Community-Based Mental Healthcare for Psychosis: From Homelessness to Recovery and Continued In-home Support

199 Pages·2023·2.963 MB·English

by  Peter Dierinck

COMMUNITY-BASED MENTAL
HEALTHCARE FOR PSYCHOSIS
This eye-opening book explores the need for, and how to successfully
organise, community mental health teams that provide in-home care and
treatment for people experiencing mental health difficulties, particularly
those suffering from psychosis.
With an emphasis on community-based care and democratic psychiatry,
the book presents two paradigm shifts necessary to bring mental healthcare
directly into the community. The first is shifting perceptions from thinking
of patients to recognising those in need of care as members of the public,
moving away from a biomedical diagnostic approach. The second shift is the
provision of support for the community environment, its families, friends
and neighbours to pave the way for hospitableness towards people with
mental health issues in a way that encourages compassion, empathy and a
respect for differences. Through clinical case material, anthropological and
phenomenological methods and personal experience in c ommunity-based
care, Peter Dierinck presents new models for sheltered housing and innova-
tive ways for struggling individuals to secure paid work within a community
system.
Community-Based Mental Healthcare for Psychosis is important reading
for psychiatric professionals, clinicians, social workers, caregivers and all
mental health professionals looking after psychiatric patients with complex
care needs.
Peter Dierinck has worked since 1987 within psychiatric institutions in
Belgium, for the most part in Psychiatrisch centrum Gent-Sleidinge on a
ward for homeless people. Since 2018 he has also worked for vzw Psyche on a
Flemish project ‘Quartermaking’, a method for inclusion in the community.
THE INTERNATIONAL SOCIETY FOR
PSYCHOLOGICAL AND SOCIAL APPROACHES TO
PSYCHOSIS BOOK SERIES
Series editor: Anna Lavis
Established over 50 years ago, the International Society for Psychological and Social
Approaches to Psychosis (ISPS) has members in more than 20 countries. Central to
its ethos is that the perspectives of people with lived experience of psychosis, their
families and friends, are key to forging more inclusive understandings of, and ther-
apeutic approaches to, psychosis.
Over its history ISPS has pioneered a growing global recognition of the emo-
tional, socio-cultural, environmental, and structural contexts that underpin the
development of psychosis. It has recognised this as an e mbodied psycho-social
experience that must be understood in relation to a person’s life history and cir-
cumstances. Evidencing a need for interventions in which listening and talking are
key ingredients, this understanding has distinct therapeutic possibilities. To this
end, ISPS embraces a wide spectrum of approaches, from psychodynamic, systemic,
cognitive, and arts therapies, to need-adapted and dialogical approaches, family
and group therapies and residential therapeutic communities.
A further ambition of ISPS is to draw together diverse viewpoints on psychosis,
fostering discussion and debate across the biomedical and social sciences, as well
as humanities. This goal underpins international and national conferences and the
journal Psychosis, as well as being key to this book series.
The ISPS book series seeks to capture cutting edge developments in scholarship
on psychosis, providing a forum in which authors with different lived and profes-
sional experiences can share their work. It showcases a variety of empirical focuses
as well as experiential and disciplinary perspectives. The books thereby combine
intellectual rigour with accessibility for readers across the ISPS community. We
aim for the series to be a resource for mental health professionals, academics, policy
makers, and for people whose interest in psychosis stems from personal or family
experience.
To support its aim of advancing scholarship in an inclusive and interdisciplinary
way, the series benefits from the advice of an editorial board:
Katherine Berry; Sandra Bucci; Marc Calmeyn; Caroline Cupitt; Pamela Fuller;
Jim Geekie; Olympia Gianfrancesco; Lee Gunn; Kelley Irmen; Sumeet Jain; Nev
Jones; David Kennard; Eleanor Longden; Tanya Luhrmann; Brian Martindale;
Andrew Moskowitz; Michael O’Loughlin; Jim van Os; David Shiers.
For more information about this book series visit www. routledge.com/The-
International-Society-for-Psychological-and-Social-Approaches-to-Psychosis/
book-series/SE0734
For more information about ISPS, email [email protected] or visit our website, www.
isps.org.
For more information about the journal Psychosis visit www.isps.org/index.php/
publications/journal
COMMUNITY-BASED
MENTAL HEALTHCARE
FOR PSYCHOSIS
From Homelessness to Recovery and
Continued In-home Support
Peter Dierinck
Designed cover image: © Iryna Spodarenko as rendered as the
owner of the image on Getty Images.
First published 2023
by Routledge
4 Park Square, Milton Park, Abingdon, Oxon OX14 4RN
and by Routledge
605 Third Avenue, New York, NY 10158
Routledge is an imprint of the Taylor & Francis Group, an informa
business
© 2023 Peter Dierinck
The right of Peter Dierinck to be identified as author of this work
has been asserted in accordance with sections 77 and 78 of the
Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this book may be reprinted or
reproduced or utilised in any form or by any electronic, mechanical,
or other means, now known or hereafter invented, including
photocopying and recording, or in any information storage or
retrieval system, without permission in writing from the publishers.
Trademark notice: Product or corporate names may be trademarks
or registered trademarks, and are used only for identification and
explanation without intent to infringe.
British Library Cataloguing-in-Publication Data
A catalogue record for this book is available from the British
Library
ISBN: 978-1-032-11464-4 (hbk)
ISBN: 978-1-032-11463-7 (pbk)
ISBN: 978-1-003-22001-5 (ebk)
DOI: 10.4324/9781003220015
Typeset in Times New Roman
by codeMantra
CONTENTS
Introduction: A Day on the Psychiatric Ward 1
1 On Model Railways 7
2 Homeless and in Mental Ill Health 21
3 Care in the Community: Recovery 47
4 Care in the Community: Quartermaking 102
5 Conclusion: Psychiatry in Recovery 181
Index 187
v

INTRODUCTION
A Day on the Psychiatric Ward
Eight-thirty: I have had my breakfast at home, and I walk to his apartment
two streets up. It is sunny and already hot. As ever, I wait longer than you
normally would after ringing the bell. His voice is tentative over the inter-
com: ‘Peter?’ ‘Yes. It’s me’. I have another wait coming, because the buzzer
is broken and he has to come all the way down from the fourth floor to let
me in. In spite of the heat, he is well wrapped up: hoodie drawn tightly about
his head. It is how he likes to dress, rain or shine. He walks ahead of me and
asks how I am. He will ask several times in the course of our conversation,
always in the same tone as when he first greeted me. It is his way of filling
in the silences. I sit down, and he asks if I would like a coffee. He made it
fresh this morning; he has been expecting me, obviously. I ask if he has had
breakfast. He says he hasn’t. He offers me some cake and encourages me to
help myself. The box is still unopened. My colleague, who has told me of her
concerns about his eating so little, took him to the shop to buy a cake a few
days ago. Clearly, her inducement has had no effect. I cut myself a slice in
the hope that he will join me. But he doesn’t. To round off my visit he and I
will phone his brother, who visits regularly. Tonight his brother will bring a
kebab. He loves those. He is proud to show off his television set, which was
connected to the cable network yesterday. The support worker showed him
how it works. He can do it. He places the two remotes by the TV set with
care. It’s amazing how well he concentrates at times. We go downstairs and
open his mailbox. I tell him to check it once a day. And that I will make
some name stickers, for his mailbox and doorbell. To make the place feel
more official. He nods in satisfaction, smiles and asks if it would be difficult
to make a sticker with his name on. The only letters we find are addressed
to the previous tenant. We go for a walk. I show him the venue for a neigh-
bourhood party this weekend. We look at the poster. It doesn’t really appeal
to him. But the poster mentions a community centre about a hundred yards
up. A friendly man there tells us more about the place and says that you are
welcome any day. It has a social grocery store, where you can collect food
parcels. On Thursdays there is a free breakfast. While there, he tells me that
he has been before, and that the place has a benefits office. He will repeat
DOI: 10.4324/9781003220015-1 1
INTRODUCTION
this several times on the way home. It seems fairly likely that he will drop in.
We walk on, and he stops outside an insurance office. A poster in the win-
dow depicts a man on a bench. He examines the poster for some time and
tells me that he likes it. I gaze at it with him, aware that I have never stood
before an advertising poster for so long. I don’t get to hear what he likes
about the poster. He tells me that he doesn’t have an answer to that question.
We walk on in the morning sun, and he sinks ever deeper into his own world.
I hear him whisper, unintelligibly. He makes rapid up and down movements
with his head, as if nodding in support of what he is telling himself. His
responses to my conversation become slower and less frequent. I wonder if
all these new impressions have tired him. When we come to say goodbye he
is more alert. He asks again when my colleague plans to visit. I answer, he
asks again and I give the same reply. It is an almost ritual repetition, which
we run through again when I give him the day of my forthcoming visit. And
again when I say that I will pop a letter in his mailbox with the date of his
first visit from the family care services. I feel like a teacher helping a pupil
to memorise a topic. As always, I am a little saddened when I leave. He
is incredibly happy to be living on his own, but it takes a huge amount of
energy to embrace these new experiences. By asking me things repeatedly
and listening to my patient answers is he just extending our time together?
Does he feel lonely at the thought of my leaving? As ever, he tells me that he
does not have the answers to these questions.
Months later, this repetition of questions on parting has come to an end.
Is he more familiar with independent living and his surroundings now? Or
has the loneliness waned because his network has grown and more people
come to visit? I suspect that both are true.
After 30 minutes, I arrive at the ward of the psychiatric centre, where
I work. We have two peer supporters with us on a short training placement.
They hate the term ‘observation placement’. They cannot wait to get talking
to the inpatients. Both are very open about their own inpatient experiences.
One, Yvonne, also has much to say about her life. She has been a victim
of domestic violence and was dependent on alcohol and drugs. She looks
bright and alert. She is glowing. She has her difficult moments, but is feeling
good now. Both peer supporters reveal a strength that will bring hope to
anyone in the group who is still in inpatient care. Someone talks about the
loneliness you feel when discharged from the hospital. Someone else says
that there isn’t enough real contact between the patients on the ward. He
also says that it is great to see people coming here and talking about them-
selves so openly. Someone from the benefits office chimes in to say that she
has been admitted to a psychiatric ward more than once in the past. She is
suddenly sounding like a peer supporter herself now. Horizons are shifting.
Thanks to peer supporters, the difference between healthcare professionals
and patients has rapidly and significantly reduced. There is a greater sense
of ‘we’. And, at last, the discussion is more about exclusion and reconnection
2
INTRODUCTION
than illness and mental ill health. Just about everyone at the meeting is keen
to visit the drop-in centre where the peer supporters get their training. A
place where you can drop in for a coffee, or even help out in the kitchen. A
place of meetings, and a place of hope.
In the afternoon we head out to a city about 13 kilometres away. I go by
bike with three patients. Johan is proud that he knows the way. We avoid the
traffic by cycling along a small river. He rides alongside me and, between
jokes, talks about his life and his most wonderful and horrendous experi-
ences. One of the group begins to tire, and we stop briefly to wait. We take
care of each other. The sun is out, and the landscape is absolutely beauti-
ful. We enjoy the surroundings and just being together. We are awaited by
the rest of the group, who came by car. Today we are walking dogs. Kathy
has brought them. They are with registered charity set up in 2008 to rescue
greyhounds in need of care. The dogs were used for racing, coursing and
breeding and were often kept in appalling conditions.
Ludo beams when he hears that we are walking dogs. The support work-
ers always give Ludo the same dog, to get them used to each other, so they
bond. Gavina, the dog, heads straight for Ludo. You can’t drag him out of
bed for anything, normally, but he wouldn’t miss this for the world. He used
to have a dog, he tells us, and was devastated when it died.
Michel, a local resident, has brought his own dog. Around the other dogs
it seems a little excitable. Hard work for its owner, who has to keep it under
control. Michel gives up in the end, reluctantly, and goes home. Our two
peer support interns have joined us and are getting to know the people from
this morning’s group meeting.
It is quite extraordinary to see these people who are living through mental
health issues smiling and walking dogs, which, like themselves, have been
through terrible experiences. The lady from the charity, who is something
of a dog whisperer, talks about the post-traumatic stress that some animals
suffer. She really enjoys her afternoon out with the people from our centre,
who take such enormous care of the animals. It does the dogs an awful lot
of good. Patients talk about pets, and how important they are to them when
they return to independent living. We have a quick drink on the terrace, a
little chat about what we’ve done and then we cycle back to the centre. For-
tunately, this time, we have the wind behind us.
It is a day of apparently disparate, yet not unconnected, activities. To
begin with, everything revolves around care in the home rather than admis-
sion to a psychiatric hospital, and the emphasis is on the patients’ own
experience and their understanding of themselves. Essentially, it is about
the importance of participation, which culminates in the development and
deployment of expertise through lived experience. In the end, we reach
beyond the peer group by establishing contact with local residents, or, that
is to say, people outside the mental healthcare setting. This is the essence
of quartermaking. It is about finding or creating hospitable places that are
3