Season 7, Episode 2, Dr Lucy Johnstone on Mental Health Services and the Dilution of Trauma-Informed Care

Join Dr Lisa Cherry and Dr Lucy Johnstone as they explore why trauma-informed practice becomes diluted when services keep diagnosis, coercion and the medical model intact. They explore meaning-making, formulation and the Power Threat Meaning Framework as practical ways to build understanding without turning distress into disorder.

RESOURCES:

'A disorder 4 everyone' events and resources: www.adisorder4everyone.com

'A straight talking introduction to psychiatric diagnosis' https://www.pccs-books.co.uk/products/sti-diagnosis

Resources and information about the Power Threat Meaning Framework: https://www.bps.org.uk/news-and-policy/introducing-power-threat-meaning-framework

A video about the Power Threat Meaning Framework: https://www.youtube.com/watch?v=fWAv4IBsCjc

Accessible introduction to the PTMF and how to use it: https://www.pccs-books.co.uk/products/a-straight-talking-introduction-to-the-power-threat-meaning-framework-an-alternative-to-psychiatric-diagnosis

Follow the PTM Framework on Twitter @PTMFramework and on Bluesky: ptm-framework.bsky.social 

Transcript

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Welcome And Why Lucy Matters

SPEAKER_02 0:32

So here we are again, another episode in the Resisting Dilution of Trauma Informed series that I'm currently doing. And today I'm joined by consultant clinical psychologist and mental health trainer Lucy Johnston. Hello. I'm delighted to be here. Hi. It's so good to see you. And we've actually recorded um podcasts before, but a really long time ago, I think.

SPEAKER_00 1:04

I looked it up. It was 2020, and I couldn't believe it was that long ago, but yes, we did. Wow.

SPEAKER_02 1:10

Good to be back.

SPEAKER_00 1:11

Good to be back talking more of the same stuff.

SPEAKER_02 1:14

Yeah, well, it's so good to see you. And and I mean, you most of your work is really entrenched in the removal of the pathologization of human beings, really, the pathologization of very normal responses to distress and to the way we live. And if anyone who's listening isn't familiar with um Lucy Johnston's Dr. Lucy Johnston's work, then um do do look it up because she is she's a a bit of a trailblazer.

SPEAKER_00 1:45

You're a bit of a trailblazer, aren't you, really? Well, that's another way of saying I've been boring on about the same stuff for many, many years. And and that um that that that that that that is true. I've started off with a conviction very early in my life, in fact, before I trained as a psychologist, that we are seeing ordinary human responses to difficulties, not mental illnesses, and that's been the theme of my whole whole career, really.

SPEAKER_02 2:11

Yeah, and I think before we kind of get stuck into any questions, I think it's fair to say that being, you know, undertaking that role, being a trailblazer in that way, has caused quite a lot of backlash for you over the years, hasn't it?

SPEAKER_00 2:26

It certainly has, yes. I mean, I've kind of found ways of living with it, and I always say I'd rather have backlash than have no response, because I think the only way to understand it is well, backlash does mean you've hit a nerve, and it does mean at least something's getting out there and some kind of debate is happening, you know. So, but yeah, I think what's changed is that I used to feel that I was one of very few people who are still friends and colleagues, in fact, Mary Boyle and Richard Bentle and others who were criticizing the medicalized approach to distress. And now I feel part of a much, much larger group. So, in a way, that feels safer, more encouraging, more empowering. And I think we're a very supportive group. So when I face backlash, I certainly don't feel alone with it.

SPEAKER_02 3:11

Yeah, that's wonderful. And it reminds me of also the work of Jay Watson and um a disorder, um disorder, and all of that, all of that work that is just so ongoing that's just really made such a difference. So if we think about um the pathologizing frame of psychiatry, how does that interact with the language of trauma-informed practice?

SPEAKER_00 3:35

That's a very interesting question. And it's a kind of I think it's an ongoing tussle in a way. Um, I mean, I came across trauma-informed practice relatively late, I think. Probably you were on board with this uh way before I was. I mean, about 2009-2010, I started reading about this extraordinarily well-researched and powerful new paradigm, really. Uh, but I mean, I had sort of been practicing in line with that my whole career because I'd always thought to use the popular slogan, it's not about what's wrong with you, it's what happened to you. But of course, trauma-informed practice gives us some really important and fascinating ways of backing that up and research that makes it credible, and strategies and ideas for kind of putting the research into practice and so on. So I think properly understood, I mean, a trauma-informed approach is what can be called, in rather a cliche phrase, a paradigm shift in understanding distress. I mean, it's totally different from, and I would say fundamentally incompatible with the dominant approach. So the dominant approach in psychiatry, which is so deeply embedded that we rarely question it, is that people are suffering from mental illnesses or disorders, need diagnosing

Backlash And Finding Allies

SPEAKER_00 4:55

by nurses and doctors, and possibly treating in clinics largely with medication and so on. And that whole way of thinking has infiltrated our whole society. So you don't just find it in mental health settings. I mean, people talk quite uncritically about mental illnesses and bipolar disorder and all this kind of stuff. So it's a very, very different paradigm. So what happens when the trauma-informed stuff comes along? Well, something I think quite interesting because I think when dominant ways of thinking and practicing are under threat, you tend to get a kind of three-stage response. Ignore, let's pretend nobody said this, and then if it doesn't go away, attack, this is all rubbish, this is not evidenced, you're telling everyone they've got a trauma when they haven't, etc., etc. And then you get assimilation, and I think that's where we are at present. And in some ways that's the most dangerous phrase, I think, because it superficially looks like, oh, great, we have trauma-informed services now, and you know, we have a wonderful holistic perspective on this, and we're incorporating all this new research. But assimilation almost by definition means taking on a new way of thinking and kind of de-radicalising it, making it unthreatening, you know, actually using it to prop up the existing paradigm and avoid the fundamental change, which I would say we need. So that's the broad context of what I think is happening, and I've seen lots of examples of it.

SPEAKER_02 6:28

You've articulated that so well, and I'm so sure that people listening are just nodding ferociously, because of course, what what underpinned and what made me want to do this series, and I've done quite a bit of writing on it as well, was how easily trauma informed slips off the tongue, but actually hasn't changed anything at all from that service or system or setting. Um, the culture hasn't changed, the person isn't yet aware of their own responses, the policies still don't reflect what's required. So I think it's it's really it's really articulate to hear you put it like that. And you also talked about what I call that problematization of the person, you know, this idea that the person is the problem. And um, I work in every sector, and every sector is the same. We almost need to knock them all down to start again so that we're not starting from this place of the individual being the problem.

SPEAKER_00 7:39

Yeah. I mean, I totally agree with that. And I do think in some senses we do need to knock it all down and start again, because you know, I've spent a very large

Trauma-Informed As A Paradigm Shift

SPEAKER_00 7:50

part of my career banging my head against the walls of systems that are clearly not going to change, along with some very, very good colleagues and so on. I don't think fundamental change is going to come within the system because in a way the most damaging aspect of the current system is part is that it's individualizing. So, as you say, it turns, you know, people's difficulties into individual deficits or individual problems they've got to pull themselves together and get over and so on. So, in some ways, the word individualising is more appropriate than medicalizing, although individualising includes medicalization, because psychology and psychotherapy can also be individualizing. You know, we can have very narrow versions of CBT, for example, that tell you the problem is, you know, adjust adjust your adjust your negative thoughts about these terrible things that you claim to have been through, and so on and so on. That's not fundamentally different from saying here's a pill to kind of rectify the imbalance in your neurotransmitters. So we need to fight this tendency the whole time. And I I do think we need good people in services to do that, but I do think there's a point at which the services are just simply not going to change, and real change needs to come from elsewhere.

SPEAKER_02 9:07

Yeah, I mean, that's a bit like thinking about trauma-informed prisons. I mean, it's an oxygen. Well, exactly. Well, exactly. It's not possible. Um I was going to ask you a question there. So where have you seen trauma-informed language being used to soften or obscure those coercive and medicalized practices?

SPEAKER_00 9:34

Uh well, everywhere, really. So I left the NHS in 2016, but I've continued to do quite a lot of supervision and training, so I've kind of kept in touch with things via that. So trauma-informed language is absolutely everywhere. So we have trauma-informed services, trauma-informed pathways, trauma-informed therapies, all the stuff that I'm sure you know about. And I think language is a powerful way of kind of doing this assimilation business because a trauma-informed pathway is too often something like, well, everyone with a personality disorder goes on this trauma-informed personality disorder pathway. Or we perhaps might dress it up a bit and call it a complex needs pathway, but essentially, it seems to me it's fundamentally not trauma-informed to be still operating within diagnostic categories. You know, a proper understanding of trauma-informed practice, it seems to me, is that none of these diagnoses make any sense. We actually don't need them. They represent a whole range of overlapping, complex ways in which people manage the effects of serious difficulties in their lives. So you can't just have a trauma-informed pathway, and I mean, and some services have got a particular trauma-informed pathway for, you know, the people for whom trauma is a problem. Well, that's almost everybody, so shouldn't everybody on that pathway? So should it be a pathway? I mean, th the whole thing makes sense and makes no sense. But it's kind of justified in quite a clever way, I think, in psychiatry. So in psych uh when I say psychiatry, I don't mean psychiatrists as such, many of whom are equally frustrated with the way things are going and who are very critical of the system. I mean everybody involved in that whole mental health system. So the clever way of justifying it is to say, oh well, we're not medical model anymore, we're biopsychosocial. Uh-huh. All over the place. Uh why why are these kind of, you know,

Ignore Attack Assimilate Explained

SPEAKER_00 11:40

ignorant critics accusing us of being kind of, you know, medical model people like in the 1970s looking for the gene for schizophrenia? We've moved well on from that. We look at all aspects of a person's life. But what biopsychosocial means, I mean, it does mean we do a history and we look at psychological aspects of someone's background and we look at what's happened to them, but then we never, almost certainly never do anything with it. It sits in the assessment interview, and we never do anything with it. So biopsychosocial essentially prioritizes the bio. So then you get into a situation where, you know, Mrs. Smith, you know, was brought up in care, was raped as a teenager, was in a violent relationship, and that has triggered her psychosis or triggered her personality disorder or triggered her bipolar disorder. So, okay, we don't need the trauma stuff anymore. That just shows us the trigger to the mental illness or the disorder, and now we get on with treating the disorder. So it's it's a kind of nonsense in all sorts of ways. It's a nonsense because it prioritises the bio for which there's no evidence. You know, we don't have evidence of the existence of these conditions called bipolar disorder and personality disorder and so on. But it's nonsense because it's not even a coherent model. What does biopsychosocial mean? You unless you can describe fairly clearly how bio and psycho and social interact, you haven't got a model. You've just got a way of saying, well, it's probably a bit of everything. Well, that's you know, everything's a bit of everything. And it seems to me that trauma-informed practice actually has a much better, I wouldn't call it biopsychosocial approach, but it does in principle incorporate those three elements and others in a way that makes sense. Of course, our bodies are involved, but in a way that doesn't prioritize the bio and so you end up saying, well, basically what we've got here is a mental illness that was triggered by the trauma.

SPEAKER_02 13:41

Yeah, and I mean trauma informed practice was meant to be very transformative, yeah, rather than, as you say, this kind of propping up of what's already known. And speaking to the last point that you made, and and in answering this question, one of the things that I'm interested in your thoughts on is I'm really keen that we don't just you know become sociologists and think that everything outside of the person is the problem because of course we come into the world too, we arrive as well. So while we don't want to be um, you know, we don't want the individual to be the problem, the individual is still in the room. So your thoughts on how we incorporate, you know, the person that's in front of us alongside the society in which we live and the resources available to that person, you know, that whole kind of mishmash that all comes together that brings that person into the room, you know, what are your thoughts about how a service or how a system can do that well?

SPEAKER_00 14:54

I mean, that's a very important question because, well, we don't want to just completely eliminate the context, nor do we want to position people as helpless victims of their social and other circumstances. And I think some of the way the ACEs research has been interpreted wrongly uh has fallen into the latter category. So I've heard some horrific examples. I'm sure you have of ACEs being used as a kind of assessment tick list, tick-tick-tick, ten ACEs, my goodness, you're bound to have lots of serious mental health problems and other difficulties. So a very simplistic, deterministic way of looking at it. So we need, of course, we need to keep the person in the room. And I mean, it seems to me fundamentally what we need to keep in the room is meaning, because it's, you know, how do we explain the fact, for example, and this is often put a criticism, isn't it? Well, you know, I wasn't traumatized and, you know, I've had a very difficult life, or conversely, I know so and so had a terrible life and she's doing okay. Well, you know, what there are lots of intervening factors that can explain those differences, but the core one I would say is the kind of meaning we make of the experiences, and that's not purely an individual thing. Either we make meaning according to what meanings are available to us or sometimes imposed on us. But if the meanings we make are very kind of destructive and difficult, it was my fault, I was a bad little girl, you know, nobody ever cared for me, the world can't be trusted, that's bound to be particularly damaging. So meaning-based approaches necessarily place the person in the room, I think. And not just the person, but you know, all the threads that have led them to be to be that person in the

How Systems Co-Opt Trauma Language

SPEAKER_00 16:40

world.

SPEAKER_02 16:41

And I'm thinking about how meaning-making and context there intersect.

SPEAKER_00 16:46

Yes, well, well, ideally they should. It's possible to have very individualistic meanings, of course, but you know, from my point of view, the meanings are both made and found, in a famous phrase, you know. So the example I sometimes give is that um in my last clinical job, I and some colleagues set up a running program of sexually abused survivor groups for women who'd been abused. And I've probably worked with several hundred of women and some men who've had those awful experiences, and each and every one of them has come to me and said, I felt so ashamed, so guilty, it was my fault. You know, I shouldn't have done this, I should have done that. Almost all of them have never told anybody, but they've all somehow developed this sh what feels like a very individual, shameful set of meanings. Now you get people in a group, and it's a very powerful way of challenging it, because you can look across the room at someone else who's saying exactly the same thing, and you can see, well, you were only seven, you were only ten, you know, it was your stepdad you were told to trust, etc. How can that be your fault? So you can start to shift your meanings in a very powerful way, but also it's a context in which you can start to say, where do those meanings come from? You know, how come all of the six women in this group have all ended up concluding exactly the same thing without ever having confided in anyone? And that can be a yet another layer of powerfully putting back responsibility where it belongs, I think. Thinking, well, what are the messages women are given? What are the messages that a men are given about entitlement and so on? What are the messages society gives us? What are the things society doesn't want to hear about? So we need complex layers of meaning. And interestingly, there is a very firmly established way in mental health services of using meaning as the core approach, which is a bit of a jargon word. I'm not sure how familiar you are with it. It's called formulation. So all psychologists and are trained in the core skill of formulation, and I've done a lot of writing training, drawing up guidelines, etc., on this throughout my career. And the definition of a formulation is an evidence-based narrative or summary. So if I give a very simple example of the kind of woman who might end up in the groups I described, they might well come along, having been told they've got bipolar disorder, or perhaps the biopsychosocial model you've got bipolar disorder triggered by sexual abuse as a child, whatever. And the formulation is a way of sitting down with someone probably over possibly over quite a long period. And you as a clinician can bring your expertise, your clinical knowledge, your knowledge, particularly of trauma-informed practice and theory. So you can say these are understandable reactions, these are common experiences. And the person themselves, of course, has their own personal story to tell and their expertise in what it felt like and what it meant them, how they constructed those meanings. And together you can put together, in a way, it's a very individual hypothesis, pompous word, individualized hypothesis, uh less pompous phrasing, a personal story, which can actually perform all the functions that psychiatric diagnoses is meant to do and doesn't, like understanding how you got here, like understanding what might be helpful. It can be an intervention itself, because if it's done well, it's validating and reassuring. And of course, it never ends, it's kind of evolving. So as you can imagine, uh, one of the battles I've had in my professional life is about what kind of formulation do we use? Because to go back to the ignore, attack, assimilate thing, there have been massive efforts to assimilate formulation into a medical model. So a psychiatric formulation would be something like trauma triggered your pipolio disorder. A psychological formulation would always be some version of your responses in an understandable reaction to the things you went through, and they are and were important ways of surviving, but there may be different ways of moving forward with the right kind of support. So one of the thirds of my work has been very much, you know, done this for decades, offering training in formulation-based practice. So it kind of like within this medical model, we have another model that's that's even quite respectable. You know, you talk about formulation practice, everybody says, what a good idea. What they don't usually say is, well, what kind of formulation practice do we do around here then? But the principles are there, the possibilities are there. And of course, you know, now I mean, this is where we come on to my the major project I was involved in the Pathrite Meaning Framework. There are lots of versions of meaning making, not putting that forward as the only way of doing it. We all make personal stories, etc. But it's a respectable way that operates somewhere within all mental health services. It's almost unique to the UK, which is interesting. So I do a lot of traveling and training abroad, and I introduce the idea of formulation. People say, My goodness, you lads do that. We don't have anything like that. So we're we're kind of lucky, but it's a long, long way from the dominant approach, of course, and properly understood. Like trauma-informed practice, it conflicts with the dominant approach, which is why it also has to be kind of hobbled and reduced, if you like.

SPEAKER_02 22:27

Yeah. I was just thinking about um, I was thinking about a number of things, being very passionate about phenomenology, which is all about how we make and the double hermeneutic. Sorry to blow people's minds, but that's how I make meaning of the meaning that you made.

Meaning Making Beyond ACEs Checklists

SPEAKER_02 22:45

Yeah, yeah. Which is um which I applied in my um in my dissertation, which I just find fascinating because there's how you made meaning, and then there's of course, how do I make meaning from the meaning that you made? Uh, you know, and I was also thinking about Giselle Pellico and just that that that the power of the not not my shame, because yeah, yeah, as you said, shame is a consistent response to sexual abuse um in childhood, and I'm sure in sexual abuse and assaults in adulthood, and to be in a room full of other people who are also expressing and experiencing that and saying it out loud, it's that that has an opportunity to then um uh you know, I want to say neutralize and you know vaporize shame. Yeah, it has those of that opportunity being in that space. That's such powerful work.

SPEAKER_00 23:46

Yeah, yeah. It was I think that was some of the most powerful work I was lucky enough to be involved in. And shame is universal, of course, but almost universal in these experiences. But shaming is a silencing tool, isn't it? That's what it's for, and that's how it operates in society. And you know, it summer sometimes we do things about which we rightly feel ashamed. But actually, one of the things I think about psychiatric diagnosis is that it's a codified professionalised version of shaming people. Because how do you define a psychiatric diagnosis? Well, a psychiatric diagnosis is actually defined as a list of thoughts, feelings, and behaviours that are thought that are said to be not justifiable in the circumstances. You know, it's not defined by doing a liver test or a kind of x-ray or a scan. It's about you look at all the criteria, they say things inappropriate to or excessive or unusual. You know, those are all social judgments. So, in a sense, a psychiatric diagnosis is a way of saying you are thinking, feeling, and behaving in a way that is not acceptable in this society. That's essentially what it is. It's a shaming and silencing process. Which is not acceptable to me. Not acceptable to the person who's doing the diagnosis, but the person who comes along has probably already internalized some of that, because those are societal messages, and then they get confirmed by an expert. Well, thanks a bunch for that. And all this stuff about anti-stigma, reducing the shame of diagnosis, it's impossible. That whole notion of a psychiatric diagnosis is intrinsically shaming. That's what it's about, and from my point of view, that is what it is for. That is the function it serves in society. We we shame people, we shut them up, and if the diagnosis on its own doesn't do enough, we drug them up and then we lock them up. You know, that's what we do.

SPEAKER_02 25:46

And you created, I mean, you slipped it in there very quietly, but the power meaning framework. Uh, and we've talked a bit about meaning. Do you want to just perhaps um explain to those who are not familiar with the power threat meaning framework um what it what it is and also where how it's being used now?

SPEAKER_00 26:09

I'd be happy to do that. I mean, so in fact, when we met in 2020, that's we talked about the framework, if anyone's interested, and I'll send some links if anyone wants to read more. So the power threat meaning framework, in a way, builds on all the themes I've just been talking about, and which have kind of characterized my career. And I and Professor Mary Boyle, who's another clinical psychologist, the lead authors. It was co-produced with survivors of services. We actually ended up drawing on a large group of about 40 people, uh, about a third of whom had had experience of being or receiving psychiatric interventions. And to put it as its simplest, it's saying, what would be the conceptual alternative to a diagnostic model of distress? What would we have if we didn't have psychiatric diagnosis and medical understandings and what Mary has called the DSM uh mindset, the whole way of thinking that goes along with it. And it happened entirely accidentally when a group of uh eight of us who'd known each other for many years happened to meet in the same place and started this conversation about what would this look like. And although none of us had ever believed in it from our shared academic research and personal experience, thinking, well, what does the alternative look like is not an easy task. And then we found ourselves caught up in this, to be honest, nightmare. Five-year processing, well, um, for which we eventually got funding for the British Psychological Society, so we had to produce something, thinking, well, what the hell have we got ourselves into here? And we came out the other end with something that actually I think we're very proud of, very much a collective effort. So, shortest

Formulation And Diagnosis As Shame

SPEAKER_00 27:55

possible description of it. Um, it's very dense and academic, it draws on a lot of research, including trauma-informed practice. It also critiques trauma-informed practice in its assimilated forms. It's freely available, all the materials are freely available on the website, there are podcasts, interviews, and so on and so on. Essentially, it's saying two things. Instead of diagnosis, we need narrative. So we talked about formulation, which is one kind of narrative, but we're talking about narrative in a much broader sense. You know, we've got this phrase where all storytellers are meaning makers. We could all make meanings of our lies. We don't have to sit on a psychologist waiting this for two years to get a formulation. And of course, most cultures over the course of human history have always had their ways of meaning-making through narrative, very often collectively. Those things count as narrative in PTF terms, and also the narrative needs to include power, so that's the social context. That's the bit that we've been saying often gets omitted, the social context. You miss that out, that out, you get individualizing approaches. So we've got a very rough structure which can be used at a personal or group or co-produced or even societal level to uh put together a narrative about any particular situation or or difficulty. And it starts with what happened to you, so that's the trauma-informed slogan. It then moves on to how did it affect you? What sense did you make of it? What did you have to do to survive? So if you put all that together, you can create a story that is not diagnostically based.

SPEAKER_02 29:40

And I love that what did you have to do to survive is for so strengths-based, isn't it? You know, it doesn't matter if it was really awful and it wasn't particularly brilliant, you found ways of surviving quite unsurvivable stuff.

SPEAKER_00 29:55

Exactly. It's turning the whole symptom approach completely on its head. It's not what, you know, not what's wrong with you. But we are s I am so pleased that you managed to find these ways of surviving. Of course, they may create their own difficulties, of course, they may outlive their usefulness, but people need to be honoured and validated for, you know, still sitting here today, so to speak. Oh God, absolutely.

SPEAKER_02 30:19

Well, I suppose the last kind of question really is around where do you see the signs of genuine transformation taking place? Where do you see it in training? Where do you see it in practice? Do you see any shifts in culture? You know, what's where's the hope? I mean, you talked a bit about, you know, we've we've sort of moved mountains, and I think we have moved mountains. Um, I think you know, the way that we've the things we've experienced over the last, you know, I suppose 15, 16, 17 years uh have really changed us so dramatically that we have we are having more responses to isolation, to aloneness, to disconnection, to divisiveness, to divisive politics. You know, those places and spaces where we can come together um have been so dramatically reduced as well through the ideology of austerity. And I'm not sure we're ever going to go back to the way things were. Not that I'm suggesting that that's some kind of wonderful place, but we we're having responses to the way that we're living now. So in a way, that has driven us to become much more focused on trauma-informed practice and much more focused on how we can come together and disseminate and vaporize shame and all of those things, but it's also created a louder noise of um rejection to those things as well. What are your thoughts about all of that?

SPEAKER_00 32:08

Well, we're not living in easy times, are we? We're not living in easy times. Um it's easy to feel hopeless and overwhelmed, isn't it? Um I suppose I part of what's happening in relation to understandings of distress is I think signs of a the current paradigm crumbling and going through the agonies of what do we have instead. So if you look at it like that, it's a slightly more optimistic way. You know, these debates weren't even happening. These debates are I love that because I think I think the whole world is going through that.

SPEAKER_02 32:44

We're living in this complete shit show. Well, because it's changing and we've got to kind of come out of that. And the resistance is so real, isn't it, to holding on, you know.

PTMF And Where Real Change Starts

SPEAKER_02 32:55

Well, I mean, exactly, exactly. I mean, of course, the planet may not survive.

SPEAKER_00 32:59

We don't have the end of the story. Let's not go down that road. But you know, I mean, there's uh work done on paradigm changes, as I'm I'm sure you know, which suggests that they are always times of intense upheaval. The optimistic way of thinking about that is something that is outdated and not needed is in the slow, painful process of being kind of you know, shuffling off the stage, but it's not going to go easily. And what we need to do now is to make really sure we're there with a proper alternative, otherwise, we'll find another version of the same thing. So I do think that's what's happening. I mean, in terms of my own mental health work, I don't like the word mental health, by the way, but anyway, we know what we mean by it. I mean, I think change always comes from grassroots ultimately. So we have done nothing to publicize the Power Threat Meaning Framework. It's now available in seven languages. I've travelled all over the world talking about it by invitation. You know, I never solicit for work, I only do what people ask me to do, along with other all of the authors and the other people who've become involved in the PTMF, into Australia, New Zealand, Brazil, you know, all over Europe, uh, Iceland, uh, America, all sorts of places, that there is a real sense that we need something fundamentally different. So that's very encouraging. It's a kind of painful birth process, if you like. And I think, I mean, particularly relevant to this podcast is that one of the things I think the framework can do is to, we hope, is prevent trauma-informed practice being assimilated. So trauma-informed practice within a PTMF lens is quite a powerful combination because if you properly understand the PTMF, no way would you be reducing trauma-informed practice to a crisis team person saying, go and have a cup of tea, and if you don't engage, it's you it's your fault, or you know, I'm going to give you these kind of stabilization leaflets, now go away and don't darken our doors again. You know, the framework is designed to avoid that and to look at how services re-traumatise and to look at all sorts of power. In fact, in the framework, we tried to avoid using the word trauma because of its, you know, individualizing connotations, because it's almost becoming a cliche. We've used the word adversity, which is a much better word for including all the things we know about the poverty, the discrimination, you know, the run down neighbourhoods. And also to include what we've called ideological power, the messages, you know, the individualizing and messages, the consumer's messages, the kind of comp messages of competition, the messages that support austerity and so on. So to give you, if I very briefly give you two examples. So um one is that there's a very, very remarkable project happening on inpatient wards in North West London, where I've done a lot of training. They've got a fantastic group of staff there who really wanted to do something different, and inpatient psychiatric wards, as you will probably know, are the very worst place to be under any circumstances, but particularly if you're feeling in any degree vulnerable. So they had these, you know, typical but pretty awful wards of you know, everybody, you know, high levels of restraint, seclusion, burnt-out staff, people returning time and time again, etc., etc. They've over a period of about eight years introduced trauma-informed practice. All staff have training in trauma-informed practice, uh, you know, the proper contextualized use of stabilization and so on. All patients on the ward are seen and offered the chance to construct a PTMF narrative about their difficulties, which guides the staff plans and interventions for that person. So it's PTMF thinking and trauma-informed practice. Um, they've produced some remarkable results, dramatically reduced levels of seclusion and restraint, much higher staff morale, patients reporting a much better experience on the wards. Now there are the limits to what you can do in that setting, and I think they may have absolutely reached the limits, but it's been very hard work but very impressive. Uh I'll put a link to there's some published papers on that. I'll put a link to that at the bottom. I've also had the very rewarding experiences of use of introducing the PTMF and trauma-informed practice to people who have, you know, on the fringes of the mental health system or are, you know, completely outside it. And there it it gets a much easier home, if you like. So I've been working with, for example, recently some homelessness workers, and a lot of them are not highly trained, and they've, you know, they haven't been so brainwashed, I would say, with medical model thinking, of course, they've kind of taken it on because it's around the place, they're much less resistant to thinking about this. It's very easy to offer them a perspective where they say, well, of course that makes sense. I mean, everyone I work with has had a terrible life. You know, these are people working on the ground doing really, really valuable work who are doing things differently. And it I think it's in those kinds of places ultimately that hope resides and change will come from the bottom upwards.

SPEAKER_02 38:21

That's amazing, Lucy. Thank you so much for coming onto the podcast today. I I'm sure everyone's absolutely loved this conversation. It's just been so full. So thank you. Not at all.

SPEAKER_00 38:34

And keep up your good work because we're all part of the change we need, aren't we? Certainly are.

SPEAKER_01 38:40

You've been listening to the Palmer Resonance Resilience podcast with me, or your host is the carrying part of the knowledge of the high quality knowledge of the point of time,

Final Thoughts And Thanks

SPEAKER_01 38:57

the type of time.