My family have used mental health services for three decades. I experienced my first hypo-manic occurrence in 1981 whenever i was writing up my doctoral thesis. In the past twenty-four years I have had sixteen shows that have led to hospitalisation.
I first satisfied Teacher Phil Barker in 1983 when he had just adopted the Couch of Psychiatric Nursing Practice at Newcastle College or university and I had just launched myself as a Consumer Specialist under the name of Section 36. During his ten years in Newcastle we worked on several assignments and spent many hours writing our views on customer empowerment, self-management and restoration. I experienced privileged when he asked me to touch upon the Tidal Model in its early stages. I feel evenly privileged and delighted to discuss the Model today.
Phil and Poppy Buchanan-Barker co-wrote this Guide on the Tidal Model for Mental Health Professionals. They have got asked me to consider set up Tidal Model helps service users on their recovery journey. I'll do this basically by reading quotations taken straight from the e book. Before we can do that I feel it necessary to look at the meanings of restoration.
The Chambers 20th Century Dictionary definition of 'recover' is 'to cure'. Inside the framework of mental health 'restoration' is normally not accepted as being synonymous with 'remedy'. From her work with service users Repper noticed that:
'Recovery does not imply that all suffering has disappeared, or that all symptoms have been removed, or that functioning has been restored. '
Pat Deegan, a professional medical psychologist with a late childhood-diagnosis of schizophrenia recognized 'recovery' is not a 'get rid of' but perceives no reason for despair.
' Being in 'recovery' means I know I've certain limitations and things I cannot do. But rather than letting these restrictions be a celebration for despair and quitting, I have learned that in knowing what I can't do, I also start all the options of all I could do'.
Acceptance is a key factor in the recovery process. Again, Pat Deegan notes:
. . . an ever-deepening popularity of our limitations. But now, rather than as an occasion for despair, we find our personal restrictions are the floor from which springtime our very own unique possibilities. This is the paradox of restoration. . . that in accepting what we can not do or be we uncover what we can be and what we can do. . . recovery is an activity. It is a way of life. It is an frame of mind and a means of getting close to the day's challenges'.
Simon Champ, a visible Australian mental health activist, also views recovery as a lifelong process which requires important changes in 'home' :
I have come to see you don't simply patch the home you were before producing schizophrenia, but you need to actually recreate a concept of who you are that integrates the knowledge of schizophrenia. Real restoration is far from a simple subject of accepting prognosis and learning factual statements about the illness and medication. Instead, this is a profound searching and questioning. A quest through unfamiliar thoughts, to embrace new ideas and a wider view of self applied. It is not an event but a process. For many, I really believe it is a lifelong quest'.
Despite agonizing times Anthony feels that we should be hopeful as the recovery period brings with it times of personal expansion.
' Restoration is described as a deeply personal, unique procedure for changing one's behaviour, values, emotions, goals, skills, and/or roles. It is
a approach to life a satisfying, hopeful and contributing life, even with limitations induced by the illness. Recovery involves the introduction of new interpretation and purpose in one's life as one expands beyond the catastrophic effects of mental disease. '
In my view, hospitalisation is a kind of 'containment' rather than a 'therapeutic process'. Service users are expected to 'entertain' themselves by talking amongst themselves, watching tv, sitting down in the smoking room, participating in pool or participating in occupational remedy. Mental health nurses need to break out of the mechanistic regime, which restricts their dialogue with service users.
When the Tidal Model is used, each service customer undergoes a holistic assessment with a specially trained mental health nurse. All activities are accepted as 'true' and not dismissed as 'hallucinations' (for example). The mental health nurse discusses with the service individual what the person feels may have induced their entrance and what they feel they need to do to address these problems. Every service user receives a backup of their assessment, which is recorded in their own words.
This process helps to build up trust between your service end user and the mental health nurse. They form a relationship whereby the nurse helps the service end user through the recovery process. The emphasis is on 'nurturing with' rather than 'caring for'. The behaviour, beliefs and indicated needs of the service user are accepted at each level of the recovery process. The user has learned that the advice of the nurse may well not actually be accepted.
'The person's storyline lies in the centre of the Tidal Model. . . . . The Tidal Model is a philosophical method of the restoration or finding of mental health. It isn't a 'treatment' model, which means that something needs to be done to improve the person. Instead the Tidal Model assumes that the individual has already been changing, albeit in small and subtle ways. . . . In the Tidal Model 'water' is used as the core metaphor.
Following the Holistic Diagnosis the service individual enters into an interval of 'Individual Treatment' and 'Group Care'. One to one Individual Treatment sessions are established on a daily basis.
, The procedure of Individual Good care involves creating a collaborative relationship within which the person can get started to develop knowing of the resources that (s)he presently possesses, which might be used to address the problem of living; what additional resources (support) might be needed; and what needs to happen next, to start to move off on the recovery journey.
Three types of group work provide a supportive social structure for the Individual Care:
The Breakthrough Group includes service users to discuss a couple of pre-prepared questions that try to generate simple representation and light-hearted as well as significant conversation. Two customers of the professional team normally lead the Finding Group, but as time passes group participants might take converts in leading the session.
'The Discovery Group therefore aspires to give a setting within which people might experience a boost with their self-esteem, reclaiming along the way a few of the personhood that is lost, either as a function of the knowledge of mental ill-health, or of the experience of psychiatric care and attention and treatment, or both. The Breakthrough Group has an opportunity within which people may reclaim and develop further their capability to share with others, on a straightforward yet mutually worthwhile basis, through simple question and answer classes'.
'The Information Group seeks to provide 'sensible' advice to people about services they may be currently using, or services that they might consider using. These suggestions is supplied in 'ordinary' language, ideally in an entertaining, interesting or elsewhere accessible way'.
'Francis Bacon's dictum that 'knowledge itself is electric power' is the principal motivation behind the info Group. Without knowledge we are not only ignorant, but also powerless. '
'The people who lead the Information Group should have in-depth understanding of specific topic areas who are able to comfortably answer sensible and looking questions from people in treatment as well as perhaps also staff members. '
'There are thousands of possible matters for the Information Group, but experience of the Tidal Model tasks across the world shows that listed below are most popular:
'The potential contribution to Information Groupings that might be made by consumer/consumer-advocates, psychiatric survivors, or other people who have navigated the restoration quest, is inestimable. Aside from special knowledge of the recovery journey, such people come carrying a huge beacon of desire. Their very occurrence alerts the 'probability' of recovery, but also frames this within a realistic storyline. '
'The Tidal Model emphasises the required search for alternatives. Given that the problems of living which people experience decides the need for help, both lay and professional, it follows that people should be focused on solutions to these problems.
However, unlike some other remedy models or treatment systems, we do not believe that the professionals possess the answers to the individuals problems. . . . . . the Tidal Model must be tailored to match everyone in the programme. Everyone requires a theory of their own to explain how they acquired there, and how they could move off again, back onto the ocean of experience. So the pragmatic give attention to finding alternatives is taken over in to the work of the Solutions Group.
The Alternatives Group is area of the 'heavy work' of care-helping visitors to learn more about themselves and their problems and instilling wish in the recovery process.
The Solutions Group is highly useful and focuses on conversations about change that is already occurring within individual customers. What subtle types of change is the person already becoming aware of? On the other hand the group will give attention to conversations in what change might end up like; how participants will know change when they face it. '
The Tidal Model concentrates after the unison between the service individual and the professional helper. However
'. . . . . the Tidal Model can be an anti-professional method of mental health care. It does not believe that there is certainly special knowledge involving mental health, known only to the professional, that can result in the image resolution of serious problems of human living, or speed the person's restoration. The Tidal Model proposes that only the person can ever own such knowledge. . . . . . . . However, the individual needs the sophisticated support to plan and do the process of restoration.
Finally the publication offers us 'Ten Commitments' which distil the substance of the practice of the Tidal Model.
'Value the words: the individuals 'account' is the beginning and endpoint of the complete helping encounter. The individuals account embraces not only the bank account of the person's problems, but also the hope for its resolution. This is actually the words of experience. We have to officer it well, as the speech starts to help the person to make her or himself anew'.
There is no doubt in my mind that the Tidal Model promotes the procedure of recovery. The main element features that set it besides from other models are:
It is based on the personal experiences of service users.
It is based on 'nurturing with' rather than 'nurturing for'.
It is a holistic model of care.
It recognises that knowledge is 'ability'.
It focuses upon solutions rather than problems.
It promotes self-management and empowerment.
It promotes the concept of 'therapeutic experience' somewhat than containment.
In this sense, the Tidal Model is truly groundbreaking.