On May 23rd, Following Baby Dance Hour in a residential home, I visited the innovative ‘Trombi’, (Culture Club), located under trees around Jyvaskyla in a Clubhouse International.
Clubhouses are a worldwide initiative supporting people with daily living, which began in New York in 1948 with Fountain House. I will visit more of these in the USA in autumn 2017 during part 2 of my Churchill Fellowship (Edit: I did; read about it here).
Trombi is a peer led, inclusive club offering groups in which new skills can learned, or where you can simply go to be with others and socialise. Trombi is open to anyone and there is no limit to the length of time you can be a part of it. Panu Koskimies of Sosped invited me along with Pauliina Lapio from TAIKE. I think the pictures speak for themselves with this post…
Now I want to talk about evidence.
Some of the major predictors of poor outcomes in mental health (and yes, suicide) include:
- Low self-esteem
- ‘Non-adherence’ with treatment
- The effects of stigma
Places like this can address each of these key issues, in respectful, collaborative and meaningful ways.
Groups on offer at Trombi include fishing, creative writing, Frisbeegolf (!), dog training, plant growing, food making, several music groups for either playing, or listening and discussion. “I am proud of my band” said one man who plays in a punk band originating from here. There are multiple guitars on the walls, and one bass. We need a bass player, they said. Doesn’t everyone, I thought. I was invited to sit with a group of members to discuss their experiences, as well as my own professional and personal journey that brought me here, and enjoy some ice-cream! Afterwards, people set up an open mic session in the main dining area.
The model is called guided functional peer support which tailors activities to interests and strengths. People can move from attending a group, to leading their own if they feel able and willing to do so. They are then called Peer Support Counsellors and a group may be set up by any member. Panu explained that whatever your interest, you can start a group. He described one who interviewed the Prime Minister and asked how he would help mental health services. You can watch the footage here (in Finnish).
Some of the key principles of recovery models I think this system exploits include:
- A safe space
- A lack of judgment
- An emphasis on ability and skills and not symptoms or diagnoses
- Collaboration and connection
- Individual preference and choice
I found that personal experience is highly valued and the peer to peer model means that power dynamics are basically non-existent, so people can fulfil a useful role without being disempowered as a passive recipient of treatment, which is a risk in a system which names users ‘patients.’ It was good to share my own story of seeking help from psychiatric services when I was younger – and not finding the responses particularly helpful.
Formulation in Clinical Psychology
Clinical Psychologists are trained to assess and treat psychological, emotional and behavioural difficulties. They use the science of psychology to treat complex human problems and promote change.
Among the key and basic principles of therapy are, listening and hearing, and secondly, normalising what a more medical model would refer to as symptoms. For example, in my job in the National Health Service, I am working with a lad whose father is a security manager in an inner city*. The work-based stories he shares contain violence and threat, and the boy experiences high levels of anxiety and panic. At first this boy believed there was something wrong with him –
“Why don’t my peers don’t suffer panic attacks? What is wrong with my brain?”
In what we call ‘formulation’, after just two sessions exploring what factors led to and are maintaining a problem, together we realised that this response might be effectively explained and understood as a normal response to the levels of threat his father is exposed to. Moreover, there is an expectation within the family that they are tough and can handle high stress, so it is not talked about or addressed, or even acknowledged. Stress thus finds another way to be expressed, through panic attacks.
- These details have been changed for confidentiality and this is not an actual case, but illustrates some of the type of work we do in psychological services
The people present – along with others in Finland – were really interested in why I have come here and had many questions! One asked me, is there evidence that medication is cheaper than this sort of approach? Actually medication is very expensive and it pains me that we are told, there is no money for well-being driven groups, but there is money for continuing medication, the effects of which are often harmful. I say this because there is considerable evidence that antipsychotic drugs are harmful to health. I am not anti-drugs, and this is a complex topic, but I feel strongly that they are overused and alternatives need to be more widely available. In addition there are no ‘side effects’ from the approaches I saw at Trombi, unlike psychotropic medications, all of which tend to have a very problematic side-effect profile. Moreover the activities here are acceptable to the users of the service, again unlike many medications which many people tend to dislike taking.
Something I found very interesting and similar to Manchester, is that there are a lot of services and organisations available, but “it is like a puzzle” trying to find out what is where and how to access, or even find. “Where is my place?” a member asked. We have identified a similar need across Manchester and a central directory is currently being developed.
“If you are depressed and you stay at home you get more depressed” said one member, and another added that attending Trombi “gives you a way into the community and to feel okay being with others, and sharing goals or reasons to keep going. And even making friends and helping other people.”
For more reading about recovery approaches, please check out a previous blog on hearing voices and links to some fantastic work on trauma and mental health.
On Day 3, I was delighted to be joined by a range of people from all over Central Finland who work in arts in healthcare for a three hour exchange meeting. Following this we took part in a most revealing and useful mutual interview with Arts Development Managers at TAIKE and I learned a whole lot more about how changes have been made within the health sector with respect to the arts. Much of this will inform my final report. By the weekend a longer post about this should be available here.
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