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Slough: towards a TC town

For Community of Communities 17 May 2016
by

rex haigh

on 9 March 2017

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Transcript of Slough: towards a TC town

The MICRO-THERAPEUTIC COMMUNITY:
NHS group therapy as an alternative to hospital admission.

Berkshire's ASSiST Programme:
The First Two Years
Natasha Berthollier, Psychologists and Team Leader
Geoff Dennis, Head of Adult Mental Health Services
Rex Haigh, Consultant Medical Psychotherapist
The new NHS therapeutic communities in the Thames Valley
2004-2011
Population =
140,000 + 20,000;
Deprivation = 93

52% ethnic groups
Immigration and UK border control
>100 Languages
Unemployment
Co-morbidity
Dual diagnosis
"Next Generation Care" - 2012
service reorganisation across Berkshire
closure of acute inpatient beds
alternative to admission funding made available
conflicting views and solutions!
the winner....
The EMBRACE group - a 'micro TC'
Intention =



1) To set up a 'safe environment' group for people with longstanding and severe non-psychotic conditions who have not been much helped by 'mainstream mental health services' - but remain quite functionally impaired or 'ill'.


2) To use therapeutic community principles as primary therapy for some people in the group, in a 'lower dose' than has been tried before.
3) To coordinate various the group with various other parts of the 'therapy pathway', so the whole experience is of 'TC' - a coordinated array of different groups - although this particular one only lasts two and a half hours.
4) To see the group as much as education ('emotional intelligence' ) as health - and see progress and leaving as 'graduation'.
5) To start seeing the whole area's provision as a 'healing town' - particularly with the development of 'Hope College' - with coordination as a recovery college of what was previously a disconnected range of different health, social services and educational provision...
4 phase pathway
18 month intensive treatment phase
3 days per week
community meeting AM and PM + formal therapy groups + eating together + social activities + 'community time' + special events
Maximum responsibility to members
Medication to zero or minimum
Support system






Community Mental Health Services
joint health + local authority
staff >100
psychiatry + psychology + psychotherapy + community nursing + social work + occupational therapy + recovery support work
range of different services
including acute inpatient beds
So ASSiST is born - 2013
"Assertive Intervention and Stabilisation Team"
£225,000
Operational programme
Implementation strategy
Recruitment:
1) Therapeutic Communities: New Forms and Functions

2) The birth of a new programme: ASSIST

3) Findings from the ASSIST programme

4) The 'micro-TC': the EMBRACE programme

5) The future: Hope College and Healing Towns
Therapeutic Communities




Team Leader - Psychologist
Two Community Psychiatric Nurses
Assistant Psychologist
Team Administrator
Part-time psychologist (1 day pw)
Consultant Medical Psychotherapist (1 day pw)
BUT - times changed - 2008 etc -
and Slough needed something different

However, it turned out to be an opportunity...
Characteristics of Thames Valley Day TCs
1300s - Geel
1790s - Retreat
1890s - Boys' Republic and Little Commonwealth
1940s - WW2 experiments
1950s - Henderson
1960s - 'Social Psychiatry'
1970s - Extensive spread - across sectors
1980s - The Age of Individualism
1990s - Decline and closure
2000s - A few survivors + NPD (next up)
2010s - New directions for TC ideas (like Slough!)
New directions
Extracting the essence:
RCPsych -
'Community of Communities'
and
'Enabling Environments'
Who are you all?

which countries have you come from?
do you know about Therapeutic Communities?
from mental health services or private practice?
which professions?

...we are looking forward to having dialogue
with you and hearing what you are doing!
So - where is it all leading?
SLOUGH
Co-
creation
- the HEALING COMMUNITY
"Hope College"
Connections across the town
Synergy at high level
Strategic partnerships
- client group, health, local authority, third sector
...AND BEYOND
Sicily, Sopo and Bengaluru
Therapeutic Community in the Community - or in the Head?
Micro-TC or Mega-TC?
Dissolving traditional boundaries
or no TC?
The
Growing Better Lives
Project:

Rex Haigh, Vanessa Jones, Fiona Lomas
Directors, Growing Better Lives CIC


Why GREENCARE matters for your Mental Health

Why does mental health need greencare?

- Disaffection with increasing technical and regulatory aspects of clinical practice - losing sight of the person

- Sense that we have lost touch with each other and the natural world in 'industrialised' health care, especially relevant in mental health

- Antidote to institutionalisation

- Less based in individual acquistive life style (with health as a commodity), and more in
inter
dependence and valuing relationships

- Congruent with - but different to - 'recovery approach'

- Can incorporate religious or non-religious spirituality
- in other words, very similar to the impetus that set up Moral Treatment at the Retreat in the 1790s, in a contemporary setting
The 'Yurtification' of mental health
Royal College of Psychiatrists
National Sustainability Award 2014
Triple Bottom Line
- Social (people)
- Ecological (planet)
- Economic (profit)
Sustainability requirements:

- Also fundamental: we work in an environment centre
- Organic allotment / composting / PV roof panels
- Minimal energy use in our yurt
- Public transport & shared lifts; Skype etc
- Off-grid and low impact (cob) buildings: next stage!


Ecological sustainability
- Is the core of what we do in PD (helping people with unsustainable lives)
- Based on the group analytic concepts
- emotionally safe space and belongingness there
- the network of relationships does (most of) the work
- Adaptogenic = better mental equilibrium rather than 'cure'
- Healthier relationships with:
- our planet, our countries & cultures, each other, our patients, ourselves
- At the core of ENABLING ENVIRONMENTS
Social sustainability
- All done in groups (treat several people at once)
- Much self-help (and often better at it)
- The groups make the environment themselves
- And usable, edible or saleable goods are produced
- The project attracts volunteers (eg assistant psychologists and associate psychotherapists)

Economic sustainability
Fair shares?
- our therapeutic community methodology includes 'democratisation' aka 'flattened hierarchy'
A serious treatment in its own right - not just an add-on

- THERAPEUTIC COMMUNITIES
- everything is part of the therapy

- For people with very chaotic lives - across agencies
- High risk - long-term care coordination etc
- Definitive therapy - NOT an adjunct to TAU

- Pre-therapy / TC / post-therapy
- Impossible to NOT do therapy in this setting

Source: NHS Centre for Sustainable Healthcare
2012: hospital closure

All inpatient services moved to Reading
Slough was not happy!

...money offered to do something about it
with formal bidding process etc
What is greencare's theoretical and evidence base?

- Biophilia Hypothesis
- EU Conceptual Framework
- originally Fromm (a Frankfurt School post-Freudian):
"the connection that human beings subconsciously seek with the rest of life"

- in evolutionary psychology as
The Biophilia Hypothesis
by Kellert & Wilson (1993)

- 'Nature Deficit Disorder': Richard Louv (2005)
Last Child in the Woods
- Sempik J, Hine R, Wilcox D (2010)
Greencare: a conceptual framework. A report on the Working Group on the Health Benefits.
EU COST Action 866. EU COST Office, Brussels
More recently
Ecominds project evaluation:
- benefits to mental well being AND
- economic benefits!
A major review last week from Natural England
towards a therapeutic community town
Slough:
Wider movements

sustainability - permaculture - transition towns
psychosocial studies
psychogeography
orthopedagogy??
...at the forefront of
modern mental health


Biopsychosocial Slough
The linguistics
of power dynamics
Street Slough...
Various faiths...
Hindu Slough
Moslem Slough
(currently used by ASSiST and Embrace groups)
Quaker Meeting House, Slough
Tranquil Slough: Herschel Park
A famous
detractor
of the town...
John
Betjeman
And a famous man from Reading...
How
The Economist
sees it
some theoretical bases of the current clinical work
Resilience and Sustainability
Belongingness
and
Relationship
Agency and empowerment
Neurobiological basic science
Group dynamics and
general systems
Futuristic Slough
Polish Slough
From the big picture
to Slough itself...
Our journey so far.....
Sustainable Slough
Resilient Slough
NHS and LA service
development in times
of austerity, using
principles of
relational health

'Hope Recovery College'
using 'co-creation' with
therapeutic community ideas

Growth of 'greencare'
and sustainability
in the third sector

All in an up and coming town with ambitious development plans

Cross-sector collaboration
Track record of innovation and awards
Clear vision of progressive services
For all areas of MH
Practical opportunities
With energy, enthusiasm and passion!
Thriving business sector as possible partners
Full transcript