Ian Caldwell describes how the human givens approach to helping people in distress has had a huge impact on mental health services in Hartlepool.

HARTLEPOOL Mind is unrecognisable today from the organisation that it was when I started working for it two years ago. Like other Mind local associations (the voluntary groups around the country coordinated by the national mental health charity Mind), it offered 'tea and sympathy' to a hard core of 30 or 40 people with severe, enduring mental illness.

People could attend 'drop-in' centres where usually they would spend their day drinking tea and coffee and smoking. Sometimes crafts or music or drama teachers would be brought in to offer them classes. Sometimes they would go on outings as a group. Users of the drop-in centre either turned up or they didn't. They never initiated activities of their own, and nothing noticeably ever changed. Today Hartlepool Mind is a dynamic place, helping 500 people a year to discover or recover a meaningful and satisfying life.

When I joined the organisation, the chair and the manager of Hartlepool Mind had been attending MindFields College seminars for over a year and were itching to offer clients a completely different kind of service, based on the human givens approach of identifying and meeting needs and best use of innate resources. Together they had put together a bid for money from the Government's "New Deal for Communities", a regeneration package for the most deprived areas in the country, and won the funds to start up a brand-new project — a mental health support network.

The 'new deal' covers five areas: employment, housing, education, antisocial behaviour and crime, and health. Our funding was earmarked for the mental health component, but we planned to address them all. In the holistic human givens approach, successful treatment for depression may involve helping people build up the skills and confidence that will prepare them for employment or college, or enable them to challenge difficulties such as unsatisfactory housing. Divisions between 'areas' are just artificial and hampering.

Although we still carried on providing Hartlepool Mind's traditional information services to the public about mental health matters and signposting them, as appropriate, to other agencies, the drop-in centre had its doors finally and firmly closed. We concentrated our energies on tackling mental health issues in a non-stigmatising way that people would be drawn to instead of shy away from. We went to talk to residents' associations and community groups about stress management sessions and assertiveness training opportunities and set up advertising and poster campaigns.

By this time, we had also won 'new deal' money for a complementary therapies project, so we organised joint complementary therapy and mental health 'days' in community centres, sports centres and church halls in our targeted area. Many people were curious enough to come along, and we invited them to attend our centre for a variety of complementary therapies (from acupuncture to Indian head massage) or to discuss practical or personal problems they were struggling with.

Although Mind's remit is to work with people with severe and enduring mental illness, we opened up access to anyone who wanted it. As we know, countless people suffer lifetimes of stress and distress but aren't formally 'diagnosed' with a problem. Others who are diagnosed with chronic psychiatric conditions might well have got their lives back on track, had meaningful intervention been available to them at the outset.

Our centre is based in a one-storey building, which comprises offices, a relaxation room, training room and therapy rooms. The atmosphere is friendly, informal and relaxed and clients can always be assured of a warm welcome. We employ five full-time workers — a manager, a support network coordinator (my role), a complementary therapy co-ordinator, a senior recovery support worker and an administrator — and three part-time clerical workers. All of them are required to attend a few MindFields College seminars, so that they understand the human givens approach — after all, it is the clerical staff who are the first to meet a patient. We also employ sessional workers, including therapists.

Some of the therapists are taking the human givens diploma course and all have attended MindFields College workshops on practical ways to shift anxiety and depression, and deal with anger and addictions etc.

All have to agree to meet the human givens' guidelines for effective counselling.

The recovery model

All staff work from one model only. We call it the recovery model. Recovery is defined as living well with or without symptoms. We view recovery as a journey, a movement from the place a person is in to places that are better to be in, learning and making use of new skills and understandings along the way. This recovery model is multi-dimensional (holistic), taking into account an individual's diet, nutrition, medication, environment, social network and so forth. This is a very different experience for clients who may previously have been shunted from one statutory service to another, where markedly different models are in use.

The NHS, unsurprisingly, relies heavily on the medical model for mental ill health. According to this view, the disturbance or dysfunction is rooted in the body, and taking the right medication can cure or contain it. According to recent figures, 91.3 per cent of psychiatrists adhere to the medical model, as do 60.8 per cent of nurses and 47.5 per cent of social workers[1].

More social workers operate from the social model, emphasising the role of family and environment. Psychologists are increasingly convinced by the cognitive model — changing unhelpful thoughts helps eradicate inappropriate emotional reactions and undesired behavioural responses. Counsellors at GP surgeries, meanwhile, tend to favour the psychotherapeutic model, particularly the active listening, Rogerian kind.

In my experience, from talking and working with clients, these models provide convenient 'get out' clauses for professionals, when a particular approach doesn't appear to have anything more to offer. So the psychiatrist who reaches the limitations of the medical model refers on to the social worker, and so forth. Clients take away the perception that it is they who are falling short, not the model. And so they do the rounds of the different agencies.

The recovery model, however, takes an overall look at people's needs and asks how we can help, whatever that entails. It could mean addressing matters such as diet, sleep problems, emotional difficulties, troublesome neighbours, unhealthy housing or side effects of medication that are interfering with quality of life. In emergencies, we act on the spot.

"What's the point in going on?"

When Ben walked in off the street, he was suicidal. A young man in his mid to late 20s, he had been 'on the sick' for some while because of depression. He rarely went out or communicated with anyone, and had spent the last few months brooding in his house. That in turn had led his relationship to break down and now he was homeless, because his wife had thrown him out. He arrived at our centre in a highly agitated state and kept saying, "What's the point in going on?" He clearly needed immediate help.

First I calmed him down by teaching him the 7/11 breathing technique (breathing in to the count of 7 and out to the count of 11, which automatically slows breathing and reduces panic and anxiety levels). By giving him a simple but powerful skill he could use straight away, he was able to take back charge over a small piece of his life, which seemed to him to have spiralled out of control completely.

When eventually he was calm and able to engage with me, instead of being overloaded with emotion, we were able to talk about what was lacking in his life and what needs were not being met. Clearly, housing was at the top of the list and I contacted a housing officer and arranged to take Ben to see him later that day. We also ascertained that he could stay with a friend for a short while, until his housing needs were sorted out. This reduced his anxiety further.

In talking with him it became apparent that his depression had been triggered by stress at work and low confidence in himself. He blamed himself for not being up to the job and then for getting depressed over it and causing the end of his relationship. We didn't dwell on his past but he mentioned that he had always been passive and hated confrontation. I was able to explain to him how stress affects the body and emotional arousal leads to black and white thinking, when everything seems so much more hopeless than it really is.

He responded positively to the information that depression wasn't a part of his character: it was something outside of himself that he wasn't to blame for but that he did need to take responsibility for shifting. One aspect of doing that, I told him, was through connection with people, instead of hiding away, as we need to be connected with others to be emotionally healthy. We covered this ground quite quickly but I didn't let him leave the centre until I was confident that he felt hopeful that change could occur and that he would return, as arranged, next day.

Over the next two weeks Ben had two sessions with a human givens therapist, during which she discovered that he found arguments with his wife excruciatingly painful and would withdraw rather than risk them — leaving a lot of unresolved issues within the relationship.

The therapist used the rewind technique[2] to take the traumatising emotion out of the memory of major rows, and guided imagery to help him visualise successfully engaging in discussion with his wife, to address differences in needs or opinions. He attended workshop sessions to learn new skills and strategies for managing stress, communicating in relationships, building self-esteem, being more assertive and countering depressive thinking by challenging negative thoughts, etc.

During those two weeks, Ben went to visit his wife and, as he put it, talked to her as he had never talked to her before. He also went to see his employers to say that he would like to come back to work. The end result was that, at the end of two weeks, when he was offered a flat by the housing department, he turned it down because he had returned to live with his wife. He was also back at work, with a new belief in his abilities and strengths, and felt positive about the future.

Getting back on track

I believe that part of our project's success is due to the fact that we are confident about what we offer. We say, "This isn't going to be long term. We'll probably see you a few times, and that will be all the help you need." This is surprising, to say the least, to some clients who have had many years of mental health service intervention.

One such person we worked with was Linda, a young woman in her mid-20s, who had been diagnosed as suffering from schizophrenia.

She heard 15 different voices, all of people who appeared to be monitoring her life and giving her instructions on how she ought to be living it. At the time that we met her, she had been hospitalised a few times but was currently living with her young daughter at her mother's home. There she would be visited every week by a member of a dedicated psychosis team, attached to the local psychiatric hospital, and she was also receiving monthly visits from a cognitive-behaviour therapist. Linda's mother acted, in effect, as the mother of Linda's six-year-old daughter Molly, even taking her to and from school, and also took care of all of Linda's physical needs. Linda perceived her as controlling.

When Linda was brought in to see us, having been referred by the psychosis team, she had no expression on her face at all and was silent unless spoken

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References

© Human Givens Publishing Limited and Iain Caldwell (2004)

This article first appeared in Volume 11, No, 1 (2004) of the Human Givens journal.

IAIN CALDWELL is the mental health support network co-ordinator of Hartlepool Mind. He originally studied psychology at Liverpool John Moores University. He has an assertive outreach nursing certificate from Teeside University and a post-graduate certificate of education from Sunderland University. He has also studied various therapy skills, gaining a certificate in hypnosis and the Human Givens Diploma. Iain has worked variously in outreach, supporting people discharged from a special hospital, and as an advocate and mentor.

> More information can be found in the following books, both by Joe Griffin and Ivan Tyrrell

Dreaming Reality: How dreaming keeps us sane or can drive us mad

Human Givens: A new approach to emotional health and clear thinking

> You can find out more about psychosis and the new thinking on its causes at the following MindFields College events:

Understanding the mental health continuum Seminar

Psychosis: and positive strategies for Recovery Workshop

Return to top

> More information can be found in the following books, both by Joe Griffin and Ivan Tyrrell

Dreaming Reality: How dreaming keeps us sane or can drive us mad

Human Givens: A new approach to emotional health and clear thinking

> You can find out more about psychosis and the new thinking on its causes at the following MindFields College events:

Understanding the mental health continuum Seminar

Psychosis: and positive strategies for Recovery Workshop

Return to top