 jumbo bags of sharp sand

·         4 jumbo bags of 20mm gravel

·         7 x 250ml boiled linseed oil

·         50 square metres of damp-proof membrane (which I bought separately
and have left at the site)


I have mentioned it to the staff at the nursery – Paul is away this week –
and I’m not sure how close the delivery lorry will get it to our own site.

Which could mean a lot of work with wheelbarrows, if we don’t get it dumped
just where we want.


As for costs, I did some calculations when I was at Wickes:

• We have spent £330 so far on the floor. We still need to get clay,
  manure (and straw as well if it’s cow poo), and ox blood or cement
  colouring.  BUT – if we use lots of the soil that is already there, we will
  be able to keep the some of the gravel and sand for other uses (like the
  adjacent water feature we have planned with the group). See below - where I
  explain the soil analysis we need to do.
  
• If we did it with (cut price) decking from Wickes, it would be
  £499 for the planks (would also need supporting structures) – and it
  wouldn’t be easily transportable anywhere else at a future date.
  
• If we did it with standard floorboard planks to make a ‘tradtional
  yurt floor’, it would be £858 for the planks (though several 2”x2” struts
  would also be needed) – but it would be usable in the future if we need to
  or decide to move the yurt.
  
• We could do it cheaper than earthen floor, for example with
  flagsones, but they are not an eco-friendly building material. Also, if we
  manage to use local soil (see next paragraph), we will have lots of sand and
  shingle left to do other things with.
  

It’s probably worth putting that lot on the record – for EcoMinds as much as
anything – to demonstrate that we are always considering the most economic
and ‘green’ ways to use the resources.


Here’s the soil analysis considerations:

The Slough soil seems pretty heavy and clay-ey to me (though I’m no expert).
SO – we can use the local soil itself for the floor, as long as we end up
with roughly the proportions in the diagram above. What I am doing at the
moment is analysing it for what percentages of clay/silt/sand it is –
following instructions I found on a website. When we know that we can work
out how much of it we can use. If we are lucky (and I think we might be,
because I think it has lots of clay in it) we will not even need to buy any
clay, because we will be able to get all we need from the local soil. But I
should know that tomorrow, when the samples on the kitchen windowsill have
settled...


So next Saturday, we will aim to do this:

1.       Stamp the ground down

2.       Cover the bottom with gravel

3.       Cover that with sand

4.       Lay the damp-proof membrane

5.       Lay sand on top of it

6.       Lay a thick layer of cob (with lower % of clay) and leave it to dry


Then, maybe the following week, we need to:

7.       Lay one or two more layers of cob (to the recipe above) – final one less than 1” thick

8.       First application of linseed oil (once dry)


Then, probably after the yurt itself is up:

9.       Second, third and final applications of linseed oil


SO... PLEASE let me know if you can come along next Saturday.

And some of you may well know lots more about these things than I do – so
please tell me if any of this could be done better!


Rex


PS

I have been reading about geese – and the more I need, the more I think they
would be a better investment, both for AAI therapy and security, than
insurance! One Essex second hand car dealer had a regular break-ins until he
got a small flock. And none since!

They need about an eigth of an acre of grazing land each, and are best
introduced as goslings – with 2 geese and one gander. And they imprint more
than any other poultry – so who ever is there during their first few days,
are seen as parents for ever (and they usually live 20 – 25 years). Lots of
transference issues to talk about in the groups then!

Rex

When is that Yurt arriving?

Hello all
Looks like ETA = 2 November then (see below)
Rex

- Show quoted text -

-----Original Message-----
From: Rob Matthews [mailto:R...@YurtWorkshop.com]
Sent: 18 October 2010 10:08
To: Haigh Rex (Berkshire Healthcare NHS Foundation Trust)
Subject: RE: invoice


Dear Rex,
We are pitching it tomorrow and a week later it will be ready for packing.
Then we will have it picked up and takes about a week to get to the UK.
The second payment is due this week, details to follow.
Many thx.

Regards,
Rob Matthews
Yurt Workshop
made with passion and commitment

www.YurtWorkshop.com
r...@YurtWorkshop.com
skype: drtwiggy
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Two Green Men

HRH The Prince of Wales acknowledges work of UK’s care farmers

His Royal Highness the Prince of Wales recently welcomed more than 100 care farmers and their supporters to Highgrove for a lunch reception marking the National Care Farming Initiative’s five-year anniversary.   This included Dr Rex Haigh, a Berkshire psychiatrist who is Chair of a social enterprise called Exclusion Link.   The aim of Exclusion Link is to work with people who have personality problems, and their carers, by establishing a ‘sense of belonging’ through a therapeutic connection with nature.

The NCFI was set up in 2005, inspired by a conference at Harper Adams University College that revealed the potential social and economic benefits to be gained from projects that allow people with physical and mental health problems to participate in normal farming activities.   Exclusion Link uses a farm near Pangbourne to work with people in farm or bushcraft settings.    They are also starting therapeutic horticulture in Slough, in cooperation with the Borough Council, with a long term vision of establishing a city farm - for both the local community, and for mental health treatment.

Gordon Gatward, Chief Executive of the Arthur Rank Centre and Chairman of the National Care Farming Initiative, said: “It hardly seems possible that it’s been only five years since we held the first national care farming conference when NCFI was born.  So much has happened since then. From being largely unheard of, care farming is now widely recognised across the UK as a valuable tool in the delivery of a wide range of social, health, educational and therapeutic benefits. I believe that the future of care farming in this country is exciting and challenging and that the implications in terms of helping thousands of people who can benefit from it are tremendous.”

Debbie Wilcox, National Coordinator for the NCFI, said: “The reception was a wonderful opportunity for all the hard work that care farmers do around the country to be recognised and appreciated. Acknowledgement by HRH the Prince of Wales of the inspiring work that is undertaken on care farms and his heartfelt speech to those present was a great boost for the care farmers, as was the opportunity to meet others from around the UK involved in similar work.” The third National Care Farm Conference, organised by NCFI, will take place on September 16, 2010, at Harper Adams University College in Shropshire.

Rex Haigh, from Exclusion Link, said “It was an exciting day, speaking to Prince Charles about how ‘industrialised’ and out-of-touch so much of mental health care is becoming. He clearly has a deep understanding of this work, and at Highgrove I saw how care farms really are taking off, all over the country. This has invigorated me to make our ‘greencare dream’ become a reality in the Thames Valley, as an important part of what people with longstanding emotional problems need”.

Care farming projects involve commercial farms, woodlands and market gardens working with health and social care agencies to provide normal farming activities to improve participants’ physical and mental health and well-being. Farming activities and the connection with nature in the rural environment are proven to improve the quality of life for suffers of mental health issues and depression, work-related stress, learning difficulties or those with a drug or alcohol history. Becoming involved with activities on a working farm can also be very beneficial for rehabilitation and re-education for disaffected and disruptive young people.  Exclusion Link runs activity week-ends for young carers (10-18 years old) in the woods near Pangbourne, as well as supporting local self-help ‘recovery’ groups to run horticultural days and other activities for people with personality problems there.

David Hare, who set up a smallholding experience for people with disabilities, near Winchester, said “I have seen the therapeutic value of people getting their hands dirty, learning from nature & appreciating the outside environment.  I want Exclusion Link to go on developing projects in the outside environment for people with personality problems so that they get a new perspective on life.   Taking a group of people from Slough with mental health problems, along with their families, to visit a farm & experience lambing time was an incredible occasion for the members of our group, and it gave therapists a new perspective”.   One service user said of the farm visit “I didn’t really want to go to the farm when they first mentioned it - but it was such an enjoyable, worthwhile & different time for me and my children, I want to do more greencare”.

Exclusion Link contact: David Hare   david@exclusionlink.co.uk  07868 596115
Photograph © Paul Burns Photography http://www.paulburns.co.uk/

LLE Bologna

Hello colleagues, it’s always useful for me to make some notes on the LLEs I do by myself with the Italians, and there are several things we can learn from it. We should do short notes after each English workshop too, if we were really up to scratch, should we not? I can feel an Ex-link policy coming on! (to add to our collection, eh Steve?)

Same as usual

·         6 community meetings, 5 small groups, cooking in turns, community time, crisis meetings

·         Standard agenda and slightly condensed timetable (now have properly translated bilingual ones)

·         One conductor for each of 3 small groups, I did Dobby

Variation from usual format

·         M>F (13:6)

·         All staff were male (making total gender balance 17:6)

·         All but a few were very group-naive participants

·         Started with didactic seminar (powerpoints etc) from Aldo & I about TC principles and how clinical practice relates to what they will be experiencing in the workshop, based on tales of Winterbourne (and subsequent modifications).

o   This was necessary to get the Italian funding

o   It meant the ‘explanation of programme’ was much quicker in the opening community meeting

·         Chose the 3 groups in advance - because several from each of three workplaces (one drug addictions, one elderly MH, one assessment centre)

·         First community meeting scheduled 3pm (and started on time, unusual for Italy!)

o   Late supper and late finish on first day – but that felt OK over here. May not be appreciated at home – evening community meeting finishes at 2030 on day 1.

·         One word summaries from each therapist after each group

·         Evaluation forms part 1 & 2 fully translated into Italian

·         All community meetings 45 mins long – worked well.

·         Day 2: afternoon community time scheduled as
“1430 Community meeting and Community Time”

o   Was useful to be able to pick up what people wanted to do in the afternoon, with weather, changing mood, etc

Good bits

·         Name game with associated item (I chose spotty dog, Aldo chose guitar, etc). It helped names be remembered

·         Always lively, never a second’s silence (as usual in Italian workshops)

·         Afternoon activity = 6 of us cycling round Bologna, led by one of the participants who is a Bologna anthropology graduate

·         Variation of Zoo called ‘Macedonia fruit’ – with killer ending to leave one winner

·         Action check-in for Sunday morning community meeting: all standing, each person had to say one word and mime how they felt – everybody had to copy it (all at once) before moving on to next person

·         Italian food, all completely self-catered.

·         Saturday dinner – very lively – Roman folk songs belted out by about 3 good singers in the group

·         Included game to write a poem to somebody on the table cloth (related to the words they associated with their name in the name game)

·         No interest in having alcohol (well, maybe ‘mixed’ rather than just ‘good’!)

·         Bedroom doors barred with paper barriers (mixed?)

Bad bits

·         Catholic seminary venue – rather municipal and bleak inside

·         No comfy chairs at all

·         Most people slept 4 to a dorm

·         No tea to drink

·         No treats (including terminal daily G&T)

Trouble

·         Choosing groups in advance felt too controlling

·         All but a few were very group-naive participants

·         Disclosure of abuse in Alessandro’s first small group

·         Two people initially felt ‘we don’t fit’ – one Croatian woman, and a black moslem man. But was very soon worked through – and they were expressing how wrong they were about that by the middle of the workshop. (At least they both spoke fluent Italian – unlike one of the staff!)

·         Two particularly notable participants – a priest in one group who was very distressed,  good resolution by final small group. Although already in his own therapy, has determined to use it more effectively.

·         Other was a man who got very angry when his questions were not directly answered in community meetings. Sensitively confronted about his ‘brittle false self’ over several groups. Apologised, generously and warmly,  in final community meeting.

·         Several crisis meetings – 1, to choose who cooks when (they went into 1^st sg without deciding); 2- to arrange support for the member of Alessandro’s group who was in crisis; 3 – (got cancelled before properly called) Alessandro woke at 1am to go to bathroom and challenged group about the joke banner on his door. Those responsible felt very guilty and started to call a crisis meeting (but, thankfully, called it off before they got me out of bed); 4 – to prolong Sunday am cm while two members were shouting at each other (it made matters worse, so I suggested we stop before sgs were due to start).

Tricks to pick up

·         One word summaries worth doing and recording each time (see below)

·         Name game with association worked well

·         Live spreadsheet of names / age / sex / work / group / training level to help suss out the groups when discussing them

·         Also photos to identify who’s in each group (as above), useful to look at in staff discussions – and getting to know names

·         Some of the games

·         Maybe have pre-lunch seminar?

Minor plans with Aldo

·         One day LLE at big community psychiatry conference in Palermo in October

·         Bilingual workshop in Verona in December – one group in English (I will facilitate), possibly for Slough / Aylesbury / MK staff (who didn’t get the Sicilian experience!)

·         Others as they come up – usually 1-2pa – but unlikely to be funded with more than air fare unless we get an EU programme grant

Major plans with Aldo

·         Manual for integrative sociotherapy. Online? Book?

·         EU-funded training programme – UK + Italy + Greece or NL

o   3 self-catering weeks (probably one per term across a year)

§  Module 1 = history and values

§  Module 2 = psychotherapy & theory

§  Module 3 = putting it into practice

o   With mixture of experiential and theory – core staff team stay all week with visiting lecturers (who hopefully eat, maybe stay overnight and have some downtime with participants)

o   To interdigitate with KUF (modules may stand in for the L5 40 credit ‘Responding Effectively’ module which has 2 LLEs anyway, and poss substitute for one of the L7 20 credit MSc modules, perhaps ‘Developing and Extending Therapeutic Practive’ module)

·         To interdigitate with van Der Straten’s ‘Trempoline’ ECETT project (I have details) – it’s called ‘training by travel’ – and is brill for experience, but has no theory. He’s currently applying for his 2^nd Leonardo grant

One word group summaries	Aldo	Alberto	Alessandro
	[kitchen groups in brackets]
group 1	Storytelling	Active	Intense
group 2	[cooperative]	Surprise	Flooding
group 3	Cold feet	[multi-ethnic]	Hard
group 4	Invaded	Tenderness	[Fun]
group 5	Warm	Doubts	Open space

Alphabetti spaghetti therapies

Sometimes I have interesting email conversations with colleagues, which I edit and put on this blog when they might help to illuminate some corner of the PD /TC /Greencare world.

Here is one that I found on my HDD today, over four years later, but which still seems relevant today. It is part of a wider conversation from the TC Open Forum, between myself, Aldo Lombardo (a TC psychiatrist and director in Rome) and an ex-service user.

20 June 2008

Dear Rex, I was in Milan for a 2 days workshop with Marsha Linehan 2 days ago. She told us about her Dialectic approach to BPD. Although she is a cognitive behaviour therapist she maintains that if you drop the cognitive part  the treatment and work only on behaviour therapy, it is effective anyway. She seems to be very skilled and passionate and caring - and keen on research to provide good EBM results. 

Marsha Linehan, originator of DBT,
'comes out' in the New York Times

She demonstrated that DBT is more effective than any other traditional treatment and prevents drop out with more success. She also insist that DBT works as long as there is a group of interacting patients and a team and explained to us the importance of moving dialectically from  acceptance  to change. I liked a lot what she had to say and how she  passionately said it. She also claims to be mandatory for a single therapist to be the key  or main worker available on the phone 24h a day to discuss any problem and support a patient through any eventual crisis and gave us vignette and suggestions to deal with a call effectively. 

Anthony Bateman, who with
Peter Fonagy, has developed
Mentalisation Based Therapy (MBT)

When I asked her if the role of the person of the therapist could be taken up by a whole group of peers she liked the idea but said that no research data are available on this to her knowledge. I mentioned day TC approach and she immediately asked me to produce the manual of the approach! She only knows of Fonagy and Bateman’s Mentalisation approach which she considers  very good,  as in a way it applies DBT principles. 

As the discussion went on she asked me to produce research evidence of TC approach effectiveness to BPD. And this is the reason why I ask you, and the list, the best striking evidence of the effectiveness of TC approach to BPD to give to her as food for more thoughts. I only remember Dolan, 1996, on cost offset after average 211 days treatment and Janine Lees et al meta analysis of over 8000 papers on TC effectiveness.

I would appreciate if you or some of this list members would help me  quote papers  to her so that she knows there are other effective ways of helping BPD.... who knows. maybe, as she seems to be a very practical person, she could modify and improve a method she acknowledges can be improved,  particularly as she is fully aware  that there is no single standard treatment for this disorder yet.

By the way, at the beginning she wanted to try her approach on every case of attempted suicide admitted to A&E dept in Washington and she  has produced a lot of research work on DBT effectiveness.... a great stimulus for us all. In my mind DBT can be very well integrated in TC approach and what I saw in Acorn ward witnesses this to the full.

Kind regards.

Aldo Lombardo

28 June 2008

Dear Aldo

Yes – of course DBT and MBT are good things, but I do worry about the way they are packaged, branded and marketed.

To me, the ‘essential therapeutic elements’ are much more subtle and nameless than the things that get written in a manual. The UK NICE guideline for borderline PD (which is out for consultation until 4 Aug) actually does rather well at capturing some of it (like long-term treatment, well organised, paying attention to attachment and endings, with a coherent theory background)  but it is paradoxically perhaps BECAUSE of a lack of RCT evidence that it has come out like this. Unless things change, when the next version comes out in approx 2012 it will be able to give much a more directive guide about which ‘brands’ of therapy ‘work’ – and something will be lost when the non-specific therapeutic elements become secondary.

Another perversion of therapeutic intent, in my book, is how manuals and the intellectual property business objectify and reify therapies into buyable and sellable commodities – which feeds the greedy competitiveness and selfish commercialisation of mental health that I still want to argue against (maybe not many of us left now!). These ideas should belong to us all – and all those who seek our services: not those who play the RCT and academic game best (of which Marsha and Anthony are clearly the world champions). And I hope that TC ideas do (belong to us all) – because they don’t belong to any one person, are fundamentally value-based and about being ordinary and human, and by some accounts go back for many centuries.

But that is not to say I have anything against DBT or MBT – I don’t – I would just be really worried that if we encourage a Darwinian approach to therapies, the current harsh climate will reduce the biodiversity (psychodiversity?) in a way that we will regret...

The way TCs would do best is to embrace all these things (as, in a way, they already have on the quiet) – and stop trying to maintain that any one theory is more ‘fundamental’ than any other. And act with integrity about subjecting themselves to RCT evaluation (by getting involved with the discussions rather than behaving with a lofty superiority), and with humility about everything that we don’t know how to do best.

End of soap box rant

Rex

30 June 2008

Dear Aldo,

I attended a training day last week on DBT based on Marsha Linehan's approach, mainly through curiosity as I'd heard it was the treatement for BPD.  As a past member of a TC, and a current community psychiatric nurse, I wanted to know what was so unique about this treatment that so many professionals saw it this way. 

I attended with a psychiatrist trained in CBT, and a Systemic Family therapist - so we all had different backgrounds.  As it is closely aligned with CBT, I expected my medical colleague to see the worth in it.  I have to say that my family therapist colleague and I both felt this approach alone was too behavioural and simplistic for long-lasting effects to be had which could not be gained from any other approach. 

Perhaps my views are simplistic, but I feel that the main gain from having therapy within a TC is the effect of the group itself - more than the collective members, it has a power of its own to contain, affirm, nurture, challenge and educate.  It allows for members to re-learn how to be, in a more healthy way. 

I agree with Rex that there are many more elements that don't have names which are so important in helping those diagnosed with BDP to move away from being 'sick' and learning to love themselves enough to want to lbecome healthily attached to the 'others' in their world. 

If there was one definitive way of managing and healing BPD, it would have been discovered and marketed by now, I would think!!

BPD has been with us always, if we look at the Bible and Shakespeare for example, so I reckon we need to use every possible tool we can. Including ourselves, and our groups, to find a way to help those who have been categorised in this way to be seen as human beings not disorders. I wish there was an easy way to record evidence of TC type treatments - then those in power might not keep closing establishments like the Henderson.  We need all the help we can get!

Sorry - I'm ranting now!!

Best wishes to you all,

Kathy