The H.O.P.E Approach: in full

The H.OP.E approach is still in its early stages of development; below is a snapshot of what we're working on so far.

Lived and professional experience alike, if you're interested in working with us to refine the approach we would love to hear from you.

Views, Commitments, & Values

Holistic

· View of a WHOLE person: a person’s strengths, difficulties and distress can only be recognised and responded to by first understanding the interplay between social, developmental, neurological, genetic and environmental factors. Similarly, the diagnostic assessing of symptomatology and prescribing of treatment as a primary response to a person experiencing and expressing distress results in an absence of compassion and simplicity of human presence and connectedness that is fundamental to supporting meaningful and effective change.

· Connection over ‘treatment’: effective and lasting change for a person happens in the presence of other human beings. Professionals who adopt the H.O.P.E approach seek to foster safe therapeutic relationships with a person, on their terms and with their informed knowledge, with the aim of supporting and nourishing change. Only through demonstrating a secure and stable attachment with the individual, and upholding an unconditional regard towards a person in distress, can meaningful support and change take place.

· Informed by other non-medical and otherwise-informed approaches: we seek to adopt and incorporate research, approaches and frameworks that seek to understand and explain distress differently. Some include: the Power Threat Meaning Framework as an alternative framework to traditional forms of assessment and response to distress and mental-ill health; the Toxic Stress Response and its impact on the brain and body; and the emergence of Epigenetics in understanding the expression and experience of distress through individual sensitivities, susceptibility and gene-environment interactions. Take a look at alternative models to understanding and responding to mental-ill health and distress here.

· As both preventative and reflective practice, the approach will acknowledge and proactively inform both professionals and the people in their care on the prevalence, risk and impact of iatrogenic harm so often found in traditional psychiatric frameworks and practices of mental-ill health.

Open

· Continuous priority on creating, embedding and maintaining a culture of transparency, honesty and accountability. When professionals uphold these principles, they are both explicitly and implicitly demonstrated to others; not only does this enable connection and secure therapeutic rapport with an individual, but it also allows opportunity for a person to speak of their distress, and the expression of it, without shame or fear of repercussion.

· Actively anti-seclusion and anti- restrictive in its practice: not only must the physical environment be truly unlocked and open, but all areas of care must be pro-prevention, pro-responsive and pro-inclusive. We acknowledge the onset of distress cannot be predicted, nor effectively managed by simply inciting a person to cease or suppress the expression of their distress. Instead, providers and professionals must engage in continual, preventative and responsive dialogue with the individual wherein documented care and de-escalation plans are frequently and collaboratively amended. Similarly, professional initiative and flexibility must always be used in real-time situations to continually and appropriately meet the needs of a person in distress; this means that, whilst care plans should document effective means of supporting an individual, professionals are able to make immediate informed judgements and, if deemed both necessary and helpful, adopt alternatives methods of support.

· Responsive, transparent and accountable practice: providers and professionals adopting the H.O.P.E approach must unequivocally open themselves to feedback and criticism on the basis of the approach’s 4 fundamental principles; without recognising and responding to faults in all aspects of care, a provider or professional cannot continually develop or improve their services to adapt and meet the needs of the people they support.

· Working with and alongside regulatory bodies and external services: providers and professionals utilising the H.O.P.E approach must, in-line with an embedded open-culture, actively engage and uphold a shared, positive, and communicative dialogue with regulatory bodies (CQC, Ofsted, BPS, etc) and external services (Social Care, local GP, CMHTs, CAMHS, etc). Within this culture of transparency, deliberate and proactive efforts must be made to avoid developing a closed-culture wherein regulatory bodies or external services are deemed an exposing, condemning or rival party.

People

· Recognise, educate and promote the use of secure, safe therapeutic relationships and attachments in supporting a person in distress: rather than viewing attachment as negative, it is a fundamental composite of being human that allows us to thrive and be in the world outside of simply surviving. When we see a person as ill, distressed and needing intervention, we don't see them as a human-being who is suffering and needing interaction.

· Readmission or need for a return to support is encouraged, understandable and expected: the H.O.P.E approach seeks to discard the notion that readmission or re-engagement with the same team, professionals or hospital is an indicator of failure on both parts, or deemed inappropriate due to an individual’s supposed ‘unhealthy attachment’ towards a place, person or source of support.

· Equal people, equal balance of power: there is no authoritative difference between the people in need of support, and the people delivering and guiding this support; the only credible and appropriate difference between professionals and people in distress is the ability to acknowledge, understand and respond to a person’s needs and distress, and later equip the individual with these abilities themselves.

· Boundaries must be explicit, authentic, protective and purposeful: the misapplication and arbitrary use of boundaries only serves to damage the relational rapport, therapeutic process and greatly undermines the likelihood of effective change for a person.

· Prevent harm by encouraging healthy, human connection and community: so often, hospital safeguarding procedures forbid healthy connection between human beings in an attempt to mitigate the risk of abuse, neglect and liability for the actions and behaviours of their staff. Not only does this mean such policies inherently allow for a lack of accountability and transparency within an organisation, service users are denied healthy and vital connection with other human beings that is fundamental in supporting embedded, meaningful change for a person. The H.O.P.E approach challenges the idea that people are adequately protected when human connection is outright banned. For real and sustainable prevention from harm to be successful, we need other people; we need healthy touch, words and interaction, not policies and ideas that ultimately perpetuate harm.

Environment

· The physical environment can positively and negatively impact the internal environment of a person: before any physical environment is designed, furnished or decorated, the needs of neurodivergent individuals and those with sensory needs in particular take priority.

· The physical environment must reflect, appropriately and neutrally, an environment indicative of ‘normal life’: clinical facilities, such as medication administering rooms, must be unobtrusive and make minimal impact to the rest of the environment. Rooms must be open and accessible at all times, including bedrooms, kitchen, art room, garden. Rather than blanket-denial of access and locking of communal spaces, minimal actions to mitigate risk must be prioritised (e.g. all kitchen knives are locked away and available on request, not the entire kitchen facility). Similarly, actions to prevent risk and meet individualised needs must not restrict the needs and access of others; instead, adjustments in regards to risk are made with and for an individual, such as limiting access to their own bedroom and not initiating an umbrella-rule that prevents all individuals accessing their personal spaces.

· All (people and professionals) are given equal and ample opportunity to contribute to discussions and decisions into what the environment looks like.

· People in receipt of support are actively able and encouraged to adapt their environment to suit individual need: for residential settings, the bedrooms belong to the person who currently resides in it, thus they should have access and opportunity to paint, furnish and decorate to suit individual needs and preferences. In communal areas, active and mutual discussion and implementation of changes to an environment must take place whenever and whichever way it is needed. For community settings, furnishings and decorative assets must be adaptable to suit a person’s individual needs; this may look like photos and ornaments being removable, chairs and larger furniture able to be repositioned in a room and a choice to include or remove fragranced or odour-enhancing devices.

· Safe environment, safe numbers, safe people: residential or day settings with multiple people receiving support must be limited to 7-10 maximum, with a high staff ratio of 1.5 professionals to 2 individuals. Blanket safeguarding, admission and staffing policies must outline the immediate ceasing of further admissions if: any persons currently residing are experiencing acute levels of distress and require additional, supplemental and extensive support; the service is, for any reason, understaffed for a reasonable and foreseeable time period and/or the ratio of professionals to those in receipt of support falls below 1.5:2 for an extensive amount of time (i.e. 7 days); the service reasonably anticipates any changes in staffing levels and/or the needs of those in their care that may impede or prevent the delivery of effective, meaningful and safe support for everyone.

Referral, admissions, and criteria; frameworks, procedures and the need for choice.

The current mental health system in the UK is subject to a fragmented and ineffective assessment and referrals framework, in which deciding where and what support a person in distress is offered access to is subject to the capacity, demand, availability and criteria of service provisions in an area. The consequences for people in distress are that their whole needs are, if at all, only met where: there is knowledge of the existence of a particular support service; the professional responsible for their assessment has reasonably deduced their needs over risk; or the context in which their expression of distress is meaningfully, preventatively and effectively responded to, not simply reacted to.

For instance, one person might be referred to community-based support services via a local GP, whilst another might be transferred to an inpatient unit directly from a medical hospital after being admitted in an emergency. Both persons might express the same acuity of distress, neither might need to be placed in an institutional setting or, conversely, both might need it. At no point is either person asked what they think they need, nor have their needs and distress levels been effectively assessed outside of the immediate and supposed ‘presentation of risk’. Simply put, the framework itself responds to distress out of fear of, or absence of risk; it is a reactive, not preventative method of assessing a person’s distress, needs and the support they thus require.

The H.O.P.E approach seeks to be utilised at every level of a person’s support ‘journey’. This means that, at the moment of distress being first identified in whatever context it may arise, the question asked is ‘what does this person need?’, not, ‘what is this person’s risk?’. Similarly, options of support and the settings in which they take place (residential, community or day-based) must only be decided once an assessment is completed that evaluates the whole context of a person’s distress, not simply immediate risk. Irrespective of commissioning, procedural and administrative barriers, all settings of support must be offered, explained and decided upon with the individual themselves, and cannot be ruled out, withheld or the existence of such settings concealed.