Structured by the Scottish Recovery Network’s CHIME model, or things which help us to recover in mental health: Connections, Hope, Identity, Meaning and Empowerment
C is for CONNECTIONS
Your mum phones the psychiatric ward and asks how you are. They refuse to give her information. She asks if her daughter is alive. She is safe here, they say.
In hospital, you wish you’d brought your communication book from your speech and language therapy studies, with photos of you, your friends and family, hobbies, work, places you’ve lived. A point of conversation for the people looking after you. They have nothing to go on except your case notes. Dishevelled hair, flat affect.
Your boyfriend is a kind of magician. His grey jumper is a magic cloak. He lends it to you and wearing it you feel powerful. In the kettle is reflected more magic. There is a time machine by the sink. He makes nourishing potions in the huge pot on the stove.
H is for HOPE
That afternoon you are sitting on a blanket on the grass outside the psychiatric hospital: you, your mum, and your care coordinator, Claire. Other service users are huddled together in the outdoor smoking area. Claire gets out her phone, shows you photos of her guinea-pigs. You used to have guinea-pigs. When you were little, you sat them on your lap and fed them dandelion leaves, grass, carrots. Or just stroked them while they purred. That afternoon, on the blanket on the grass, something inside you shifts its weight from foot to foot.
I is for IDENTITY
A friend says he was on Cleeve Hill the other night. There were police there, he says, after an escaped lunatic. You try to laugh and correct him. Do you mean there was somebody who’d left a psychiatric hospital, you begin, then pause, doubting yourself. Are you in fact an escaped lunatic?
M is for MEANING
You are in bed, in your room. On the floor are your trainers and notebooks. Down the corridor, huge washing machines. The stains and cracks on the walls are like scars. They hold messages from previous occupants. You read their story.
You are taken for a radioactive Meckel’s scan in a huge tube. You are in fact at the centre of the South Pole, in Antarctica. The staff are part-whale, and treat you well. You are about to enter the sea amid shoals of fish. Apparently you entered the tunnel with no signs of resistance, and remained there patiently for an hour. No abnormalities were detected.
E is for EMPOWERMENT
They say you are in hospital. You are in fact in an international congress with representation from a number of countries. They have interpreters, but there is no interpreter available for you. Because you are not talking, you are deemed to lack mental capacity, and decisions are made by medical staff.
You imagine a different scenario: When you arrive, your key worker introduces themselves and uses pictures to explain where you are, and what it means to be sectioned. You understand, and no longer feel as if you are in prison. If you cannot speak, you are offered a Yes/No board to point to, or symbols that represent food, drink, toilet, family. Staff get to know your strengths as well as your current difficulties. Jargon is always explained. You have an advance statement about how you would like to be treated, and who you would like to represent your wishes. Staff give you hope that you will recover. Peer support is available. People talk to you about what you are thinking, including voices or unusual beliefs. Perhaps they use the Maastricht approach to help with this. You are asked What has happened to you? not What is wrong with you? Throughout the hospital, the signs are accessible, so that you always know where you are.
This is a sequence of prose poems based on my experience of mental health breakdown. It follows Scottish Recovery Network’s CHIME framework, or things which help us recover: Connections, Hope, Identity, Meaning and Empowerment.
I wrote the piece in the second person ‘you’ instead of ‘I’, to make it more immediate. I was influenced by Claudia Rankine’s powerful book ‘Citizen’, in which she writes about her experiences of incidental racism. Using ‘you’ brings the reader closer; it draws you in.
I also draw on my speech and language therapy training. According to the Mental Capacity Act, to be considered to have capacity for a decision, you must understand language, retain information for long enough to weigh up the pros and cons, and communicate your answer. If you are non-verbal, you must be supported to communicate in other ways, e.g. writing or using pictures. While in hospital, I was silent, and assumed to lack capacity. I cannot remember having any support for my communication needs.
A study found that over 60% of mental health service users had unmet communication needs (Walsh et al., 2007). The Royal College of Speech and Language Therapists (RCSLT) is campaigning for the inclusion of speech and language therapists in mental health teams.
I also explore how you ascribe meaning to your beliefs during psychosis. The Maastricht Interview, and Hearing Voices Network seek to explore the real-life experiences and thought patterns behind someone’s voices or unusual beliefs.
In this piece, I strive to raise awareness, and make people think and maybe laugh a little too. Perhaps it will make the experience of psychosis more relatable and easy to understand, and help reduce the discomfort in talking about it.
- We often fear what we do not understand. Our best defence is knowledge – Lieutenant Tuvok, Star Trek Voyager.
Ruth
Useful websites
Hearing Voices Network. (2021). https://www.hearing-voices.org/. Organisation providing peer support for people who hear voices, see visions or have other unusual perceptions.
Recovery Education Unit. (2021). https://www.recoveryeducationonline.org/our-courses-2/ Maastricht Interview training to support people who hear voices, and other training available in recovery-focused approaches to mental health.
Scottish Recovery Network. (2021). Let’s talk about recovery https://www.scottishrecovery.net/lets-talk-recovery/ Excellent website full of resources about recovery in mental health. Includes resources about the CHIME model: Connections, Hope, Identity, Meaning and Empowerment.
Policy and other resources
Accessible Information Standard. (2017). https://www.england.nhs.uk/ourwork/accessibleinfo/. Law requiring accessible information to be available in health and social care services.
See also: NHS England and NHS Improvement (with SENSE) (2019). Accessible Information Standard. Short video explaining how this works.
Communication Access UK. (2020). https://communication-access.co.uk/ Introducing the communication access symbol, an initiative to help individuals and businesses become communication-friendly. Access free training in how to support people with communication needs.
Department of Health and Social Care, HM Government. (2021) Open Consultation: Reforming the Mental Health Act. https://www.gov.uk/government/consultations/reforming-the-mental-health-act/reforming-the-mental-health-act
Leamy, M., Bird, V., Le Boutillier, C., Williams, J., & M. Slade. (2018). Conceptual framework for personal recovery in mental health: systematic review and narrative synthesis. The British Journal of Psychiatry, 199 (6). https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/conceptual-framework-for-personal-recovery-in-mental-health-systematic-review-and-narrative-synthesis/9B3B8D6EF823A1064E9683C43D70F577 The original research paper which introduced the CHIME model.
NHS. (2021). Mental Capacity Act. https://www.nhs.uk/conditions/social-care-and-support-guide/making-decisions-for-someone-else/mental-capacity-act/
Royal College of Speech and Language Therapists. (2021). Mental health: link to communication and swallowing needs. https://www.rcslt.org/wp-content/uploads/media/Project/RCSLT/rcslt-mental-health-rcslt-factsheet.pdf
Royal College of Speech and Language Therapists. (2021). Speech and language therapists helping to determine mental capacity. https://www.rcslt.org/wp-content/uploads/media/Project/RCSLT/mental-capacity.pdf
Royal College of Speech and Language Therapists. (2021). RCSLT briefing on Reforming the Mental Health Act White Paper. https://www.rcslt.org/wp-content/uploads/2021/03/RCSLT-briefing-on-Reforming-the-Mental-Health-Act.pdf Proposals in reply to the Government’s resource ‘Reforming the Mental Health Act’.
The British Psychological Society. (2000-2021). The Power Threat Meaning Framework: Summary. https://www.bps.org.uk/sites/www.bps.org.uk/files/Policy/Policy%20-%20Files/PTM%20Summary.pdf A psychological framework that seeks to understand mental health issues from questions such as ‘What has happened to you’ and ‘What did you have to do to survive?’
Walsh, I., Regan, J., Sowman, R., Parsons, B., & A.P. McKay. (2007). A needs analysis for the provision of a speech and language therapy service to adults with mental health disorders. Irish Journal of Psychological Medicine, 24 (3), 89-93. Paper describing communication and swallowing difficulties experienced by service users in hospital and in the community.