Whole system approachesDealing with the institutions in our minds

Mike SmithClinical Director AFG

“…dangerous, don’t listen to a word he says”State hospital manager Denver Co

It’s a global issue !

• Mike Smith Clinical director AFG England• Stop seeing things in our local ways

Different interventions at different phases

• Recovery as a journey (Smith 1997) whole lives/• Beginnings • Destinations• A lot in the middle that’s hard to make sense of.• Makes sense looking back• Use the knowledge of the journey to help others

If recovery is a journey, a process, a direction rather than an event or a label then there has to be a map, a guide, short cuts, beginnings and an overall direction.

Recovery from what? And to what?

• They said that I was mad • And I said it was them who were mad

• Damn the they outvoted me

k

• If you talk to God it called prayer

• If god talks back its schizophrenia!

Normalise the experience

• 1 in 4 people are mentally ill!• Think of your 3 best friends• Are they OK?

• If they are ------- then its you!

What is normal ?

www.crazydiamond.org.uk

0102030405060708090

time

thriving

recovered

stable

succumb/ chronic

FunctioningWellbeing Symptoms

Alternatives and choices

Core Beliefs of citizenship

High Staff Expectations and energies

Potential to Leave completely supportive services--Exits

Rights, Responsibilities and Advocacy

Inclusion

Holistic Approachpersonalisation

Social networks, social support

Ownership -Person accepting &

takingControl of own life,

SelfDetermination

Informed Risk Taking and locus of

control

Interdependence

Citizenship approaches

Expert advice peer and professional

Rapid but limited Health interventions

Maintenance approaches

MAINTENANCEMODEL

Social ControlFrustrated by Risk

Removal from society

reductionist views

Loss of rights

Low Self and Staff Expectation

Service for life no exit pathways

Symptom Management not mastery

Illness Concept

Permanence

From what• Large institutions and imperialist illness and exclusion

systems• Low throughput (they grew slowly) up to 65% did leave

within 1 year, recovery rates (medical) were quite high (higher than present rates) social recovery measures low, stigma high

• Low threshold of evidence for the status quo but the status quo has a tradition, power and a legacy that is still evident today.

• Poor practice• Human abuse

To what• Fragmented services• Gaps in systems (mind the Gap)• Funding and focus of systems changed in 1970’s • Approaches to deinstitutionalisation varied across Europe• Community Care (but did it ?) • Competition in a market for customers but who is the customer?• Evidence based care, but recovery rates not increasing (Whitaker

2011) disability rates increasing and evidence is in itself politicised.

• Systemic abuse falling and rights growing but very expensive and politicised regulation, law can be misused

Change the structure, change the system?

• Has worked as part of a process of deinstitutionalisation

• Moved the building• Restructured our funding and the market (de

centralisation & personalisation)• Incidence of mental illness increasing by 17%

every 10 years• Public spending lowering

Changing what• From damaged goods - to people struggling• From disease - to distress• From symptom management - to self acceptance, growth and self

management• Hopeless - to Hopeful• Expert gift model - to wise advisor• Patient -to person• Removal of rights - to reclaiming of Rights -to ownership of rights and

responsibilities (Citizenship) • Independence - to interdependence• Problem focussed to solution focussed• System centred to person centred• Credentialed by state of Colorado

Whole person-Whole System Whole lives

• 16 may event