Source: Griffin and Tyrrell (2004) Human Givens
Air to breathe, water, nutritious food and sufficient of the right quality of sleep.
We also need the freedom to stimulate our senses and exercise our muscles. In addition, we instinctively seek sufficient and secure shelter where we can grow, reproduce ourselves and bring up our young in safety.
Our physical needs are intimately bound up with our emotional needs.
Emotional needs include:
... security safe territory and an environment which allows usto develop fully
... attention (to give and receive it)
... sense of autonomy and control
... being emotionally connected to others
... being valued by the wider community status
... friendship and intimacy
... meaning and purpose which comes from being stretched in what we do and how we think.
If these needs are not met as we grow up, we easily become needy, greedy, angry, anxious and depressed hugely negative forms of emotional arousal.
Innate human resources
Nature programmed resources which evolved alongside our needs include:
The ability to develop complex long-term memory, which enables us to learn and add new knowledge to our innate knowledge.
The ability to build rapport, empathise and connect with others.
Imagination, which enables us to focus our attention away from our immediate emotional responses and solve problems more creatively and objectively.
A curious, conscious, rational mind that can check out emotions, question, analyse and plan (a left brain hemisphere activity).
The ability to store and develop knowledge that is, to understand the world through metaphorical pattern matching (an unconscious, right brain hemisphere activity).
An observing self the awareness of being aware: that part of us which can step back from our intellect, emotion and conditioning and be more objective (a frontal lobe activity).
The ability to dream, which discharges unexpressed emotional arousal from the day just gone to free the brain to deal with the next days emotionally arousing concerns and thus preserve the integrity of our genetic inheritance.
Even in this truncated list form, it is possible to see how many of these needs and resources could be used to provide a simple yardstick for gauging the effectiveness of an institution, political policy, company or service: in other words, how well it measures up to the criteria of meeting physical and emotional needs - the human givens.
All around the country Primary Care Trusts are struggling to develop mental health services despite significant investment. Since the National Service Framework in mental health came out in 1999, every Primary Care Trust has been busy setting up secondary care teams in assertive outreach, crisis resolution and home treatment, as well as looking at ways of treating the anxious and the depressed that are so prevalent in GPs surgeries. A single visit to Hartlepool MIND has convinced me that community mental health services, for all grades of mental illness can be brought together under one roof.. What Hartlepool MIND are achieving is truly revolutionary and enlightening.
Last year Hartlepool MIND saw 800 clients, nearly 1% of a 90000 population. Most of these walked in off the street, though more and more are being referred to them by the health services including the Psychiatric Consultants and local GPs. Some are referred whilst on the psychiatric ward. They are now even getting clients sent direct from the courts, though the first they knew of this was when the clients arrived on their doorstep..
Most of us who work in the Health Service are aware of the law of chaos, whereby any useful effective service soon gets snowed under and waiting lists quickly form. How does Hartlepool MIND prevent this? Their answer is that they help the patients rehabilitate themselves, so that they become active members of the community, often with employment, by teaching them to discover the mental resources that they never knew they had, but are in us all. The client then has better things to do with their time than attend mental health services and there is always an open door should they need to return, which is unusual. They have thus done away with drop-in-centres and the like, which they see as fostering dependence. The goal is to give the client as intensive care as they need, but to keep them in the service for only a short period.
The average stay in treatment is around four months, with only the very rare exceptions being more than eight months. The centre works nine to five, five days a week, but clients can attend daily at first, if it is felt appropriate. Money for running the centre in this manner, at first came from the New Deals for Communities grant, a regeneration package for the most deprived areas in the country. Most of the funding still comes from voluntary sector grants, though we did meet the PCT commissioner, whilst we were there, as the Primary Care Trust is also a contributor.
The Centre works based on a Human Givens Approach. Human Givens uses the theory that in us, Human Beings, have the resources and indeed are genetically programmed to seek our needs as human beings, but if these needs are not met, then we dont thrive mentally or indeed physically. When our needs are not met this may show in a number of ways including depression, anxiety, psychosis or delinquency. These needs can be summarised in the following list:-
- To be Connected to others
- Autonomy and Control
- To be part of the community
- To be stretched intellectually and physically
New clients are assessed by one of the centre managers to identify their unmet needs and an action plan is formulated. The action plan looks at who needs to be involved and what activities need to be carried out, with target dates. A positive approach is then taken to therapy, the client is made to feel it is going to work. Then, working on the Human Givens basis that we all have the resources to gain our human needs, though some of us may never have learned how to access them due to their circumstances, or they may not be using them appropriately, clients are taught life skills. Social needs are also fully investigated and clients may be taken to see a housing officer, a debt counsellor or a job broker.
A client may get the benefit of attending one or more of the 27 courses which they run according to demand and are listed.
- Anger Management
- Caring for Yourself
- Dealing with disputes
- Developing a Social Network
- Getting the life that you want
- Managing Anxiety and Panic Attacks
- Managing Depression
- Managing OCD
- Mental Health Awareness
- Neighbourhood Disputes
- Pain Management
- Parenting under Pressure as well
- Personal Development
- Recovery ( Getting Better)
- Relationship skills
- Self-Esteem Workshop
- Self Hypnosis and Life skills
- Sleep Clinic
- Social Skills Training
- Solutions (Practical Support)
- Stress Awareness
- Understanding and Dealing with Addiction
- Unusual Beliefs
The approach is totally individual and is fitted to the patients requirements. Ian Caldwell, director of the centre, says that they are totally honest with their clients. If someone is not a very nice person, then we have to tell them he says, theres no use beating about the bush. If we dont point it out to them, but also saying that we can show them how they could change, so that people might start liking them, how will they ever get some friends and how are they ever going to recover? And of the centre does have some ground rules, they will not see patients who are drunk or aggressive, but will ask them to come back another day. Despite this they had only one patient last year who they had to exclude totally.
Im sure one of the major keys to their success, is that they dont give up on anyone, and the clients must become aware of this. They then ensure that every client is rehabilitated into an active life before they are discharged. Therapists are only paid for the work they do and lose out if the client does not turn up, so they are further incentivised, to ensure that the patient is motivated to continue their therapy. They are all totally pragmatic in their approach and have the philosophy that the patient will recover, but that to do so the patient must make changes and this will take effort on the patients part. They told us of a mother who had not been able to get out of her bed for 2 years and her house for even longer. The clients mother was carer for both the client and her children. The client had been receiving home visits from a Cognitive Behavioural Therapist for 5 years. So how did they get her out of bed to be able to start therapy? They got her a noisy alarm clock, which was set and placed on the other side of the clients bedroom door. The children and their grandmother were instructed not to touch it. A few months later the client was functioning well as a mother again.
The Human Givens approach should not be under-estimated. This practical approach has been devised by two psychologists, Joe Griffin and Ivan Tyrell, and written up in their book Human Givens. They accuse modern psychology of being in the stone age and much of psychiatry to be flawed, because of its dependence on the medical model. To have over four hundred schools of psychological therapies seems nonsense to them. Why, they ask, dont we just get the stuff that is effective and works form the individual schools of psychotherapy together and treat psychology as the evolving science that it should be? They also say that being so hung up on evidence based practise, holds us back. What we should be using is practise based evidence. For instance, in Hartlepool we can see the effectiveness of their approach and hear anecdote after anecdote of patients regaining their lives, (practice based evidence), but without a random controlled trail, which would be practically impossible to do with individualised care, it will never become the so called gold standard of medical practice (evidence based practice).
As a GP with special interest in mental health I was particularly challenged by Tom (surname) one of their trainers, who suggested that depression and anxiety had no place in general practice. Medicalising it, instead of treating the underlying causes, .means that we are creating dependency and avoiding the clients needs. In other countries things are not the same, in Germany for instance, no-one would go to the doctors with non-physical problems. He also pointed out that most people with mental health problems do not go to the doctors anyway. Maybe they know that the doctor can do little to change their social circumstances. Iain Caldwell also pointed out that if psychosis is left alone then clients will recover in about two thirds of cases, whereas if treated medically, there is a eighteen per cent recovery.
And they just love difficult and challenging patients. If someone is hearing voices, then the attitude is that they will make the patients life so busy that the voices will no longer be important and they tell them so. They will give the Human Givens explanation of hearing voices, that it is Dreaming in the Waking State. Iain has also found that many of the clients who the medics would label as psychotic, started off by daydreaming, to escape from the real world which may not have been pleasant for them and eventually the fantasy world may become so different to the real one, that they are tipped into madness.
The therapist see four patients a day, four days a week and five on the other day, so they have plenty of time to plan therapy and to discuss their cases with the rest of the team. All the team, including the administrative staff, have had some Human Givens training, which gives the team common strategies for treating depression, anxiety, psychosis, phobias and Post Traumatic Stress disorder.
Depression, so the Human Givens institute believes, is related to excess dreaming. Joe Griffin has conducted research suggesting that we dream to empty our brains of unresolved emotions from the previous day. If, for instance, we have a row with our someone but then sort things out, then this will not produce a dream, but if we go to bed with feelings festering, then it will produce a dream. We dream in metaphor, which is why dreams are strange. Depressed people are generally very anxious and because they ruminate over doom and gloom, their high number of unresolved emotions produce excess dreaming and REM sleep, so that the normal seventy to thirty percent ratio of restorative to REM sleep can be reversed and the lack of restorative sleep together with vivid dreams that wake the patient up, causes the tiredness and lack of energy associated with depression. Treatment involves showing the patient progressive relaxation to calm them down When they are more rational, they cam then explore how they can start to do things differently. Exercise is encouraged, we know that this raises serotonin levels and is at least as effective as antidepressants.
Possibly the most effective single Human Givens treatment is the Rewind technique, a single session treatment for Post Traumatic Stress Disorder and Phobias (PTSD). Despite the Human Givens team offering to cure the two lay advisers to the recent report on Post Traumatic Stress Disorder for the National Institute of Clinical Excellence (NICE), this technique was not investigated by NICE. It is unbelievably effective, which is in some ways its downfall, as we seem to have been conditioned by the psychological communities that therapy needs to take a long time. Phobias and PTSD do not however take a long time to be conditioned in our brains. The rewind technique uses guided imagery in a relaxation state, in a way that forces previous sub-conscious material to be processed by the left temporal lobe, which can then look at the material in an objective manner. I have known patients literally get bored repeatedly reviewing the material that an hour ago they could not face without severe negative emotions.
The success of Hartlepool MIND is certainly a major challenge to the medical model. Whilst they use some alternative therapies, particularly those that induce relaxation such as aromatherapy and hypnosis, they are sceptical of many of these too, as they are aware that it can be very easy to suck vulnerable people into therapies which may not be of benefit, yet be costly to the patient.
I visited Hartlepool with a team that included the Chief Executive of our Mental Health Trust, the team leader of our Community Mental Health Team and the Chairperson of our Services User Group. Already we are planning how to set up a similar service, so that our patients can at least have a choice of therapeutic models. Like all traditional services, our patients are currently having to be first labelled with a mental illness and then either given medicine to contain or control their illness, or referred to counselling or psychology. When one of these treatments fails to work, we usually try another, which may make the patient feel that it is they who are failing, when of course it is us, and they get stuck in the system, doing rounds of the various services. Everyone was impressed by their holistic system and its effectiveness.
Recently Richard Layard presented a paper to the Prime Ministers Office, showing that mental illness costs us two per cent of our Gross Domestic Product . His solutions include doubling the numbers of psychiatrists and psychologists in training and for every future GP to have six months in psychiatry. Having visited Hartlepool I would seriously question this way forward. Their service is effectively taking patients out of the psychiatric service, we heard for instance, of patients who had been supported in the psychiatric system for fifteen years, but rehabilitated in a few months by Hartlepool MIND. They are helping people off benefits and into work, reducing family breakdowns and relieving carers of their duties.
With only five full time workers, a manager, a support network co-ordinator, a complementary therapy co-ordinator, a senior recovery support worker and an administrator, as well as some sessional workers, they should make the impact on the economy that Prof Layard seeks. It would seem to be a much more cost effective approach. The cost of running the centre for a year, is about half a million pounds. If MINDs success continues, then in the next five years about five per cent of the most needy population in Hartlepool will have found that they have the capacity to live a better and more rewarding life. This must produce a major positive impact on their health of the population and the GDP of Hartlepool.
Ian Walton, Primhes trustee
This article has been published in Journal of Holistic Health