Blog: Tom Taylor on Service Development
As Survivors Manchester begins 2016 as an official ‘Improving Access to Psychological Therapies’ (IAPT) compliant service, there is much to feel positive and excited about.
However our Clinical Lead, Tom Taylor, argues that there is also a need for caution when working within externally standardised systems and protocols, particularly with those that often are deemed as complex and vulnerable groups. It is known that vulnerable men, their family members and significant others with disorganised attachment styles may ‘slip through the cracks’ unless we continue to strive to offer flexible and responsive service delivery based on individual needs, and provide a secure base for those clients with unstable attachment patterns.
The recent and tragic death of Greater Manchester resident Rebecca Kelsall, the vulnerable young Mother who committed suicide having been discharged from NHS mental health services following her failure to attend two consecutive appointments, represents a devastating reminder of the potentially lethal consequences of trying to squeeze the most vulnerable members of society into a system that arguably does not or cannot accommodate their complex needs (Guardian.com, 2016).
This has always been clear to us here at Survivors Manchester, as a specialist trauma focussed service dealing with complex trauma presentations with composite traumatic histories – essentially represent the bulk of clients accessing our services.
Our own figures indicate that around about 80% of those that access support are adult survivors of childhood sexual abuse (CSA) and anecdotally, for many of this 80% their sexual abuse represents one aspect of what can often be a catalogue of trauma, incorporating developmental impacts, neglect, verbal, emotional and physical abuse. Such traumatic experiences that take place during childhood, our most formative years, hold potentially devastating consequences for healthy human functioning throughout the lifespan. It impacts negatively on brain, mind and body.
However, it is the catastrophic impacts that such traumatic early life experiences have for the ability to relate to self, others and the world around us, or in other words the ability to form, develop and maintain healthy relationships, that represent such a formidable barrier for those severely traumatised in childhood who wish to access health services.
As services right across the sector struggle to survive the current political-economic climate, and with funding cuts showing no sign of ending, there has never been more pressure for services to prove their worth in the hope of avoiding the scythe for another annual quarter.
Outcome data currently represents the veritable ‘lifeblood’ of services, with the need to record the number of referrals, interventions and successful treatment exits – paramount for the maintenance of funding streams. This also means that for those individuals who miss appointments there needs to be some form of structured protocol in place regarding how many appointments may be missed without contact being made before the case file may be deemed inactive and therefore closed.
Now as one may expect, there are literally a billion reasons why people may choose to disengage from service and do. However, it is the aforementioned adults who have been subjected to prolonged, enduring trauma throughout early childhood that will undoubtedly display an apparent inability to engage in any consistent and structured relationship whether personally or with a professional and/or a service.
We learn how to relate to ourselves, others and the world from the adults and environment around us as babies and children. We develop the essential tools for monitoring and regulating our emotions, understanding and communicating our own needs, as well how to respond to the needs of others – all the essential ingredients for developing and maintaining healthy relationships. As social creatures, these are essential skills for self-care, mental health and ultimately survival.
So far so good for those fortunate enough to have grown up in a secure enough environment that enabled them to develop a ‘secure attachment style’. The result of this would be an ability to navigate interpersonal dynamics throughout life.
Now imagine what it’s like for those people who were not fortunate enough to have learnt these essential life skills during childhood, simply because they were being subjected to all manner of horrors, and traumatic experiences at the time when they are, by definition at their most weak and vulnerable.
For these individuals who have grown up without the luxury of a ‘secure base’ from which to explore and experience the world, they have consequently had no opportunity to develop an internal equivalent that will not only enable them to tolerate and regulate intense emotions but also to access and maintain help and support throughout life. It is these service users of our respective organisations and services that are so desperately in need of our interventions and support, yet these are the people whose needs are often failing to be met by a whole system that neither fully understands them and struggles to accommodate their form of learned chaos.
For those individuals that are insecurely attached, a new attachment relationship with an organisation or service, and its team may be essential in order to integrate more healthy experiences that could not be accommodated in their earliest relationships. By providing consistency, tolerance, understanding and acceptance, we as professionals are in a position to offer a literally transformative experience. We can do this by offering a positive and new attachment relationship to those insecurely and/or disorganised attached individuals who need it most. In this sense organisations such as Survivors Manchester become the much needed ‘secure base’ for those who were denied both this, and a way of being with others within their earliest relationships.
Maybe its utopia to imagine that this could be something that can be accommodated nationally, but within the current health system as it stands however it cant. For as the death of Rebecca Kelsall clearly demonstrates, there is simply not enough flexibility within service delivery to foster this type of change.
But I present this in the hope that the food for thought here regarding the future development and evolution of services, that are ultimately designed to treat and support the most vulnerable within our society, is eaten and digested.
Maybe it’s time for significant change regarding the ways in which we do this.