On April 22nd I attended a short introduction to the work of the Severn and Wye Recovery College in Gloucestershire and Herefordshire. Recovery colleges are said to be a new approach to recovery in mental illness, based on an educational model. But I thought the introductory session I attended gave mixed messages in several ways, leaving me unsure about the whole idea.
The first mixed message was the event itself, advertised as a “taster day”. I booked the day in my calendar, only to find out later that it’s not an all-day event at all, but just a 2½-hour session run in the morning and again in the afternoon. From the point of view of staff it’s a day out, that’s true. From the point of view of people attending, it’s either a morning or an afternoon session. Better advertising would take the target audience’s point of view into account.
The college is some kind of joint venture between 2gether NHS Foundation Trust and other bodies. It was originally funded last year by a grant from the Mental Health Foundation, a charity with significant government funding. The college does not yet have more permanent funding.
The college is offering four courses this year — its main Realising Recovery course and three others. In the taster session we got only a pretty vague idea of the main course, but we could try out any two of the others for half an hour each.
An introduction by someone from 2gether with the daunting job title “Non Medical Consultant for Social Inclusion” covered a little of the history of recovery colleges and of the Severn and Wye Recovery College in particular. She projected densely worded slides on a small patch of wall, and used lots of jargon. ImROC was mentioned in passing. I couldn’t imagine that much of this was what we all wanted to hear about. A better introduction would take the target audience’s point of view into account.
The main presenter was an experienced lecturer who knew how to tell stories to get his message across, and who made valiant attempts to engage with an audience numbed by the introduction. This was good stuff. The college would work a lot better if it this chap could be persuaded to teach all the presenters how it should be done.
He spent a little time telling us about his own history of mental illness, (episodes of psychosis, as it happens), but it turned out that the thing that transformed his life wasn’t anything to do with an educational model, but his relationship with his partner, a therapist.
He showed a film clip about a man who had stopped speaking for seven years, who started to recover after overhearing a psychiatrist saying that he believed in his potential, and whose recovery finally became solid when he inherited responsibility for his father’s beehives. We were told this shows the importance of hope and vocation (in the old sense of life’s purpose and meaning) in recovery. Hope, if not vocation, certainly seems to be a key concept in the work of the college.
He also told us about an American woman, Patricia Deegan (I think), who had recovered from psychosis because, as he put it, “someone didn’t give up on her” and who now has videos on YouTube.
Another testimonial came from a woman who had suffered from, (and maybe still suffers from, it wasn’t clear), paranoid schizophrenia. She seemed to have some kind of fixation on the main presenter, who constantly reminded her what to say in a very controlling way, and often spoke for her. She had had a “very destructive early childhood”, he told us on her behalf. Their relationship came across as a bit creepy.
The message of her testimonial was, once again, not the value of any educational model, but the value of a relationship with an individual person, who happened to be the main presenter’s partner again, and who “gave her hope…stuck with her” and “didn’t give up on her”.
The third testimonial was from a man, a former chef, who had been a psychiatric inpatient many times since his late teens. He did have good things to say about the recovery college course, but the best bit for him was the individual coaching he received after the course ended. Again, a relationship with an individual person was the most significant thing for him.
The last testimonial was from a man who had suffered a psychotic breakdown long ago. He had valued attending the recovery college last year, but (and by now you’ve guessed it) his greatest praise was for the individual mentoring scheme run by the charity Bipolar UK. He is now an individual mentor for four people.
So the weird thing about the main presentation was that the testimonials were not for the new-fangled educational model at all, but for a very traditional model of what I would call therapeutic alliance. As the main presenter put it:
“You need someone to hold the hope for you.”
I chose mindfulness as the first of my two half-hour tasters. The full mindfulness course offered by the college takes four two-hour sessions (although other mindfulness courses elsewhere are typically longer). About eight of us sat in a circle in a small room with a presenter, and a dentist’s waiting room atmosphere descended upon us.
The presenter told us he is originally from New York, and has been practising mindfulness since the 1970s, including a time when he lived in India. It seemed to indicate that he knew his stuff. Unfortunately he seemed to struggle to be fully present in the situation he had landed himself in, leading a small group of beginners in mindfulness. Much of what he told us was incomprehensible waffle, and he had a distracting habit of making a statement and then giggling.
The handout contained the following quote, allegedly by Ralph Waldo Emerson (though my computer search of his complete works failed to verify it):
“With the past, I have nothing to do; nor with the future. I live now.”
It’s hard to fathom how a man of letters such as Emerson could dispense with both the past and the future. One of the things he really did write (in his Historical Discourse at Concord on the Second Centennial Anniversary of the Incorporation of the Town, September 12, 1835) was:
“Man’s life…is the sparrow that enters at a window, flutters round the house, and flies out at another, and none knoweth whence he came, or whither he goes.” The more reason that we should give to our being what permanence we can;- that we should recall the Past, and expect the Future.
Early on the presenter told us that he wouldn’t be giving each of us a raisin. And for those of us who didn’t like raisins he wouldn’t be giving us a piece of chocolate instead. If you’ve ever done the famous mindfulness exercise with a raisin (or chocolate), you’ll know exactly what this is about. If you’ve never done it, it’s utterly baffling. For the utterly baffled, this presenter offered no explanation. He just giggled.
The funniest episode of the whole morning was when he announced that he was going to be silent for five minutes while we all concentrated on noticing our breathing. I immediately realized that he’d covered his watch with some of his notes, but he didn’t think of that. A couple of minutes passed, and he looked for his watch only to discover that he couldn’t see it. So in the middle of the five minutes meditating on breathing he had to shuffle through his papers to find his watch. And then, of course, he must have realized that he didn’t know what the time had been when the five minutes started.
I have sympathy and admiration for anyone who finds it difficult to relate to a bunch of complete strangers gathered in a small room and who gets a bit flustered as a result. I have little sympathy and little admiration for someone who claims he’s been practising mindfulness since the 1970s and then loses his presence in the moment so completely that he can’t find his own watch. Here was living proof that mindfulness doesn’t work.
The unfunniest episode of the whole morning was when, right at the start of this half hour, one of the participants excused herself saying she felt unwell, and left the room. No one went after her to see that she was OK. In fact she sat just outside the room where I could see her through the window in the door, and I kept an eye on her. I didn’t notice anyone else ever looking in her direction. At the end of the half hour as everyone else left the room they mostly walked right past her. I checked with her to see how she was, and then someone who seemed to know her came along.
In our mindfulness practice, as we were invited to become aware of the voices of children playing outside, and the hum of machinery from somewhere, I was also aware of the woman sitting alone outside, feeling unwell, quietly out of sight, and out of mind. This should not be what mindfulness is about.
I chose the drama-based course Step Up! as my second half-hour taster. It’s supposed to help build confidence and communication skills.
We were told that although it’s drama-based it’s not really based on drama, whatever that means. I suppose it means the course is actually based on drama but now that they’ve printed the leaflets they realize people are put off by the idea of joining a drama group, so they’re trying to downplay it (no pun intended).
For half an hour the extremely enthusiastic and bubbly presenter led a group of us in what are usually thought of as warm-up exercises, the kind of thing you do for five minutes before a meeting in order to loosen everyone up. Except in this case there was no meeting to get loosened up for, just continuous warm-up exercises.
Of course, if you lack confidence and communication skills the very last thing you’re going to do is join any kind of group run by an extremely enthusiastic and bubbly presenter who’s going to try to get you to do possibly embarrassing things in front of a bunch of total strangers.
So we didn’t have anyone in the group who particularly lacked confidence and communication skills. There was one chap who was a bit withdrawn and who made eye contact only when he had to, but he didn’t get any extra help with the activities. I thought he was, if anything, even more withdrawn by the end of the half hour.
Within minutes I found myself standing in the middle of said bunch of total strangers, who were all looking at me and expecting me to confidently communicate either “apple”, “orange” or “fruit bowl”. It was horrible. I chose “apple”.
The enthusiastic and bubbly presenter soon had me looking at the clock wondering when the half hour was going to end. Each session in the full course lasts for a painful to imagine 2¼ hours.
Afterwards, I wondered how the enthusiastic and bubbly presenter would have coped with a group of people who really do lack confidence and communication skills (if they could ever be tricked into joining her course). It’s possible, I suppose, that she would change her tune completely and make it much less threatening. She did say that the full course works on things that the participants choose.
But if that’s the case then in our half-hour taster we didn’t get any realistic idea of what a real session would be like. She didn’t let us choose what to work on, or how threatening we wanted it to be. And that defeats the object of the taster.
The third taster
There was only time to attend two out of the three taster half-hours. Unfortunately I didn’t make a note of what the third one was about. If it had a handout, I didn’t receive a copy of it. There’s no mention of it in the college prospectus, either the printed version or the online version.
I vaguely recall that the third taster might have had something to do with gratitude, which is widely believed (amongst those who believe such things) to be associated with happiness, and which features in theories of positive psychology.
Overall, the session was interesting and enjoyable, but I ended up finding the recovery college concept hard to believe in. No one strongly supported the educational model by telling us what they had actually learned in the college that they didn’t know before, and the presenters didn’t seem to be skilled teachers who could engage with people as individuals in an empowering way and break skills down into simple steps.
I can easily imagine that people who already have certain skills will enjoy attending recovery college courses to exercise those skills in new ways, and I can easily imagine that they’ll give great feedback scores to the college. But it’s hard to imagine anyone learning very much new, or building up skills that they didn’t already have when they started.
The prospectus mentions research into recovery and resilience, and learning about how mental illness develops, but this introductory session avoided those topics. In particular, any one-size-fits-all (or “transdiagnostic” in the jargon) theory of how mental illness develops would be very controversial and hard for professionals with a mainstream background to accept.
I get some sense that the recovery college tells people there can be hope for the future, but no sense that those who have attended find purpose and meaning in their lives as a direct result. I worry about giving people hope through empty promises.
A few cherry-picked quotes from people who have attended the college make it seem wonderful, but there’s no sign of rigorous evaluation or dependable outcomes. It all seems to be a poorly-designed experiment with vulnerable people’s lives at present.
Testimonials from the many people who had found a transforming relationship with an individual to be the most significant factor in recovery undermined the whole idea of an educational model. Recovery simply isn’t just a matter of education.