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Relational Discovery:
A relationally-focused model for systemic culture change in
forensic mental health settings
Louise Yorke, Clinical Psychologist
Malinder Bhullar, Forensic Psychologist
Brian Darnley, Forensic Psychiatrist & Psychotherapist
Overview :
Context and culture
Need for culture change
Relational Discovery model
Reflections and next steps
Coryton Cove Dawlish
Langdon Hospital,
Dawlish, South West England
Culture is………
“The way
we do
or think
about things around here”
Why culture change ?
Why Culture Change ?
Q: Why culture change?
A: Trauma, emotions, behaviours can
be replayed and affect staff, patients
and the organization
Why culture change ?
Commissioning for Quality & Innovation (CQUIN ‘16-18)
Decrease length of stay (LoS) + Increase repatriation
vs
Financial penalties
CQUIN Part L:
1) Improve training and skills for staff
2) Increase quality and N therapies for patients
Diagnostic: SWOT Analysis
Defining the
Relational Discovery Model
‘ a sustainable culture
where staff and patients can work,
learn and develop together
to improve working lives, increase
wellbeing and reduce risk ‘
Who is involved ?
Who will benefit
from Relational Discovery ?
Everyone
All staff and patients
DEFINITIONS: Relational Discovery
‘ An approach that introduces a
relational focus to all activity,
noticing how being in dialogue and
working together supports positive
development ‘
Why a relational approach to
culture
change and clinical practice ?
Because problems occur and are solved
in the context of relationships:
• family
• friends
• our relationship with ourselves
• the environment (workplace)
• & society
The importance of relational approaches is
recognized internationally across settings
Psychologically informed planned environments
(PIPEs: National Personality Disorder Programme)
Enabling environments in mental health settings
(Royal College of Psychiatrists)
CAT in forensic settings / organizational change
(Pollock et al 2006; Shannon et al 2017)
Open dialogue approach for psychosis
(Seikkula et al, 2006)
The Cognitive Analytic Therapy (CAT) model informs Relational Discovery (Ryle & Kerr, 2002)
Because CAT is underpinned by a comprehensive theoretical model that has been used successfully in:
1:1 and group therapies,
formulation,
reflective practice and supervision,
consultation and change in organizations
Why use the term Discovery ?
The term is linked to and supports the aims of the Recovery focused Discovery Centre at Langdon where activity builds:
hope,
skill,
independence,
self-determination.
‘Discovery’ is consistent with the
extension of the Recovery literature
recovery in the bin
https://recoveryinthebin.org
recovery in the binA service user led movement
“We believe that there are core principles of‘recovery’ that are worth saving
These principles cannot be found in a onesize fits all technique, or calibrated by anoutcome measure.
We ask that mental health services shouldnever put anyone under any pressure to‘recover’, by over emphasizing or evenimposing ‘Recovery Stars’ or WRAP’s. “
The concept of ‘Discovery’
promotes equality not pathology
Applicable to all staff and patients
Not diagnosis dependent
Emphasizes daily opportunities:
to learn about ourselves and others
to develop skills and build relationships
to work to set and achieve our goals
Six Elements of Relational Discovery:
Training Training across the MDT in DBT & CAT skills & Specialist
trainings to build skills – cascaded & updated; Local induction
& subsequent therapeutic training (HIIT)
Therapies Design & implementation of group and 1:1 psycho-education
and therapies across diagnoses to prepare for offence focused
work (Building Blocks for Change = CBT/Emotions; Life in
Balance = DBT skills; Substance Misuse; Understanding
Psychosis)
Risk Training in collaborative risk assessment and management for
staff and patients,HCR-20, SAPROF, Relational Security
Reflection Develop relationally and formulation focused reflective
practice across site
Governance A quality improvement project; outcome measures;
transparency, trust, communication strategy
HR / Line
Management
Relationally informed HR and line management, consultative,
collaborative
What are five benefits of RD ……..?
1. A relational reflective formulation-focused
therapeutic culture
2. Clarity, collaboration, co-production, cohesion
and creativity
3. Improved knowledge, skills and confidence
4. Pathways for patients and staff
5. Increased motivation
….and five more benefits of RD ?
6. Reduced risk
7. Reduced length of stay
8. Reduced stress and sickness
9. Improvement in recruitment and retention
10. Positive leadership and pastoral care;
relationally informed HR
A Model of Good Practice
The Relational Discovery Model has been
commended by the Quality Network for
Forensic Mental Health (Royal College of
Psychiatrists) as good practice.
Reflections and next steps….
1. Culture change is possible using a relational model
implemented by psychologists.
2. Importance of attending to threats to change,
(SWOT); (Changes in funding, managers, support
and challenge of interdisciplinary working)
3. All elements of the model are required for
sustainability and to manage organizational
anxiety
4. Need for awareness of Organizational
Development Literature e.g. Kotter, 1995
“All that is meaningful grows from
relationships;
it is within this vortex that the
future will be forged ”
(Gergen, 1994).
What continues to inform our
Relational Discovery model ?
” Long-term commitment to new
learning and new philosophy is
required of any management that
seeks transformation.
The timid and the fainthearted, and
the people that expect quick results,
are doomed to disappointment."
(Deming, 1990).
To finish….
….If you would like to know more
about Relational Discovery….
Please contact: Dr Louise Yorke, Psychology Lead,
Langdon Hospital, [email protected]
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