Quality standards for the provision of humanistic health care and

Person Centred Medicine in the NHS (England)

Perinatal Psychiatry may have the key

John Cox

Institute of Health Visiting professional conference

Reengagement of Health Visitors

Personal

Second edition of the EPDS Manual

Cox Holden and Henshaw 2014 - and six other publications.

Time to reflect on the Francis Enquiry and the missing culture of care

Reengagement with the affairs of my native country

Time to search for new models of health care that will enable a true Medicine de la

Personne.

Tributes to friends and colleagues

Prologue/Conclusions

• Three Titles for my talk!!!

• Marce Society is the place where we wish to present our new ideas and research - to try them out . ( see my interview with Kathy Wisner in 2009)

• That was so In California when I made the first presentation on the EPDS in 1986. It remains so today.

• Perinatal Psychiatry shows the way in a health service that is hungry for new integrative models of care.

The Health Visitors in my life

• Column in The Health Visitor Journal in which answered the question

• ‘how can a man know about Postnatal Depression’

Health Visitor Pioneers

• Some known to me:

• Eunice Sendagire (Uganda)

• Jeni Holden ( Scotland )

• Jane Hanley ( Wales)

• Cheryll Adams ( England )

• Asha Day

Francis report sequelae

• Total System failure.

• 290 recommendations

• Where is/ was Person centered Care?

• What are the roots of compassion?

Need for greater conceptual clarity to respond adequately to Francis.

• What is a Person?

• What is caring?

• What is compassionate empathy?

• What can replace the worn out and inaccurate splitting between Biomedical physicalism and a Bio- psychosocial model of George Engel?

Philosophy

• Martin Buber: What is a tree? The dialogue

• Merlau- Ponty: human beings who are embodied.

• Jaspers: subjective symptoms grasped by empathy.

• van Staden: Person is primary in relation to its constituent parts- biology, psychology and sociology

Psychology

• Inter-subjectivity (Trevarthen)

• Bowlby-attachment.

• Rogers: Person Centered

• Balint: Joan Raphael Leff: Psycho-dynamic insights

Theology and religious tradition of Compassion

• The Good Samaritan ( Luke Chapter 10)

• The Desert Fathers .Spiritual Direction (Atwell and Fulford). The journey.

• Relationship based healings: Mindfulness, Koranic healing, corpotate prayer

Sociology

• Kin ( Campling)

• Neighbourliness ( Montgomery).

• Therapeutic Communities: the lost skills of the Large and Small Group

The interpersonal dimension is missing : what to do?

• Broaden our paradigms and models for research and clinical work eg a Body Mind Spirit Paradigm

• Update Engel’s Bio –psychosocial model

• Implement the BPSI – the Bio – psychosocial Interpersonal model for health care delivery

Practical Action

• Organise Schwartz Rounds

• Continue Balint Groups

• Teach Subjectivity (Yakeley et al)

• Advocate a Collaborative Economy

• Marshall interdisciplinary advocacy

• With parents and Carers change the culture

• Implement Music Therapy

Expect Commissioners to Implement four core interpersonal Standards into NHS contracts- AND into the Centre for Quality Improvements Standards (CQI)

(Cox and Gray 2015.)

(1) State how you will cherish and support all your staff to provide a humanistic Person Centred Medicine and Person Centred Care.

2) Indicate how you will provide regular supervision from experienced mentors for all your staff - including general managers.

3) Give details of the educational curriculum and teaching methods you will use to train staff in the principles and practice of Person Centred Medicine and People Centred Care (e.g. Balint Groups, Listening Skills and Compassion focused courses).

4) Indicate how you will identify role models for the provision of Compassionate Health Care, and how you will implement a culture of Intelligent Kindness.

Conclusions

Perinatal mental health services can show the way.

We are fundamentally a relationship based interpersonal mental health

service .We hold the key for the whole of

medicine.

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