HEALTH (NVMH) AN ECOLOGICAL PARADIGM Presented by Ray van der - - PowerPoint PPT Presentation

NEW VISION FOR MENTAL HEALTH (NVMH)

AN ECOLOGICAL PARADIGM

Presented by Ray van der Poel, Head of Business and Development CPCAB Richard Oldfield, Curator and Editor for the NVMH project

www.newvisionformentalhealth.com

NEW AND INTERESTING THINGS ARE HAPPENING IN MENTAL HEALTHCARE – FIND OUT ABOUT THEM HERE AND HELP SHAPE A NEW VISION FOR MENTAL HEALTH

What would mental healthcare look like if, knowing what we know today, it could be redesigned from scratch?

THE NEW VISION FOR MENTAL HEALTH (NVMH) AIMS TO

• 1. Provide an international and interdisciplinary platform where practitioners,

trainees, experts-by-experience and others can explore the emerging range

• f new ideas and approaches
• The NVMH website curates these ideas via a growing compendium of posts together with

providing opportunities to comment and contribute

• 2. Weave these various ideas and approaches into a New Vision for Mental

Health

• The NVMH website sets out a coherent, collaborative and evolving vision
• 3. Develop resources, policy recommendations and practice guidelines that

support the shift from a biomedical paradigm centred on the treatment of symptoms to a complexity-based, ecological paradigm centred on the person-in-connection

• The NVMH project will begin collating and developing resources, policy recommendations and

practice guidelines

WHY NOW

Our mental health and social care systems simply aren’t working properly Example NVMH post:

• Hilary Cottam – an internationally acclaimed British

social entrepreneur who founded Participle (www.participle.net) to design working exemplars of a new welfare state – suggests in her TED Talk: Social Services are Broken: How Can We Fix Them?

HILARY COTTAM’S TED TALK: SOCIAL SERVICES ARE BROKEN: HOW CAN WE FIX THEM

PERSONAL REFLECTION ON PERSON CENTRED HEALTHCARE

WHY NOW

The current biomedical paradigm is well past its sell-by date Example NVMH posts:

• Rani Anjum and Stephen Mumford question A philosophical

argument against evidence‐based policy Journal of Evaluation in Clinical Practice , 2016.

• Andrew Miles and Jonathan Elliott Asbridge Clarifying the

concepts, epistemology and lexicon of person-centeredness: an essential pre-requisite for the effective operationalization of PCH within modern healthcare systems Journal, European Journal for Person Centered Healthcare, 2014

PERSONAL REFLECTION ON PERSON CENTRED HEALTHCARE

WHY NOW

A new complexity-based, ecological paradigm is here… but it needs weaving together and implementing Example NVMH posts:

• The Value of Systems and Complexity Sciences for Healthcare,

edited by Joachim Sturmberg

“This forces the modern physician to go back to the bedside, listen and examine the patient, and construct a thoughtful approach to care with the individual at the centre of management, rather than guidelines or diseases.” S. Lee Hong & Simeon J. Hain

• Cultivating our humanity: A systematic review of care farming &

traumatic grief, by Richard Gorman and Joanne Cacciatore

• Power Threat Meaning framework Lucy Johnstone and Mary Boyle

et al., 2018 identifying patterns in emotional distress without diagnosis.

OUR VISION

In developing our new vision for mental health we identified five major themes:

• Emotion-focused care – ensuring services are emotionally safe and

supportive by focusing on developing genuinely caring relationships

• Collaborative practice - working collaboratively to contextualise practice

with each person

• A coherent system – designing a service system that serves people-in-need,

rather than itself and moves beyond the biomedical model

• A wellbeing society – developing a society that recognises the wider factors

that impact on mental health and takes meaningful account of these across all government policies

• A balanced budget - a budget more fairly divided between biophysical and

mental & emotional healthcare

AN EVOLVING VISION

These five themes fit within an evolving new ecological paradigm i.e. one focused on inter-relationships. These inter-relationships are wider in scope compared to purely biophysical or psychosocial models. Example NVMH post:

• Contextualising science in the aftermath of the evidence-based medicine era:

On the need for person-centred healthcare, by Andrew Miles and Jonathan Elliott Asbridge, 2013

“Rather , the patient is a person with dimensions which extend well beyond the purely physical and which include the psychological, emotional, existential/spiritual and social components of human existence which add layer upon layer upon layer of complexity to the biology of the patient and which collectively, not separately, constitute the magnificence, even mystery, of the being and relating of the individual human person.”

ECOLOGICAL PARADIGM OF MENTAL HEALTHCARE SOME KEY FEATURES

• Each person is connected within a complex web of

relationships in the context of their family, community, culture etc.

• Holistic - in which the brain is viewed, not as an

isolated organ, but within the context of the whole person

• Shift from the treatment of symptoms towards the

practitioner working with complex causality

• Diversity as a basic principle - which translates to a

pluralistic approach to mental healthcare

• Importance of a healthy environment, defined in its

widest sense

THREE LAYERS AND FIVE THEMES

Three concentric layers differentiate three broad categories of factors that contribute to or detract from mental health (i.e. causality), with each person- in-connection containing additional contributing factors relating to their own internal, social/relational and developmental dimensions. Importantly, the ecological mental healthcare paradigm shifts the focus towards understanding and working with complex causality.

Layer 1: Practice (e.g. Therapist and client)

• Theme: emotion-focused care
• Theme: collaborative practice

Layer 2: Community (e.g. Primary mental healthcare system at local level)

• Theme: A coherent system

Layer 3: Society (e.g. National government policies)

• Theme: A wellbeing society
• Theme: A balanced budget

Person- in-connection

LAYER 1 - PRACTICE

Theme: Emotion-Focused Care The rational-technical approach has brought enormous scientific development … and so it’s been assumed that mental health problems can also be solved in this way… however:

• Within mental health problems the core experiences

are emotional: people have feelings not disorders

• For services to be emotionally safe and supportive

they need to focus on developing and maintaining genuinely caring relationships

LAYER 1 - PRACTICE

Theme: Emotion-Focused Care Example NVMH post:

• Power Threat Meaning framework Lucy Johnstone and Mary Boyle et al.,

2018 which identifies patterns in emotional distress without diagnosis. Rather than asking “what is wrong with you?” the practitioner asks:

• What has happened to you? Translated as “how is power operating in your life?”
• How did it affect you? Translated as “what kinds of threats does this pose?”
• What sense did you make of it? Translated as “what is the meaning of these situations and

experiences to you?”

• What did you have to do to survive? Translated as “what kinds of threat response are you

using?”

LAYER 1 - PRACTICE

Theme: Collaborative Practice Only the person knows their unique life context, which means practice needs to be:

• Person-centred and collaborative rather than practitioner or treatment-driven
• Contextualised for each person, rather than one-size-fits-many

Example NVMH posts:

• A new therapy for each patient: evidence‐based relationships and

responsiveness, by John C. Norcross and Bruce E. Wampold in the Journal of Clinical Psychology, October 2018 - this recently published paper summarises a meta-analysis by the American Psychological Association 3rd Task Force on evidence-based therapy relationships

• The CPCAB practice model represents a trans-theoretical model of working with

complex causality centred on the person-in-connection

Internal Relational Developmental

7 Practice Processes (CPCAB) - working with complex causality:

1: Working ethically and professionally 2: Working with the relationship 3: Working with difference and diversity 4: Working with a primary focus on the client 5: Working with self-awareness 6: Working in a coherent framework of skills and theory 7: Working reflectively

Layers Practice Community Society Person- in-connection

EXAMPLE: the CPCAB practice model integrated within an ecological paradigm

LAYER 2 - COMMUNITY

Theme: Coherent System UK mental health system is incoherently organised:

• GP training based mostly on the medical model within a treatment paradigm.
• GPs as the main primary-care gatekeepers to mental health services which,

given the largely non-medical nature of mental health problems, often leads to inappropriate referrals/diagnosis/treatment. Example NVMH post:

• A Very General Practice, Citizens Advice Bureau (2015), found that:

“GPs in England report spending almost a fifth (19 per cent) of their time on social issues that are not principally about health. The implied cost to the health service of this time is almost £400 million a year.”

LAYER 2 - COMMUNITY

Theme: Coherent System This may point to the need for a new type of mental health professional who might:

• Work in tandem with GPs, seeing the large percentage of people who are

thought to have non-biophysical problems.

• Largely take over the current role of GPs as primary care gate-keepers to

mental health services, therefore holding a budget with the ability to issue non-medical and social prescriptions (referral) e.g. care farm, counsellor, exercise coach, local authority housing officer, cold-water swimming club, forest-walks group etc.

LAYER 2 - COMMUNITY

Theme: Coherent System Example NVMH post:

• Health Connections Mendip: “… a new and

exciting service which provides peer support, social prescribing, one-to-one and group support to enable people living in Mendip to improve personal and community resilience…This support is in addition or instead of the support they have traditionally received from their GP practice and

• ther healthcare services.”

Health Connections Mendip Annual Report 2016.

LAYER 3 - SOCIETY

Theme: A Wellbeing Society A wellbeing society would aim to maximise mental health via wellbeing policies in education, economy, environment etc. Example NVMH post:

• Mary O’Hagan’s Wellbeing Manifesto, prepared for New

Zealand government

• The New Psychology of Health: Unlocking the Social Cure, by

Catherine Haslam, Jolanda Jetten et al., 2018

LAYER 3 - SOCIETY

Theme: A Wellbeing Society Example NVMH post:

• The endless striving for GDP growth has become the surrogate for

societal ‘wellbeing’. International Forum for Wellbeing: beyond GDP what comes next?

• Madness, Mystery & the Survival of God by Isabel Clarke. Spiritual

emergence or psychosis? Concerning the Interacting Cognitive Subsystems model & overlap between transliminal & psychosis.

• Bad education, an opinion piece by Richard Oldfield pointing to

how we should focus on children and young people to break the generational cycle of mental ill-health.

LAYER 3 - SOCIETY

Theme: A balanced budget The National health service (NHS) in England spends roughly seven times more

• n biophysical healthcare compared to mental healthcare. Many biophysical

illnesses are linked to lifestyle issues that can best be prevented or alleviated through psychosocial means. Example NVMH post:

• Government-commissioned report in 2017 Thriving at Work. Puts the Annual

cost to UK economy of poor mental health: £74bn - £99bn, incl. £33bn - £42bn cost to employers. And, up to 300,000 people with long-term mental health problems have to leave their jobs each year.

CURRENT STATS AND NAVIGATION FOR NVMH WEBSITE

• Launched Sept. 20th of last year.
• 280+ items of news/information/opinion/ideas (plus event-listings)
• 4 new items added every week
• More than 40,000 views so far

Five themes Eight broad subject areas Emotion focused care Clients & Patients Collaborative Practice Research A Coherent System Wellbeing A wellbeing Society Talking Therapies A Balanced Budget Psychiatry Culture & Society New Approaches Education Five most viewed posts

• 1. How Autism Freed Me to be Myself
• 2. Bad Education
• 3. The Rosenhan experiment
• 4. Take Your Pills (Netflix documentary)
• 5. How to Find Other People Coming Off

Psychiatric Drugs: Introducing TWP Connect

TASKS FOR NEW VISION FOR MENTAL HEALTH PROJECT

• Gather feedback about:
• Website (including welcoming suggestions for additional content).
• Proposed ecological paradigm, with a view to its further evolution.
• Wider possible project and what might/should come next.
• Update the vision section of website (to reflect this presentation).
• Add a resources section to website.
• Contribute to potential future steps, including development of practice

guidelines and policy recommendations. Richard Oldfield Curator and Editor richard@newvisionformentalhealth.com www.newvisionformentalhealth.com

SPONSORS

Counselling and Psychotherapy Central Awarding Body (CPCAB), the only awarding body in Europe to specialise in the field of counselling and psychotherapy and the largest awarding body in the UK in this field. The Counselling Channel, producers of videos about self-help, wellbeing, counselling, psychotherapy and a range of other talking therapies. Anthony Crouch CEO CPCAB anthony.crouch@cpcab.co.uk www.newvisionformentalhealth.com