Thursday, 20 October 2016

A Portuguese dream for mental health

There is a sad story behind Casa Alba, of a wealthy family who have realised the limitations of mainstream mental health care, and are trying to set up one of the most progressive services in the country - from scratch.

Casa Alba is an ultra-modern building in the gentle hills a few miles outside Estremoz, for residents with severe psychotic conditions. They are using therapeutic community methods, but also traditional psychiatry: they are not of the Soteria inclination.

One of the purposes of the foundation behind all this is to disseminate the best progressive practice in mental health - so they hold a biennial conference: which was called 'The Intervention Triangle' on this occasion: see for details.

José Romão de Sousa

Conventos dos Congregados, Estremoz

Monday, 17 October 2016

Portuguese flavoured LLE

The shopping was epic, as usual, the venue felt like something out of Narcos, and the LLE was the most international - and intercontinental - we have ever had. With staff from India, Italy, Venezuela, Portugal and UK; and delegates from Portugal, India and St Martin it was a vibrant and lively mix!

Sunday, 2 October 2016

Mental Health as a social movement

As you come out of the metro - Il Duomo
Shops in Milan
Milan is somewhere I have never been before – but I do remember being told, a few years ago, that when you go to the north of Italy (I took that to mean further up than Florence or Bologna) you need to dress in a smart, stylish and rather formal way. Not exactly my usual modus operandi. And I was invited to this occasion about a year ago by the organisers of the annual conference of the Italian association of therapeutic communities‘Mito e Realta’ – with the flights and hotel booked in the spring, and several reminders to send my talk for translation at least four weeks in advance. So I had a long time to get anxious about it.

As I understood it (which, admittedly, wasn’t very well) this was the first ‘Annual Forum’ of the whole-Italian equivalent of our British ‘Community of Communities’.
Logo of the Italian association of TCs
They had already invited us (usually meaning Jan Lees and myself from the British TC movement, but also some others sometimes – particularly in the months when Jan was having her bionic surgery done), to the first three of the equivalent Sicilian events – which, by being in southern Italy (and even more so by being Sicilian), were necessarily friendly, informal and relaxed affairs. So I was expecting these two days to be a rather familiar type of event, with a day of leisurely talks, and a day of celebrating the success of the TCs who had managed to go through all the processes to be accredited. And all in Armani suits (except me) and with immaculate northern Italian style (maybe).

But I was wrong. The friendly informality was the same as I was used to – and there were at least a few people who were less dressed up than I was. The relative simplicity of the Sicilian ‘visiting project’ was blown out of the water by the innumerable different levels, processes, methodologies, clinical and geographical considerations – all with a perplexing array of different permutations which were presented to us. Simone Bruschetta – who I have always considered a reasonable and straightforward sort of guy – had become the mysterious mastermind of a web of inter-related projects, stretching across Italy.
Simone Bruschetta - aka Bond
Like a true Bond film, the different cells all had their own secret language – like ‘VIVACOM’ and ‘SCAF’ and numerous other coded messages for the eyes of the initiated. Acronyms are often hard enough to follow in English – but when they are in Italian, I have to give up hope of understanding them at all. But everybody there understood them well enough, and the business was done.

But then there was the conference programme – which I should have studied before – as it had included several spaces on the programme for me, as the UK supervisor and ‘esteemed visitor’, to fill with my erudite thoughts and utterances. If only…! There were three or four occasion on which the people on the platform turned to me and said ‘over to you, Rex’ in Italian, sometimes when I was least expecting it. But, in the lovely Italian tradition of kindness to visitors and to those who don’t speak the language, it seemed to go reasonably well. Whatever rambling and disconnected thoughts I managed to put into the microphone which was then put under my nose, which were then translated into Italian, seemed to be well-received. I think it was more important to smile and say friendly things, than try to say anything seriously meaningful!
Marta Mingharelli, M&R Presidente

The pre-arranged part of the proceedings were on the first day, and seemed to go quite well. John Turberville, one of the leading figures at the Mulberry Bush School in Oxfordshire and current chair of the Community of Communities advisory group, gave a talk about how the London-based Community of Communities project currently works. Then I gave an edited version of the current bee in my bonnet - about what TCs need to do to cope with modernisation, globalisation, terminal fragmentation and inevitable eco-meltdown (see previous blog entries). The questions and discussion points ranged between the ‘evidence-based practice is killing everything of value’, ‘thank goodness that a proper RCT has been done’ and ‘all you need is love’ (relationships) extremes. I felt a pang of guilt and sense of betrayal to a couple of elderly and distinguished Italian psychoanalysts, who I had met years ago, by proposing that we need to ‘get modern’. But no voices were raised, tempers lost, or friendships hurt in the process.

There was then, despite IT problems, the presentation of a one hour video film which has been commissioned by Mito e Realta, and produced by professional film-makers. It was a remarkable exercise which took (only) three months to film – including dozens of Italian TCs, showing the depth and intensity of their work. Group members were clearly enthusiastic about appearing, including in their therapy groups – which is sadly inconceivable (and probably illegal) in the UK – at least for those in the NHS. The whole process of their ‘Community of Communities’ process was explained step-by-step, and in a way that was both intimate and authoritative. The film-makers said that they hope to produce a version with English sub-titles before long, and I hope they do. It would be an excellent introduction to the work of therapeutic communities for a wider audience – but also one which we in the British TC movement should be doing for ourselves.

The second day was altogether different: the first part was easy to understand, when three TCs had about a quarter of an hour each to introduce themselves to us. It started with the external auditor giving a report about how they did in trying to meet the standards – qualitatively as well as quantitatively –then a presentation by people from the community, with pictures and more of an impression of ‘what its really like’. Congratulations to ‘Gnosis TC’ near Rome for getting top marks in everything – but also for coming across as lovely people doing a brilliant job, in ways we’d hope all TCs to be.

The next session was led by Raffaele Barone, the Sicilian public health psychiatrist who I think has worked tirelessly to do as much as anybody anywhere to humanise mainstream state-provided mental health services – and demonstrate the intellectual poverty at the core of biomedical-only psychiatry.
Raffaele Barone
Several of the questions seemed to be rather disbelieving of how such an approach was possible, and perhaps envious that their own commissioners, managers and political opinion-formers were not as sympathetic as they were in Raffaele’s patch (Caltagirone in Sicily). But I have often met Raffaele over the past few years, and have seen how hard and continuously he works at building the understanding in the institutions of power, and public opinion, that psychologically sophisticated approaches need.

After this session, I was called up for one of my impromptu opinions – and, struggling for something sensible to add, remembered the conversation that Geoff and I have been having in Slough. We are starting to think of ‘health as a social movement’ – so I linked that to Basaglia and the late 20th century Italian psychiatric reforms, along with the 1950s social psychiatry revolution in the UK, and said that we need another mental health uprising, led by service users and focussing on ‘mental health as a social movement’. The time is ripe.

And although the rest of the day went into complex details about how different communities in different networks had managed to audit themselves, that conversation, started by Raffaele, is what stayed with me – and what I think it’s all about. Not just in Italy, but also in Slough, and the British TC movement, and anywhere else people are oppressed by state-run organisations that make people’s mental health worse by stripping them of their power and dignity.