The art of mental health care

One of the things I have been most grateful for during my academic career was the opportunity to travel the world. I’ve been able to visit places I might have only ever dreamt of seeing short of winning the lottery. Teaching, research and publications were (and still are) the currency that gave academics a voice. You really needed to be good across each of these aspects to ensure your voice was heard by as many folk as possible. One great opportunity to use your voice is at conferences. Prior to the pandemic, conferences were lively gatherings where people could meet, present their research and thinking and, of course, network. Many folk, like me, also enjoyed the opportunity to visit foreign lands.

Often the conferences I spoke at were those that focused upon mental health, mental illness and wellbeing. It’s true to say that over the years I would meet some familiar faces at these conferences, and strong, lasting friendships grew out of these regular ‘meet ups’. One of these relationships was with a legend in mental health care – Phil Barker. He was 20 years in front of me as an academic, and was a prolific author and researcher. He was also a highly regarded psychotherapist and nurse. In 1987, he became the first Professor of psychiatric nursing in the UK. I became Professor of mental health care in 2006. This was an interesting year for lots of reasons; more later.

Phil and I also shared other similarities. Both of us only wore black. We both loved silver jewellery. Whereas I let my hair grow long, he kept his short. but had the most amazing ZZ Top beard. We both enjoyed philosophy and the use of words to explore ideas. He always wore red clogs, whereas my clog collection is a lot more colourful. He is a lifelong runner, and runs every day. I’m a walker, and I walk every day. Now you may be asking what has any of this to do with the price of eggs? It’s a question my mother would often pose.

Well in 2006, while staying at Trinity College, Dublin, Phil had an epiphany. He realised that most of the people he encountered in his work as a psychotherapist were shadowed by ‘the ineffable’: that is a kind of intuitive understanding of what it was that troubled them, but an inability to put it into words. The following day he resigned his Professorship at Newcastle University. He returned to his native Scotland and using art, began to explore the ‘ineffable’ that shadowed his own life. Retiring from academia, Phil left behind a legacy that continues to influence contemporary mental health care. In 2004 Phil and Poppy Buchan-Barker (Phil’s wife) published what has become a seminal piece of work, ‘The Tidal Model: A Guide for Mental Health Professionals’. It was a book on mental health recovery. The book drew upon almost five years of research with his colleague Dr Chris Stevenson. At the time, it was a significant alternative model to the prevailing psychiatric theories of care. It emphasised how individuals living with a mental illness could benefit from taking a more active role in their treatment and care.

There isn’t room in this blog to explore every aspect of the Tidal Model; you can listen to a brief explanation by Phil here, or a slightly longer version here (look out for the red clogs). Phil defines the Tidal Model as ‘a philosophical approach to the discovery of mental health. It emphasises helping people reclaim their personal story of mental distress, by recovering their voice. By using their own language, metaphors, and personal stories, people begin to express something of the meaning of their lives. This is the first step towards helping recover control over their lives’. Phil describes a number of key philosophical assumptions that underpin the Tidal Model.

These are: a belief in the virtue of curiosity; recognising the power of resourcefulness, instead of focusing on problems, deficits, or weaknesses; respecting the patient’s wishes instead of being paternalistic; accepting the paradox of a crisis as an opportunity; acknowledging that all goals must belong to the individual patient; and recognising the virtue of pursuing elegance, the simplest possible means should be sought. Fundamentally, the mental health professional should believe that recovery is possible. Perhaps this sounds rather obvious, but sadly it’s not always the case.

Now you might still be wondering, interesting as all this is, what does it have to do with the price of eggs. Well last week I self indulgently poured myself a hot Vimto and enjoyed one of the Guardian newspapers ‘long reads’. If you have time for a cuppa, you can also read it here. It is a beautiful and eloquent piece written by Gavin Francis. In nearly 20 years as a GP, he has, as a result of the pandemic, become more aware of the concept of recovery and the individual experience of illness and expectations of wellness. His many years of medical training took for granted the western bio-medical approach to the body. What Gavin, like Phil, has come to realise is that illness is not simply a matter of biology or pathology, but also one of belief, culture, sociology and psychology. For me there are a couple of sentences in his piece that capture the notion of recovery so well. In Gavin’s own words: ‘All worthwhile acts of recovery have to work in concert with natural processes, not against them… …a doctor who sets out to ‘heal’ is in truth more like a gardener who sets out to ‘grow’ – actually nature does almost all the work’. It seems to me, as health care professionals, we should try and keep this in mind, as we work with our patients and their loved ones.  

And 2006. Almost the last time I saw Phil was in 2006 in Alice Springs, Australia. It was a great conference in lots of ways. He was a judge of the conference papers and awarded first prize to the one that my long time writing partner, Prof Sue McAndrew and I had presented. The story doesn’t end there. The following year, I was in Finland, attending the public defence of one of  my Finnish colleagues as part of his PhD studies. Phil, was one of the external examiners. We raised a glass or two. These days, under the new name of Phil McLoughlin (in honour of his grandfather), Phil has now returned to his artistic roots and has taken up painting full time. In his own way I’m sure he is on his own path to recovery. I believe all health care is an art. For me, the art is when to use the science and when to let it lie.