Whole system approaches Dealing with the institutions in our minds

1. Whole system approachesDealing with the institutions in our minds Mike Smith Clinical Director AFG

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

3. It’s a global issue ! • Mike Smith Clinical director AFG England • Stop seeing things in our local ways

4. 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

5. 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.

6. Recovery from what? And to what?

7. They said that I was mad • And I said it was them who were mad • Damn the they outvoted me

8. If you talk to God it called prayer • If god talks back its schizophrenia! k

9. 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!

10. What is normal ?

11. Functioning Wellbeing Symptoms www.crazydiamond.org.uk

12. Expert advice peer and professional Self Determination Ownership - Person accepting & taking Control of own life, Rapid but limited Health interventions Interdependence Social networks, social support personalisation Citizenship approaches Holistic Approach Informed Risk Taking and locus of control Inclusion Rights, Responsibilities and Advocacy Alternatives and choices Potential to Leave completely supportive services--Exits Core Beliefs of citizenship High Staff Expectations and energies

13. Maintenance approaches Social Control Frustrated by Risk Removal from society MAINTENANCE MODEL Permanence Illness Concept reductionist views Loss of rights Symptom Management not mastery Service for life no exit pathways Low Self and Staff Expectation

14. 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

15. 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

16. 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

17. 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

18. Whole person-Whole System Whole lives • 16 may event