A very modern sort of party

A colleague called Merryn called me a couple of years ago. She is a TC-friendly psychotherapist with a social work background, working in the hottest spot of British psychiatry - London SE5 - where there be dragons, living in the dungeons of the Maudsley Hospital, the Institute of Psychiatry and Kings College.

A quiet and leafy SE5 street

But there is a heavenly and leafy street nearby called Windsor Walk, and behind the shiny black door of number 10 there is a magical place where the dragons are slain, thinking is possible and there are no happy fluffy CBT bunnies (see previous).

Merryn - with a team of several experts - has produced and delivered a mental health podcast called 'Making Sense of the Madness', which was a formidable task, as she and her partner-in-crime Rob Thorman described at the party. That call - in the days of covid - was asking me to be one of the people waffling on about mental health (though a lot less waffling after the editing, I expect)

So their excellent podcast was launched tonight, in this leafy home of thoughtful mental health - a very modern type of event, the like of which I have never been to before. A bit like a book launch, but much more on-trend - you can listen to it in the car. 

But it was a lovely do.

Rob and Merryn at the launch

I will let it speak for itself...

Making Sense of the Madness is an 8 episode audio series that explores what’s going on and what’s going wrong with the provision of mental health treatment in the UK today.

Hosted by professional psychotherapist Merryn Jones and her therapy-curious son-in-law Rob Thorman, the series takes a holistic look at what we mean by mental health and how it’s treated.  As they interview a range of leading experts, academics and professional practitioners, join Merryn and Rob on a journey that takes their listeners from hospitals to prisons to universities and everyday life.

Ultimately, MSOTM argues that the current proliferation of more manualised, short-term treatments such as CBT, often neglects the role that wider societal factors play in contributing to poor mental health. This reductionist one-size-fits-all approach is leading to longer-term, psychotherapeutic, relational treatments being cut within our NHS. As a result, we’re not providing the most effective help to some of the people in our society who need it the most.

Episode Guide

Episode 1: The Closure of the Three Boroughs Personality Disorder Service with Merryn Jones

Rob interviews Merryn about the service in the Maudesley hospital that she was clinical lead for, unpacking what the service offered, what we mean by personality disorders, why they are often such a challenge for the NHS to treat and why the service’s closure is indicative of wider patterns across the UK.

Episode 2: The Battle of the Psychs with Rex Haigh and Vanessa Jones

Merryn breaks down for Rob the differences between psychiatry, psychology and psychotherapy. Rex Haigh and Vanessa Jones speak about the evolution of Therapeutic Communities and why it is that they now find themselves under threat.

Episode 3: The Cognitive Behavioural Tsunami with Farad Dalal

Farhad Dalal talks to Rob and Merryn about his highly influential and polemic book on Cognitive Behavioural Therapy (CBT), providing compelling evidence that suggests the treatment is nowhere near as effective as its own statistics and research claims.

Episode 4: The Politics of Managerialism with Dick Blackwell

Dick Blackwell breaks down how the forces of managerialism, neo-liberalism and the triumph of the statistical over recent decades have created the conditions which allow CBT to be over-prescribed within our NHS today.

Episode Guide

Episode 5: Treating People in Crisis with Sophie Jones and Sophie Butler

Psychotherapist Sophie Jones describes her job as an art therapist in a mens’ prison; Sophie Butler explains her role as a liaison psychiatrist in an A&E. Rob and Merryn reflect on the support available for people in crisis and how a person’s environment contributes to their mental wellbeing.  

Episode 6: The Need for Actively Anti-racist Public Health Policy with Professor James Nazroo

Professor James Nazroo talks to Rob and Merryn about his research into how race interacts with mental health within the UK and what can be done to improve mental health outcomes for people of colour and people from minority ethnic backgrounds.

Episode 7: Psychotherapeutic Solutions with Philippa Marx, Sophie Jones, Janine Turkier and Jennifer Clegg

Rob and Merryn take a deep dive into psychotherapy and explore a range of different disciplines within the field, from pyschodrama to art therapy to couples therapy, group therapy and more!

Episode 8: Reflections with Merryn Jones and Rob Thorman

In the final episode of the series, Rob and Merryn reflect on their journey and explore what the world might look like if some of the principles advocated in their podcast were taken up more widely in our society.

 

About the hosts

 

Merryn Jones is a psychotherapist who worked for many decades as a social worker and within the NHS and other public services as a group psychotherapist and clinical lead. She is now semi-retired and has a small private practice. merrynjonestherapy@gmail.com

Rob Thorman is a freelance screenwriter and lecturer at the Met Film School. He is also Merryn’s son-in-law! He is passionate about the healing powers of both stories and therapy. He is represented by Rowena Wallace at Peach House. rchthorman@gmail.com

 

Merryn and Rob would like to thank you so much for coming to support the launch of Making Sense of the Madness.

We hope that you enjoy the podcast… and tell all your friends!

 

You can listen to Making Sense of the Madness by searching for it on Spotify or wherever else you get your podcasts. The eight episodes will be released weekly on Wednesdays from 19^th July.

 

From MANIFESTO to MOVEMENT - for relational practice

If you have been reading this blog before, you will know what this is all all about. As a picture is worth (at least) a thousand words (especially nowadays) - so I'm not going to write much.

After about five years of gestation, the embryonic relational practice movement got its act together and launched the manifesto.

We did it at the Royal College of Psychiatrists, hosted by the closely related 'Enabling Environments' project. Under what felt like a wary and watchful eye - to ensure we did not transgress any college policies or guidlines. Such is the nature of modern charitable organisations' burden of managerialist and corporate requirements.

The gathered masses (full house of 180 expected, but only about 100 there, with train strike threats)

Nick Benefield explains what it is all about

John Alderdice (and then Clare Gerada) give the political angle

The audience are rapt!

Russell Razzaque explains the relation to 'compassionate and relational psychiatry'

David Robinson joins us to their own work and aspirations

A community meeting to set everybody off to action

And then there was the launch of the actual manifesto itself (link - www.relationalmovement.net ) for which we enjoyed a glass of wine or two. It looks like tyhjere are plenty of people - from all sorts of different places - who already understand what this is all about, and want to take it forward.

IF YOU WANT TO BE PART OF THE MOVEMENT -

GO TO THIS WEBSITE AND FILL IN THE VERY SIMPLE FORM. 

You will not be bombarded with unwanted emails!

Why 'compassionte mental health' matters

Arriving at the gate

As recorded here before, the Compassionate Mental Health 'gatherings' are important events that need recognising as part of the groundswell of voices that are arguing for fundamental change in mental health services. This one was in a wonderfully wacky ancestral home - Trevor Hall, near Llangollen in North Wales. Three of us had intended to present TC workshops on both full days - but sadly we were down to two (Anando and myself) and had to get there on lovely long slow trains across the length of Wales. 

But the event, as usual, was extraordinary. A powerfully thoughtful, emotional and relational space for people to come together from utterly different places - but who all wanted to pull in the same direction. 

This included several unforgettable talks and events. An utterly immersive talk and worshoop from Martin Martin Kalungu Banda - with tales of his time as chief of staff to the president of Zambia and as a professor of business studies at Oxford - as well some beautiful sung music from his family. 

Martin describes true communication

Scientific results and promise for 'neuro-feedback' from two pioneers of the field, Sebern Fisher (USA) and Mirjana Askovic (Australia). Helping NHS services to prevent unhelpul practices from Kier and Holly. 

Kier and Holly describe a different way for the NHS

Reflections on surrealism and psychosis from Pat Bracken, one of the world's leading critical psychiatrists. An extraordinary talk about the numinous personal experience of psychosis from a wannabe Swiss nun Andrea Zwicknagi, which was an immersive experience in Christian mysticism. 

Andrea takes us to a different level of experience

Then all the usual things as well - intimate compassion exercises, a powerful experience of community amongst like-minded people, excellent food, shared understanding and passion for change, and a loving relational respect for each other - wherever we were coming from. 

We must have more of this stuff! 

 More parochially, and my own interest in Therapeutic Communities and Relational Practice, I was very interested in Martin's experience of our TC workshop on the first day - almost as an live example of what he was describing in his talk a couple of hours before. 

Work in progres...

Happy Fluffy Bunnyland

After ten years of the relational practice movement: 

• There will be much less violence in prisons, and being a prison officer will be a much more satisfying job. Applications from heavies and thugs who wanted to legitimise their misanthropic world view will dry up. 
• Nurses will be able to us their own initiative to creatively and compassionately care for the people they are looking after 
• Social workers will be able to explore individual and family dynamics, and reduce risk by the quality of relationships they have with children and families. There will be far fewer child protection cases. 
• Residential care homes will all be enabling environments (though not necessarily Enabling Environments) and residential care work will be an attractive and reasonably paid job. 
• Employment and Housing offices won’t need heavy duty screens to protect staff from the public; nor will they need security guards. 
• Nowhere will need ‘zero tolerance of ….’ notices on the wall. 
• General Practice will be an attractive career option for medical graduates; ditto general and CAMHS psychiatry 
• Teachers won’t be frightened of OFSTED and children at school will enjoy a much richer, more artistic and cultural curriculum. SATs will have been replaced by improvement of standards by collaborative learning (and results will improve most where there is more collaboration) 
• Health service managers won’t game the system to get better metrics, but will all spend much of their time in staff sensitivity groups with clinicians, and sometimes service users too. 
• CQC inspections will be exploratory and supportive, with co-produced peer review and an emphasis on improvement rather than judgement. 
• In mental health services, coroners will be seen as helpful people rather than a faceless authority to be utterly feared. 
• Everybody in hospitals will be more worried about loneliness, emotional safety, single use plastics, food waste and UPF than ‘dangerousness’, floridly expressed emotion, ligature points or knives in kitchens. 
• Architects will be experts on relational as well as physical environments in all public service buildings and facilities; nature will always be a primary consideration. 
  
  
• Dixon of Dock Green will be back on telly, everybody will talk to each other at bus stops or on trains, there will be no wars or need for an army, 
• Social media will use AI to exclude anybody being horrid to anybody else, and we will all live in fluffy-bunnyland in good health till we die at 105 and Boris Johnson will be our happy jolly PM again.
  
  
•  Well, maybe not all of those.

Four of them all at once, like the proverbial buses...

1 Tim Makower and Homestead. 

We’re in the middle of Tim’s firm’s participation in LFA (London Festival of Architecture) – which is 3 Wednesday evenings just near Tate Modern. They are all part of the networking and cross-fertilisation needed to get the project - for better designed (fabric, psychosocial and occupational) residential mentl health facilities - under way.
Brigid, Neels and I slightly subverted the first one, last Wednesday, by turning it into into a TC-style democratic community meeting - after the panel of four experts had presented their own contributions. It was very interesting to see how the 'design' of the social space - in a circle rather than rows with pre-defined  boundaries and democratic facilitation, changed the nature, participation and openness of the conversation. The next one is on TCs anyway… 

The overall structure of Homestead is still evolving – but looks like being a collaboration of like-minded organisations overseeing ‘franchised’ projects in different places. Hopefully not like McDonalds, though – and allowed to ‘grow in their own soil’, as good therapeutic communities always should.

 It’s great working with architects rather than health services – I just love the way they think big and scattergun their ideas out there… When we had the 3-day meeting at Tim’s Wiltshire house in April it felt to me like most of the clinical people were rather preoccupied with risk and what’s not possible, while Tim and others were wanting to make a plan for a whole new way of reforming mental health. One of my joys of retiring from clinical work is that I am free to think more like an architect! (But need to be surrounded by some sensible clinicians so I don’t just have a manic meltdown). 

 2, 3 & 4 North American initiativess 

... in the addictions TC tradition – sometimes called ‘Classic’, ‘Addiction’, ‘Hierarchical’ or ‘Behavioural’ TCs, or ‘Concept Houses’ - as opposed the UK’s ‘Democratic’, ‘Maxwell Jones-type’ or ‘Mental Health’ TCs. The things they have in common and how they differ is a question with never-ending answer – but all the Americans and Canadians we’re working with come from the addiction tradition, and quite a hard-line version of it. They also have a never answered question about choosing between harm-reduction and recovery +/- abstinence 

They have come across the democratic model in different ways, but both interestingly involving dear old Steve – the Canadians by having their reding groups go through our TC book, and the Utah people being put onto us by George DeLeon – who is the main addiction TC researcher in USSA (and probably everywhere); Steve Pearce and I both knew George quite well, and he helped Steve get started planning his RCT research in Oxford. 

 But they see some of the addiction TC tradition as perhaps old-fashioned, or maybe just not quite compassionate enough who are more vulnerable or less robust (it’s the original ‘tough love’ I think), so want to learn about the democratic TC tradition and probably end up using elements of both. 

2 Vancouver and British Columbia 

(for BCARA – BC Addiction Recovery Association) The dates and place for the LLEs are set now – 13-18 and 15-20 September at Manning Park, BC. They have read the book (several times I think – they know it better than I do!) and are planning to train staff from 12 pilot projects with the two LLEs. For that, there are 2 from Bangalore (Shama and Anando), one from Portugal which is current president of INDTC (Joao) and two of us coming from UK (Veronica and myself). Maybe one or two others too – I think Joao has a trainee with him. Maybe others too – it is always interesting to have extra people there as researchers/social therapists/general extras. We have a monthly zoom community meeting with them all at the moment. The pilots are mostly in or near Vancouver, but a wide variety of types of places – and the project lead Rob Turnbull is calling them ‘Adapted TCs’., an excellent term. They’re also planning some serious research and evaluation. 

 Map: https://www.google.com/maps/d/u/0/edit?mid=1_YMdE1sYB3FesACwIIxostqkCEkNu44&ll=52.125476640480954%2C-121.22534945000001&z=6 

3 The Other Side Village, Salt Lake City, Utah 

The plan is for a newly built village of tiny houses for 400 people who would otherwise be living rough – through the various entangled factors that lead to homelessness. Once settled in, residents will be expected to work in one its connected social enterprises, pay rent and be abstinent. Addiction isn’t the main problem here, but amongst them: they know that Classic Addiction TC methods are too severe, or just aren’t right, for this vulnerable population. They have been running ‘The Other Side Academy’ for several years now, using that model as a fairly standard USA-type TC – pretty hard core from how they talk about it. What they now want is a DTC-based community programme as a 1-2 year induction to people living in a community of others in the same situation. BTW – they are not a Mormon-based initiative, I wondered, and did ask. 12 of them came over to London in April to see lots of TCs, CofC, Grendon Prison etc – and two of the Slough TC founders (Geoff and Natasha) are going over there lin June. We also do some online training for them. They are very determined to get it all started pretty soon! 

4 Alberta, Canada T

wo retired psychiatrists – who have worked with the Vancouver people before – are also wanting to use some DTC ideas in the next province across. It’s a very different approach, organised province-wide with provincial government support and funding. Alberta is a rich stare with its oil money, so can afford to do it well – a bit worrying maybe, but maybe ok as long as they don’t have oil or petrochemical sponsors? But that one is only in its infancy.

Just some thoughts about some interesting things going on at the moment.

Even if the NHS doesn't think much of DTCs, maybe others do!