Taking over the asylum
Are we ready to embrace truly service user led services, asks Alistair Sinclair.
I was back on trains in April, which gave me the opportunity to hear from a lot of people about their approach to ‘co-production’, a word and concept, championed by public health, that’s slowly entering into the mainstream. I was in Norwich on the 17th, facilitating a UKRF asset-mapping recovery seminar for (mostly) service users and ‘peer supporters’. The next day at the London User Forum (LUF) in Barking I heard about some great user-led stuff going on in London, and a week or so later I was in Widnes at a recovery event doing a bit more community asset mapping and hearing about a different LUF, the Lancashire User Forum. A couple days after that I was in Rickmansworth in Hertfordshire delivering another UKRF seminar, this time focused on assets in the ‘Three Rivers’ area.
Tim Sampey, the CEO of ‘Build on Belief’ (BoB) a charity established in 2012 (having grown from SUDRG in Notting Hill, West London) to run peer-led activities and services for people with substance issues, spoke at the Barking LUF. In an eloquent, passionate and ‘off the cuff’ speech, this stood out for me: ‘There’s something going on… a revolution… service users are becoming a major part of the delivery of services… this is going to get bigger and bigger… we need to connect with each other across London and learn and grow together.’ I’ve been reflecting on Tim’s words, on what I’ve seen in the last month, the willingness of many service users, practitioners and community members to share their assets, get involved, ‘co-produce’, and thought a little bit of recovery history might be interesting.
Larry Davidson in his book The Roots of the Recovery Movement in Psychiatry (Wiley-Blackwell, 2010), traces the beginnings of ‘recovery’ as an orientation back to the work of a chief physician, Phillipe Pinel, and Jean-Baptiste Pussin, who worked together in Paris at the Bicêtre Asylum from 1793. Pussin, the superintendent of the asylum (working alongside his wife) had himself been an ‘inmate’ at the Bicêtre in 1771.
So what did they do to dramatically improve ‘recovery’ within the asylum? In a nutshell, they imposed a zero tolerance policy on abuse – nearly all the staff were eventually sacked and replaced by ‘former and recovered inmates’. They supported a community-learning environment and, most significantly, they gave meaningful work to the ‘inmates’.
‘We will find, perhaps surprisingly, that recognition of the value of hiring people in recovery to provide care to others – what is currently called “peer support” – can be traced back to this era, when Jean-Baptiste Pussin… was not only the first to remove the inmates’ chains but also the first to use the strategy of hiring convalescing patients to provide traitement moral to the patients of the asylum.’
I’ll leave you with a couple of questions. If, as Duncan Selbie from Public Health England says, homes, jobs and social connections lie at the heart of wellbeing and health, and if ‘co-production’ is key to the development of ‘healthy’ services and communities, how ready and willing are we to let the ‘inmates’ run the ‘asylum’? Are we prepared to remove all the chains?
Alistair Sinclair is a director of the UK Recovery Federation, www.ukrf.org.uk