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Sunday 29 September 2013

THE MENTAL HEALTH DEBATE = A GREAT ARTICLE - "At War With Ourselves"- By Rufus May, a Psychologist from Bradford U.K. - Courtesy of Mad in America Website

At War With Ourselves

September 15, 2013

If we call someone mentally ill, in some ways we may be recognising their predicament as a powerful one, and their need for support.  However, we may also be judging their state of mind as faulty. But what if what seems a faulty mind is much more than that?  What if it is an expression of emotional conflict that needs, not to be cured, but to be understood and reconciled with?

We can go deeper than trying to say what is wrong with someone, how ill they are, or what category they fit into. We can instead ask: How do parts of them feel? What might different parts of them need? And what are the contexts in which these experiences have emerged?

We may also see the social context as an important place in which to create change.  An individual’s difficulties are intertwined with their social network.  Therefore, rather than seek to merely fix the faulty individual, we may want to bring the people around the person together and find new – and more helpful – ways of relating that benefit everybody.

A challenging mood or behaviour can be seen as having its own logic; its own purpose that needs to find new ways to be heard and new ways to express itself. For example, a young person’s refusal to eat may be a way to seek control in a life where the young person has felt they had very little control.  If we can give that person the experience of trusting relationships. Then, gradually, new forms of safety will be experienced and the reliance on controlling food intake will be likely to diminish.  If we merely call this behaviour an eating disorder and attribute it to mental illness we may miss the opportunity to learn from the behaviour about what is lacking, and needed, in the young person’s life.

Calling someone mentally ill may allow us to not think about our role in the development of their distress, and what our role could be in ameliorating it.

I once sat with a young man who had paranoid ideas – and his warring, separated parents – for an hour and a half in my kitchen. By just having a meeting based on dialoguing principles the son’s paranoia lifted significantly.  I am not offering a blame-the-parents model here. We are all connected, and affect each other. We all have different sensitivities. Responsibility is shared. Moving towards understandings of painful events that acknowledge responsibility but also avoid blaming and morally judging each other are important in any peace process.

But if we assign someone the role of being mentally ill, we begin a cold war against their distress. We refuse to listen to possible reasons for their distress in the social contexts around them. Reconciliation will be unlikely to occur.

Personally I prefer the terms ‘confusion’ and ‘distress’ to the term ‘mental illness,’ although ultimately all terms are limiting in their own ways. Many people hold onto the term ‘mental illness’ to signify the extremeness of what they have been through.  So, in offering alternative conceptualisations we need to tread carefully and acknowledge the intensity of people’s experiences. I think if we can broaden the language about our individual sense of disharmony and turbulence we can have greater freedom to understand our complex lives.

We have in the UK a national mental health anti-stigma campaign called Time to Change. They have spent over 25 million pounds on media initiatives aiming to reduce fear and discrimination for people who have been given psychiatric diagnoses.  Time to Change says it’s good to talk about mental illness.  The argument goes; the more we talk about mental illness the more acceptable it will be in society and the less discrimination people will face.

I agree it’s good to talk about a taboo subject but only if that talk – as well as encouraging empathy – uncovers new ways to see problems and find solutions.  I recently challenged Time to Change about how much they use terms like ‘mental illness’ – and diagnoses -because I think, used rigidly, they can add to stigma and misunderstanding.  Even the concept that 1 in 4 people have a mental illness encourages a conceptual division – between those thought to be sane and those thought to be insane – that may make empathy more difficult.

If we replace the illness model with one that sees suffering and confusion on a continuum, then it is easier for us all to relate to each others’ predicaments.  This feels more inclusive, rather than separating off the ‘ill’ from the ‘well’ in an artificial and compartmentalised fashion. A group of us are planning to write to Time to Change about the language they use.  This article is about an alternative way of looking at what gets called mental illness. But first I will share a few reflections on this tension between wanting to embrace this phenomenon many call mental illness and the desire to re-frame it so we can embrace it more wholeheartedly.

My impression is that many people accept the term mental illness and find it useful in their lives. I don’t want to offend them, I don’t want a war of ideas with them where I hope to get them to convert to my way of thinking. I do want to suggest that many people may wish to hold the term mental illness very lightly or not even use it at all. In my eighteen years working as a psychologist I have generally found non-medical terms to be more helpful in trying to help people find more peace and agency in their lives.

However, the term ‘mental illness’ may be helpful to use if you need to access a health service or a state benefit. Some people may like to see themselves as having an illness because it conveys a certain level of suffering, and that it is not something they are choosing but rather something that happens to them. In this way some may find it is quite validating of the level of distress or confusion they at times experience.

In an individualistic society people who fail are often blamed for their failures, to be ill means you can seek some refuge from this blame. On the other hand, the other side to this exemption from blame is that the identity of being ill can lead people to feel helpless in the face of their emotional and social difficulties.

The one thing people are in agreement about is that there is fear and discrimination towards people seen as having mental illness and that this needs to change. Not only is mental illness often seen as dangerous, it is also seen as embarrassing.  It’s embarrassing to talk about our experiences of confusion and distress because we risk being rejected by others.  Also, we are not used to talking about it so we don’t have much of a vocabulary when it comes to talking about troubled minds.

The ‘mentally ill’ person is often represented culturally as a sad pathetic creature or an out-of-control maniac; possessed, we assume, by biological demons.  Stories in the news and in entertainment often feed into the cultural fear of mental illness.  Because madness is frightening and embarrassing we don’t try and understand it in everyday conversation or in schools.  There seem to be two approaches to diminishing this fear of confused minds.

One is to try and get everyone to accept that this thing we call mental illness is nothing to be ashamed of or to be unreasonably afraid of.  The second approach is to say that to reduce the stigma, the fear of mental illness, we need to completely re-conceptualise it.  We need to replace the language of illness with something more inclusive and socially meaningful.  Rather than an individual flaw it’s an understandable reaction to life events. Maybe these two movements of either accepting mental illness or re-conceptualising it are two different ways of trying to get to the same place.

However, when we call an experience mental illness we often then assume the content is meaningless. If on the other hand we see difficulties as meaningful reactions to difficult life events, then we give it a place of learning in our communities, not just something to be sympathised with.

If a word opens a door for us we tend to like it. If, growing up, my mother is from time to time bedridden for weeks – overwhelmed with sadness and unable to communicate with me – it may make sense to me to see her as having a mental illness. It’s a shorthand that lets others know something about the discomfort she is in and how difficult we both find it to deal with. In the absence of a richer vocabulary and a community that responds to this sadness, designating someone as mentally ill gives us a framework through which to see things and a hope of a medical solution.

However, there is a problem with seeing distressed parts of ourselves, or confused behavior, as mental illness in need of a medical cure.  If we see distressed or confused minds as being diseased, like a cancer – to be battled with and got rid of – this takes the inner conflict we are experiencing to a new level of warfare. We are pitching ourselves against ourselves. A more holistic model of illness and healing sees the body’s dis-ease (i.e; lack of ease) as a way to deal with toxins that needs to be worked with, not against.

I am keen to promote alternative ways to view overwhelming mental and emotional experiences that seek to both empathise with the situation, and also understand the deeper possible meanings they point to. Rather than see ourselves as singular individuals with one personality I have found it useful to understand the self as made up of  lots of competing parts that need to be heard and express themselves.  While some of these parts feel in our control others may seem to have a mind of their own and to feel and act in ways we may not be conscious of, or when we are aware we find them challenging. An example is: when we get angry, we may say and do things we normally would refrain from doing.

When someone is distressed or appears confused, rather than seeing this as an affliction that needs to be battled with I find it more helpful to see it as an inner conflict between selves that are in opposition to each other.  The way forward is not for the well-self to defeat the sick-self, which may be what is attempted in a more medical approach to healing. Rather; healing is about a reconciliation between the different energies and personalities that make up the whole of who we are.

When we get mentally overwhelmed it is because parts of us are trying to protect themselves in powerful ways that are confusing to the person or those around them.  For example, in depression parts of us withdraw when they are exhausted. They are perhaps full of fear and don’t want to fail again. The person may also be overwhelmed with feelings of grief, sadness and bitterness to the point of a complete sense of nothingness and pointlessness.

In what gets called obsessive compulsive disorder a child-like part of us may be in control. It knows that – temporarily – it can protect the person from pain by creating an illusion of control in an unsafe and uncertain world. In mania, impulsive energies and child-like parts and power-hungry parts team up and overtake the exhausted responsible adult parts. They are running on suppressed energy, and often it is a powerful cocktail of pent-up frustrations and grief.

When we are seen as delusional, our magical and imaginative children may have taken over our awareness, creating stories that seek to protect us and in some ways symbolise our emotional strife and need for safety. Our heroes and our messiahs are often given a role to protect us  from painful feelings of isolation, vulnerability, and loneliness.

When we hear voices we may be hearing parts of ourselves we have consciously or unconsciously separated from and personified.  Angry voices are often parts of us that have witnessed or been subject to neglect, emotional or physical violation, manipulation and exploitation. They are angry at the person and the world that has let them down.

Somebody who experiences high levels of anxiety may be highly sensitive, and this trait needs to be honoured as an ability to feel energies and emotions strongly.  Anxiety also seems to mount up when we are trying to keep a lid on angry and frightened parts of ourselves.

Suicidal feelings come from parts of ourselves that are overwhelmed with painful feelings. They want a break. They are telling us we need new ways to look after and respond to these painful feelings. When emotional pain feels listened to or is channelled in some way into activity, it calms down markedly.

So, rather than see people who are confused or deeply distressed as just ‘mentally ill,’ we should try to understand the different parts of the person that are trying to protect themselves. Angry voices need listening to, and a safe way to act out their concerns. Manic parts need a chance to express themselves on a regular basis so they wont be over-aroused and cause a mutiny in the future. When I help someone bring parts of themselves to the peace table, I have to confront and make peace with similar energies in myself.  So when we seek help from others to reconcile conflicts we also learn from this about ourselves and we grow in understanding, too.

This is not as easy as it sounds, of course. We have a community of parts that need to be negotiated with. In my experience, for example, renegade parts that have sabotaged the person’s dreams are not easily forgiven and given a new role in the psyche.  Even though the person may logically understand that a part has sought to protect them in the best way it knows, they may still resent the damage they perceive the part has caused. If the person does not want to give space to a part of themselves they are angry with or ashamed of this need to be respected. We need to feel safe and acknowledged before we are willing to make peace with parts of ourselves we may not want to recognise, or still see as our enemy.

I don’t see brains and bodies not being involved in these psychic conflicts.  Genes will no doubt play some role in what selves we develop and will interact with our environment.  Similarly I don’t see drugs and physical approaches like diet, massage and yoga as not being relevant to helping people. A drug may help us get a temporary break from a conflict or lessen our emotional tension but its benefits should not be exaggerated. We can and often use a biological approach to deny and suppress hurting parts of ourselves, and if we sustain this it will likely lead to a back-lash of some kind. Parts that we attempt to block from consciousness may find some way to powerfully rebel and return later; stronger and more virile.  Or if suppression is successful these parts may retreat into apathy and listlessness and this energetically is likely to permeate the person’s life.  Thirdly, the anxiety created by suppressing angry or hurt parts may lead us to endlessly seek solace in addictive behaviours.

As I mentioned earlier, individual distress and confusion occurs in a network of social contexts. We need many ways to intervene in the community that promote dialogues and understanding.  I see what is seen at first as madness as a reasonable response to difficult life circumstances. The peace process required is both within ourselves and within our social contexts.  Our manic or paranoid or depressed parts are all trying to protect us when we are overwhelmed by life events.

If we just see these parts as ‘ill’ we will be unlikely to honour the needs they are telling us about. If we decide distress is a meaningless mental illness we are declaring war on our responses and attempting to force them into exile. They will not thank us for this, a listening approach will reap greater dividends in the longterm.

Rufus May is a psychologist in Bradford, England. He believes everybody can flourish with the right support network. His work is part of an emancipatory movement that includes the hearing voices movement, community development approaches and other self-help and holistic health movements.

Friday 27 September 2013

ANTIPSYCHOTICS - More Toddlers, Young Children Given Antipsychotics Researchers question the 'worrisome' trend.


More Toddlers, Young Children Given Antipsychotics
Researchers question the 'worrisome' trend.  


MONDAY, Jan. 4 (HealthDay News) -- The rate of children aged 2 to 5 who are given antipsychotic medications has doubled in recent years, a new study has found.

Yet little is known about either the effectiveness or the safety of these powerful psychiatric medications in children this age, said researchers from Columbia University and Rutgers University, who looked at data on more than 1 million children with private health insurance.

"It is a worrisome trend, partly because very little is known about the short-term, let alone the long-term, safety of these drugs in this age group," said study author Dr. Mark Olfson, a professor of clinical psychiatry at Columbia University in New York City.

Prescribing antipsychotics to children in the upper range of that age span -- ages 4 and 5 -- is justifiable only in rare, intractable situations in which all other treatments, including family and psychological therapy, have been tried and are not working, Olfson said.

And it's questionable whether 2- and 3-year-olds should ever be prescribed antipsychotics, Olfson said.

The study is published in the January issue of the Journal of the American Academy of Child & Adolescent Psychiatry.

Presumably, only children with the most severe mental problems would be given the potent drugs. Yet, less than half of children on antipsychotics had received any mental health services, including a mental health assessment or treatment from a psychotherapist or psychiatrist, the study authors noted.

"You don't see the kinds of mental health services you would expect to see if we were dealing with the most profoundly disturbed toddlers," Olfson said, raising the question of whether doctors had done everything they could to help the child before turning to medications.

The overall numbers of children prescribed antipsychotics remains small, at less than one half of one percent of the national sample. But the numbers are rising. In 1999-2001, about one in 1,300 were being treated with antipsychotics. By 2007, that had risen to one in 630, according to Olfson.

For 5-year-olds, about one in 650 were being treated in 1999-2001. That doubled, to one in 329, in 2007, he noted.

Research published online in December in the journal Health Affairs by the same research team suggested children on Medicaid are even more likely than children with private insurance to be prescribed antipsychotics.

The most common antipsychotic drug prescribed to children was risperidone (Risperdal), which accounted for nearly three-quarters of antipsychotic prescriptions. In adults and teens, risperidone is used to treat schizophrenia and bipolar disorder. Risperidone is also approved by the U.S. Food and Drug Administration to treat unstable mood or irritability in children with autism aged 5 and up.

Children who were most likely to receive risperidone were male and aged 4 or 5, according to the report. The most common diagnosis was pervasive developmental disorder or mental retardation, attention deficit/hyperactivity disorder or disruptive behavior disorder.

Previous research has shown children on the drugs may experience metabolic and endocrine abnormalities. Little is known about their impact on the developing brain, Olfson added.

"I don't want to minimize the problems children can have at this age, but there are psychological treatments that have been proven to help parents and the kids that emphasize the quality of the parent-child relationship," Olfson said.

One reason for the uptick may be increasing numbers of children diagnosed with autism and some research showing risperidone may help with autism-related irritability, the researchers noted.

Dr. Peter Jensen, co-director of the division of child psychiatry and psychology at the Mayo Clinic, agreed that the trend is concerning. "We have no doubt there are prescribing practices out there that are very, very worrisome," Jensen said.

It's imperative that children receive a full mental health assessment before getting these drugs, to understand the family situation and school environment and if there is a family history of psychiatric problems, as well as undergoing a physical exam to rule out other medical problems.

"These agents should not be used as an adjunct to a family stressed to the max," Jensen said. "With kids who are 2 to 5, most can be managed without these medicines. Rarely a 5-year-old goes on them. But a child of 2 or 3, in my experience, I have never had to put them on [an antipsychotic]. There is so much else that can be done."

The stress and difficulty of coping with a child who has significant mental health issues, the need to have a child behave well enough to be permitted to attend school, as well as lack of adequate coverage for family therapy and mental health services, may push doctors and parents into believing they have little choice other than medicating the child, Jensen said.

More information

The U.S. National Mental Health Information Center has more on children and mental health issues.

SOURCES: Mark Olfson, M.D., M.P.H., professor, clinical psychiatry, Columbia University, New York City; Peter Jensen, M.D., co-director, division of child psychiatry and psychology, Mayo Clinic, Rochester, Minn.; January 2010, Journal of the American Academy of Child & Adolescent Psychiatry

Professor Sami Timimi - Campaigning to improve mental health among children and young people - Courtesy of Youngminds Website

Campaigning to improve mental health among children and young people - Professor Sami Timimi : www.youngminds.org.uk


No More Psychiatric Labels

Child psychiatrist Sami Timimi is calling for the abolition of   formal psychiatric diagnostic systems because he says they have failed to advance our understanding or treatment of mental disorder. He outlines below his reasons for reaching this conclusion.Unlike the rest of medicine, psychiatric
diagnoses have failed to connect their diagnoses with any causes. There are no physical tests that can provide evidence
for a diagnosis. Diagnoses in psychiatry are descriptions of sets of behaviours that often go together. By itself a psychiatric
diagnosis cannot tell you about the cause, meaning or best treatment. Even the descriptions of behaviours have large
crossovers between them. For example, ‘distractibility’ can be found in diagnoses such as ADHD, anxiety, depression, and
autism, as can aggression, difficulties with making peer relationships, and agitation. This problem is predictable
when the basis for the categories is only symptoms (behaviours) and not signs (measurable physical differences). If, as
now seems likely, our diagnoses do not reflect real differences in our biology, then there is always a potential to do harm if we use them as if they tell us something about the cause. For example, if we believe that when a doctor makes a diagnosis of ADHD they have discovered some real life-long abnormality in
that child’s brain, we may accidentally lower everyone, including that child’s, expectation of what they can achieve.
Using psychiatric diagnosis does not aid treatment decisions
A positive outcome for treatment of psychiatric disorders is most strongly related to factors outside of treatment (such as social circumstances) and in treatment the strongest association is with developing a good therapeutic relationship with the clinician. Matching the diagnosis with a specific treatment
(whether a specific drug or specific psychotherapy) has an insignificant effect.
Long-term prognosis for mental health problems has got worse
Unlike the rest of medicine, no overall improvement in mental health outcomes has been achieved in developed countries
over the past half century. Some studies indicate the opposite; that compared to a few decades ago there are more patients
who have developed chronic conditions such as chronic schizophrenia than in the past. This is particularly so for young
people, more of whom are being labelled as having a long-term disability because of a mental condition than ever before,
with rates of psychiatric medication being prescribed to children rising year-on-year without any accompanying evidence that their long-term outcomes are improving.
Use of psychiatric diagnosis increases stigma.Surveys of public attitudes toward mental illness have found an increase in Western countries in the number of people who believe that mental illnesses are like other illnesses and caused by biological
abnormalities such as a “chemical imbalance” in the brain. However, the “illness like any other illness” model is overwhelmingly associated with stigmatising attitudes such as a belief that patients are unpredictable and dangerous, increasing the likelihood of wanting to avoid interacting with them.
It imposes Western beliefs about mental distress on other cultures. Countries around the world are being encouraged to adopt Western beliefs and to recognise diagnoses like
ADHD, depression and schizophrenia.
However, outcomes, particularly for more severe mental conditions, have been consistently better in developing
countries than developed ones. Several international studies have also concluded that the greater the inequality (in
economic and social resources) in any society, the poorer the mental health.
In the process of encouraging the adoption of Western psychiatric models, we not only imply that those cultures
that are slow to take up these ideas are‘backward’, but we may also undermine effective local practices and distract
attention from factors that do make a difference to mental health such as economic ones.
Alternative evidence-based models for organising effective mental health care are available. We already know about many factors associated with greater likelihood of developing mental distress such as trauma (particularly early childhood trauma), adversity, socio-economic inequality, lifestyle and family
functioning. In addition, rating levels of impairment and distress would provide a more accurate and less stigmatising wayo f categorising mental health problems than using psychiatric labels.
The message from research into outcomes from treatment of mental health problems is that using diagnosticcategories to choose treatment models makes little difference, but concentrating on developing meaningful relationships with service users does. Service users, including young people, need to be active collaborators in their recovery.
Furthermore, the biggest impact on outcomes comes from factors outside treatment such as the social circumstances
and levels of support. Evidence-based services need to learn how to work with the lived reality people experience, not
just the space between the ears.
A more mature understanding of mental distress that is not based on wishful thinking or prejudice will recognise that mental health concerns us all. Campaigns like ‘One in Four’ will then become redundant. 

Mental health is a part of all our lives – the more important campaign is ‘One in One’ with psychiatric labels no longer used. !

For more see www.criticalpsychiatry.net
Sami Timimi is Consultant Child
and Adolescent Psychiatrist and Director of Medical Education
at Lincolnshire Partnership
Foundation NHS Trust

The Holistic Politico-Psychological Model of Mental Health and Wellbeing (Traxson et al 2012) - A Discursive Tool to Facilitate Producing an Effective Multi-professional Hypothesis for Presenting Behavioural Patterns

"Mental Health issues are NOT disorders BUT a transient and often functional response to an accumulation of  stressors in a young persons life." (Dave Traxson - Chartered Educational Psychologist)


"What we need is a holistic narrative of need for young people NOT a dysfunctional discussion of dubiously diagnosed disorders!" Dave Traxson 2012.

- 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.


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.


 "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)

"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) 















Optimal Performance




Personal Characteristics
Human / Personal
Environment / Ecology
'Human Bridge' relationships
Interpersonal Skills
Education quality / Teachers
Play Therapy / Playing
Physical Skills
Toxicity /Pollution: Air/Water
Art Therapy / Painting
Cognitive Skills
Political / Spiritual
Biological  (genetic, health, diet, sleep, physique etc)
Music Therapy / Playing
Drama Therapy /Performing
Emotional Skills
Emotional Articulacy
Organisational ability
Interpersonal /Social
Alternative Curriculum
Psychological Skills
Literacy ability
Spiritual/Political beliefs
Social Pedagogy (N.European)
Numeracy ability
‘Life Coaching’ / Mentoring
Logical ability
Energy / Focus
Behaviour/Thoughts/ Feelings
Talking Therapies/Counselling
Thinking abilities
Receptivity to ideas
Historical (norms in family)
Sport / Physical outlets
Kind / Caring
Patterns  (habits, routines, biorythms, 'family dances')
Find 'Exceptions to Rules' /'Rays of Sunshine'
Self-Esteem/ Self-Efficacy
Self - awareness
Cultural / Ethnic / Gender
‘Reframing’ possibilities

Artistic ability
Sexualised behaviour
Solution Focussed ideas
Self-Management of Stress
Sporting ability
Poor/ Broken attachments
Developing self-control
Mental Health
Leisure/ Reading
Physical  -  including abuse Emotional  - including abuse
Relaxation training
Humour /Mood
Screen time / Sensory load    
Breathing exercises ('7:11')
Coping strategies
Security / Stability
Aesthetic/ Media/Sub-culture
Yoga / Mindfulness
Mood / Humour
Helping others
Vision for future
Bullying / Intimidation
Meditation:T.M./Benson etc.
Solution Focussed
Thinking Ability
Optimism / Hope
Oppression / Prejudice
Level of urban/rural deprivation
'Repunctuation of day'

Contribution to Society

Motivation / Drive

Class, Race, Gender, Age

Using Creative Strategies + 'Whatever floats child's boat'




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.

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.


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 maximsing 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. 
The aim of the metaphor is to help people identify and reduce the 'teaspoons','cupfulls' and 'kettlefulls' of stress to help give people more self-control, enabling them to stay calm - Traxson 1993.                                                                                          


"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)
-Person centred counselling
-Non directive counselling
-Play Therapy
-Art Therapy
-Music Therapy


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.


-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
-Dancing / line dancing




-Equine Therapy
-Horse riding
-Rearing animals
-Stroking pets
-Animal welfare





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


"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.