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 of 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) Person- in-connection • Theme: A coherent system Layer 3: Society (e.g. National government policies) • Theme: A wellbeing society • Theme: A balanced budget
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
Layers Practice Internal Community Society Person- in-connection EXAMPLE: the CPCAB Relational Developmental practice model integrated within an ecological paradigm 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
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.”
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