News & Reflections

Psychosis & Institutional Racism- ISPS UK Conference and AGM


Institutional racism is sometimes viewed as the elephant in the room in mental health and psychosis. We know that people from racialised minorities are more likely to be diagnosed with schizophrenia, more likely to be subject to the Mental Health Act, and more likely to be restrained or be under a Community Treatment Order. And yet- it seems to many working or campaigning in the field that we have failed to address these issues, and that too little has changed over the past few decades.

How do start talking about and addressing institutional racism, when so often it can feel invisible or taboo? How does institutional racism affect people who use services, but also family members and carers, and professionals (psychiatrists, psychologists, nurses, OTs, HCAs etc) who deliver services? What are the barriers which stop us talking about it – and how do we address what we struggle to recognise?

This day will encourage discussion & reflection on how institutional racism plays out in the field of psychosis, from multiple perspectives. We will reflect on how we can name it, and how, together, we can start to find ways of addressing it.

Book your ticket here

Speakers:

Dr Suman Fernando, Honorary Professor, Faculty of Social Sciences and Humanities, London Metropolitan University and former (retired) consultant psychiatris

Dr Philip Thomas and Dr Alison Faulkner on the Privilege, Partiality and Power of Whiteness

Sara Haq on Complex Subjectivities and Survival Strategies for Collective/Cultural Psychosis

Dr Colin King

Other speakers tbc

Followed by ISPS UK AGM, 17.00-17.30

All are welcome to attend

Details of the day:

Coffee and lunch will be provided. Please contact us if you have any questions about the day or access.

£10 for ISPS UK members, £30 full price, £10 concessions.

Book your ticket here.

 

NEW ISPS book: CBT for Psychosis, Process-orientated Therapies and the Third Wave

A new ISPS book has been published: CBT for Psychosis, Process-orientated Therapies and the Third Wave, edited by Caroline Cupitt.

Cognitive Behaviour Therapy (CBT) for psychosis is constantly changing and evolving. Recently, in what is sometimes called the ‘third wave’, therapy has become more concerned with the individual’s relationship to their experience, rather than with the content of it. This more process–orientated approach appears to tap into universal psychological processes. The aim is to reduce distress by changing the function of the experience, rather than necessarily the experience itself. Written by some of the leading figures from around the world, CBT for Psychosis: Process-Orientated Therapies and the Third Wave brings the reader the latest developments in the field.

Presented in three parts, CBT for Psychosis first explores theoretical perspectives on recent developments in cognitive behavioural therapies. Part two examines specific therapeutic approaches, including metacognitive training, mindfulness, acceptance and commitment therapy, compassion focused therapy and the method of levels. Finally, part three presents two critical perspectives: the first offering a reflection on the experience of receiving CBT, and the second looking ahead to possible future developments.

Offering a cutting-edge collection of theoretical, therapeutic and critical perspectives, CBT for Psychosis: Process-Orientated Therapies and the Third Wave will be of great interest to clinical and counselling psychologists, both practising and in training, as well as psychiatrists, nurse therapists, occupational therapists and other healthcare professionals working with people experiencing psychosis.

You can buy it at a discounted price here. If you are interested in reviewing it, please contact us.

ISPS Book Series: Series Editor Vacancy

We are looking for a new honorary co-editor for the ISPS book series, published with Routledge, to help continue to expand and develop this important strand of ISPS’s work. There are now over twenty books published in the series, further books commissioned, and a number of proposals under consideration.
The opportunity has arisen as one of our two co-editors, Alison Summers, will soon retire. The person appointed now will work in partnership with the second current co-editor, Anna Lavis. The book series co-editors work alongside a separate editorial advisor for the academic monograph series, currently Andrew Moskowitz. We also have the invaluable support of an editorial board, with members drawn from a variety of disciplines and perspectives.
We are seeking someone with a good understanding of the ethos of ISPS, whose interest in psychological and social aspects of psychosis is relatively broad and who has experience of writing on these topics. The co-editor needs to be able to respond to submitted manuscripts within a short time frame, and to deal with email communications promptly.
For further information, or to express interest in the role, please contact Anna Lavis and Alison Summers. To express an interest, please send a letter outlining why you would be interested in the role and the strengths that you would bring to it, alongside a curriculum vitae, by 31st August 2018.
Person Spec:
  • A commitment to ISPS’s aims and willingness to become a member of ISPS;
  • Knowledge of recent developments in the treatment of, and/or academic research into, psychosis;
  • The ability to write clearly and lucidly on mental health topics;
  • Written and spoken English to the standard of a native speaker;
  • Excellent communication skills;
  • Previous experience of publishing, editing or peer reviewing.
Role Outline:
Series editing tasks shared with co-editor include:
  • Identifying topics for new books; approaching potential editors/authors; responding to unsolicited suggestions
  • Giving feedback on draft proposals, book chapters and manuscripts.
  • Liaising with authors over the progress of work and answering author queries promptly
  • Liaising with Routledge re proposals, sales, finances, contracts
  • Liaising with co-editor, and with the ISPS International Organiser Antonia Svensson, who provides a few hours’ support per month to the series editors. In addition to email, currently we are meeting by Skype, approximately quarterly
  • Reporting to the ISPS International Executive Committee
  • Liaising with the editorial board
Time Commitment:
Variable; average commitment perhaps two days per month.
Remuneration:
None. Series editors receive up to £300 per annum expenses, and three copies of each book that comes out during their editorship. They have recently also been offered a free place at the ISPS international conference.

Update on the Young Voices Study at Manchester Metropolitan University

Manchester Metropolitan University Young Voices Study is just coming to the end of the pilot phase, during which the researchers wanted to gain a better understanding from young people about their experiences of hearing voices, as well as hearing from parents/carers. Through interviews and an online survey, they heard from over 100 young people and parents about varied experiences of voice hearing, additional sensory experiences that accompany voices, difficulties accessing tailored help for young people under 14 years old and many accounts of creative avenues that help young people cope (e.g. music, running, writing). They have a new PhD student joining the study in September to explore multiple sensory experiences with young people and are currently seeking funding to establish some support groups in the Northwest.

For more information on the study, including links on how to take part, please click here.

 

‘Compassion & Compulsion’: ISPS UK event in Preston on 31st July

‘Compassion & Compulsion: exploring the tensions faced by service users & clinicians when people experience psychosis.’

Come and join us at an ISPS UK event in Preston, Lancashire, on the 31st July, from 18.00 to 20.00. FREE for ISPS members, tickets £6 or £4 (low waged). You can book your ticket here.

Professor David Pilgrim from Liverpool University will do a presentation about the issues faced by mental health services when using coercion. Jen Kilyon and Neil Caton, both ISPS UK Committee Members, will then give a response to the paper after which we will open up to questions and comments from the audience.

David Pilgrim is Honorary Professor of Health and Social Care, University of Liverpool and Visiting Professor of Clinical Psychology, University of Southampton. He has published extensively in the field of mental health policy.

Jen Kilyon campaigns for genuine informed choice in mental health care where those who need it can be in a safe place that is right for them. She promotes respectful non-judgemental and family/network inclusive approaches to psychosis such as Open Dialogue. Jen is an ISPS UK and Soteria Network Trustee and helped to set up the first Soteria House in the UK.

Neil Caton has lived experience of psychosis and has several experiences of being admitted to psychiatric unit, one of which was compulsory. He will explore his experience of these admissions. Neil has worked as an involvement worker for the early intervention service. He has been an ISPS UK trustee for 5 years and runs a hearing voices and paranoia group in Chorley.

Book Review of ‘A Kind of Mirraculas Paradise: a True Story of Schizophrenia’ by Sandra Allen

Review by Jessica Pons, ISPS UK member

Her family cast Uncle Bob as a drug abusing, ‘crazy’ misfit. After reading his life story (after he hounds her to try and get it published), Sandra questions this stereotype she’s learnt to accept and begins a journey of getting to know her uncle for herself.

Through reading his diaries and talking to him about his memories, it becomes apparent his stories are not the ‘delusions’ they initially appeared. At times Bob questions the validity of his diagnosis. I particularly like the way he talks about his medication: sometimes he wants to take it, whereas other times he’s not keen. Sandra allows Bob’s story to flow without neatly fitting into one model of thought around what it means to be diagnosed with schizophrenia.

Sandra shows a burgeoning critical mental health gaze. She begins to see past the lens of his diagnosis and through putting together his story, her beliefs regarding schizophrenia are challenged. She becomes more comfortable with having more questions than answers, more grey than black and white. This uncertainty is representative, I think, of where we’re up to when thinking about sensory experiences and strong beliefs.

A book that shows the vagaries of time and truth, I think Sandra Allen does her Uncle Bob justice in this version of his autobiography. Sandra tries to stay as close as possible to her uncle’s narrative. I think she gets the balance right between allowing the book to tie together, and allowing her uncle’s creativity and voice to come through.

https://www.amazon.co.uk/Kind-Mirraculas-Paradise-Story-Schizophrenia/dp/1501134035

ISPS UK is recruiting Trustees to join its Board

ISPS UK promotes psychological and social approaches to psychosis. We provide a place where professionals, people with lived experience of psychosis, family members and carers can share their ideas, hopes and struggles, and can examine their differences in constructive dialogue and debate. Our work includes organising national and regional conferences and workshops on key issues, supporting the development of local groups and special interest groups and promoting good practice in psychological approaches to psychosis.

If you are passionate about creating a paradigm shift in how we understand and treat psychosis, and can spare a half day a month, please consider joining us.

To apply to be a Trustee, please download our Trustee recruitment pack and send a CV and a covering letter to admin@ispsuk.org, by no later than Thursday 31st May.

Interviews will take place on the 12th and 13th June.

For an informal conversation about the role or organisation, please email us to arrange a chat with Akiko Hart.

We would especially welcome applications from those with extensive experience in any of the following areas:

  • Governance
  • Employment law
  • Financial planning and control
  • Event/conference management
  • Marketing and media relations

As ISPS UK is a membership organisation representing and bringing together a broad variety of people, we would especially welcome applications from individuals who

  • identify as having lived experience
  • are family members or carers
  • are psychiatrists
  • identify as BAME

 

 

Book Review of ‘Emily’s Voices’ by Emily Knoll

Review by Lucy Fernandes

I have oftentimes found solace and a sense of connection in other people’s memoirs, which is why I read ‘Emily’s Voices’, a memoir by Emily Knoll which was published recently by Amazon. It feels important to me, in light of the Hearing Voices Approach, that a voice hearer has taken the step of writing about her experiences and publishing them for other people to read and to benefit from.

Emily tells of her upbringing in a family where her mother prioritised her own emotional needs over those of Emily and her brother, and Emily was encouraged to keep her feelings about this silent. Emily’s mother puts pressure on Emily to succeed, especially in music, and often finds things to criticise about Emily’s cello playing. Years later when Emily is working as a live-in au pair, she finds herself up against a rather unkind employer, Gloria, who piles on the household chores and is very critical of Emily’s cooking. It is during this time that Emily begins to hear voices.

Emily’s voices make cold, critical comments about Emily as if they are scrutinising her from a distance. For example, one of her one of her voices comments ‘I think she makes no effort’. Elsewhere, Emily tells us about a conversation with her mother, where her Mum tells Emily ‘part of the problem is that you don’t make any effort to meet a boyfriend’. Emily hints at a connection between her upbringing and her voices by including the facts of her life all together in one memoir. However, she leaves it up to the reader to join the dots. I hear an echo between the way Emily’s voices talk about her, and the way she writes about her own life: clipped, unemotional sentences of broken commentary.

Emily helpfully discusses the stigma surrounding voice hearing and bravely admits that one of her biggest struggles is she stigmatises herself. We catch a glimpse of this when, worried about stigma, Emily tells her flatmate ‘My mental health problem doesn’t make me a psychopath’. I wonder whether Emily’s use of medicalising language is a way of self-stigmatising. Throughout her memoir, Emily frames her experience in terms of mental illness. Emily has internalised a medical view of her experiences, so much so that even her voices frequently diagnose her with schizophrenia, something she finds upsetting.

Emily looks in several places for support as she learns to cope with her voices. Two close friends, Beth and Daniel, talk openly with her about what she is going through, as does Emily’s Granny, who insists ‘a problem shared is a problem halved’. Emily writes poems, a journal, a short story, and connects to music to release her emotions. Her therapist, Daphne, supports her to begin to make sense of her voices. Perhaps the most important thing Emily does for herself is apply for a job on a research project about hearing voices. Here, her lived experience informs her work.

Emily’s Voices is a success for me because I felt I got to know Emily. I grew familiar with her struggles and, in doing so, I came to recognise the value of her achievements as, step-by-step, she makes her journey towards a life she can be happy with. For much of her life, Emily feels lonely and even one of her voices points out ‘she wants to be understood’. In the careful scrutiny of her life across the pages of ‘Emily’s Voices’, Emily lets herself be understood.

What is psychosis?

We asked attendees at the ISPS Liverpool conference: what is psychosis?

An introduction to the Power Threat Meaning Framework for ISPS-UK members

This is a brief attempt to introduce The Power Threat Meaning Framework to ISPS-UK members. It was published on January 12th in London and attracted much interest with over 400 attending the launch.

A group of senior psychologists (Lucy Johnstone, Mary Boyle, John Cromby, David Harper, Peter Kinderman, David Pilgrim and John Read) and high profile service user campaigners (Jacqui Dillon and Eleanor Longden) spent five years developing the Power Threat Meaning Framework as an alternative to more traditional models based on psychiatric diagnosis. They were supported by researcher Kate Allsopp, by a consultancy group of service users/carers, and by many people who supplied examples of good practice that is not based on diagnosis.

The Framework was funded as a project by the British Psychological Society’s Division of Clinical Psychology, although it is not an official DCP or BPS set of Guidelines (suggestions for good practice) or Standards (codes of practice which are mandatory for psychologists.) Like many documents published by the BPS every year, it is a scholarly work intended to promote discussion and debate, and thus in the long term to contribute to evolving best practice and not just for psychologists

The Power Threat Meaning Framework is a new perspective on why people sometimes experience a whole range of forms of distress, confusion, fear, despair, and troubled or troubling behaviour. It is an alternative to the more traditional models based on psychiatric diagnosis. The Framework summarises and integrates a great deal of evidence about the role of various kinds of power in people’s lives; the kinds of threat that misuses of power pose to us; and the ways we have learned as human beings to respond to threat. In traditional mental health practice, these threat responses are sometimes called ‘symptoms’. The Framework also looks at how we make sense of these difficult experiences, and how messages from wider society can increase our feelings of shame, self-blame, isolation, fear and guilt.

The Power Threat Meaning Framework is thus an over-arching structure for identifying patterns in emotional distress, unusual experiences and troubling behaviour, as an alternative to psychiatric diagnosis and classification. The document sets out the conceptual and empirical basis of such a system and is intended as a foundational intellectual resource. It is important to note that it is not tied to a particular level of explanation (social, psychological or biological) or to a specific theoretical orientation such as cognitive, behavioural or systemic. Thus while it can be used as it stands, it can also be seen as a meta-framework within which many existing models and bodies of evidence can be accommodated, and which can be used to inform future projects translating the framework into practice.

To put it at its simplest, the PTM Framework replaces ‘What is wrong with you?’ with four key questions:

  • ‘What has happened to you?’ (How is Power operating in your life?)
  • ‘How did it affect you?’ (What kind of Threats does this pose?)
  • ‘What sense did you make of it?’ (What is the Meaning of these situations and experiences to you?)
  • ‘What did you have to do to survive?’ (What kinds of Threat Response are you using?)

Translated into practice with an individual, family or group, two additional questions need to be asked:

  • ‘What are your strengths?’ (What access to Power resources do you have?)
  • …and to integrate all the above: ‘What is your story?’

The PTM Framework offers a structure for restoring the links between meaning-based threats (such as betrayal, abandonment, physical danger) and meaning-based threat responses (such as hyper-vigilance, self-injury and carrying out rituals.) Placing all of these in the wider contexts of power and social/ideological meanings helps to identify some broad, probabilistic and overlapping General Patterns and regularities organised by meaning rather than (as with medical diagnosis) by biology.

The Framework offers a way of constructing a non-diagnostic, non-blaming, de-mystifying story about strength and survival, with the potential to re-integrate many behaviours and experiences which would currently be diagnosed as symptoms of mental disorder. The overall message is: ‘You are experiencing an understandable reaction to difficult circumstances. Anyone else who had been through the same events might well have ended up reacting in the same way. However, these survival strategies may no longer be needed or useful. With the right kind of support, you may be able to leave them behind.’

A main aim of the PTM Framework is to restore the aspects that are marginalised and obscured by current diagnostically-based practice: the operation of power, the links between threats and threat responses, the wider social, political and cultural contexts, and the meaning-making and agency of those who are struggling to survive within their embodied personal, social, socio-economic and material environments. Narratives in the broadest sense can offer, and in many settings and cultures already do offer, a rich and meaningful alternative to psychiatric diagnosis. The PTM Framework suggests ways of supporting, conceptually, empirically and practically, the construction and co-construction of narratives, both within and beyond service settings.

 The Power Threat Meaning Framework can be used as a way of helping people to create more hopeful narratives or stories about their lives and the difficulties they have faced or are still facing, instead of seeing themselves as blameworthy, weak, deficient or ‘mentally ill’. It highlights and clarifies the links between wider social factors such as poverty, discrimination and inequality, along with traumas such as abuse and violence, and the resulting emotional distress, confusion, fear, despair or troubled/troubling behaviour. It also shows why those of us who do not have an obvious history of trauma or adversity can still struggle to find a sense of self-worth, meaning and identity.

As well as having implications for therapeutic or clinical work, the Framework suggests constructive alternatives in the areas of service design and commissioning, professional training, research, service user involvement, peer support and public information.

It is important to note that Power Threat Meaning is an over-arching framework which is not intended to replace all the ways we currently think about and work with distress. Instead, the aim is to support and strengthen the many examples of good practice which already exist, while also suggesting new ways forward. The ideas presented in this project are necessarily described mainly at a theoretical level, and much more work will be needed to translate the conceptual framework into practice. The project team welcomes feedback and suggestions for adaptation and improvement, acknowledging that at present the work is at an early stage of development. This is something that ISPS-UK members would be encouraged to do. The longer term aim is to make the PTM Framework into a publicly available resource, by developing accessible versions and materials to support professionals, carers, service user/survivors and anyone else who is experiencing/working with emotional distress. In the meantime, the Appendices in the Overview give some examples of how non-diagnostic alternatives are already operating, together with suggestions and resources for further implementation of these ideas and principles.

There has been much interest on social media about PTFM especially twitter and blogs.

There have been a number of blogs discussing it and an article in The Independent which are well worth looking at:

https://criticalmhnursing.org/2018/01/26/a-mental-health-nurses-first-response-to-the-launch-of-the-power-threat-meaning-framework/#more-1364

https://pegortwo.wordpress.com/

http://www.independent.co.uk/voices/mental-health-trauma-services-mother-family-individual-children-a8215511.html

Among the comments are: ‘It allows people to create their own theories about their lives”.

It is “like a road map the PTFM offers a whole lot of routes but not necessarily the destination. We are going to have to work out where it takes us.” “How could it be applied to organisations that are seen as coercive?” There has been discussion about how to apply it within systems that are so diagnostically-driven, as well as often based upon a business model.

I would recommend all ISPS-UK members to read it and give it a try! The Framework attempts to give us an alternative way of working with MH problems, something that many of us have been wanting for a very long time.

The PTM Framework versions and resources:

The full version is quite long and detailed and consists of eight chapters.

http://www.bps.org.uk/PTM-Main

  • Introduction
  • Chapter 1: Problems of medicalisation and diagnosis
  • Chapter 2: Conceptual and philosophical issues
  • Chapter 3: Meaning and narrative
  • Chapter 4: The social context
  • Chapter 5: The role of biology
  • Chapter 6: The Power Threat Meaning Framework
  • Chapter 7: Service user consultation
  • Chapter 8: Ways forward
  • Appendix 1: Evidence supporting the General Patterns

A shorter overview is available online as well and consists of Chapter 6 in the main document and is probably the best place to start to understand the Framework for ISPS members. It is available on request as a hard copy from membernetworkservices@bps.org.uk.

http://www.bps.org.uk/PTM-Overview

There is also an introduction on the BPS website as well as a guided discussion and slides from the launch. These give a quick introduction to the Framework.

https://www.bps.org.uk/news-and-policy/introducing-power-threat-meaning-framework

Alf Gillham

20/02/17