Tidal perspectives

Tidal Perspectives

The Tidal Model is focused on the person and its method is, undeniably inter-personal. When one person genuinely encounters another, the magic of the human encounter takes place.

Here, we publish below some of the comments we have received, which represent what people made of their encounter with the Tidal Model.

"The real contribution of the Tidal Model to a recovery focus lies in the direct experience of the service user. Evaluative studies illustrate repeatedly that this is a great strength. In an age where choice is purported to be at the heart of successful and responsive services (especially in the case of ‘inpatient’ services where no discernable ‘choice’ exists as regards the model of service) does the Tidal Model not offer this?"

Steven Michael. Chief Executive, South West Yorkshire Mental Health NHS Trust, England

"The Tidal Model relocates the person and their story at the heart of the caring process and urges mental health professional to ‘care with’ people as opposed to ‘care for’ people. Mental health carers are encouraged to form a genuine, meaningful, collaborative relationship that acknowledges the importance of the person’s story and the power to heal that is within us all.

After over 30 years in mental health nursing and education, the Tidal Model helps me, as a nurse and lecturer, to articulate the essence of mental health nursing and remain focused on the person - their needs, wants, dreams and desires. It challenges me to remain in touch with my own humanity and vulnerability, so that I may genuinely engage with, and learn from, the person who is experiencing distress".

Dr Agnes Higgins Associate Professor of Nursing, Trinity College Dublin, Ireland

” An essential skill in mental health nursing is being able to recognise difference. The Tidal model supports the development of this skill because it is an approach based upon uniqueness.

When we meet a person (patient) for the first time we should listen intently to their story. What is that makes this person different from all the other people we have met? This is the first question the nurse should address.

Even if the person has an illness which many other people also have, the nurse should be seeking to establish what it is that is different about the person from all of the other people they have dealt with who have the same illness. To be able to work in partnership with the person and to determine effective recovery strategies together it is crucial to be able to recognize these differences”.

Robert Davidson. Director of Nursing - Greater Glasgow and Clyde Mental Health Partnership

"One can become dispirited working (or being treated) within mental health services. There is much to be critical of in relation to the way people continue to be coerced and controlled, their problems construed as some kind of chemical imbalance, and the confidence with which health professionals presume to know what people need.

As a set of values, commitments and recommendations for practice the Tidal Model equips nurses and others with the skills to be with and help people even in the most potentially psycho-noxious ‘treatment’ environments… to be with people, rather than to do to them. The Tidal Model can restore hope and pride to health professionals as much as to service users. It emphasises humility (a rare commodity when certainty is so often striven for), our common humanity and citizenship (the right to be fully human), and care (in both the affective and instrumental sense). The Tidal Model is an aggregation of collective wisdom to enable others to realise their potential as human beings and as helping agents."

Richard Lakeman. Lecturer, Dublin City University Ireland

"The Tidal Model helps patients to be aware of and accept themselves as they are and it helps them to aim at changing at the same time. This is an interesting therapeutic contradiction. This therapeutic contradiction coincides with much Chinese and Japanese philosophy.

The patriarchal model is fading away in the Japanese mental health care. Now it is legally required to respect the patient’s right and to provide appropriate explanation to obtain consent."

Professor Tsuyoshi Akiyama. Director, Department of Psychiatry, Kanto Medical Center, Tokyo

"In Justice Health the challenge of maintaining a therapeutic, rather than custodial relationship, are real and ongoing. We needed something to convert the latent energy of the staff team, based in a wish for things to be different, into action. We needed a force to get things going. Our exploration of the Tidal Model led to service wide excitement that now that force had been identified!

Dr Andrew Cashin Associate Professor of Justice Health Nursing Professorial Unit, University of Technology Sydney

The Tidal Model argues for a collaborative nursing practice that helps the person in care to reclaim his or her personal identity. An orientation according to the Tidal framework has the potential to help Danish nurses to underpin their professional self-understanding in a new and meaningful way. In this sense, the Tidal Model creates two parallel processes: it invites nurses to help people to recover after mental illness and lends itself as a theoretical tool for Danish nursing to reclaim a new professional identity.

Dr Niels Buus Research Nurse; Centre for Psychiatric Research; Aarhus University Hospital, Risskov.

"A feature of the ten commitments that appeals to us is the articulation of the centrality of the language and experience of the one who comes to the attention of the psychiatric service system. This opens up new possibilities for the ways in which conversation and writing take place in psychiatry and what their purposes are. It is very easy to be a champion of the Tidal Model from a user perspective"

Cath Roper - Consumer Academic, Centre for Psychiatric Nursing Research, Melbourne

(Click here to read more of Cath's Tidal perspective)

"The most refreshing thing I find in the Tidal Model is the position of learner and teacher. As consumers in the mental health services we rarely find clinicians prepared to sensitively listen, uncluttered by bias, to the heart of our story. This model asks the practitioner to be the skilled apprentice, to sit with and learn from the individual's distress , not to deal to it. Respect is effused throughout the fabric of the model's way of working. As someone who has battled in a void to make sense out of the experience of so-called madness I have to only to surmise how respectful relationships may well have profoundly altered the compass bearing of my personal journey. The essence of this is simple.

Anyone who has had the privilege of working with Dr Phil Barker and Poppy Buchanan Barker will know that respect is the hall mark of their work. The Tidal Model deserves joyful investigation and then serious certain implementation.

Anne Helm - Consumer Consultant and Educator, Aotearoa (New Zealand)

"The Tidal Model, give me some hope to fantasise about a future where there are no DSM's, ICD's, scales, screens and inventories. A future where we are listened to, and responded to individually, with respect for our rich and varied frames of reference"

Louise Pembroke - Survivor activist, 'Psychiatric Refuser' and Former Chair of Survivors Speak Out and the National Self-Harm Network

(Click here to read more of Louise's Tidal perspective)

"It is difficult for community organisations such as ours to implement more humanistic approaches that go against mainstream service delivery and policy based on the medicalisation of mental health. We need highly articulate champions like Phil Barker and Poppy Buchanan Barker to provide encouragement and provide us with convincing and well founded material to underpin what we do".

Hugh Norriss and Gary Platz - Wellink Trust, New Zealand

(Click here to read more of Hugh and Gary's Tidal perspective)

"The Irish Advocacy Network want to endorse the work that you and your colleagues are doing in developing the Tidal Model of Recovery. From a service user perspective it espouses a humanistic ethos based on the principle of caring ‘with’ rather than ‘for’ the individual, and aims to see the person as a person and not as a clinical set of symptoms that need to be treated or fixed

We believe the “Tidal Model” is unique in that it offers a framework of care based on assessment and care criteria which are person-centred, where the person's life story provides the focus and fulcrum for recovery, based on real needs and ownership of the recovery process".

Paddy McGowan - Former Director, Irish Advocacy Network - Expert by Experience and Lecturer, Dublin City University

(Click here to read more of Paddy's Tidal Perspective)

"Our passion is psychiatric and mental health nursing. The Tidal Model has fanned the fires of our passion, or perhaps has affirmed it. Certainly, it provided us with language to speak our practice”.

Margaret Tansey and Dr Nancy Brookes, Royal Ottawa Hospital, Canada

(Click here to read more of Margaret and Dr Nancy's Tidal perspective)

"The Tidal Model is an excellent approach. It parallels and enriches physicians' clinical approaches with its assessment of the patient's personal clinical picture. In our setting, it supports the move to a research-based program. Nurses have a closeness in their relationships with patients, and their involvement needs a framework with goals and boundaries as offered by the Model. The Tidal Model promotes nurses' self-confidence, fosters interaction, and increases inter-disciplinary team work. The Personal Security Assessment and Plan, especially for suicide is excellent, tactful, and thorough. Nurses who practice within the Tidal Model don't need anything more, it is enough!"

Dr Jean-Claude Bisserbe - Professor of Psychiatry, University of Ottawa

"The Tidal Model is not yet another psychiatric nursing model. It is an interactive structure designed to preserve people’s independence and dignity, whilst ensuring that the ordinary decencies that should characterise care, will not easily be displaced by brutishness or casual disregard. I hope it will become a forerunner of many more courteously effective frameworks for collaborative mental health care”.

Tom Keen - Former University Lecturer and psychiatric nurse.

"The centrality of the human story in the Tidal Model and its recognition of the importance of attending to meaning rather than symptom, will fit well with the new Australian culture of healing that must be co-created, and which will benefit all in distress".

Tom Ryan - Former Director of Nursing, Townsville, Australia

"The emphasis the Tidal Model places on human connections values the range of whanau (family) found in this place, where whanau may be a single parent and child unit, or a vast interconnecting web of people who trace their descent from a single ancestor".

Jacquie Kidd - Lecturer, Wintec, Hamilton, New Zealand

"The idea of psychiatric rescue in the model, reminded me, again, of a analogy for clinical supervision, in Brian Patten's poem 'Waves':

And the one throwing the lifebelt,
Even he needs help at times,
Stranded on the beach,
Terrified of the waves".

Kevin Coyne - psychiatric nurse, North Birmingham, England

"Phil Barker has long been a unique advocate for the well being of persons who are 'psychiatrically labelled'. I met him for the first time on the Internet about 7 years ago, on a mailing list devoted to mental health advocacy. I deeply admire his commitment to psychiatric nursing. As an ex-patient myself, I know that the mental health staff who are most helpful to us are the ones who have direct contact with us. This gives the profession of psychiatric nursing a noble, though often undervalued, role.

The philosophy of the Tidal Model, based on simple 'caring', is one developed from Phil's firsthand experience of working with, and listening to, persons who actually receive psychiatric services. Although it seems only common sense that 'caring' is the most healing modality for a person experiencing fear and mental confusion, this concept is, within the current mental health system, novel and refreshing. One can only hope that the Tidal Model will become a Tidal Wave".

Sally Clay - Mental Health Consumer/Advocate, Florida, USA.

"The Impact Research Team is made up of four people who are using, or who have recently used, Mental Health services. Our work together to improve Mental Health services has taken us all over the country where we have opportunities to encounter wide ranges of service users and providers. Time and time again we find patients looking for care which is patient focussed and staff wanting to deliver it. The Tidal Model is one of which we have some experience and we would recommend it to any practitioner looking for inspiration and guidance in this field of work".

Impact Research Team, Hull, England

"Tidal is an apt title since many of us have felt like a tidal wave has swept over us at least once in our lives! But then again there are some nice tidal pools of serenity as well. This web site has helped me re-explore those tidal pools, that have allowed me to cope with this crazy world. Phil Barker's accumulated knowledge, life experience and compassion for his fellow man, have contributed to a wonderful source of education and hope not just for Consumers/Survivors/Users, but anyone wishing to learn so much about life, past, present and future"

Ed Manos - Prosumer -Advocate, , New Jersey, USA

"A ground-breaking model, which challenges the professional conspiracy surrounding assessment, and offers users a real voice within the assessment process".

Dr Irene Whitehill - User Consultant/Adviser to Northern MIND, England

"Currently mental health education risks either drowning in the blandness of a tired humanistic agenda or being press-ganged by an evidence-based admiralty. The Tidal Model may help us steer a more promising middle route".

Dr Alec Grant - University of Brighton, England

"The Tidal Model encourages nurses to re-engage with nursing, providing a supportive framework to develop nursing practice in practice that is both holistic and person focused. The Tidal Model involves nurses becoming actively involved in a practice development process that challenges them to think and act beyond traditional/routine approaches to practice. In choosing to develop nursing practice, nurses are doing much more than improving the quality of the care experience of the person in distress (although this is a laudable goal in its own right). Of equal significance, nurses’ develop increased confidence in their own ability to influence clinical practice.

The Tidal Model supports and guides the development of psychiatric nursing. Nurses who work within the model to develop their practice will find it within themselves to develop nursing as a therapeutic practice in its own right. This is highly significant as it allows nurses’ and nursing to ‘find its feet’ as an equal member of the multi-professional team. Nurses in this context choose not to allow their practice to be governed by the needs or expectations of other occupational groups. Rather, nurses are encouraged to re-engage with the heart of psychiatric nursing practice, person centred caring, and by so doing, create the freedom to practice psychiatric nursing on its own terms, in its own right. So, actioning the Tidal Model in practice inevitably involves nurses in a development process that harnesses the potential for growth and empowerment for the person in care and psychiatric nursing alike".

Dr Angela Simpson - Lecturer, University of York, England

"The Tidal Model shapes and recaptures the essence of nursing and will provide hope and focus for our discipline. The Model fosters a collaborative relationship because it requires the nurse to work alongside and with the client for the client's well-being".

Ngaire Cook - Clinical Nurse Specialist, Porirua, New Zealand

"You have lifted my spirit at a time when things seem a bit grim. Too much change and interference etc. In return, may I share a recent brief encounter with Robert (alias) whilst out shopping, who shared 11 years of his life with me, when I was his CPN some years ago. Greeting me with a broad smile, Robert updated me with some enthusiasm on his recent life events. In three or four minutes I learned of his recent bereavement, move into a group house and other achievements.

Early in his psychiatric career, he had met R.D. Laing and subsequently spent much of the next 30 years fighting the psychiatric system - sometimes me, literally! Considering his life experience I was pleased to see how happy he seemed though the scars of much drug treatment showed in the lines in his face.

I recalled an early learning experience when I foolishly told him of mywish to help him regain his autonomy, which he countered furiously with, "I'll reclaim my autonomy when I'm fucking well ready". Robert ended our chance encounter with, "It's been good to see you again!" placing his hand firmly upon my shoulder in a brotherly fashion before turning away and striding off up the road. I was deeply moved by this touch. I reflected, having only just taken a proper look at your Tidal Model. I thought about the role I had fulfilled in trying to support and understand him over many years.

Had I been his swimming instructor, navigation teacher (I have RYA qualifications!) or lifesaver? (I got a bronze medal in the sea scouts!) Or was I just a passer by on the beach who hailed the coastguard on seeing his distress? Or had I been trying to drown him to put him out of his misery? Or was I a weather forecaster trying to predict the storms and tides so that I could place red flags on the beach to stop him swimming when conditions were getting too dangerous? Sometimes it just felt like swimming alongside him, usually against the tide. Sometimes I thought I was King Canute!

But mostly I think he saw me as a lifebuoy, envious of my ability to float, often tantalisingly just out of his reach. But I was there for him as much as I could be, as long as we kept near enough to each other, but I sometimes feared he'd pull me under if he clung on too hard. He seemed to understand my reservation despite railing against it. Perhaps one day I can share your Tidal Model with him and ask him what he thinks. Thanks for inspiring my reflections."

Will Baker - Mental Health Educator, Somerset, England

"The Tidal Model's reference to the 'fluid nature of a person's experience', reminds me of Wilhelm Dilthey's 'fresh, fluid spring of understanding' and Husserl's adoption of the notion to emphasise the paradox that scientific objectivity is, indeed, grounded in an ever-changing historicalness of the life-world...The Tidal Model offers an excellent means of joining people together (the 'patient', the 'professionals and the 'carers') in an attempt to contain the psychiatric emergency and subsequently cultivate 'trephotaxis' in the wider fields of the community"

Peter Wilkin - Author and former CPN Supervisor, Rochdale, England

"I support the Three Dimensions of Care and, personally, welcome the placing of the 'world dimension' as the first dimension. The Model is important too in placing the nursing relationship at the centre of things...treating people with respect and as agents who still have power over their lives, validates them and their distress"

Peter Campbell - Founding member, Survivors Speak Out, London, England

"The Tidal Model seeks to take the humanity of the person-in-care seriously. The uniqueness of individuals and their experience is recognised and by discussing resolutions and identifying resources - including spiritual supports - acknowledges the capacity for health. This is an approach that wants to reveal the person behind the 'patient'. As a Chaplain I find this both welcoming and refreshing".

Cathy Wiles - Mental Health Chaplain, London, England

"The water metaphors in the Tidal Model remind me of many poetic sources. Philip Larkin wrote a poem entitled 'Water' (1954):

'If I were called in
To construct a religion
I should make use of water.

Going to church
Would entail a fording
To dry, different clothes;

My liturgy would employ
Images of sousing,
A furious devout drench,

And I should raise in the east
A glass of water
Where any-angled light
Would congregate endlessly".

Kevin Coyne - Psychiatric nurse, North Birmingham, England