The mental health continuum: spreading the message

Jon Neal describes how Suffolk Mind is successfully introducing human givens concepts across the whole county.

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Bury St Edmunds is a historic market town, just 30 minutes away from Cambridge. Visitors in the near future may find that, between exploring or shopping in the busy town centre, they can take a rest on a roomy bench – but not of the traditional type, which make it uncomfortable to face a companion, and are often lined up in a spaced-out row, all facing forward. Instead, they may find benches in all different designs – some attractively semi-circular in shape, sometimes placed in a semi-circle in close proximity, or some designed as a ‘bench for one’, set aside at a little distance.

Instead of signs saying ‘cathedral’, with an arrow indicating the general direction to follow, they could find more helpful information, such as, beneath the arrow, a picture of a person walking and the words ‘10 minutes’. And there may even be visual guides, such as attractively coloured paving stones leading to the exact location of historic sites. They will find special attention paid to good lighting and to natural greenery. In brief, as well as taking account of people’s physical needs for easy access, the town centre planning will also take direct account of people’s emotional needs – such innovations reflecting needs for connection but also privacy, sense of control and security, and general wellbeing. 

All this will be highly visible evidence of just how varied is the impact of the human givens, gradually being spread throughout Suffolk through the work of Suffolk Mind. Organised more and more on human givens principles, we are working to filter these valuable understandings into all aspects of life in our county, as everything – ranging from the built environment to public services to home, school and work life – can act either as a barrier or an aid to getting needs met. So we were delighted to be asked for our contribution to the Bury St Edmunds Town Centre Master Plan, supplementary planning guidance which will be consulted whenever new developments or changes are proposed. 

Suffolk Mind, founded in 1987, is a very different place now from 10 years ago, when it concentrated on services more traditionally associated with a voluntary mental health organisation, such as the provision of supported housing and ‘floating’ help for the residents, all diagnosed as having severe and enduring mental health problems. We still do offer this service, but a very different overall emphasis to our work has evolved. This was all well before my time (I joined in 2016) but the first significant change was a shift towards more professionalism, rather than relying on volunteers. The organisation started to attract broader talent. However, it was still run on traditional hierarchical lines, with staff finding it difficult to find ways to contribute their own ideas about how the organisation might branch out in its work. 

That started to change around 2011, when loss of contracts and cuts in funding, affecting all charities, really started to bite. It became apparent that many voluntary organisations were floundering in other ways, too – while distracted by the ‘need’ to ensure a viable existence, all genuine meaning and purpose in the work was lost. Suffolk Mind, struggling with two restructurings, a merger and resultant redundancies, was also affected by this consequence and it seemed key to address it. A change of personnel at the top and the necessary, if painful, streamlining resulted in a slimmed down and much more focused and empowered, enthusiastic group of staff, ready to develop and learn new skills – with the help of a supportive, if somewhat anxious, set of trustees. In the words of Sue Gray, business development leader at the time, “There was the vision and energy to break out of the traditional mental health mould, although exactly what that looked like or meant wasn’t yet clear. Our sense was that we needed to reach everyone in Suffolk with the message that individually, as a community and across every aspect of our society, we could ‘do’ something about mental wellbeing in the county.”

Two new ventures

She introduced ‘pipeline workshops’, regular morning sessions run as an open forum where anyone could pitch an idea for what they felt the organisation could and should be doing and everyone, from the cleaners to the accountants, could give feedback. The idea was to encourage participation and sense of ownership of the work at all levels. The coordinator of Suffolk Mind’s community resource service at that time was Ezra Hewing (now our head of mental health education), who already held the Human Givens Diploma. Through his work, which involved managing mental health support workers and redesigning a longstanding programme of psychological education courses and workshops for people in the community, he saw an opportunity to introduce these ideas more widely. It was the pipeline workshops that gave the thumbs up to two important innovations he introduced, which set us on the path we are striding along today. 

As it had long been recognised that people from the local Muslim community did not readily access local health and social services when needed, the first idea was to work with a local mosque to develop a resource booklet, which drew on the Qur’an and Islamic traditions to address emotional wellbeing in a way meaningful for Muslims.¹ Indeed, the booklet opens with a quotation from the Hadith (teachings attributed to Muhammad): “Seeking knowledge is obligatory on all Muslims, both men and women”. The booklet explained stress, anxiety and depression, and how to recognise the symptoms, and listed local services offering help. It also integrated the modern understandings embodied in the human givens approach with traditional Islamic psychology, to provide people with information and techniques to recover from mental ill health. This venture was such a success that it was taken up by national Mind and, to date, five years after first publication, 13,000 copies have been sold, along with hundreds of ebook versions. As a result, national Mind commissioned a training programme on faith, culture and mental health, which it continues to roll out to all local branches that want to run it.

The second idea that Ezra ran by the pipeline forum was perhaps the more significant for our future development as an organisation. He had been approached by an insurance company, concerned about growing staff absences attributed to mental health problems, and devised a training programme to help them. Through this, he took the opportunity to introduce the idea that mental health and mental ill health fit along a continuum and that staff wellbeing could best be achieved through applying understandings of the human givens approach – in other words, by designing work and the working environment in ways that met everyone’s emotional needs. A detailed account of this work was published in this journal² and became the starting point for what was to become a rapidly expanding workplace wellbeing service offered by Suffolk Mind.

The workplace wellbeing service

We initially contacted some local businesses, on the strength of the success of Ezra’s project, to ask if they would like help to improve team motivation and performance, and reduce absence rates. However, mostly it works the other way around, with companies making the approach to us; they tend to have had a few people off sick with stress and they want help with Mental Health First Aid, a term organisations increasingly recognise, providing a pattern match to what they think they need. Mental Health First Aid is a clever name for what is now an internationally recognised training programme, originating in Australia, that is the counterpart of physical first aid. However, it has similar limitations. Just as a first aider can recognise and immobilise a broken leg but not actually fix it, so mental health first aid only teaches someone to recognise a problem and do something temporary to stop it escalating (for instance, calming the person down) until ‘proper’ help arrives. Once we explain that, at Suffolk Mind, we direct our attentions further upstream and can help employers take steps to prevent mental ill health from occurring in the first place, most are very ready to buy into the human givens model instead. 

Rust out and burnout explained

We introduce the human givens approach through a half-day training called “Your needs met”, which covers emotional needs and innate resources. It dwells particularly on the importance for work performance of getting a good night’s sleep and explains the three barriers to getting needs well met: toxic environment (particularly common in some workplaces!); resources unwittingly misused (for instance, through worrying); and resources damaged (for instance, through trauma caused by bullying). 

We will often refer to the human function curve, which shows how people can move so easily from stretched to stressed, illustrating it through reference to ‘rust out’ and ‘burnout’ – both terms now familiar to most people in organisations. Rust out is a term originally used by occupational psychologists to describe employee apathy and lack of interest and motivation, the person who turns up at work in the morning but is always thinking ahead to leaving time, disconnected from any sense of purposeful activity. We can explain that, while that may appear to be the opposite of burnout, which results from too much stress, they have exactly the same root: needs not met. In rust out, people tend to lack a sense of control over, or meaning and purpose in, their work – essential emotional needs which, when not met, result in just as much stress as burnout. 

We illustrate how stretch comes from feeling invigorated by learning new skills, taking on new challenges, achieving, and feeling meaning and purpose, while stress results from demand outstripping supply, low sense of status, not feeling competence or connection, etc, with overwork affecting work-life balance (in human givens terms, community and emotional connection). It is a brilliantly effective way of bringing the idea to life for line managers, human resources personnel and people who run small businesses, because they can readily see themselves and their colleagues in the descriptions. They can vividly see how mental health at work impacts on mental health at home, putting paid to the unhelpful belief still current in many workplaces that domestic problems should be left behind the front door.

Further options

Taking this course opens the door to various further options. Some companies require all their staff to take “Your needs met”, so that they all have the tools for understanding each other differently. For instance, someone sitting alone at lunchtime might be lonely and welcome companionship but, equally, they might be choosing to take a little privacy for themselves.

Many managers go on to take our one-day workshop, called “Supporting staff mental health for managers”. This illustrates the use of RIGAAR, the human givens therapy session model of rapport building, information gathering, goal setting, accessing resources, agreeing strategies and rehearsal, as a helpful framework for managers to use in one-to-one sessions with staff. Originally the day was designed to help managers support staff in returning to work after stress-related absence. However, it is so fit for many purposes that it is now also used to help managers hold effective supervision or catch-up sessions with members of their team. 

Another option we offer is half a day on mental health awareness, which explains the mental health continuum, how unmet needs precipitate stress and busts a lot of myths. While we normalise mental-health-related difficulties by giving the statistic that one in four people suffers a mental health problem at some time and that one in 10 experiences something more serious (usually everyone in the room will know someone on antidepressants or in counselling or who has been diagnosed with a particular condition), we point out that the strongest, most significant statistic is that related to recovery – ie that recovery is the most likely outcome of anxiety and/or depression; and that, even for people experiencing serious mental ill health, there is still a chance of full recovery and ability to achieve a good quality of life, in accordance with the degree to which emotional needs are met in balanced healthy ways. We, of course, refer to human givens methods for achieving this.

Sleep well, work well

There are two other workshop options. One is half a day specifically on stress management, which looks at needs and resources and provides techniques for relaxation and calming down. The other is a one-hour talk called “Sleep well, work well”, which is often the first programme that businesses choose. This distinguishes between different types of sleep, such as deep sleep and rapid eye movement (REM) sleep and explains the role of dreaming. We illustrate it with a vignette about an imaginary employee who sleeps well because his needs are sufficiently well met in balance – he has a partner he loves, who respects and accepts him for who he is; he has sufficient time for his interests outside of work, enjoys his job, feels valued and welcomes the challenges it brings, etc. Then suddenly a merger is mooted and he begins worrying about whether his job will be safe. So he starts dreaming more and waking early, feels exhausted, worries about how he will get through the day and whether his increasingly poor performance will make it even more likely he will not be picked to keep his job, etc, etc. This makes it graphically clear how quickly a person can slip from needs met to needs not met – and to escalating difficulties, through the cycle of depression. 

The course also provides practical tips on how to improve sleep, such as not staying up too late watching screens, not having too hot a bedroom, not exercising too late, and so on. But the main point is to sow the seed that it is a life that works that gets us the best sleep at night. 

One-to-one consultancy

Some organisations go on from all this to buy our package of support called “Wellbeing performance”. For a monthly fee, we provide one-to-one consultancy, training for the leadership team in meeting their own and others’ needs, and a quarterly Emotional Needs Audit for all staff. This last can throw up a lot of useful information. For instance, if a company employs 100 people in 10 teams, they can get to see whether certain needs are better met in certain teams, and why this might be so. If, say, one team scores particularly low on privacy, we can facilitate a workshop to see what is going on – it may be that staff have nowhere convenient that they can go on a break – and come up with a plan. We can also keep track of improvements. One small company scored low for community at their headquarters, relative to those working out in their smaller satellite offices. The company decided to institute a regular social evening for HQ staff. Another company scored low for control across the board, so we introduced a support session for managers, to help them understand, and find ways to enable, more autonomy for staff.

A place of sanctuary

The concept of the mental health continuum, which Ezra had first introduced through the workplace wellbeing project, became regularly talked about and used internally at Suffolk Mind. We started to develop new services for people at all stages of the continuum. To support the wellbeing end of it, we have developed a beautiful medieval church into a wellbeing heritage centre – a place providing sanctuary and information about how to stay well and get a life that works, for everyone from every walk of life. This project was set in motion by a former chief executive, Jo Searle, nine years previously, when the Churches Conservation Trust, which looks after redundant churches, got in touch with Suffolk Mind to see if we could make good use of the deconsecrated 15th century local church in Ipswich, called St Mary at the Quay. (It had originally been on the waterfront, thus the name, although that has long gone and it now, alas, opens onto a busy road.) The project won lottery funding to the tune of £3.6 million, with an additional £1.4 million coming from other sources, such as the EU and Historic England. The heritage centre is now known as Quay Place. We feel it fits in well with our human givens understandings, as learning about how our lives are intertwined with those of the past can enable us to feel more grounded and part of something bigger than ourselves.

Although the intent was always to use it for activities that enhance mental health, such as yoga and complementary therapies, which are still offered, the human givens influence is now central, as the focal aim is to provide a variety of means by which emotional needs can be met. Quay Place is open every weekday and can be hired out at weekends for conferences, exhibitions, wedding receptions and even wakes – all part of the turning of human life. The building itself is both spectacular and calming, with plenty of private areas providing lots of opportunities to meet needs for privacy. People are welcome just to come in and choose somewhere to sit quietly and read a book, or to relax and reflect, or watch the world go by. 

Using the hands

It is well known that using the hands is a good way to enhance mental health, and needs for community and connection are also well met through the craft projects we offer. At the moment, a poppy-making group meets every Monday morning, with the aim of creating 2,018 poppies (knitted, sewn or crocheted, materials provided) to be draped around the war memorial in Ipswich on Armistice Day this November – much as a spectacular display of thousands of poppies was fixed around and about the Tower of London a few years ago. The project is run by volunteers and, although open to all, tends to be attended mainly by older women, whose needs for attention and achievement are also well met through it. 

On the same morning, there is a Sporting Memories group – which attracts mainly older men (often, couples come together and divide up between the two groups). Sporting Memories offers a creative way of tackling early dementia, as people who are keen on sport very commonly remember where they were and all that happened when particular major sporting achievements took place. Volunteers help people reminisce and share memories over tea or coffee and a biscuit or two. 

We also run from Quay Place a popular parents and children group, called Explore Parents. Local explorer Thomas Eldred, who was the second man, after Francis Drake, to navigate the world, lived in Ipswich, so this group encourages children to find out, and share with others, interesting facts about him, and offers other activities involving exploration (concretising a metaphor for learning), which parents and children can do together. Besides all this, there are rooms that can be booked out by businesses for meetings and three therapy rooms that can be hired out by the session for massage, aromatherapy, acupuncture, etc – and, of course, are used for human givens therapy.

On the way out of the building, everyone will pass a board on which are hung short ropes and instructions for tying sailors’ knots, such as the figure of eight, the bowline and the reef knot. It is another nod to our maritime connections – and, for those who have a go, another chance to experience a small but not insignificant achievement …

EARLY Minds

Further out in the field, a recent promising venture has been EARLY Minds (‘early’ an acronym for ‘emotional awareness and resilience learnt young’), which uses storytelling to convey messages about fulfilling needs and potential, tapping into the pattern matching potential of hearing inspiring stories. The project was made possible by initial funding from Suffolk County Council and its effectiveness is in the process of being evaluated, so that it may have the opportunity of winning continued funding from some other source. Three of our staff members, Ezra Hewing, Joe Everett and Charlie Green, who have all trained in human givens, run two-hour sessions in primary schools, in which they tell two or three particular stories and explore them thoroughly with the children, from a human givens angle. 

One is the well-known story of the lion that strayed from its jungle and got lost in the desert, where it wandered, increasingly disoriented and desperately thirsty. Then, with relief, it came upon a pool and ran towards it, only to rear back when it saw a fierce lion looking back at him from the water. He kept approaching and retreating in fear, until finally, not caring any more, he plunged his head into the water and drank. And, of course, the ‘other’ lion (his reflection) at once broke up and disappeared. This wonderful and ancient story provides the basis for discussing all sorts of needs and resources that the children can identify with. They work with it at many levels, including colouring in an illustration of it and identifying a place where they themselves can feel safe, and who would be there with them, which they then draw and talk about. 

Another story, adapted from an ancient Persian tale about Nim the half boy, involves the hero taking on a dragon and, in the process, learning that the dragon breathes fire over fields when he is angry. So Nim teaches the dragon 7:11 breathing, and then the children all learn ‘dragon breathing’, too, and undertake to teach it to one other person when they get home. Then there is the tale about a hat-maker, who tells his daughter how he retrieved hats stolen by a tribe of monkeys by taking advantage of monkeys’ habit of mirroring responses. His daughter attempts to use the same strategy when the next generation of monkeys steals her hats, but the strategy doesn’t work second time around. This introduces the idea that we learn through mirroring and pattern matching but that sometimes patterns don’t work in our favour – we may need to change the way we do things, if we want to get our hats back!

To embed the ideas further, every classroom gets to keep cuddly toys representing the animal protagonists of the stories – so, for instance, a child who is upset can go and cuddle the dragon and remember to do 7:11 breathing to calm down; or cuddle the lion to give them the courage to go for what they want. 

Further along the continuum ... 

To meet needs further along the mental health continuum, we run workshops on anger and anxiety management, reshaping them to explain emotional arousal and better management of it, all through the concept of meeting emotional needs, and showing how to use resources more effectively to stay calm. We also offer the “Your needs met” workplace wellbeing half day as an open course in Bury St Edmunds and Quay Place once a month and a Healthy Minds Counselling Service, for people at various points on the continuum, to help them tackle depression, anxiety or any of a range of issues that are holding them back from living truly fulfilling lives. Suffolk Mind charges a modest amount for each session (all the money going to the charity), as it is strongly believed that paying for a service increases motivation to make the most of it, but we do offer bursaries for the unwaged. The counsellors volunteer their own services for free, and we are very grateful that former chief executive Sue Gray, who now holds the Human Givens Diploma, is going to join them as soon as she qualifies fully as a human givens practitioner. 

Then, further along the continuum again, there are our ecotherapy projects, where volunteers, supported by a paid part-time manager, help people facing mental health challenges enjoy growing food and vegetables on allotments together, in places that meet many needs. Many people who were isolated and depressed, or may have considered themselves agoraphobic, have experienced a massive uplift through the meeting of their needs for connection, attention, achievement and meaning and purpose somewhere in nature that they feel safe. 

Support services

Further along the continuum again, we have a service called Waves, which was started by the original Suffolk Mind and is a support group for people diagnosed with borderline personality disorder. How it runs is decided by the members themselves, including the rules for membership, engagement and activities. GPs make referrals but people can self-refer, too. Members used to be able to attend indefinitely but, as the group was so popular, that left a long and ever-growing waiting list. So the clinical commissioning group in our area asked us to introduce a time limit, which is now six months. Support workers help members with aspects of daily living and management of emotions – and, as with everything else now that we do, human givens understandings are threaded through this. One or two of the support workers have become so enamoured of the approach that they want to go on to take the Human Givens Diploma.

And then there is the supported housing for people with severe and enduring mental health problems (although, as we know, if they had been able to access the right help early enough to get needs better met and use resources more effectively, many might well not have gone on to suffer severe or enduring mental health problems at all). We have one house that is like a care home, where eight residents live with support, each having their own rooms but eating communally the meals provided. Others live in self-supporting flats and are considered to be ‘transitioning’. They may be people who have experienced burnout or a psychotic episode or have come from a secure unit, and it is expected that, with help, they can re-enter society fully again – they receive visits from support workers to help them with tasks such as forms for benefits or job applications. All are under the care of the NHS and are receiving treatment of some kind, not necessarily of the human givens variety. However, we are bringing even this arm of our work into the human givens framework, working with the support workers to widen their understanding of what they can offer, using the human givens approach.

Spreading the word

There is so much going on that we don’t often have to ‘sell’ our services proactively – people keep coming to us. However, we do keep trying to spread the understandings as widely as we can, in keeping with our early aim of increasing mental wellbeing throughout the whole of Suffolk. The workplace wellbeing service, more than any of our ventures, has helped us shape perceptions far beyond the reach of Suffolk Mind. Clinical commissioning groups, statutory bodies such as those for children and young people’s services, and adult and community services, have commissioned training from us, so everyone involved will now have some knowledge of human givens principles. Indeed, these have been built into the county’s emotional wellbeing programme for children and young people, which sets out aims for the next few years. Suffolk’s director of public health – responsible for determining the overall vision and objectives for public health – is also in regular contact with us and is enthusiastic about our approach.

Everywhere we can, we spread the knowledge further. When money is raised for us (for instance through schools or local clubs), as chief executive I may be invited to go and receive the cheque and give a short speech. On finishing writing, I am about to do just this, at a local golf club that has kindly raised some funds for Suffolk Mind. They probably expect to sit politely through 20 minutes of talk on the services we run for unfortunate people, whose lives are entirely disconnected from their own. In fact, as always, when I get these opportunities, I am going to talk about emotional needs and innate resources and make it relevant to every single person present. And so the ripples continue to spread …

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This article featured in the "Human Givens Journal" Volume 25 - No. 1: 2018

 

References

1. The Qur’an Emotional Health: an introduction (2013). Suffolk Mind and Ipswich and Suffolk Muslim Council.
2. Hewing, E (2012). Work and the mental health continuum. Human Givens, 19, 2, 23–7.

All the photos in this article show aspects of Quay Place, the wellbeing heritage centre run by Suffolk Mind.