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, louiseyorke@nhs.net

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