PLOS Mental Health Community Case Studies

Community Case Studies: The damaging effects on community mental health when unique services are lost

PLOS Mental Health introduces ‘Community Case Studies’. Here we speak to our authors about their circumstances or initiatives to better understand community-specific factors that affect mental health. We recently spoke to Psychotherapist Nicky Forsythe, an author on a recent Opinion piece about how we should frame lay counselling, and the founder of Talk for Health, which is a social enterprise teaching evidence-based methods for therapeutic talking in communities, free of charge. Sadly, due to a funding crisis, this valuable resource, and lifeline for many in the community, faces closure. We heard from Nicky about the dangers of this, and consider the dangers in general, when community-based mental health support is not prioritized.

Please tell us a little about yourself and what brought you to Talk for Health

[NF] Mental health has been my whole life. My mother, who was a pioneer in psychosexual education, experienced repeated psychotic episodes and as a result was sectioned and often heavily medicated. However, in her experience, the medication was not helpful. In addition, my sister experienced a psychotic episode at 18. At the time, when I was at University, I took her with me to Italy. I remember being inspired by a friend of mine there who treated her as normal despite experiencing what would be called delusions. Due to my family history, I myself have always feared ‘madness’, and experienced depression, anxiety and what some people called non-ordinary states over the years. I underwent a decade of Psychoanalytic Psychotherapy from when I was 29 and personally, I struggled with this approach. Eventually, I found that Humanistic Psychotherapy worked best for me and I trained as a Psychotherapist. I then set up the first ‘Talk for health’ group in this very room where I am sitting now. I did this with three fellow therapy trainees in our first year of training.  We had enough experience in Counselling skills for me to set up a clear protocol in which we shared and gave feedback to each other – specifically 15 mins sharing and 10 mins feedback each, every Friday afternoon. It was so powerful and helpful for me that, out of what I had learned, I developed a four-day programme for others back in 2008. Within this programme, we cover skills of sharing, connecting with yourself, emotional literacy, giving feedback to others using counselling skills, group chairing, and time-sharing. At the end of the programme, people are taught a clear ‘recipe’ for an ongoing group, just like the group I had with my peers. The training is done in a group format, and in a way where members can remain connected with as and when needed, on an ongoing basis.

I turned ‘Talk for Health’ into a social enterprise in 2013 and we have been commissioned by, and delivered to, different National Health Service (NHS) bodies in North London since then.  We have also heavily relied on grant income to ensure that our service remained free. Over our 10 years of operation in North London I developed things so that we had a network of 30 ongoing groups that any Talk for Health ‘Graduate’ (i.e. person who had done the 4-day programme) could attend as frequently or infrequently as they wished.  We also developed a ‘Train the Chair’ protocol so that Graduates could be trained to chair the groups consistently, in pairs, as volunteers, and a rigorous ‘Train the Trainer’ programme so that Graduates could lead the 4-day programme as paid sessional trainers.  By the end we had upwards of 20 licensed trainers and 40 active group chairs.

How have organisations such as Talk for Health helped community Mental Health?

[NF]. I have always been keen on data collection. I feel that talking therapies can be unaccountable and it is always important to be able to assess how well something is helping, and not just using qualitative measures. In collaboration with a PhD student at Roehampton University, we were able to continuously record data, which measured the wellbeing of those using our services. We used validated quantitative measures including the PHQ-9 and WHO-5. We collected data at 4 different time points from over 1000 people. We’ve seen that after the programme, wellbeing improved significantly, with a large effect size and what is unusual is that this was maintained at 3-6 months (as therapies often record a decline in wellbeing after treatment ends). With Talk for Health, treatment never ‘ended’ – people often dipped in and out of groups for years.  This resulted in the development of a large community (30 groups), and there were community events every month, teaching people new skills to support themselves and others such as therapeutic writing, dance and movement, and breathwork. Those involved felt a great sense of belonging – and as we know, loneliness is a huge contributor to depression. At Talk for Health, once you become a Graduate, you are always one.  You are always part of the community. Indeed, we often have people coming back to the community many years after their initial programme – maybe 10 years later – when they find themselves in need. The beauty of this is not just a sense of belonging, but accessibility – you don’t need to wait for a referral to join.

For me it has a great impact as I have not had a decent education and I have found myself in difficult situations in past…being a part of Talk for Health has improved the way I communicate and it has provided me with great insights about how to listen to people around me

Community Quote

What damage does the loss of services such as this do?

[NF] Many have said to me that this service has been their lifeline. Some quotes from our community are included in this blog. I do believe that as a result of the loss of support offered by Talk for Health, lives will be tragically lost. And of course, the loss of this service is bound to have a knock-on effect on mental health service waiting lists and the overuse of medication. I worry people will be medicated, and this is not always the best treatment for many. It will result in a huge cost to the mental health system here.

It has saved my life. It helped to heal my trauma. It has changed my life, And not just me I am one of [thousands]. I have worked with others who have gone onto train the trainer and done phenomenal work also with others. The value of talk for health and the staff is priceless..

Community Quote

Is there any possibility of this service being saved?

[NF] It would need someone or a group of people to ‘reboot’ it, and very significant investment.  We have always been a tiny team managing this huge project and for someone to keep this going, it would need a much bigger infrastructure.  I’m very open to this kind of conversation as it is awful to see 15 years’ worth of work, systems, manualised IP and around 60 trained staff and volunteers be totally wasted. The best option would be that services such as ours are set up as a trading social enterprise – where those who can, pay.  My vision has been, mistakenly, that this should always be free (and being commissioned by the NHS, it had to be).  This was unrealistic.

As a broader point, moving forward, there needs to be a radical shift in the way such services are budgeted and commissioned. In my opinion, there is so much money spent on NHS and bureaucracy that does not need to be there. This money should be going directly to the front-line. The level of bureaucracy we have to go through obstructs us and other organisations from delivering services that save lives.

I was down, overwhelmed, had no idea what was happening to me or how I was going to cope when by chance I attended Talk for Health.  I will always remember that day, that gave me hope

Community Quote

Finally, do you have any general advice for people who would like to support others with mental health condition

[NF] There are plenty of peer coaching programmes around that I recommend people look into. Locally, the Camden and Islington trust coach people who have had difficulties themselves to support others.  A lot of the services available are what I think of as ‘mock therapies’ in which someone is helping someone else. These are really valuable but the great thing about Talk for Health is in my view the reciprocal nature of it – everyone helping each other. There is also a level of dependency on a whole community rather than an individual, which people experience as healthier and safer.

At PLOS Mental health, we will continue to follow case studies like this globally, which not only demonstrate how much we can learn from and benefit from community-based mental health services, but the dangers faced when they are not prioritized.

Disclaimer: The views in this article are those of Nicky Forsythe and not necessarily those of PLOS or PLOS Mental Health

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