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.
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