A PSYCHOLOGICAL FORMULATION OF MENTAL DISTRESS - THE HPP MODEL COMMENTARY - (TRAXSON, PARKER, ROWLAND AND MATTHEWS 2011)-------"What we need as professionals is a naturalistic narrative of needs NOT a dysfunctional discussion of dubiously diagnosed disorders." - A menu of alternatives to medication is proposed to trigger creative thinking about the options available to deal with behavioural difficulties.

THE HPP MODEL OF MENTAL HEALTH AND WELLBEING FOR YOUNG PEOPLE

FEATURES OF THE HPP MODEL

- A multi-dimensional discursive approach - 

challenging the dominant 'within   child' biomedical model of Mental Illness that currently drives the majority of practice with Psychiatry and related CAMHS professionals.

- An optimistic approach to understanding and resolving Mental Health needs that uses a Humanistic Psychological perspective to generate thinking and solutions for a client.

- It provides an Aide Memoire to professionals in a multiagency meeting to stimulate discussion about areas that might be impacting on a young person’s world and also stimulates creative solutions involving them to resolve their current difficulties.

- Colleagues using it have reported that it promotes Reflection on the young persons’ needs and helps to ‘unstick’ bio-medical ‘log jams’ or ‘cul de sacs’ that can often result from only looking at the situation from a rational scientific angle.

- A blank Proforma allows summary notes to be taken of the discussion that can then be formulated into an Action Plan to help avoid the need for psychotropic medication to be used with the child.

INSTRUCTIONS FOR USE OF THE PROFORMA: 

1)Place the detailed table of the HPP Model within easy reach.

2)Use the prompts, as appropriate, under each heading to elicit discussion with  all professionals of the child’s holistic circumstances and needs.

3)Make brief notes of the key points of the discussion in the right column of the proforma.

4)Formulate a 'working hypothesi based on the collated information.

5)Then use it to help select appropriate strategies to meet the child’s specific and unique needs.

6)Monitor the success of the Action Plan and Review the hoped for improvements in the child’s Mental Health and Wellbeing.

 SOME QUOTES RELATED TO THE MODEL:

 "The promotion of holistic assessments and self-directed behaviour in young people is more effective than treating  them as mentally ill or as patients  that the health system acts upon in either a hopefully beneficial or sadly all too often a harmful way.”         ( Dave Traxson)

"Child Psychiatry is so very subjective and idiosyncratic that it would be better to use Social Sciences Methodologies not the current Medical Science Protocols in order to better Safeguard Children from harm.”       (Dave Traxson )

“An individual child's mental health can not be separated from the health of all the many interacting strata that constitute a rich and diverse society in our modern world. It starts with the family and wider community in which they are nurtured or not as the case may be."   (Dave Traxson)

“ The Paramount responsibility of any childcare worker is Safeguarding the welfare and the emotional wellbeing of the children with whom they work,” as stated by many Directors of Childrens’ Services in the U.K.

“Formerly, when religion was strong and science weak, men mistook magic for medicine; now, when science is strong and religion weak, men mistake medicine for magic.”(Thomas Szasz)

PROFESSOR THOMAS SZASZ

"Giving a child a label of mental illness for behaviour is STIGMATISATION not diagnosis. 

Giving a child a psychiatric drug is POISONING not therapy."

“No further evidence is needed to show that 'mental illness' is not the name of a biological condition whose nature awaits to be elucidated, but is the name of a concept whose purpose is to obscure the obvious.”(Thomas Szasz) 

http://cope-yp.blogspot.com/2012/01/hpp-total-performance-model.html 

CLICK ON LINK ABOVE TO GET THE PROFORMA

THE FORMULA :

TOTAL PERFORMANCE =


(POTENTIAL + PERSONALITY) 


- INTERFERENCE + SUPPORT 


SO, A HUMAN BEING'S 

TOTAL PERFORMANCE

IS THE INTERACTION OF THEIR INNER 

POTENTIALS 

AND THEIR UNIQUE
 

PERSONALITY 

MINUS THE INTERFERENCE 

FROM MANY FACTORS 

PLUS SUPPORT
 (WHAT WE CAN DO AS A SOCIETY)

TRY THE PROFORMA AND MAKE NOTES UNDER EACH CATEGORY TO HELP YOU FORMULATE YOUR PROFESSIONAL 
WORKING HYPOTHESIS.

HOLISTIC  

there are a multitude of interactive factors or variables that impinge on individual children and can either support their healthy growth or interfere with the positive development of their 'identity' and their 'integration of self. '

Just a few are:

ENVIRONMENTAL e.g.  deprivation, poverty, exercise, locality, air quality including crop spraying and sound pollution.

EDUCATION e.g.  positive expectations of children, personalised programme quality, personal relevance + alternative curriculum, and quality of teaching / inpirational teachers.

TOXICITY e.g.  relationships, abuse, medications, cultures, environmental pollution and dietary additives or deficiencies.

BIOLOGICAL e.g.  physical and mental health, genes, diet, obesity, toxins, metabolic rate and 'recovery rate.'

INTERPERSONAL e.g. 'interpersonal transactions', ‘family dances,’ friends, social networks and social dynamics.

SPIRITUAL e.g.  beliefs, dogma, ‘inner peace of mind,’ spiritual ideation, mediatation, metaphsical variables and personal relevance.

POLITICAL e.g.  oppression , class, ideology, ‘mind set,’ class,  elites, status, power relationships, prejudice and personal relevance.

BEHAVIOURAL e.g. learnt responses, traits, behavioural patterns and reinforcers (external and intrinsic)

HISTORICAL e.g. family norms, parenting, support for education and the individual, family traits and successes.

PATTERNING e.g. routines, established patterns, family 'dances,' responses and biorhythms.

EMOTIONAL e.g. loves - hates, hopes - fears, ‘emotional articulacy’ or  E.Q., handling relationships and feelings.

INTELLECTUAL e.g. interests, hobbies, reading interests, self- expression, response to challenge and stimulation.

AESTHETIC e.g. music, colours, arts and crafts, architecture, environmental stimuli e.g. light, smells, or auditory.

All of these dimensions have Positive and Negative elements. The aim of mental health work is simply to ameliorate where-ever possible some of the Negative ones and to promote the psychological benefits of increasing the person’s development of their chosen positive ones in many and varied ways.

Mental wellbeing will then automatically improve within the individual child and also within their circle of influence i.e.their family friends and colleagues.

POLITICO

  

that all individuals live in and their 'mind set' is fundementally affected by a 'social world' within which they either succeed / thrive or struggle / decline. 
It is an essentially political ecosystem where it is often normal for power to be unequally distributed with the powerful always striving to maintain their dominance. 
They consequently further diminish the influence of the 'disempowered' and 'underclasses' in order to  'profit' from them or 'abuse' their power over those individuals. Subcultures within the greater society that the individual chooses to join or is coerced to belong to can also impact greatly at this level e.g gangs, secret societies or evangelising groups of any faith or political persuasion.

PSYCHOLOGICAL

that an individual's mind and will are the strongest determinant of their 'empowerment' or success in life and should not be impeded by the "toxic labelling" of unnecessary categorisations and scientifically dubious judgements made by professionals.This would the help to reduce unnecessary "toxic prescribing" of drugs that may not be in the person's short or longer term best interests.

Labelling with a new category of mental illness using the DSM5 in 2013 is increasingly unacceptable to more and more members of society.

"The good it does is temporary. The harm it does can be permanent.”(Ghandi)

We therefore need to maximise appropriate  SUPPORT and reduce areas of  INTERFERENCE to help people achieve their 'POTENTIAL' and use their unique  PERSONALITY  to SUCCEED with their TOTAL PERFORMANCE  both mentally, socially and physically. 

So simply put as a society we must find nurturing, relevant, empathic, creative and motivational ways of supporting people who are struggling to succeed or experiencing temporary states of alienation, fear and disempowerment in their current state of being.

Performance is the total response of a human being both mentally and physically to the demands placed on them and to the world around them.

Mental health teams should be working towards achieving and maaximsing these shared outcomes with individualised approaches that suit a persons current wants, their self-determined needs and their current situation, starting with where they are at and not where society or professionals think they are or 'should' be.be.                                                                                                               We need to reduce the stress in their ‘stress bucket.’

Reduce the 'teaspoons','cupfulls' and 'kettlefulls' to help give people more self-control - Traxson 1993.

THE SUPPORT OFFERED COULD INCLUDE:

"Human Bridge" activities :

- Social Pedagogy - an intensive North European approach using regular psychologically based life -coaching, by highly qualified professionals, for vulnerable and 'Looked After' YP e.g. of positive outcomes of the model is that 6 out of 10 get into University that have had this approach compared to 6 out of 1,000 in the U.K.

- Trusting relationships with key adults - who act as a 'social interpretor' and 'learning coach' to support YP through the school day etc.

-"Positive Targetting" - key adults arrange regular appointments with YP to motivate them and discuss concerns, helping to problem solve situations. They have 'meaningful conversations' with the YP about the 'relative progress' they are achieving.

-Mentoring and life - coaching.

- Modelling - where YP observes closely a trusted adult completing relevant and key tasks, discusses it, does in parrallel and then attempts it themselves.(The Model - Lead - Test Approach of Direct Instruction)

                                                                                                        TALKING THERAPIES :

-Cognitive Behavioural Therapy (CBT)

-Solution Focussed Brief Therapy (SFBT)

-Reality Therapy (RT)

-Rational Emotive Therapy (RET)

-Psychotherapy

-Person centred counselling

-Non directive counselling

-Coaching

-Play Therapy

-Art Therapy

-Music Therapy

OTHER THERAPIES.

Hydrotherapy, Aromatherapy,
Hypnosis and 'Ego Strengthening',

Positive Visualisations / Affirmations, 
The Emotional FreedomTechnique (EFT), 
Neuro - linguistic Programming (NLP),

 'Retracking’,"Repunctuating the day" with postive activities etc.

PHYSICAL OUTLETS FOR CHANNELING FEELINGS:

-Outdoor pursuits programmes

-Land based sports e.g. the Zen of Golf

-Martial arts training + discipline

-Walking and trekking

-Water based sports

-Sky diving and bungee jumping

-Xtreme sports 

-Gym fitness routines

-Circus skills e.g.juggling

-Zumba

-Dancing / line dancing

-Music

-Yoga

HEALTHY DIET INTERVENTIONS

PROMOTING GOOD SLEEP PATTERNS

ANIMAL BASED INTERVENTIONS:

-Equine Therapy

-Horse riding

-Rearing animals

-Stroking pets

-Animal welfare

WORKING FOR CHARITIES

WORK EXPERIENCE WITH CARING EMPLOYERS

STRUCTURED PLAY

INCREASING SELF- EXPRESSION:

- Poetry

- Painting / sketching

- Sculpture

- Pottery

- Playing an instrument

- Joining a band

- Music

- Dance

- Creative writing

- Photography

- Digital photo labs etc.

Building self-esteem programmes

Stress management programmes

Building self-control programmes

Building Emotional Intelligence (EI) programmes

Parent training programmes

Alternative curriculum programmes

Progressive Relaxation Training (PRT)

Deep breathing techniques e.g.'7-11'

Yoga

Massage

Meditation

Mindfulness training (focussing on the present - sensory experiences e.g. breathing.)

 

MAPPING ANALOGY FOR PLANNING:

"Any  journey is therefore personally mapped discussing these options with a trusted other and routed based on all the idiosyncratic topograhical features( e.g. the 'hills','valleys' and 'sanctuaries.') that might or might not assist them or hinder them on their travels." (Traxson 2011)

We should aim to build resiliency in vulnerable others in all of these following areas:

To overcome adversity and build resilience, children ideally require:

   
 unconditional love and acceptance

    some autonomy/ choice over decisions
    trusting relationships with significant adults
    feelings of independence / self-direction

    making relative progress with tasks
    secure relationships in the community

    strong role models foster friendships and commitment
    a safe, stimulating and stable environment

    create a sense of 'belonging'
    self-confidence and faith in themselves and their world
    an intrisic sense of optimism and self-worth

   

All these things help to build resilience.

Ideas on Building Resilience by the 'father of positive psychology' -  Martin E.P. Seligman.

"Strangely, however, about a third of the animals and people who experience inescapable shocks or noise never become helpless. What is it about them that makes this so? Over 15 years of study, my colleagues and I discovered that the answer is optimism. We developed questionnaires and analyzed the content of verbatim speech and writing to assess “explanatory style” as optimistic or pessimistic. We discovered that people who don’t give up have a habit of interpreting setbacks as temporary, local, and changeable.

That suggested how we might immunize people against learned helplessness, against depression and anxiety, and against giving up after failure: by teaching them to think like optimists."

This HPP Model we believe builds incrementally on the previous BPS - biopsychosocial model proposed by Meyer et al from the 1970's onwards.( excerpts from an article on the Critical Psychiatry website written by Professor David Pilgrim , Lancashire NHS) This model has sadly not significantly altered the power base of the psycho-physical / bio-medical model which still predominantly pervades the collective thinking in child mental health work and modern psychiatric practice.