A fine line

A Proven Alternative To The Medical Model In Mental Health Care

Psychminded exclusively publishes a chapter of a new book, entitled Madness Contested, in which Fiona Venner and Michelle Noad detail the philosophy and success of the unique service.

Leeds Survivor Led Crisis Service (LSLCS) was founded in 1999 by a group of mental health service users, who had campaigned for an alternative to the medical model of psychiatric care for people in crisis. The service was initially run in partnership with Social Services and became a registered charity in 2001.

Madness Contested

The organisation was set up to be a place of sanctuary and as an alternative to hospital admission or statutory services for people in acute mental health crisis. As a survivor-led service, the organisation continues to be governed, managed and staffed by people who have experienced varying levels of mental distress themselves. We have developed our services based upon the knowledge we have gained through our own experiences of mental distress and use our expertise to help others within a non-diagnostic and non-medical philosophy (Venner, 2009; James, 2010).

We also develop our practice in response to the needs articulated by our visitors and callers and their experiences of what is and is not effective in supporting people in acute mental health crisis.

The following chapter will describe the services provided by LSLCS and our practice as a survivor-led person-centred service. We will articulate how we differ from mainstream psychiatric services and our contrasting approaches to diagnosis, power and control, and working with risk. Direct quotes from our visitors and callers will illustrate how and why our services are successful, which will include a discussion on the contested idea of love as a therapeutic tool. We will demonstrate how we support people to resolve or better manage crisis and reduce the risks they present to themselves and other people. Finally we will argue that our approach is not only therapeutically effective, but cost effective.

LSLCS refers to the people who visit Dial House or are involved in group work as visitors and the people who call the Connect helpline as callers. These terms were chosen by visitors and callers themselves as preferable to service user, patient or client and will be used throughout this chapter.

What are the services provided by Leeds Survivor Led Crisis Service?

* Connect
Connect is a telephone helpline open from 6 pm to 10.30 pm every night of the year. The service provides emotional support and information for people in distress. We receive around 5,000 calls per year. People can ring who are in crisis, anxious, depressed or lonely and they will be offered non-judgemental and empathic support or information about other services. Connect supports people in crisis, as well as providing a preventative service by supporting people before they reach the point of crisis. Connect also receives funding to provide emotional support to carers. The helpline is staffed by volunteers who have gone through a comprehensive and rigorous training programme and receive ongoing supervision, training and support. Many of them have their own experiences of mental health problems. There is a paid supervisor on each shift.

* Dial House
Dial House is a place of sanctuary open from 6 pm to 2 am every Friday, Saturday, Sunday and Monday. Visitors can access the service when they are in crisis. They can telephone to request a visit, or turn up at the door between 6 pm and 10.30 pm. Visitors can use the house as time out from a difficult situation or a home environment where they may feel unsafe or that may exacerbate their difficulties. Visitors can relax in a homely environment and can also receive one-to-one support from a crisis support worker.

* Group work
The service hosts a number of weekly peer-led groups held at Dial House. Peer support allows people to share their experiences of coping with crisis in order to gain new perspectives. This idea for group work came from visitors and they have been supported to develop their skills to the point where they now plan and facilitate the groups themselves, with only minimal support from a group work support worker.
The ‘My Time’ groups aim to provide social contact and support to people whose crisis is due to chronic isolation and loneliness. ‘My Time Wednesday’ is an emotional support group where people can explore the effects of crisis and learn new coping strategies in a supportive environment. On Thursdays the social support group ‘My Time Thursday’ cook a meal and plan activities.

Background and what we believe:

LSLCS supports people at acute risk of suicide and/or self-injury. During 2010, 64 per cent of visitors to Dial House were suicidal and self-injury was a presenting issue in 50 per cent of visits. This includes a small minority of people who self-injure in severe or life-threatening ways.

Most of our work is with people who have survived varying forms of trauma, most commonly sexual abuse. The most common issues presented at Dial House are those relating to people’s experiences of current or past sexual violence (64 per cent in 2010).

We recognise that the people supported by us not only experience extreme distress because of trauma in early childhood but also because of trauma experienced in mental health services. The mainstream mental health system and the medical model of psychiatric practice have been widely critiqued as being oppressive and coercive (e.g., Bentall, 2003, 2009; Johnstone, 2000; Laurance, 2003). We are also aware of the stigma and discrimination experienced by those who struggle with their mental health. In response to this, our philosophy recognises that ‘deprivation and oppression not only impact on people’s ability to cope with distress, but can be the cause of distress’ (LSLCS, 2007a).

Psychiatric diagnosis is a subject at the core of mental health critique (Tummey & Turner, 2008). However, our therapeutic approach is the person-centred approach (Rogers, 1951). This is non-diagnostic and treats the person as an individual and not as a label. Diagnosis and the person-centred approach are not compatible as conceptual frameworks. Carl Rogers, founder of the person-centred approach, objected to the use of diagnostic labels because they place the locus of evaluation outside of the person and in the hands of professionals (Rogers, 1951). Rogers states, ‘there is a degree of loss of personhood as the individual acquires the belief that only the expert can accurately evaluate him and that therefore the measure of his personal worth lies in the hands of another’ (Rogers, 1951, p. 224).

The person-centred approach is a phenomenological approach which recognises the validity of the subjective experience and reality of the individual. As Rachel Freeth puts it,

Within the person-centred approach, phenomenology does not refer to a method of categorising mental experiences. It focuses on a person’s subjective experience, as it is, without trying to impose a preconceived framework, define or explain it. The person-centred approach is concerned with how human beings experience the world and construct meaning. (2007, p. 976)

Most of our paid staff are qualified or qualifying person-centred counsellors or therapists. We describe the approach within our practice as follows:

(a) belief in the organism’s tendency to actualise
we support the visitor/caller’s direction
the worker and visitor/caller co-create certain facilitative conditions.

With regard to people’s tendency to actualise (see Mearns and Thorne, 1999 for further discussion), we understand this to mean that people do the best they can, in the circumstances they are in, with the resources they have and are innately motivated towards growth. Carl Rogers (1951) used the metaphor of potatoes growing in an inhospitable environment to describe it:

[Whilst the] actualizing tendency can, of course, be thwarted or warped … it cannot be destroyed without destroying the organism … They would never become plants, never mature, never fulfil their real potential. But under the most adverse circumstances, they were striving to become. Life would not give up, even if it could not flourish. (Rogers, 1980, p. 118)

When working with self-injury, our approach would be to think of the actualising tendency. We would respect that a caller or visitor is trying their absolute best with the resources that they have and in the circumstances that they find themselves. Even if somebody’s self-injury is severe or even life threatening, we would view this as their attempt to survive and grow within the life that they have.

Furthermore, we support the direction of our visitors and callers. This is often described as ‘non-directivity’. This means that we respect the tendency of the individual towards growth and their creative attempt to survive even if we dislike the outcome. For example, when we support someone who is severely disfigured and disabled due to self-injury, we may find this shocking and distressing. However, we respect and understand that the self-inflicted injury was the person’s attempt to survive unbearable, intolerable distress.

We refer above to the certain facilitative conditions of the person-centred approach. Carl Rogers defined these conditions as empathy, congruence (being genuine and authentic in the therapeutic relationship) and unconditional positive regard. We interpret this as an aspiration to treat all of our visitors and callers and each other with warmth, kindness, respect and compassion.

When we are working with someone, we support the whole person as the wonderful, complex, challenging being that they are and with whatever they present. In contrast to the medical model, we certainly would not view self-injury, hearing voices, flashbacks or hallucinations as a symptom of a person’s disordered personality or illness. For example, if a woman describes inserting razor blades into her vagina, our response would not be to conceptualise this as part of an illness. Rather we would see this as an understandable and logical response in someone who has had a lifetime of sexual abuse and sexual violence and is creatively trying to find a way to stop it from happening again.

How we differ from mainstream psychiatric services:

As a survivor-led, person-centred organisation in the voluntary sector, we are on the margins of the mental health system. We exist outside mainstream psychiatry. This position means that we attract people who have slipped through the net of mental health provision, been excluded from services, or with whom services have failed to engage. Some of our visitors have histories of violence, forensic histories and many have been labelled as having a personality disorder.
In contrast to mainstream mental health services, we aim to provide an anti-oppressive service. Our person-centred approach and our respect and attempts to live out values such as equality are at the core of such an anti-oppressive stance (see Dominelli, 1997 for further discussion). Anxieties with regard to risks can derail such ideals; however, our service Mission Statement says that we aim ‘to work sensitively and appropriately with people at risk’ (LSLCS, 2007b). In December 2007, we won a Guardian Public Service Award for working with people with complex needs, which demonstrates our success in this area. The following sections demonstrate the ways that we are different to mainstream services which have contributed to this success.

* Diagnosis/labelling
As an organisation set up to be an alternative to psychiatric services we are fiercely opposed to the use of psychiatric diagnoses. We pride ourselves on providing a non-medical approach to working with extreme mental distress. Our philosophy is about being alongside people in crisis, not treating them. We also believe passionately in the transformative and healing power of human connection. As our philosophy states,

We believe that to deal with a crisis, a person must feel safe, listened to, and connected to other people. (LSLCS, 2007a)

The fact that we are a non-diagnostic alternative to the medical mainstream is something our visitors and callers value greatly. All the quotes that follow come from Leeds Survivor Led Crisis Service visitor and caller feedback, 2006–2010.

Dial House is mint! It’s proper ace, it’s decent, proper nice. Staff are really good, they listen and people are well nice to be around. It’s cool to be around people who know what you have been through and who understand you – people who don’t judge you.

It is different to other services – it is easier to talk to staff. Staff are nice. They don’t judge you or put a label on you – saying that’s what’s wrong with you.

We are interested in the emerging concept of formulation as an alternative to diagnosis (Johnstone, 2008). In practice this would be developed collaboratively with the person and is an individual summary which holistically examines all areas of a person’s life in order to try to identify the reasons behind their problems and to also determine any useful interventions. However, we are aware that at times formulation can be used as a mechanistic form of categorisation; we would see this as incompatible with the person-centred approach.

* Power and control
The mental health system can disempower people further due to the lack of control that people often experience within services. For instance, psychiatry has been condemned for detaining people and treating them against their will (Johnstone, 2000). Furthermore, the numbers of people ‘detained in hospital have soared by 50 per cent in a decade’ (Laurance, 2003, p. xix).

Therefore, much of our appeal to our visitors and callers is that we are in the voluntary sector, as opposed to the public sector. This means that the organisation does not have any statutory powers, so people use our services entirely of their own volition. All our visitors and callers self-refer to Dial House, Connect and our group work. This is highly significant for mental health service users who may have been subject to coercion and compulsory detention under statutory services. The relationship between staff and our visitors and callers has a different, and arguably more positive, dynamic than the interaction of staff with patients who have been sectioned on a locked ward. As one of our visitors states:

Most of all what I celebrate about your service is not being ‘done to’. Others, statutory services, want power, they ask ‘who are you?’ establish the role and that’s very disempowering. I’ve never had this at all from Connect or Dial House.

* Risk
LSLCS’s approach to managing risk can be summarised as trusting the innate capabilities of our visitors and callers and giving them as much control as possible in managing the risks they present to themselves and/or other people. We believe in engaging fully with people in relation to risk and allowing them to explore their absolute worst thoughts and feelings without over-reacting. We believe that this is a way of reducing risk. We believe that if you give someone the space to explore in depth their thoughts, feelings and plans in relation to suicide, this will reduce the risk of it actually happening.

This also applies to risk to others. Over the years, we have supported people to explore difficult feelings, for example, that they want to set fire to their house, harm their brothers, abduct a baby, or steal cars. Our approach to this is to listen very carefully and sensitively question the person to help them work out why they are telling us this. Is it because they actually think they will do it and want us to try to stop them? Or is it because the thought terrifies them and they want to talk about it? Often the latter reduces the power of the thought and makes it less likely that it will happen. We would criticise standard risk assessment tools as reductive and unsubtle because they do not allow scope for such in-depth risk analysis.
LSLCS aims to provide an empowering service and we believe in giving people as much control as possible in managing risk. On several occasions we have supported people who routinely try to end their life at Dial House. This is understandable, as it is an environment where people feel safe and they do not want to end their life at home where their children or partner may find them. When people try to die at Dial House it is obviously both dangerous and distressing. The way we address this is to be very honest with the person and explain that while we do not want to exclude them from the service, what they are doing is unacceptable. We explain to the person that it is not fair to other visitors and staff, and that frequent attendance of ambulances will detract from the sanctuary element of the house. We would ask the person how they think they can continue to use the house in a way that is safe, and support them to come up with their own plan for how we manage the risk they present.

Sometimes people may make choices such as having someone with them all the time or only being in the bathroom for a few minutes before we go in. This is interesting because in some ways it looks like special observations in hospital. We would not choose to follow someone around, or open the bathroom door. However, it is amazing how differently people feel about this when it is something they have chosen. So rather than being about containing worker anxiety, it is a way of empowering individuals to take responsibility for the risk they present.

In 12 years we have never had a single serious violent incident. Nor have we had any incidents whereby visitors have been violent to each other or to staff. Furthermore, we have never had a death or serious injury at Dial House. We work with extremely high levels of risk and we doubt that there are many mental health services with such an impressive record of lack of serious incidents. We firmly believe that this is entirely because of the way we treat our visitors and callers, the amount of trust we place in them and the amount of control they retain whilst at Dial House. Therefore, we agree with the approach practised by Maytree, a London-based sanctuary for people who are suicidal, who state: ‘We believe that the seemingly high risk option of sticking with trust, often, in the end, carries lesser risks.’

Feedback from our visitors suggests that our approach is effective. Visitors report that that we have successfully supported them to reduce the risks they present to themselves:

I was on the verge of hanging myself, but by visiting the house, and having support, my life was turned around, and even though I still feel really depressed, I think I will be able to get through the night.

Connect helps me to work through my feelings and stop me from cutting and overdosing.

On many occasions, after leaving Dial House and having support has left me emotionally drained and I know I will not go home and do something like end my life. Also I may feel more rational; listening to other visitors also helps me gain perspective.

Why and in what ways are our services effective?

So, if we do not work with diagnoses, nor utilise all the tools, potions and paperwork statutory services have to offer, why and in what ways are our services successful? The survivor movement has pressed for a greater voice in services and assertion of their rights (see Laurance, 2003), therefore we feel that it is most appropriate for our visitors and callers to articulate what it is about our services that is most effective.
In order to ensure that we are providing a respectful, consistent, compassionate and empathic service, we undertake detailed evaluations of our services. Each year, we gather much informative feedback from our visitors and callers. This is collated from a variety of sources including visitor feedback books and questionnaires in Dial House, annual postal questionnaires and also by conducting reviews with regular visitors. We also have a focus group whereby current visitors and callers can contribute towards the development of the service. Furthermore, we have recently recruited two ex-Dial House visitors onto our Management Committee.

The feedback we receive is remarkably consistent and through this we have identified what we refer to as the five elements of effective support:

* listening
treating people with warmth, kindness and respect
people do not feel judged or assessed
being in a different and calm environment
peer support.

Again, the following quotes are from visitors and callers who have used our service between 2006 and 2010.

* Listening
It is a sad indictment of both our society and our mental health system that our visitors and callers experience being attentively listened to as a revelation, although we receive such feedback all too often. The following quote demonstrates the transformative and healing power of feeling that somebody has listened and cares:

It has made me feel wanted. I can talk to someone who listens. I leave feeling warm, rather than with a cold heart as if I’ve got nowhere.

Treating people with warmth, kindness and respect

I’d like to thank all the staff for being supportive towards me, I find it a bit strange, ’cos I am not used to it.

In 2006, Leeds Survivor Led Crisis Service won its first award. This was the Guardian Public Services award for customer service. The award submission required us to illustrate how we exceeded the expectations of the people who used our services. Our submission used the above quote to demonstrate how low service users’ expectations are. The fact that we are kind, affectionate and respectful consistently exceeds the expectations of our visitors and callers:

Just a short note to say thanks to K for helping me to wash my hair. It seems like such a simple thing to help with, but it is the fact that Dial House are there to help with everything including simple things which makes Dial House such a unique and fantastic place. Thanks again.

As the visitor herself states, it is a small task to support someone to wash their hair. Arguably it is the love underlying the act which has moved the visitor. The next visitor explicitly refers to the love they received at Dial House:

I would be in a real quandary without the kindness and empathy, and companionship which I experience when I come to Dial House. Thank you so much for all your love and support.

It is only having established our reputation and won five national awards that we are beginning to feel confident enough to publicly state that one of the ways our service is effective is that visitors and callers receive love from our staff and from each other. ‘Love’ is a contested word, which can carry both sexual and ‘naff’ connotations. Unconditional positive regard is one of the core conditions of the person-centred approach. Carl Rogers has stated that it could be fair to refer to unconditional positive regard as non-possessive love (see Tudor and Worrall, 2006 for discussion). Roger’s use of the word could also be described as the form of love called agape – love for all of humankind. However, Rogers was also cautious about his use of this word.
Similar to Rogers, we have reservations about discussing love. Arguably, the only way that healing will occur is through the transformative impact of being truly in contact with another person. Yet, we are mindful of the challenges of explicitly referring to love. After all, many of our visitors have been sexually abused in the name of love by people who were supposed to be their caregivers and professed to love them. What we offer is something different; a non-possessive love that does not ask for anything in return.

It can be strange, and even painful, to receive love if you are not used to it. Being treated with compassion, care, kindness and affection can magnify what you did not have as a child and represent a painful contrast to the relationships you have experienced.

The very fact that we will even discuss love is undoubtedly one of the factors that differentiates us from a diagnostic approach to mental distress. This difference is reflected in our policies and our practice. One of the longest sections in our staff code of conduct concerns touch, as we often hug our visitors. We strive to be extremely thoughtful and mindful with regard to this physical representation of love, which would almost always be initiated by the visitor. Our code outlines that it is a personal choice if staff hug visitors. It states that staff must be aware of the visitor’s history, gender issues and also self-aware regarding their own personal boundaries and history in relation to touch.

Occasionally, our approach causes difficulties. One of the authors had the experience of hugging a visitor, whom she believed was about to hug her. The visitor had in fact been going to shake her hand and was overwhelmed by the physical contact as it was the first time in 15 years that he had been hugged. This was a painful experience for the visitor, but one he was able to work through within the containing boundaries of Dial House and his relationship with the worker. It is now the case that whenever the visitor meets the worker, he jumps up and hugs her.

Many organisations, statutory and voluntary, simply apply a no-touching rule, and arguably this is safer as you will not encounter difficult scenarios such as the one described above. We would see our willingness to take risks in an area as contested as love and touch as our greatest strength. To withhold this would feel as though we were denying our visitors the potency of the human connectedness necessary for development and emotional healing.

People do not feel judged or assessed

The crisis support workers at Dial House have been very supportive and non-judgemental towards my behaviours.

The person-centred approach asserts that all behaviour is understandable: ‘Behaviour is basically the goal-directed attempts of the organism to satisfy its needs as experienced, in the field as perceived’ (Rogers, 1951, p. 491). All behaviour, however challenging, is the person’s attempts to meet their needs; or trying to do the best they can, in the circumstances they are in, with the resources they have. Holding this in mind enables us to respect the visitor’s attempt to meet their needs, even if the manifestations of this are truly terrible.
Visitors and callers also tell us that the fact that we do not support them according to their diagnostic label is valued:

When I’ve talked to people and tell them I have paranoid schizophrenia they have walked away, but you lot listen. Can tell people here what illness is – you don’t give me a title [label].

Staff are genuine and totally different to the rest of the system. Non-judgemental. Staff treat you better than in the rest of the system.

Being in a different and calm environment

Thank you for getting me away from the funny farm for a couple of hours, the peace and quiet was a nice change from the noisy, hectic, crazy ward.

People can visit Dial House when they are inpatients, even if they are under section, providing they have permission to leave. The above quote powerfully illustrates that people in acute mental health crisis need a sanctuary or a place of asylum. The quote starkly highlights that this is often not how inpatient wards are experienced. The person refers to the noise and chaos of the ward and Dial House providing a welcome break from this. Laurance (2003) reports psychiatric wards as being dirty, overcrowded and unpleasant. However, Dial House provides an alternative environment:

The house has a special feel of welcome. I really like not having a TV in the main room. I like all the little extras like towels and fruit on the table.

The house itself has a tremendous aura of peace. You feel better as soon as you close the door and shut out the world. There is food available should you need a meal, and staff to help you mix with other visitors and eventually to become calm.

* Peer support
Visitors gain as much support from each other as from staff at Dial House. It was a recognition of this that led us to develop our peer-led group work. Peer support can counter the stigma of having a mental health problem and reduce isolation and loneliness:

It gives me a break. By being around people in the same situation as you; you are not having to feel ashamed.

Social time has helped my confidence. I couldn’t trust strangers before coming here and now I have made some friends and met some lovely people.

* Cost effectiveness
In addition to the positive impact we have on the lives of our visitors and callers, we prevent people from the need to use statutory mental health services and the medical services provided by Accident and Emergency. In 2009, our organisation was reviewed by our funders, NHS Leeds and Leeds City Council. One of the conclusions of their review was that there was considerable evidence that our services saved money of other parts of the health economy such as inpatient units, Accident and Emergency and the ambulance service. They also concluded that we supported other teams, such as the statutory Crisis Resolution Team, to function more effectively.

In recognition of both the cost effectiveness of our services and their therapeutic value for visitors and callers, we have received a significant increase in funding from NHS Leeds. Until recently, Dial House was not open on a Monday night. We have been given increased funding to expand the Dial House provision and to also undertake a project targeting people who present to accident and emergency departments in Leeds having self-injured. In the current financial climate, this is a great testimony to the efficacy of our non-medical approach to working with people in mental health crisis.
In addition to this, we have demonstrated our value further by having a Social Return on Investment (SROI) analysis undertaken about our organisation. SROI is a credible national tool which is used to demonstrate the impact of projects which are difficult to evaluate, such as regeneration schemes or community development teams. Through a process involving consultation with all stakeholders, an SROI consultant undertakes a cost-benefit analysis. By comparing the costs of an organisation to its benefits, you can demonstrate cost savings to the community and the long-term value of investment. An organisation ends up with an SROI ratio. Our ratio is £1 to £5.17. This means for every pound invested in Leeds Survivor Led Crisis Service, society gets £5.17 back. Or the £375,000 invested in our organisation over 2010–2011 becomes just under £2 million.

The challenges of mainstream funding:

As outlined above, LSLCS receives almost all of its funding from the NHS and Leeds City Council. We are funded directly by the statutory sector to offer an alternative approach to that provided in statutory services. Despite being highly critical of diagnostic approaches to mental distress, most people are signposted to our services from secondary mental health care and we liaise extensively with the statutory Crisis Resolution Team and the Leeds Personality Disorder Clinical Network (LPDCN). Yet, we also remain firmly outside the statutory mental health system.

This interesting tension is highlighted by our relationship with LPDCN. Whether to partner LPDCN was a dilemma given we do not recognise the term ‘personality disorder’ or work within a diagnostic framework. The partnership succeeds because LPDCN respects the politics of the voluntary sector and understands that it is in the interest of their clients, who have traditionally been poorly served by mainstream psychiatry, that we are seen as outside the NHS. Both we and LPDCN refer to the partnership as at a distance. LPDCN funds our services, whilst respecting our autonomy.

It is essential that LSCLS is valued by staff working within mainstream services so they continue to signpost people to us. At the same time, we strive to maintain our identity as a radical, innovative alternative to statutory care. Achieving this balance is an ongoing challenge, requiring both passion and diplomacy.

Concluding comments:

Over the last 12 years, we have been highly successful in providing a viable alternative to the medical model of care for people in acute mental health crisis. Our structure, team work, model, philosophy and practice enable us to work effectively with people who are in acute states of distress and at high risk. We believe our success is due to treating our visitors and callers with warmth, kindness and respect and having high expectations of them, whatever label they have been given. We believe this approach has a greater influence than any clinical technique.

This chapter is entitled ‘A Beacon of Hope’ because this is part of the title of an article written about us in Mental Health Today on the event of our tenth birthday (James, 2010). It is also a direct contrast to the hopelessness of being told that your personality is disordered or that you have a severe and enduring psychotic illness. At Leeds Survivor Led Crisis Service we attempt to hold hope for our visitors and callers even when they cannot hold it for themselves. We believe that people can and do recover from extreme distress. There are many inspiring examples within our team of people who have personal experience of mental health crisis. We have received feedback from our visitors that this in itself is a hopeful aspect of a survivor-led service.

I think Dial House staff are so dedicated to their work and the service users that they all deserve a medal or some form of recognition! At the minute I am not able to work due to my mental illness being at its worst … However, in the future all being well, I hope to become a volunteer at Dial House. Survivor-led help is amazing because I know that people who talk to me here understand what I am going through. Thanks for being my glimmer of hope – every cloud has a silver lining and Dial House is mine. Smile.

This chapter has provided a brief overview of our services and philosophy and has described how we are now extremely well established as an alternative to mainstream services. We pride ourselves on being a person-centred survivor-led mental health crisis service. Although we differ in our approach to diagnosis, labelling, power, control and risk, we consistently receive positive feedback from our callers and visitors whilst maintaining professional relationships with statutory services.
Our work demonstrates that the restoration of positive mental health for those experiencing crisis relies on human connection, relationships and feeling that one is part of humanity. Our ‘progressive’ and ‘radical’ approach to mental distress has proven successful, cost effective and valuable. Therefore, we would recommend that our approach should inform the practice of all mental health professionals and should be at the centre of all future mental health services.


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