Terry  Couchman
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Most of the 'pressure' is currently coming from Service Users, who feel that service shortfalls should be addressed as a priority. It appears that we may be being too polite. That is my fault.

For the future, in the left hand column you will see more forthright declarations of the most serious contributions to poor mental health and social distress. I am afraid institution play a significant part in this and professional's are implicated by association, a few deserve it.

I realise that many of the topics being discussed on this web site appear highly complex. I have been criticised for talking over peoples heads at times. I don't apologise for this. Even professional people have difficulties with many of the issues we deal with; especially understanding the mechanisms of mental health & social distress.

Challenging established assumptions and institutionalised conduct, requires sound argument and evidence. Emotional arguments will not carry any weight against formal institutions, They are too well defended, but public embarrassment, with substantiated facts will have a more profound effect, benefiting Service Users and Professionals.

There is now enough evidence to dismiss many of the underlying assumptions concerning mental ill health & to implement Government recommendations, based upon the principles and law of human rights. The failure of Institutions to recognise and adequately pass on and implement these principles will be now challenged by public action.

There are also many Service Users who are capable of understanding these complex ideas and alternative perspectives. It is the discussions we have with them, as well as professionals, that show they recognise the same contradictions that are becoming recognised generally, affecting mental health and personal wellbeing. We will be organising Conferences and Campaigns to highlight these issues.

Service Users have suggested, or evidenced, alternative perspectives and further provide some of the evidence to support the validity of alternative theory. I ask those not academically inclined to forgive our indulgence. We have your interests at heart in challenging the established assumptions. Campaigns will be the other channel for expressing Service User and Professional frustrations.

Dummying Down:
It is not my job to assume that everyone is 'dumb'. I am not into 'dummying down'. There is too much of it already. My job, as I see it, is to present the various emotional and intellectual arguments that arise and try and stimulate theory and other forms of rationale that better explain the contradictions that arise with current theories, based upon current assumptions. That is the Scientific and Ethical thing to do.

Mental health is a positive human attribute and is what makes us the highly adaptive species that we are. In the West, in particular, we completely misunderstand mental health 'defences' and 'psych-social adaptive processes'.

Over 100 years ago, Freud took 'Fable' explanations of variation in behaviour, thinking and morality, intended to illustrate human variety and complexity. He then used these to explain 'pathologies', along the ancient 'health' model. This is the only, half scientific, model that Freud had available at the time.

These Fables were not seen as forms of 'mental illnesses'. They were descriptions of differences in experience, behaviour & predictable consequences. They were lessons and warnings for the masses. The science of the times. Other fables, religious axioms and 'Old Wives Tales', did similar jobs in explaining social and physical phenomena.

Everything in modern, conventional, 'mental health' practice has been built upon misperceptions of Fables & Religious Morality (which had already become corrupted in meaning over centuries). Like so many quasi-spiritual, economically driven, distortions, they are prejudices; geared to validate and maintain the status quo. To keep things within a narrow band of Western Capitalist, or even Communist 'normality'.

There is little to choose between them once they are distorted towards selfish ends. Any quasi-scientific, clinical or social model, or theory that encompasses these prejudices is bad science and dishonest. Our current prejudices and distortion lead to racism, sexism, ageism and just about every other injustice (the Law has developed along similar lines, from similar assumptions and with similar intentions).

People take different courses according to their 'little geniuses' and their particular social experiences. 'Others' then try to put them in the 'normal' 'box'. That is what makes people mentally ill and disabled. We do it, mostly in ignorance, but there is also some fear and provocation involved. We are protecting our own insecurities by doing this (Think about Racism, Sexism, Ageism, Fascism - This is Mentalism!)

It is on the basis of current theory and rationales that current practices are implemented, including those that are disempowering and create high dependencies. Service users, who look at themselves and these rationales more critically, are dissatisfied. They know something is wrong, some know more precisely what it is but are not listened to.

This institutional resistance to active democratisation of services, is seen as a complacent attitude of those who perpetuate outmoded and disabling ideas and practices. I do too, since early in my career. Newcomers often see  the flaws. They often come in from 'outside the box' and see the contradictions.

Just because something is 'comfortable' and has been around a long time, doesn't make it right, or effective. Besides, even if a basic theory had some greater credibility, it is still possible for its interpretation to become distorted and practices continue to be inappropriate. That happens to, it is difficult to stuck to inconsistent rules.

The need for better understanding, in order to 'widen' choice and to empower, is embarrassingly obvious to many and I believe this is a crime. There are so many vested interests in seeing mental illness as an intractable weakness, usually needing clinical interventions. It is convenient for those in secure and powerful positions, not to act and even actively resist changes.

It suits some established professionals & managers, drug companies, powerful institutions, like police & courts, irritated neighbours, some members of family, abusers and bullies, employers wishing to distract from their negligent, unreasonable and abusive practices, anyone looking to blame someone else for their problems, or hide their incompetence, prejudice and ignorance..

Well We Are Not So Dumb After All:
Those using this web site can take from this whatever they find helpful and at whatever level they find meaningful. I would encourage any person, with any intellectual skills, to work through the more challenging sections and ask questions. There will be 'Service User / Survivor Conference staring soon and there will be opportunities to get hands on, alternative perspectives on these issues.

I am not arguing a 'purist' position, just a need to take a more rational, constructive, evidenced based perspective on Mental Health. Not superficial evidence either; that is open to prejudice and this is why the observations need to be reflective and critical, of ourselves, other practitioners, institutions practices, policies and theories.

My own remaining 'prejudice', based upon the balance of probability, explaining the most abusive behaviours, is that there are Psychopathic (mostly 'regressive' genetic tendencies) that underlay some 'normal' & some 'mentally distressed' people's personalities, which are intractable and are resistive to social treatments. This is the real mental deficit.

There are also seriously damaged, Sociopathic individuals, who are resistant to looking at the abusive part they play in their own, as well as others distress. Extreme cases are relatively rare. These damaged individuals can have any mental health, or drug and alcohol problem, which then exacerbates the sociopathic character and behaviour. This is the bit that may necessarily require persistent 'clinical treatment'.

All other forms of mental health trauma, breakdown, prejudice or misdiagnosis, are substantially recoverable from, or can be adjusted to feel 'safe' and relatively creative and adaptive features which can benefit the person and others (as was, before the breakdown - See inside for more details). Make room for 'difference', it is your fear that tries to suppress it in others, rather than understand and respect it.

Service Users are often more capable of understanding these issues than they are given credit, and, if they wish, they can submit their own alternative views and theories. Some may need some help getting a handle on these new, alternative perspectives, after all they have been brainwashed by everybody for long enough. I hope that clears up that concerns, anyway.

Reflection on Radical Practice:
Personally, I really enjoy seeing someone with schizophrenia, or a bi-polar condition, later being identified as 'misdiagnosed'. No cure needed then! Just a change of perspective (usually with a little push :-) The point is, I found it incredible that these mistakes happened so often and with such damaging consequences.

As far as I know, only one of my clients have sued an Institution. His 'paranoia' was the result of institutionalised sexual abuse in the care of education and social services. You know the one, there was also a politician involve. Perhaps not, there are so many.

Anyway I don't want to be too down on people. We are here to inform, to enlighten, so that we may learn to trust the statements of those we care for, irrespective of how bizarre they may seem at times. The problem is, once we loose our client's trust it is very hard work for the rest of us to undo the damage (and it costs a lot).

Reading between the lines is a skill we can all acquire and, respect for others accounts of the important perceptions of their histories, is an obligation we have (whatever our own beliefs and experiences). Lets listen more to our clients & patients, really listen I mean.

Clients & Patients tend to make more sense when the fear, anger and frustration (at being misunderstood, ignored and mistreated) has subsided. That is assuming there is someone who is not afraid of having their own beliefs challenged and are willing to patiently listen, of course.

I was actually looking for a 'social cure' for schizophrenia and thought I found it, clients taught me there was a 'solution' and usually no cure was needed. I will make do with that. We need to watch our judgments. No wonder it is usually the young who see the errors. It is a shame they are kicked into line so often. The system is abusive in that respect. It knocks initiative out of us.

There are now a number of basic levels to usefully address:

1. Experiences, Concerns & Complaints of Service Users and Family Carers. The need to properly collate and incorporate these concerns into the development of policy and practices.

2. The active encouragement & support of Service User & Family Carer Initiatives, in an endeavour to help them provide their own Forums & Cooperative Services (appropriate to each of their needs). This is the next stage beyond 'Direct Payments'.
    

3. The Critical Ethical and Practice concerns of Professionals, especially in competing for funding and resources and in ensuring the more effective & appropriate use of those existing resources, to maximum benefit to Service Users.

4. The critical consideration of Legal & Social Policies and Strategies of Government & Institutions [including implications of / for Human Rights], in the light of present practice, expressed Service User concerns and known service shortfalls.

5. Health & Social Theory as it affects 'Mental Health' in its widest sense. This requires a fundamental revision of the basic assumptions concerning the underlying causes of what is essentially a 'classification system', with little evidence to support existing trends in identifying 'causalities'.

6. Issues of Ethics, Morality, Social Inclusion, Accountability, Responsibility, Culpability, Best Practice, Least Restrictive Practice and Empowerment, etc. (You know, all those wonderful words and ideas, printed out in glossy brochures)

7. The critical overview and considered incorporation of many other modern 'concepts' that arise out of 'Human Rights' legislation and 'Best Practices' (including those which may appear to contradict Human Rights).

Amongst this last category is the complex issue of 'Mental Capacity' and the responsibility we each now have to demonstrate, through evidence, a person's lack (or otherwise) in each specific, critical area of their lives.

We then have the additional responsibility (where Capacity is lacking) to seek evidence to support proposed actions that would be in keeping with the person's known and understood wishes. We have to do this in cooperation with family members, other professionals and advocates, who may think, or see things, differently.

Student Updates:

Try this link today: Conspiracy Theory
It needs tidying up but it should be informative & fun.  I really would like your feedback. It could make a good basis for an Essay, or Two (or three :-)

Another Recently established section is Health & Social Care. It contains a page on the brief History of Health & Social Care. Health & Social Care were not separate disciplines, once upon a time.

I am developing challenging 'Social Analytic', 'Psycho-Social' pages in this section which I am calling 'Social Health' (see links on Left). These are attempts at unifying medical and social models.

Apologies; this work is still in the early stages of development but is supported by 'The Theory' section, which I will be doing some more work on over the weeks. Another section, presents our arguments at a more emotional level, is: 'Cut The Crap'

I think students may find these challenging and I will get some useful links in these section eventually. Social Analysis is a valid counterpart to Psycho-analysis. Psych-social perspectives have can provide improved, mutual understandings.

The focus is on identifying the wider context of personal, family and institutional problems. Context and expectations have a significant impact upon people' ability to thrive, socially and clinically. Many people are resistant to Psychotherapeutic approaches and Cognitive Therapy is too technical for others.

I have successfully used the principles of Social Analysis, in Therapeutic Counselling, for many years. I have also developed a full fledged therapeutic approach which I call Psych-Social Therapy, These offer a good balance between 'generic' psychotherapy and cognitive therapy, with a twist of 'Reality'.

The value of using these approaches is that the client identifies the 'stories' and 'metaphors' that best represents, models and communicates their experiences. These models need to be 'sharable' in some way, of course, but any social engagement can be therapeutic & any shared model can be 'good enough'.

Any arts medium, News Media items, Relationship examples, existing therapeutic, even mechanical, domestic & technical 'models' can but utilised in the establishment of the clients 'theory' about the psycho-social world that they inhabit.

This essentially creative process is empowering and shareable, without need of highly intellectual analysis (except for those wanting to know how & why the 'magic' works). See: Psycho-Social Therapy

Intellectual Challenges:

All Community Institutions have a significant effect upon people's motivation and skills, to take responsibility for their own lives. When institutions become institutionalised and assert executive power, they have the effect of disempowering Workers and the Service Users. They become less effective because they become less adaptable to individual needs.

Insecure and defensive Institutions arise because initial incompetence (often due to micro-management and risk averse policies) produces 'reaction' from increasingly 'aware' Service Users. As long as there is imbalance of power & responsibility, the relationship between institution and citizen is going to be potentially strained and give rise to complaint & litigation.

The necessary skills and motivations are there, within any workforce (and waiting in the wings, within more adventurous projects) to enable Service Users to get the service they need, in a form that empowers. This enables them to take responsibility for informed decisions and thereby reduce the risks to a level that suits them. This then reduces the risk of litigation.

Defensive and controlling institutions increase risks to Service Users and increase the possibilities of litigation, due to the fact that they hold on to the power. They therefore, by default, retained the responsibility. Risks can not be 'eliminated' without depriving people of their rights and freedoms. It is not enough to "close, or pass on cases as soon as possible". This is all unprofessional and damaging to clients & families.

The risks must, of course, be seen to be assessed, informed, managed, and reviewed. That also involves 'risk' but it should be the individual professional's accountability, 'supervised' by advisory service managers. Micro-management does not work. It disempowers and frustrates 'responsible actions'. Get your team right, provide the resources and encourage initiatives.

The ultimate power should be with Service Users, empowered through the support of competent professionals and other informed carers, monitored by independent agencies, ensuring that a balance of power has been achieved, adequate resources provided, shortfalls recorded and care & risk plans agreed and set down for all agreed actors in the care plan.

This does not have to be very complicated. The obligation is to provide services to a level that enables the Service User to enjoy a normal life, as independently and informed as possible, using their own and normal community resources, to provide the bulk of support, with an informed level of risk that the service user 'chooses'. They should have their own 'Notes'.

To achieve this, we need to consider the 'optimum' level at which to provide services. Neither inappropriate to the needs and risks, or too restrictive, or inadequate. It is the professionals task, determined by ethics, to 'advocate' for Service User initially, then to inform and support them in advocating for themselves and to identify how, when and where to obtain the help they may need (contingency plan).

All professionals are then responsible (collectively) to ensuring appropriate relationships are established with any carers, family, voluntary, paid and unpaid. That these relationships are acceptable to the Service User and that everyone who is agreed to be involved, is informed and accepts the agreed plan and risks, as ultimately determined by the Service User, adjusting to take account of evidenced impairments of 'Mental Capacity'.

For further considerations along these lines, including the consideration of 'Mental Capacity' (affecting us all) please see the full article -  Go to: The Pros Unplugged

This Document is still at some stage of development. You are invited to respond and comment on its content and its logic. If you return to the document at a future date, you will be able to see its continued development, hopefully reflecting your own and others commentary.

I thank you, in advance, for any contribution that you make. Please also feel free to visit and contribute, in any valid way, to these and other social issues, through our Forums. There is also a Chat Room and protected Chat Space for more serious group discussions and individual counselling. Please feel free o use this space for your legitimate activities.

Copyright:

Although you will see very few reference to other formal writings in this document, I acknowledge general recognition to the discussions and debates that I have had with students, practitioners and clients over the years. Most of the ideas and theory has evolved through this rather pragmatic process (operational research), rather than any formal reading.

If any content of this document describes concepts, theory, or ideas that have been established else where, (prior to my writing, either here or else where - in part or in full), I acknowledge their entitlement to claim them as their intellectual property for financial purposes, if they can evidence this. I also reserve the right to retain them as my intellectual property, with due recognition to those who have made direct contributions, including other writers, should I identify such a past influences.

Other than this, I invite you to share and copy any content, to the benefit of intellectual debate and the benefit of individuals and groups, without restriction, other than it be used for constructive purpose, in the wider context of my writing.

Should you wish to use any material presented here 'as is', I ask that you then make reference to myself and the web site. The 'Reading Date' would be a useful 'publishing date' for the Current Edition. 1980 is the core publishing date for most of the basic ideas and theory (unless stated otherwise).

This 'Reading Date' may be an important part of this 'reference', as the document (by its 'internet fluid' nature) will be constantly changing and this may affect meaning and interpretation, for those following up on such a reference at a later date.

Thank you for your cooperation.

TRC. eMail: terry.couchman@visitweb.org

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