The Micro-Therapeutic Community: using groups to keep people out of hospital

1) Therapeutic Communities: New Forms and Functions

2) The birth of a new programme: ASSIST

3) Findings from the ASSIST programme

4) The 'micro-TC': the EMBRACE programme

5) The future: Hope College and Healing Towns

Therapeutic Communities

[Add greencare section here]

Population =

140,000 + 20,000;

Deprivation = 93

• 52% ethnic groups
• Immigration and UK border control
• Health and Adult Social Care
• >100 Languages
• Unemployment
• Co-morbidity
• Dual diagnosis

1300s - Geel

1790s - Retreat

1940s - WW2 experiments

1950s - Henderson

1960s - 'Social Psychiatry'

1970s - Extensive spread - across sectors

1980s - The tide turns

1990s - Decline and closure

2000s - A few survivors + NPD

2010s - New directions needed

New directions

Extracting the 'essence':

• RCPsych - 'Community of Communities'

and Enabling Environments

• Group analytic based theory
• Wider movements eg GREENCARE
• RELATIONAL PRACTICE

Similar developments elsewhere:

• Sicilian state support
• Sopo near Bogota
• Bengaluru

The new NHS therapeutic communities in the Thames Valley

2004-2011

Characteristics of Thames Valley Day TCs

What is greencare's theoretical and evidence base?

- Biophilia Hypothesis

- originally Fromm (a Frankfurt School post-Freudian): "the connection that human beings subconsciously seek with the rest of life"

- in evolutionary psychology as The Biophilia Hypothesis by Kellert & Wilson (1993)

- 'Nature Deficit Disorder': Richard Louv (2005) Last Child in the Woods

- EU Conceptual Framework

- Sempik J, Hine R, Wilcox D (2010) Greencare: a conceptual framework. A report on the Working Group on the Health Benefits. EU COST Action 866. EU COST Office, Brussels

Community Mental Health Services

• joint health + local authority
• staff >100
• psychiatry + psychology + psychotherapy + community nursing + social work + occupational therapy + recovery support work
• range of different services
• including acute inpatient beds

• 4 phase pathway
• 18 month intensive treatment phase
• 3 days per week
• community meeting AM and PM + formal therapy groups + eating together + social activities + 'community time' + special events
• Maximum responsibility to members
• Medication to zero or minimum
• Support system

Royal College of Psychiatrists

National Sustainability Award 2014

The Growing Better Lives Project:

Why GREENCARE matters for your Mental Health

So ASSiST is born - 2013

• "Assertive Intervention and Stabilisation Team"
• £225,000
• Operational programme
• Implementation strategy
• Recruitment:

Rex Haigh, Vanessa Jones, Fiona Lomas

Directors, Growing Better Lives CIC

Our mission statement:

"Next Generation Care" - 2012

• service reorganisation across Berkshire
• closure of acute inpatient beds
• alternative to admission funding made available
• conflicting views and solutions!
• the winner....

• Team Leader - Psychologist
• Two Community Psychiatric Nurses
• Assistant Psychologist
• Team Administrator
• Part-time psychologist (1 day pw)
• Consultant Medical Psychotherapist (1 day pw)

“Greencare is a holistic and economically viable alternative to treatment with medication and hospitalisation. Sustainability is about connecting people to each other and to nature, helping people to see that there is a life worth living, and on a planet that is worth living on.”

BUT - times changed - 2008 etc -

and Slough needed something different

However, it turned out to be an opportunity...

The EMBRACE group - a 'micro TC'

Intention =

1) To set up a 'safe environment' group for people with longstanding and severe non-psychotic conditions who have not been much helped by 'mainstream mental health services' - but remain quite functionally impaired or 'ill'.

2) To use therapeutic community principles as primary therapy for some people in the group, in a 'lower dose' than has been tried before.

3) To coordinate various the group with various other parts of the 'therapy pathway', so the whole experience is of 'TC' - a coordinated array of different groups - although this particular one only lasts two and a half hours.

4) To see the group as much as education ('emotional intelligence' ) as health - and see progress and leaving as 'graduation'.

5) To start seeing the whole area's provision as a 'healing town' - particularly with the development of 'Hope College' - with coordination as a recovery college of what was previously a disconnected range of different health, social services and educational provision...

So - where is it all leading?

SLOUGH

• Co-production - the HEALING COMMUNITY
• "Hope College"
• Connections across the town
• Synergy at high level
• Strategic partnerships

- client group, health, local authority, third sector

...AND BEYOND

• Sicily, Sopo and Bengaluru
• Therapeutic Community in the Community - or in the Head?
• Micro-TC or Mega-TC?
• Dissolving traditional boundaries
• or no TC?

Who are you all?

• which countries have you come from?
• do you know about Therapeutic Communities?
• from mental health services or private practice?
• which professions?

...we are looking forward to having dialogue

with you and hearing what you are doing!

The MICRO-THERAPEUTIC COMMUNITY:

NHS group therapy as an alternative to hospital admission.

Berkshire's ASSiST Programme:

The First Two Years

Natasha Berthollier, Psychologists and Team Leader

Geoff Dennis, Head of Adult Mental Health Services

Rex Haigh, Consultant Medical Psychotherapist