Spiritual Space

HOLISTIC HEALTH IN THE NHS AND SOCIAL SERVICES SECOND AID
A place for complementary therapy in mental health.

By Jan Moore

Current demands on health services challenge us to review our clinical practice and to think innovatively about the use of resources. Although often viewed with skepticism, some complementary therapies can be a useful adjunct to more traditional methods. This paper describes a pilot study of one such initiative by the Leicestershire and Rutland Healthcare NHS Trust and Leicestershire County Social Services Department which demonstrates the benefits of complementary methods in a mental health setting

Introduction

Resources are being stretched to their limits as the demands on community mental health services increase. There is no indication of a reduction in this upward trend, or that resources will expand to match need. In these circumstances it is becoming increasingly urgent to find new and effective ways of working alongside our established approaches. One way forward is to make use of those complementary therapies which can work in harmony with conventional medicine, but which focus on mobilizing the client’s own resources. This idea poses an interesting challenge in that it requires us to reflect on our professional belief systems and our clinical practice, in ways which involve thinking in a more holistic manner. Given the constraints on all services, this is perhaps an opportune time to open up a dialogue about how best to manage the diversity of problems which health professionals are being asked to tackle.

Many patients referred to mental health services have faced abrupt and alarming changes in their lives; changes which potentially confront all of us but which, for them, have provoked sufficient psychological and physiological disturbances to require professional help. At these times what may be most helpful to some patients are brief but intensive interventions, which consider the needs of the whole person and not just those specific to the psychiatric condition. This may be sufficient to promote the patient’s self-management skills and their capacity to resume self-responsibility. It is in this area that the interface between psychiatric treatments and certain complementary therapies might prove most productive.

One example of this is ‘Second Aid’ which was originally established by Judy Fraser, a spiritual psychotherapist, who designed its three, four-day courses. These aim to increase self-awareness through an exploration and acknowledgement of physical, emotional, intellectual and spiritual needs. This is achieved through a variety of approaches which include meditation and guided visualizations as well as exercises demonstrating the influence of the intuitive self in every day life. Colour is the language of the more subtle aspects of the self and course members are invited to explore their own relationship with and feeling for different colours. These methods operate alongside more traditional group discussions. In addition, an individual manual gives members a point of reference both during and after the course. The aim is to offer a variety of stimulating techniques which can be thought provoking, challenging and fun.

Second Aid is a process that helps course members to explore, unravel and balance the conditioning and misconceptions which may be complicating their lives. It provides an opportunity to reflect on their attitudes towards themselves and others and to find a way of reaching their own truth and what is right for them in the context of their current circumstances. Second Aid offers a space in which to think about the management of change, whether this has been imposed or self-created. Above all, it is a step on the path to self-awareness and involves a brief, but intensive, examination of an extensive range of needs, the fulfillment or neglect of which determine the sense of well being or dis-ease.

Although the material is universal in its application and it has been taught in a wide variety of settings, Second Aid courses had not previously been taught within the Health Service or a Social Services Department. However, given the volume of referrals in our Community Mental Health Team, it seemed appropriate to consider the possibility of offering it as an alternative intervention. Leicestershire & Rutland Healthcare NHS Trust initially provided funding for two courses to be held within a community mental health team setting.

The Courses

These were open to patients who had become stuck in their difficulties and who needed further input and resources from the team. Those suffering from psychotic phenomena were excluded, although membership was open to anyone else. Referrals came via Community Mental Health Team colleagues.

In spite of group members’ reservations and anxieties about working in a group, there was no shortage of applicants. For some, their involvement with the mental health services had spanned several years and their treatments had included a variety of medical as well as psychological approaches, (for example cognitive behavior therapy and psychodynamic therapy). For others, their contact with the service had been relatively brief over a period of months. Problems were typical of caseloads within community teams and they included sexual abuse, divorce, bereavement, stress at work, deliberate self-harm, panic attacks, anxiety and clinical depression.

The courses were held at the Community Mental Health Team base over four full days and each catered for ten people. Of immediate interest was the fact that most participants had to overcome large hurdles in order to attend the course at all. For instance, there were long distances to travel, childcare arrangements to be made and anxieties about never having previously ‘survived’ groups. These problems all needed to be overcome in order to attend at all and hence the process of group members addressing their own needs and mobilizing their own resources started before the course had formally begun.

As could be anticipated, trust was a major issue for course members. Their fear of becoming vulnerable, the frustrations of feeling stuck in repeated patterns of difficulty and their difficulties in accepting changes which were outside their direct control were also significant themes, as were their sense of failure, their prejudices and their discomfort with their imperfections. The common thread which linked members of both groups was their sense of feeling out of control and an inability to steer themselves towards constructive positive change.

The style of the course provided a creative framework through which new experiences (for example, meditation and the exploration of the significance of colour) created new mediums for self-expression and an opportunity to play with new ideas. Given the chance to consider their needs in a more holistic way, course members were also able to disclose things about themselves they had previously hidden, for example their spiritual beliefs. An opportunity was also provided to reflect on the inter-relationship and co-existence between all their needs and how neglect of these in one area could impact on another – for example – in the ways that emotional states were affecting their physical bodies.

Overall the courses were a success – the feedback being extremely positive. Group members had experienced a variety of benefits which ranged from a general improvement in their sense of well being to discharge from the mental health services altogether. This prompted requests from mental health colleagues to undertake and sample the course for themselves. Funding was subsequently granted by Leicestershire County Social Services Department for four more courses. We ran these in the year 2000 – two for staff, one for careers and a further course for patients. Leicestershire & Rutland Health Care NHS Trust have commissioned a further course for patients in March 2001. The local Interagency Planning Group is currently considering the approval of a continuous rolling programme of courses in which there will be sufficient flexibility to offer all three levels of course and one day refreshers.

Conclusion

The course material was presented in exactly the same way to all groups and the commitment to, interest in and feedback from each of them was very similar. What has been useful to patients has been equally valuable to professionals and careers. Perhaps this demonstrates the need in all of us to improve our self-awareness if we are going to achieve and maintain a state of well being. How we cope with crisis management, change and how we communicate our truth are issues which affect all of us, whether we are providing a service as professionals or whether we are recipients.

Although there are varied therapeutic tools available within the mental health services, Second Aid courses differ in that they aim to focus on physical and spiritual needs, as well as the purely psychological. This fits well with the Government’s implementation of the National Service framework which lays down models of treatment and care which include “the physical and spiritual facets of mental health and mental health problems” (Standard One). Exciting possibilities now exist in opening up the development of more holistic approaches and practices within our work, not least the opportunity to develop more mentally healthy workplaces for staff. Second Aid has a significant contribution to make in these areas.