'Doing better' on psychosis

Kawthar Alli reports from the International Social and Psychological Approaches to Psychosis conference in Liverpool, with the theme 'Making real change happen'.

This was an exhilarating four days of intense intellectual stimulation; thought-provoking questioning and heartfelt storytelling from service users, carers, mental health activists and professionals. Whether you wanted to listen to a lecture or attend a more interactive workshop there was more than enough choice – from psychodynamic to open dialogue and CBT. After a hectic first day of absorbing ideas I opted for something relaxing and therapeutic so I attended the poetry workshop run by resident poet Gill O’Halloran, where we had the space to reflect on the meaning of the conference and what change meant to us (the theme we all composed into a poem).

Friday morning began with a political edge, with talks from Kwame Mckenzie asking us to question the social contract that governments have towards their citizens. He emphasised the role of the socio-political factors, such as the 'austerity' approach that the UK government has led since the financial crash of 2008, and how that impacts mental health. The message that resonated with me was that mental health cannot be looked at within the confines of the therapy room – decreased government spending has a real direct impact on wellbeing, and professionals need to acknowledge these factors when formulating mental distress. This message struck home as I walked around Liverpool city centre, observing the high rates of homelessness and wondering how that will impact their mental health.

The Culture and Ethnicity lecture had to be one of my favourites of the conference, resonating with me as a Black African woman. Firstly Victor Kouratovsky from the Netherlands spoke about the link between psychosis and migration. He explained the historical trauma of colonisation and how war plays amongst BME groups. Factors such as the fragmentation of identity also impacts physical health and can lead to conditions such as irritable bowel syndrome. Kouratovsky described culture as an envelopment creating a set of social practices which buffers stress… this is then threatened in migration as cultural norms are challenged by the host country, with integration empathised.

Samrad Ghane spoke about how he uses a culturally-adapted CBT for 'jinn' (the supernatural being of Muslim culture) related symptoms. This was the first time I have ever heard a mental health professional speak on this topic as it’s usually an issue that is dealt with by Imams: this showed me that beliefs in spiritual causes of mental health can be resolved through family and psychological therapy. 

On Saturday morning, mental health nurse Tamryn Palmer spoke about her interesting work in Zimbabwe trying to do early intervention work in a completely different culture with limited resources. In the afternoon, research findings from Richard Bentall and Sarah Butter emphasised the link between an insecure attachment and paranoia but not hallucinations (which were linked with sexual abuse). Paranoia even amongst the normal population was interestingly four times higher in non-white groups and in general higher in marginalised groups in the UK. One explanation for this was that paranoia can serve as a protective factor against feelings of inadequacy and low self-esteem. Saturday ended with the screening of Crazywise, which gave very interesting insight into the world of those suffering with psychosis around the world. Skyping with the film-makers at the end brought out a lot of clinician concerns about how much we should be open to shamanism in western culture, and where a western model of evidence-based therapy fits in. On the other side service users expressed their frustration with the NHS and the lack of alternative explanations of their psychotic experiences. Rather than an illness should we see it as a breakthrough or spiritual experience?

By Sunday I was exhausted but also excited about 'ISPS for whites only', a workshop which Val Jackson organised as part of the discussion to understand why BME groups are not as involved in the organisation. This discussion brought to the fore hard questions about how inclusive the ISPS is: could there be more topics on discrimination discussed, and more liaison with black and Asian charities that promote mental health awareness? The last keynote on Sunday by Debra Lambshire was an honest, raw and powerful insight into her journey from a service user in an asylum-like setting to her status as one of the leaders investigating service user experiences in New Zealand. Her story warmed many hearts, and she received a standing ovation from the audience. Tears ran down her cheeks in appreciation.

One of the key things I gained from the conference was an increased level of empathy for service users and carers. Often we can get so caught up in the day-to-day running of services that we forget to truly listen to people’s stories. From the first keynotes by Rachel Waddingham to the last one from Debra Lambshire their courage in sharing their struggles in mental health services and their recovery journeys was an eye-opener to the importance of 'experts by experience' and the concept of the 'wounded healer'. We also heard the voices of carers such as Shelagh Musgrave, who spoke about the resistance she has faced as a mother working with mental health services. Her disappointment and frustration about how she has been treated by mental health services made me reflect on how family members can be viewed as friend or foe, and how much family therapy is really offered to people with psychosis.  

The conference also provided great networking opportunities meeting with like-minded people who all wanted change and believed we could all do better. Enjoyable, insightful and eventful, I look to the next conference in Amsterdam 2019. 

- Kawthar Alli is a Counselling MA student at Goldsmiths College and a project worker at Mind.

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