This is a guest blog by Martin Webber FRSA. Martin received a grant and help to run a crowdfunding campaign from RSA Catalyst for his ClearFear Game combating social anxiety. He is currently running a crowdfunding campaign through the new RSA curated area on Kickstarter to further develop his project.
The Big Idea: harnessing the power of fun and games to combat social anxiety through a real-life participatory social game.
Anxiety affects us all. Sometimes, a little bit is a good thing. It can sharpen our minds before a performance or help us to complete a piece of work, for example. More often, though, it can get in the way of leading a normal, productive life. Severe anxiety can stop us sleeping, going out and getting on with our lives.
Research in the US has found that as many as one in ten people suffer from social anxiety disorder – a persistent fear of social situations – at some point in their lives. National Institute for Health and Care Excellence guidance recommends medication or psychological therapy for the treatment of social anxiety. However, only about half of adults seek help and most only do so after experiencing problems with their anxiety for over 20 years.
As we all have fears and anxieties, and because formal treatments are either inappropriate or unavailable, we are creating a game which helps people to confront their fears in a fun way.
With the support of RSA Catalyst, I am working with Philippe Greier of Playmakers Industries to create the ClearFear game. Along the way, we have harnessed the expertise of people recovering from substance use problems at Kingston Recovery Initiative Social Enterprise and researchers in the Connecting People study team to design the game. Through introductions made by RSA staff, we also gained the help and advice of other RSA Fellows David Floyd, Andy Gibson, Ellen Pruyne.
ClearFear is a real-life social game in which players are helped to find their own super-powers. By becoming our own superheroes, ClearFear game players tackle missions with the support of a small team to overcome their fears. Together, game players create a secret smiling society which no longer fears fear.
The ClearFear game has been tested by many people in the UK, Austria, Bolivia and Sweden. Our latest test has been with people recovering from substance use problems in the West Kent Recovery Service, where the RSA is piloting its Whole Person Recovery System.
The feedback we received from players has been positive. The laughter emanating from the attic room in Tonbridge where we last played the game suggests that it can be fun. Perhaps that was because the missions which players completed were completely bizarre, such as asking a stranger to move their car from one place to another or making a box out of twigs. Others included finding out an interesting fact about Tonbridge from someone in a local shop – which took a few attempts – or hugging a stranger – which, as you might expect, met with diverse responses.
The missions took people slightly out of their comfort zone, but as they were completed in a team their successes were celebrated together.
How does it work?
But does playing the game actually make a difference? We don’t yet have an answer to this question, but at the International Centre for Mental Health Social Research (University of York) we’re evaluating a pilot of the game to see if it helps to connect people, reduce anxiety and improve players’ well-being and feelings of empowerment. We have some ideas how it may work.
The ClearFear game superhero narrative provides a fictional frame for the exploration of reality. Unlike psychological therapy which takes people towards their fear, ClearFear takes players away from it into a fictional frame to poke fun at it. This ‘dramatic distancing’ is somewhat paradoxical, but enables players to engage with buried aspects of themselves more profoundly. Fear becomes a nemesis to overcome through a series of fun missions.
Missions are the antithesis of gradual exposure techniques, which are typically used in psychological therapy to carefully expose people to situations which they are fearful of. ClearFear missions are fun, some may say frivolous, but being part of a team of players where everyone has a mission to complete equalises the status of the tasks and reduces individuals’ anxiety about what they have to do. Teams of three can frequently complete their missions in under one and a half hours, demonstrating that exposure to fearful situations with the support of other players can be tackled with fun.
The superhero narrative of the game reminds players that they have strengths. Developing and testing the game with people recovering from severe problems who sometimes feel that they have nothing to offer to society has demonstrated how powerful this can be. Starting off talking about the problems they have experienced in their lives, players help each other to identify what they are good at and enjoy doing most. Asset-based approaches help communities to develop and we see the same beginning to happen with the ClearFear secret smiling society.
There is a long way to go. We need to take the game to the next level and to complete our evaluation to see if it works. To help us, we have launched a crowdfunding campaign on the RSA Kickstarter page last week. We are doing well so far but need to keep up the momentum. Please take a look and help if you can: bit.ly/clearfearfrsa
We aim to source some additional funding to enable us to develop a version of the game with mission cards, a gamer’s toolkit, and a fully-functioning website with clear instructions so that people can share their successful missions. This is to allow individuals to play the game.
If you want to help us reach our target of £5,000 by 31st October, please pledge your support and share it with your contacts.
We all have mental health and we need to look after it. Let’s embrace the possibility that social gaming is good for our mental health. Let’s clear fear together!
To get help from RSA Catalyst for your social venture visit www.thersa.org/catalyst.
Looking around at the environmental degradation, financial turmoil, and increased social inequality around us, perhaps you’ve had the sinking feeling that we are creating our own demise. Presumably you are hoping there is a way that we can work ourselves out of this mess. You wouldn’t be alone.
Robert Kegan, Professor at Harvard University, gave a fantastic, if somewhat haunting, lecture here at the RSA last week. The event, “The Further Reaches of Adult Development: Thoughts on the ‘Self-Transforming’ Mind” chaired by Jonathan Rowson, briefly reviewed Prof Kegan’s work on adult development and introduced the audience to his intriguing theory – lovingly called “Bob’s Big Idea”- about the implications of more people reaching the ultimate stage of development.
image from wrike.com
To get the full effect of Bob’s Big Idea, at least a basic knowledge of his adult development work is needed. I encourage you to watch the event in its entirety, but will very crudely paraphrase the first half of Kegan’s talk here, where he asserts that humans undergo various stages of development of mental complexity. We are “makers of meaning” and to organise this meaning we have basic frameworks through which we look at life. We work through these various frameworks, or stages, over our lifetime. Kegan’s talk focused on the fourth and fifth stage of development (a summary of the adult development stages, produced by Dr Jennifer Garvey Berger, can be found here).
The fourth stage, called the self-authoring stage, is where people start to loosen the reins of others’ expectations. As the name suggests, this is the phase when you are able to begin to write your own identity, rather than viewing life through the lens of what others think of you. The self-authoring stage is one in which “we are able to step back enough from the social environment to generate an internal “seat of judgment” or personal authority, which evaluates and makes choices about external expectations”.
According to Kegan’s research, some people reach the fifth and final stage, the self-transforming stage. If it is reached, it is generally at some point in life after middle-age. In this stage, people can start to hold more than one position. They are able to grasp that even their own way of seeing things might be flawed. With a self-transforming mind,
“we can step back from and reflect on the limits of our own ideology or personal authority; see that any one system or self-organisation is in some way partial or incomplete; be friendlier toward contradiction and oppositeness; seek to hold on to multiple systems rather than projecting all but one onto the other.”
Bob’s Big Idea
Why is the population living so much longer? Not how, but why? Why do we live 20-40 or more years beyond our fertile years?
What if we are living longer so that our older people can figure out how to save our species?
Kegan’s idea is that, as a species, we are trying to figure something out: how to survive. He suggests that whenever a species moves collectively in a direction, it is always for one reason, to ensure survival, and it is exactly the same for us. The self-transforming stage, as mentioned above, is usually reached after middle age, if at all. So the longer we live, the greater the chance that more people will develop into self-transforming level of mental complexity. Kegan notes that we are creating our own demise and effectively asks: What if we are living longer so that our older people can figure out how to save our species? “Are we looking for a way out of hell?”
As RSA colleague Matthew Mezey summarises: old people will save the world.
Is higher better?
So does this mean that we should all be striving to reach ‘level 5’?
The phrases “adult development” and “mental complexity” get banded about the office from time to time, and in the past I was somewhat reluctant to join in the conversation. This partly down to lack of knowledge about the topic, but mostly down to the feeling that this type of language felt terribly elitist to me. It’s not that I don’t believe that people can be at different stages of development (because I do), but more that I am not yet convinced that higher is necessarily better. Is there any correlation between level of mental complexity and happiness or wellbeing?
Speaking to Kegan after the event, I learned that the answer is twofold, and depends on the sense in which we talk about wellbeing. Hedonic wellbeing is about affect and an element of life satisfaction; that is, it is what we mean when we think of wellbeing as being in a good mood, enjoying the moment, and having general life satisfaction. Interestingly but perhaps not surprisingly, there does not seem to be a correlation between stage of development and hedonic wellbeing; people at all stages are subject to a similar rollercoaster of joys and sorrows.
Eudemonic wellbeing, on the other hand, is less about feeling pleasure and more about having feelings of meaning, purpose, belongingness; having competence; being self-accepting. It is imaginable that indeed reaching higher orders of consciousness could be helpful in achieving these components of wellbeing.
reaching higher orders of consciousness could be helpful in achieving these components of wellbeing
When the conversation turned to mental illness, Kegan explained soberingly that paranoia might look very different to someone in a self-authoring stage of development than someone in self-transforming stage of development.
As with so many important questions, the answer is nuanced. This blog post has not done justice to Kegan’s talk last Thursday. I encourage you to listen to the talk, regardless of your views on Bob’s Big Idea, as a great way to learn more about the higher levels of adult development and to open up similar thought-provoking questions.
Nathalie Spencer is part of the RSA’s Social Brain Centre
A trained psychologist myself, I took great interest in today’s call of the British Psychological Society for a departure of the biomedical model of mental illness. And, to my delight, so did other colleagues – read a great blog post from Social Brain’s Emma Lindley here, where she writes that we might be right now witnessing a bona fide revolution that may change mental health services so radically, ‘they will be unrecognisable to the children of my generation.’ As Emma points out, the debate is as much driven by differing concepts of human nature as it is by politics, and the struggle for professional relevance and power. It is the latter aspect that I want to focus on in this blog post.
The RSA has long taken an interest in professions and their future (including this project in the early 2000s), and is currently managing an independent review of the Police Federation. Further international projects with other professions may follow soon.
Interestingly, even though Psychiatry is the younger term, it is the arguably the older science, and literally means ‘the medical treatment of the soul’, whereas Psychology means ‘study of the soul’. Psychology and, specifically, its subdomain Clinical Psychology, have always had a hard time standing up to their medical cousin. Part of the reason for that one can find in the etymology; isn’t medical treatment is just so much more tangible than mere study? Thus, in more than one hospital of the world (including one I interned in a long, long time ago), Psychologists have not been much more than overeducated sidekicks to doctors. This may change soon.
The main reason for this is that over the last decade, and particularly since 2008, Psychology has arrived in the scientific establishment. It did so by using a strategy applied by underdogs since the advent of mankind: collaboration. (And, of course, the emergence of discipline rockstars like Steven Pinker has helped.)
Not having enough leverage itself, Psychology entered functional marriages with up and coming disciplines like neuroscience and traditional ones like economics, a process that led to the creation of new interdisciplinary fields like behavioural science. A prominent victim of this process was homo economicus – the notion that humans are wholly rational and narrowly self-interested. Homo biomedicus (not an official term, my inadequate creation), the similarly reductionist paradigm underlying present day psychiatry that acknowledges only the physical side of human existence, but leaves aside the social and psychological aspects, may very well be next.
There are two reasons to be concerned about the potential revolution of mental health services given that professional battle lines are drawn:
Firstly, while for Psychology there was the possibility of a non-threatening complementary relationship in the mutual interest with economics or neuroscience, with Psychiatry it is different. Here the question is ‘who runs the show?’, or, if you will, one of professional hegemony. Still, one hopes that the critical voices on both sides steer the process away from the zero-sum-game it is in danger to become, which certainly would leave everyone worse off.
Secondly, the homo biomedicus model is not entirely wrong, just as the homo economicus model is not completely off the mark. The concept has its merit and adequate areas of application, and it will need to be taken into account when designing future services based on a richer, more complex understanding of man as Homo biopsychosocialis that is embedded in a capabilities-based approach. Throwing out the baby with the bath water would be just as wrong.
Josef Lentsch is Director of RSA International – follow him at @joseflentsch
Today, the Division of Clinical Psychology has issued a statement that essentially says that our system for diagnosing mental illness is unreliable, lacks validity and is not fit for purpose. This follows a similar statement from the American National Institute for Mental Health last week in which it was announced that NIMH would not be using the new DSM-V (the prescribing manual for mental disorders) because of concerns about its validity and use value. These two announcements are of tremendous significance, and could herald the beginning of a bona fide revolution in how we respond to and treat mental illness.
I think that mental health services will change so radically within my lifetime that they will be unrecognisable to the children of my generation
For several years I’ve been saying, albeit tentatively, that I think that mental health services will change so radically within my lifetime that they will be unrecognisable to the children of my generation. I really hope these recent announcements are the beginning of that transformation.
Arguments about the revisions to the DSM have been simmering for a long time, and the new issue is already several years later in being published than expected. You could look at this as a predictable and relatively insignificant resurgence of the long held divisions between psychology (which assumes mental distress is caused by traumatic life events) and psychiatry (which treats mental illness like any other physical condition, and assumes causes are biological).
You could regard it as being politically driven – in both the UK and US, the cost of mental illness is utterly unsustainable, and anyone who’s ever taken time to look at the figures will know that a majority of prison inmates have a history of mental illness. As Barack Obama put it rather starkly, it’s easier for a mentally ill person to buy a gun than to get proper treatment in the US. In the UK, the political narratives are spun separately, with few people joining the dots to see what’s really going on.
it’s easier for a mentally ill person to buy a gun than to get proper treatment in the US
On the one hand, mental illness is on the rise. It costs us £36 billion a year, in sickness absence, unemployment, not to mention treatment. The pharmaceutical industry produces more and more psychotropic medications, most of which are incredibly expensive, and all of which are developed on relatively limited understandings of how they work or why they work (if they work, which, frequently, they don’t). On the other hand, the voices of mental health service users are finally started to be heard, and the resounding message is that things need to be done differently. In support of that, both the critical psychology movement, and critical psychiatry movement have both been asking questions with increasing urgency. Running alongside are parallel problems around mental illness and employment; mental illness and education, and mental illness and social exclusion. All of this needs unpicking and exploring in a lot more detail.
This week is mental health awareness week, and the focus is on physical activity and its benefits for mental health. I’m fully in support of this, and a firm believer in the importance of physical health for mental health. But it strikes me that there are bigger and more important issues happening too.
My PhD thesis, Making sense of mental illness: The importance of Inclusive Dialogue, goes into some of these arguments in a lot more detail, some of which I hope to return to and develop in another blog post.
Here is an interesting Guardian piece on a transnational YouGov-Cambridge study. The research compared attitudes towards responsibilities of the state versus those of individuals in the UK, US, France and Germany.
To summarise, when it comes to the role of the state on issues like ‘a decent minimum income for all’ or ‘helping poor children get ahead’, British views are significantly more continental than atlantic. With the exception of company pay – on inequity of salaries, Britons are more liberal than Germans and French, if not as liberal as Americans – the results put the US on the individualist side, and UK, Germany and France broadly on the statist side; which highlights once again that the conversation on public services in the US is a very different one to this side of the pond.
What is just as interesting as the results, however, is the way the study is structured. It takes a classic two-dimensional approach: state versus individuals.
What about views on the responsibility of, and for, communities?
They are a pillar of social power just as much as the other two dimensions. And given fiscal pressures on both sides of the Atlantic, an increasing amount of challenges will need to be dealt with via this ‘third dimension’ (e.g., as my colleague Matthew Parsfield pointed out recently, in Mental Health, or as our CEO Matthew Taylor has argued, in Care).
But as so often, communities get left out of the equation – what statisticians would call an omitted variable. Arguably, without taking this third dimension into account, there is a lack of depth in the insights generated.
My hunch is that we would see a picture emerge that is more complex and informative than the binary US/Europe divide. But perhaps there is already some comparative data out there, maybe even longitudinal – might a reader point me in the right direction?
The RSA is well positioned to work across all three dimensions internationally, as we have strong Fellowships in all four countries (altogether we have Fellowships in 101 countries, the US being the largest one with almost 800 Fellows), as well as Fellow- and staff-led projects in the US and Germany. I will elaborate on these in my next blog posts.
Also, I am looking forward to the upcoming RSA Lecture with Tim Smit, CEO and Founder of the Eden Project, who asks the very question: ‘Where does responsibility for community lie’?
Mental health is a globally pressing issue. Conservative estimates suggest that 400 million people worldwide suffer from various mental illnesses, while the World Health Organisation predicts that by 2030 depression will be the world’s leading cause of the burden of disease, with mental health problems already exacting a greater toll than tuberculosis, cancer, or heart disease.
Yet look at this global picture more closely, and to some observers it appears as though this burden might not be spread evenly around the world. With recovery rates for schizophrenia and depression in the USA, UK, and other wealthy countries worse than those in Nigeria, India, and other developing nations, it looks as though the poor world is outperforming the rich when it comes to dealing with some mental disorders.
Theories as to why this may be abound. These range from the perhaps outdated and stereotypical idea that there is a greater tradition of family and community solidarity in economically developing nations, to the social anthropologist Tanya Luhrmann’s theory that a combination of greater stigma and “disgraceful” normative care practices in the West often mean that sufferers of devastating mental disorders like schizophrenia concurrently experience a range of other afflictions – ostracism, homelessness, poverty, substance addiction and a set of humiliating interpersonal experiences that she calls ‘social defeat’.
Last night, in his RSA lecture entitled ‘The Global Mental Health Crisis: What the rich world can learn from the poor’, Professor Vikram Patel of the London School of Hygiene and Tropical Medicine offered a slightly different perspective. Focussing on access to care, he gave examples of the relative ingenuity of mental health care practices in countries like India, where he has done extensive work.
There is, he said, no shortage of psychiatric professionals in wealthy Western nations; for example California alone has more psychiatrists than the whole of South Asia. Despite this, some 60% of people with mental illness symptoms in the USA do not access any form of psychiatric care. The UK, even with its free-of-charge National Health Service, only performs slightly better, with 40% of sufferers not seeking or receiving treatment. As explanations for this he pointed to the sometimes alienating, over-complicated professional culture of DSM-influenced approaches to mental illnesses in the West, and the remoteness of psychiatric practitioners to their patients in both lifestyle and outlook as reasons for people not knowing about or feeling they can access services.
By contrast, he presented a model of public health in India that, with limited resources in the form of professionals or pharmaceuticals, utilises lay community health workers to provide collaborative, locally appropriate community-based care. Specially trained lay workers operate under the direction of psychiatric professionals to provide outreach services, ‘psychiatric first aid’, and social interventions based in the home, in a Wellcome Trust-funded controlled trial, documented in a series of documentaries available online.
Back in the UK, the RSA is looking to draw upon a similar approach as part of its Connected Communities project, which seeks to explore ways of building resilient communities in which people’s wellbeing and life satisfaction benefit from social connections with their peers. Working with Nicky Forsythe of Positive Therapy, we shall shortly be launching an innovative Talk For Health peer support programme which will train key members of community networks as lay counsellors, giving them the confidence and knowledge to take the therapists’ skills of empathy, non-judgemental listening, and conversational support out of the doctors’ surgery and into the hands of the community. In Bristol, we’ve just launched an innovative tablet computer app called Social Mirror, which volunteer health champions will use to help people map their social networks and, where necessary, receive suggested social prescriptions. Simultaneously, we are working with Talk To Me London to launch an exciting pilot project in New Cross that seeks to encourage Londoners to engage in conversations with strangers, with participants identified by their ‘Talk To Me’ badges which show that they are friendly and willing to chat. The designers of the project promise that it will “be the most innovative, culture-changing campaign of our times”, so stay tuned for more on that.
With ever-increasing strains on public health and social care budgets, and worrying research that demonstrates links between social isolation and the risk of mental illness and death, it is hoped that we can learn much from Professor Patel and others in the ‘poor world’ who are demonstrating that innovative, ingenious social interventions can help manage the burden of mental illness by supporting connected communities. Keep checking this blog, follow #RSAConnected and @SocialMirrorApp on Twitter, or email firstname.lastname@example.org and ask to join the relevant email lists to keep updated with how this work progresses.
The stigma of mental illness is alive and well. Despite the fact that campaigns like Time to Change have been working hard to eliminate stigma and discrimination against people with mental health conditions, it seems that it’s still all too easy to casually slip into a culture of blame.
A short article in the Guardian published this morning reported the results of a study that indicated a link between being a child of parents with mental health problems and being at risk of harm. That such a link exists is troubling, and our response to this ought to emphasise the need for better provision of support where it is needed most.
Maev Kennedy’s piece starts with very much the wrong tone, with the sub-heading: “Report by Ofsted and Quality Care Commission reveals that 30% of adults with mental health problems have children.” This reads as though a shocking number of (by implication) irresponsible and dangerous parents with mental health problems have children, and really ought not to.
Kennedy doesn’t make a comparison with overall figures for having children. The stats are a little difficult to decipher, but my interpretation is that roughly 39% of couples across the population have children, so what is striking amongst people with mental health problems is that the proportion having children is significantly lower.
The case example Kennedy chooses to provide is that of a mother whose children “were only taken into care when their mother went into hospital” going on to describe a woman who had not showered for six months, rarely left the house and spent most days asleep. It sounds as though this woman was suffering from crippling depression, and was in desperate need of proper help and intervention, not for her children to be taken into care as soon as she began to show signs of distress.
Kennedy’s piece finishes with the damning line, “although an estimated 30% of adults who experience mental health problems have children, there is no national obligation to notify relevant authorities or collect information on how they are coping.” This almost makes it sound as though having a mental health problem is akin to being a paedophile, and that some sort of national register should exist to monitor the parenting abilities of anyone who experiences difficulties with their mental health.
My guess is that the piece was written quickly and that its author probably did not intend to produce an article that exhibits stigma and has a tone of judgement and blame. However, it is this type of subtle stigma that perpetuates damaging stereotypes and allows marginalisation and othering of people with mental illnesses to continue.
Mind published an interesting blog post on their website today, in which a woman with bipolar disorder describes the importance of her spirituality in staying well. The spirituality she describes is explicitly non-religious.
It’s interesting to contrast her experience with the recent finding that people who are ‘spiritual but not religious’ are more likely to experience mental health difficulties than those who belong to a religion.
Mark Vernon’s piece discussing this is well worth reading. It occurs me to that the writer of Mind’s blog post is absolutely right in saying that giving due attention to spiritual needs is long overdue.
It’s important to make a couple of points about the framing of this issue. Firstly, that ‘spirituality’ can be more than merely ‘new age’ and secondly, that it doesn’t always have to be juxtaposed with religion. Indeed, the Social Brain Centre is in the early stages of exploring how spirituality might be reconceived based on new understandings of human nature, and there will be more about that here soon…
Having a ‘dual diagnosis’ means that someone who has mental health problems also has problems with one or more drugs, including alcohol. In my years as a substance misuse practitioner I would frequently work with individuals where underlying and undiagnosed mental health issues would have a significant impact on problematic drug and alcohol use.
The continuing issue in my experience was that mental health services would frequently be unprepared or seemingly unable to work with individuals that presented with substance misuse issues. This would create a huge gulf in service delivery with many being unable to access appropriate support to meet their needs. The relationship between dual diagnosis: substance misuse and dealing with mental health issues a research report published in 2009 aimed at addressing some of the finer issues relating to ‘dual diagnosis’, and although there has been an improvement in the relationship between drug and mental health services, red tape and referral processes can still often prove to be a block to treatment.
In February 2011 the government released a paper entitled No health without mental health. The paper outlines the government’s strategy and action plan for improving mental health and well-being stating;
“This Government recognises that our mental health is central to our quality of life, central to our economic success and interdependent with our success in improving education, training and employment outcomes and tackling some of the persistent problems that scar our society, from homelessness, violence and abuse, to drug use and crime.”
Unfortunately the paper does not detail the specific issues relating to ‘dual diagnosis’ and how this strategy can shape and improve service delivery for individuals accessing drug and alcohol treatment.
In 2011 I was involved in an eight week pilot, which enabled those accessing services and exhibiting potential mental health problems the opportunity to be seen and assessed in the treatment centre by a clinical psychiatrist. This allowed for immediate referrals to be made to GP’s and mental health services for treatment, the initial results were positive and fundamental to the successful completion of treatment for many individuals over that period.
So how does this relate to a ‘Recovery Agenda’? The ineffective treatment of mental health problems relating to people accessing drug treatment services could jeopardise the potential for meaningful recovery. If the ideal vision is for treatment is to be but a small part of the recovery journey, then surely a more integrated service focused on ‘dual diagnosis’ will be required in the future. The tagline for the above mentioned government paper is ‘Delivering better mental health outcomes for people of all ages’ maybe that should include ‘all backgrounds’ to achieve real success in improving mental health for all.
Filed under: Education Matters, Fellowship, Social Brain
One of the unwritten conventions of working at the RSA is that, if a Fellow calls, you try your best to answer. So far, this has felt like anything but a burden, and has led to fascinating discussions and an emerging set of ideas for education projects, all which aim to engage Fellows at every stage.
Yesterday I met with RSA Fellow Sarah Bickerstaffe. An Associate at Improving Care, she is also carrying out research on social impact bonds in the mental health sector, and has recently set up a social enterprise to deliver Mental Health First Aid training. Imported from Australia, this two day programme trains people to identify and support people with mental health issues – from spotting panic attacks, to simple ways to talk to people who may be suicidal, to having more subtle conversations. Freed from an initial DoH programme, a new Community Interest Company is now thriving, with an interesting franchise model that encourages its instructors to innovate , whilst assuring quality in an atmosphere of high trust. Sarah has written about her work here.
Unsurprisingly, mental health first aid has taken off mainly in the public and voluntary sectors so far, for instance in the criminal justice and health sectors. There are also discrete courses for young people that could link well with the Modern Baccalaureate (which RSA is developing a partnership with).
Sarah is keen to develop new approaches to attract the private sector. There should be a strong business case for this, although the evidence on effectiveness is not quite mature yet. Although all kinds of businesses would benefit from this, as mental health is a common issue across any workforce, there are certain industries who encounter mental health issues more frequently, so might benefit from bespoke training. Nightclub bouncers, for instance, or bus drivers.
My first choice for a mental health first aid trial would be to run the course for cabbies. Sensible regulation during the last ten years, especially in London, has made the taxi industry far less shadowy. My local cab offices are staffed and their cabs driven by polite men, usually first generation immigrants, often highly educated. Their presence on our roads, and especially when waiting in their offices on our main shopping streets, discourages crime and anti-social behaviour. RSA’s project on how taxi drivers can change habits to promote fuel efficiency shows a capacity and appetite for a different kind of ‘Knowledge’.
Cab drivers could probably do with some general first aid training (In Germany, everyone has to pass a first aid qualification to get a driving licence), but might benefit in particular from mental health first aid training. Given their role in fuelling the night-time economy, they are likely to confront mental health emergencies, often drug and alcohol-related, sometimes leading to violence. Could there be a business case for cab drivers participating in mental health first aid training? Sometimes of course, as my favourite movie taxi scene shows below (rated 15) , it’s the driver himself who needs help. But beyond the specifics of mental health first aid, are there other ways to turn cab drivers into our fourth emergency service?