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This tide's already changed

The recovery approach in mental health is not new. Our research-based recovery model has been operating across the world for 10 years, say Phil Barker and Poppy Buchanan-Barker.

April 9, 2008


Recovery may be, according to the Sainsbury Centre for Mental Health, ?an idea whose time has come?, but it has been around for at least 70 years.

In the 1930s, Carl Jung?s belief in the power of conversion influenced the birth of Alcoholics Anonymous (AA). People had to believe that they could recover and that god would help them change. To this day, most AA members believe that alcoholism (and drug addiction) is a disease, but one they can recover from, by handing one?s destiny over to god and enlisting the support of fellow travellers. Their success confirms Jung?s hypothesis that belief can move mountains.

The current mental health recovery story is little more than a footnote to AA. Recovery still belongs to those who ?believe? ? whether in god or themselves. However, recently it has been argued that recovery belongs only to people who ?use mental health services?. The Sainsbury Centre for Mental Health recently warned professionals from trying to ?take over the concept of recovery?. This sends quite the wrong message.

Like ?mental health?, recovery must be everyone?s business. Proposing that recovery only applies to people who are, or have been, ?service users? perpetuates the old ?us-and-them? mentality, which bedevilled traditional psychiatry. ?They need to recover because they are ?mentally ill?? (or otherwise broken). ?We have no need of recovery, because we are sane? (or perfect). What nonsense!

Everyone is fragile, weak, and generally messed up, at some point in their lives. Most people manage to keep a lid on their distress and disturbance. Caring for, and about, one another is critical. As GK Chesterton said: ?We are all in the same boat on a stormy sea and we owe each other a terrible loyalty?

Over 25 years ago, we started to write about the ?problems of living?, recognising that ?life? was the problem ? not some abstract ?illness?. Just because we did not carry a diagnosis hardly meant we were perfect, and certainly didn?t mean we had no problems. We also realised that people had resources that sustained them since, given their circumstances, they could have been much worse off. Rather than trying to change people through ?therapy?, we needed to help people use these resources to make their own life changes.

In the mid 1990s we pulled these assumptions together into what became the Tidal Model of Mental Health Recovery. People needed hope, if they were to put their past behind them, but they also needed others to believe in them - as persons. The big question was - how to help people make their own recovery?

We knew there could be no answers ? just lots of questions. A single definition of recovery was impossible since, like love, loss and pain, recovery will mean different things to different people. We discover that meaning by helping people talk about it.

Once people can talk about ?where? they are in their lives, they can begin to imagine where they would like to be in their lives. We reframed Lao Tzu?s famous saying: ?the journey of a thousand miles doesn?t begin with the first step ? it begins in your imagination?. How could we help people use the power of their imagination to make changes in their own lives?

People told us that recovery meant ?taking back something they had lost?. For many, it was the act that was most important. This helped us develop the concept of reclamation: ?seeking return of one?s property?. When people become ?patients? or ?service users?, their most important possession ? their personal identity - is taken from them. If they are to live a full and meaningful life, the first step is to reclaim the story of their life, spoken in their own, inimitable voice. They need to become persons who steer their own life course.

The Tidal Model is, arguably, the most radical recovery model. It focuses all its attentions on helping people reclaim their voice; own their life story; be their own person. All the practical processes of the Tidal Model were shaped and refined by people with experience of serious breakdown and hospital care. The individual and group work approaches help people ?take back? the story of who they are as ?persons?; including the story of how life created problems for them. All this is spoken and written in their language ? not in professional jargon. Day by day, people write new pages of their life story, exploring what they need to do to move on. In so doing, they become more aware of the resources that might help make this happen.

The Tidal Model is recognized internationally as a key theory for the practice of mental health nursing. It is probably also the first recovery model to be subjected to rigorous research, within mainstream health and social care settings. Over 100 Tidal projects have been established across most of Scotland, as well as Wales, England, Ireland, Canada, Japan, Australia and New Zealand. These services are developing person-focused care across the health and social care continuum: from outpatient addictions, through acute and forensic units, to the care of older people with early stage dementia. In Canada, colleagues are using the Tidal Model in palliative care, as an alternative philosophy for the care of people who are dying.

This reminds us that recovery is not a ?thing? and certainly is not a destination - it is something we do in our lives. We cannot become ?recovered?. We try to become wiser in dealing with the problems that life throws at us. Once we have ?solved? one problem, life will doubtless throw us another. This is far from easy and many people do not wish this responsibility. However, people have told us that this helps them make sense of their pain and distress. It also helps professionals reclaim their vocation ? recalling why they wanted to help people in the first place, and what this might say about them as persons.

Like recovery, reclamation is everyone?s business.

* Phil Barker is a psychotherapist in private practice and honorary professor at the University of Dundee. He was a mental health nurse for more than 35 years and the UK's first professor of psychiatric nursing practice. He is also professor of health science, Trinity College, Dublin, Ireland

* Poppy Buchanan-Barker is a counsellor, advocate and director of Clan Unity International, Scotland.

They have, between them, authored a number of books, including The Tidal Model: A guide for mental health professionals and Spirituality and Mental Health: Breakthrough


Enlightened thinking

From: Margaret Reardon, team leader, Partnerships in Care, UK
Date: March 18, 2010

The ward I am currently working on has introduced the Tidal Model. Initially I thought it was another paper exercise. However, having gone on a RAID approach dealing with people who have a mental health problem, personality disorder or learning disability I feel I can relate it towards the Tidal Model which looks at the recovery model.

This article has enlightened my thinking about more effective ways I can help people recover to some kind of normality.


This Tide's going the same way

From: Kevin Leighton, health and social care tutor, further education college, UK
Date: November 2, 2010

No, the tide's still running in the same direction - preoccupation with the individual. The Tidal Model appears to be loosely based the principles of Eastern philosophy and religion, yet one of the most important of these principles is to minimise 'self' and embrace broader forms of experience. In mental health care this would mean reducing the contemporary fixation with individual problems/therapies and re-emphasising the importance of balanced community life. Put simply, regular socialization within a sane, functioning community group is potentially far more effective than specialist individual therapies. These approaches only tend to reinforce the idea that the person is somehow 'challenged' (and therefore signalled for a career in therapy). We need to focus on healthy community solidarity first and the unhealthy individual second. Blasphemy!

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