Helpforce Cymru Manager, Fiona Liddell shares insights from a study of crisis intervention care.
Years ago I was Joint Warden of a retreat centre and was often delighted and amazed at the transformation we saw in people who stayed, whether for a few nights or more. People arrived with the ‘baggage’ of daily life but left with a lighter metaphorical load, having connected, or reconnected, with other people, with nature, with history, with God, with a wider vision, or whatever.
So I was interested to come across a study* of a charity retreat centre in New Zealand which focussed on supporting people in psychological distress. It may sound like a rather niche topic, but the concluding insights are, I think, far reaching. It gives us better understanding of the potential of non-clinical, comprehensive support from a voluntary organisation.
The charity in question provides crisis respite. The research aimed to develop a theory as to how such respite supports people who are experiencing distress, identifying not only key outcomes but also the factors and mechanisms to explain how these outcomes were achieved.
Discussion about how to support people in crisis often centres around the need for expanding and improving clinical mental health services. Many people, however, do not need clinical treatments but do need more than a phonecall to a crisis helpline. Respite can be an effective option.
A SPECTRUM OF RESPONSE
Taranaki Retreat (the Retreat) offers a comprehensive and flexible service including practical and emotional support from a support worker, optional activities such as pilates, gardening, arts and crafts and follow up contact and support for a limited period after a guest has left (service users are referred to here as ‘guests’). Stays are usually five or ten days but can be longer and are free of charge to guests, being funded through charitable resources, including voluntary donations. The Retreat is not able to cater for people with acute mental illness such as psychosis, or those with substance related issues.
MECHANISMS FOR CHANGE
Five inter-related outcomes for Retreat guests were identified: reduced emotional distress, reduced suicidal feelings and restored clarity of thought were the most prevalent. Also improved sleep and restored daily functioning in the case of those who reported dysfunction related to sleep or daily functioning (such as ability to drive or to study) at the start of their stay. Collectively these outcomes represented a resolution to an individual’s crisis.
What is interesting to me is the findings of the study in relation to five underlying mechanisms for change: ‘providing time out’ and ‘interruption of unhelpful behaviours’ both resulting from being able to remove oneself from what is unhelpful. The other three have more to do with the quality of the new environment ‘acknowledgement of distress’, ‘offers of genuine care’ and ‘the presence of allies’.
THE DISTINCTIVE VALUE OF VOLUNTARY
Staff members’ non-professional status, and the support of volunteers added to the perception that care was motivate by genuine desire to help. The fact that staff, volunteers and financial donors chose to support as they did, was felt to be ‘humbling’ and increased motivation for recovery.
Having staff and volunteers around who were easy to relate to, often sharing their own experiences and who presented in an informal manner, added to feelings of being valued, understood and of ‘being in the presence of allies’ and this was often in contrast to guests’ experience of formal mental health services. The sense of supportive ‘allies’ extended to a degree, but not universally, to other guests as well.
A distinctive hallmark of voluntary organisations is their more holistic, flexible and value driven approach, compared to statutory services.
This fascinating study, which I have summarised here only briefly, concluded that ‘…both the volunteer aspect and the non-professional aspect appear to bring distinct and important advantages. Volunteers are not merely a useful addition, or a source of free labour – they are central to positive outcomes.’
So we must not fall into the trap of thinking that professional care is the only care that counts. If this study makes the case for good, non-professional crisis services, what other areas of health care might also perhaps be actually better delivered by non-professional staff or volunteers? And how do we ensure these services are more widely available and that they are connected into mainstream provision?
ABOUT HELPFORCE CYMRU
Helpforce Cymru is working with Third Sector Support Wales (WCVA and 19 CVCs), Welsh Government and other partners to develop the potential of volunteering to support health and social care services in Wales.
*Reference: ‘The provision of comprehensive crisis intervention by a charitable organisation: findings from a realist evaluation’. Magill R, Collings, S, Jenkin G (2023) in Voluntary Sector Review Vol 14 No 1.March 2023.