The
Tidal Model was the first research-based model
of mental health recovery, developed originally by
nurses, with the active support of people who were
using, or had used, psychiatric services.
Tidal is now recognised, internationally, as a
key mid-range theory of nursing practice (Brookes,
2006).
Recovery Begins at the Lowest Ebb
Many
'recovery' approaches focus on 'self-management':
helping people to 'manage their symptoms' or 'plan
to achieve wellness'. Such approaches are often only
useful after the person has recovered from the major
'crisis' or 'breakdown', which required mental
health care in the first place.
The
Tidal Model believes that recovery must begin at
the person's lowest point. In the case of someone
admitted to psychiatric care, the voyage of recovery
should begin as soon as the person enters the
service. If not, there is a risk that precious time
will be waster - and the person will slowly become
'institutionalised' as a 'patient' or 'service
user'.
All the
processes within the Tidal Model - represented by
individual and group work formats - are focused on
helping people when they are at their most
distressed. We cannot wait until they are
'feeling better' to begin the process of
'self-management'. People need to be helped to
engage with their experience of distress as soon as
possible, so that they can begin, slowly, to learn
what they can do to manage this, and what help they
need from others by way of support.
A Model of Genuine Collaboration
The development of
the Tidal Model represented a unique
collaboration between professionals involved in
delivering mental health services and people who
needed such support. From its earliest beginnings,
the Tidal Model drew upon the support of
'user/consumer consultants', both within the UK and
internationally. These consultants helped to 'field
test' the various individual and group processes of
the Tidal Model, helping to shape and refine
them so that they became 'consumer-friendly'.
This model of
'collaboration' continues to the present day, as we
make fine adjustments to some of the original
processes, and additions to the menu of supporting
activities.
Tidal: A definition
"The Tidal
Model is a philosophical
approach to the discovery of mental health.
It emphasises helping people reclaim the
personal story of mental distress, by recovering
their voice. By using their own language,
metaphors and personal stories people begin to
express something of the meaning of their lives.
This is the first step towards helping
recover control over their lives".
Tidal is
philosophical in the sense that it is a way of
thinking. We need to think about what might need to be done
to help people reclaim their stories, and eventually
recover their lives.
By philosophy we
mean a way of finding good reasons to hold what
often appear to be quite ordinary, though sometimes
unusual, world views. People often say that Tidal
is ‘common sense’. However ‘ordinary’ Tidal
might appear its key assumptions and practices are
certainly not ‘common’. It would be more accurate to
say that Tidal is a form of ‘uncommon sense’.
Tidal
emphasises the
discovery of mental health, as its
meaning varies from one person to another. We hope
that people will discover what mental health means
for them – as unique persons.
As people, all
we have is our story. All we can ever be is framed
by the story of our lives – the events that have
occurred, and how we responded to them. This story
charts not only the changes that have occurred on our voyage
from birth, through childhood and adulthood and
eventually into death but also the growth and
development that has taken place within us.
When people
experience problems in their lives often they are
described as being ‘mentally ill’ or affected by
some ‘psychiatric disorder’ or ‘psychological
dysfunction’. Frequently, the person’s story is
overshadowed by stories of ‘illness’ or
‘psychological disorder’. People
often talk less about the ‘person’ and talk
more about the ‘patient’, ‘client’, ‘service
user’ or ‘consumer’.
Tidal focuses on the
person’s story as this is where
the person’s problems first
appeared, and where any
growth, benefit, or recovery will be found.
The Tidal
Model is people-friendly. It has no age, class
or cultural boundaries and is being used to
facilitate recovery as easily with younger people,
as with adults, or with the older person.
Although its
origins are much older, the Tidal Model was
developed, in the mid-1990's, from research into
people's perceptions of their need for
psychiatric nursing and studies of the power
relationship between nurses and the people in their
care. Originally developed as an alternative model
of mental health nursing practice, the
Tidal Model now finds support within psychiatric
medicine, social work, occupational therapy and
psychotherapy. Increasingly, Tidal is viewed as an important alternative approach to
helping people use their voices as the key
instrument for charting their recovery from mental
distress.
The
Tidal Model has found much support within
various mental health 'user', 'consumer', 'survivor'
communities around the world. Tidal's value
base - the Ten Commitments - echoes
the ambitions of many mental health activists and
advocates. We hope that through Tidal it will
be possible to establish genuine person-centred
mental health care that also is respectful of
culture and creed.
However, like
any other 'model' of human relations, we recognise
that the Tidal
Model is no more than ideas on paper.
Ultimately, the model does not 'work', it is the
people who are important. We need to remind
ourselves constantly of this. As our Maori
friends taught us: What is important in the
world? It is the people, it is the people, it is the
people.
The Tidal Model
offers a useful philosophical and theoretical
template upon which to build and develop a genuine
'nursing of the mind'. From Tidal theory we
have developed a range of ways of working with
people - individually and in groups - that can be
adapted to fit the person's changing circumstances. However, ultimately, the
people who are helped to address or deal with their
distress and problems of living will not thank the
Tidal Model.
They will thank you
- personally.
Reference
Brookes
N (2006) "Phil Barker: Tidal Model of Mental Health
Recovery" Ch 32 in AM Tomey and MR Alligood (Eds)
Nursing Theorists and Their Work (6th Edition)St
Louis, MI: Mosby Elsevier
