The ISPS UK annual conference 2025, held in Manchester in May, invited delegates to consider the theme “Beyond Them And Us: Finding Common Ground” and to participate in a trialogue session hosted by Dr Liam MacGabhann. Brief introductory talks by ISPS UK trustees offered context from each of the three perspectives of ISPS UK members: mental health worker, family/carer, and lived experience.
Reflections from Simon Downer
I am a psychiatrist working in the NHS and also a trustee of ISPS UK. I am aware that many, like me, struggle to work in more thoughtful and collaborative ways within a system that often valorises more hierarchical, medical and coercive approaches.
During this ISPS UK conference, as with most events, I identify myself as a psychiatrist just like I did at the very beginning of this reflection! How much I need that identity, choose to accept or reject it, or what it means for me are all things that are in a constant state of flux, and development. It often seems to dominate my presentation of myself, in preference to being a father, musician, footballer, son, partner, hiker, psychotherapist. It is a powerful label. And it creates for me a state of constant internal tension and conflict. I feel the need to accept my role as part of an abusive and violent system, one that deprives people of their liberty, disempowers them, and forces ways of understanding themselves upon them. But also wish to distance myself from it. It is interesting to me that how I express my professional identity hugely depends on the context.
“I’m a psychiatrist,” can be met with awe, excitement or disgust.
Others at this conference were invited to define themselves as ‘person with lived experience’ or ‘family/network member’. I wondered whether others felt as conflicted as I did in expressing that identifying label.
The day started, after an introduction by ISPS UK Chair Jacqui Dillon, with three short talks from trustees ‘representing’ those three groups.
I had the opportunity to talk to Dr Liam MacGabbhan the night before the conference, and understood something of the theoretical and deeply ethical basis of the trialogue approach. I helped him to move all of the tables so we sat in one large circle. In the process of doing that with him, I felt like I was helping to construct something. A space. Liam took the facilitative role, but did so in a gentle and inclusive way. People were invited to speak by raising a hand, and others listened respectfully. No one was asked to identify themselves when they started talking. No names, no roles. I felt apprehensive, and also excited. What would emerge? What would be created together? Many people spoke about their experiences of violence and abuse in the psychiatric system.
There were several moments of more acute tension. The most important conversations are also the ones that are hardest to have. One of earlier talks was by a social worker (and ISPS UK trustee) who spoke about her role as an AMHP (Approved Mental Health Professional) and how she also taught and campaigned against the current mental health law. One person shared their feelings about that. How could she continue to section people, feeling that way? It felt like a difficult moment, a point of real conflict. The conversation moved on, as it did all morning, because different people had many things to share not necessarily related to that which had gone before. Perhaps this is the challenge of working with such a large group, and a group that was only just formed, was that it was harder to stay with that. We were able to continue our discussions in smaller groups in the afternoon, but again those were groups that had only just formed. In creating consistent and stable relationships together it becomes possible to have difficult conversations. Coming to appreciate our internal conflicts and tensions, as well as those with each other, is painful and challenging. To stay with it and not move on is equally difficult, and requires a sense of relational stability.
For this conference, using trialogue as its core approach was an inspiring way of allowing those tensions to be felt and spoken. It is only through being able to authentically speak our feelings can we truly be able to forge lasting allegiance. Even awe, excitement or disgust.