My name is Mark Smith, and I’m the co-founder and co-chair of The Joshi
I know it’s already been said, but before I start, I want to thank everyone for being here today at our Imagine Inverness seminar- in person and on Zoom.
I have the strongest sense that we are on the precipice of something extraordinary here.
We have the chance to make Inverness and Highlands one of the most progressive, caring, compassionate and successful places for mental health recovery in the UK – possibly even the world.
These aren’t just pretty words. What we’re proposing here today is a system of community and mental health care, backed by the World Health Organization as one of the most successful models in the world for recovery from pretty much any form of mental illness, on top of almost 50 years of documented evidence.
But let me start with the story of how we got here. I am fortunate to have never suffered from mental-health issues myself, but I have paid a very high price for a system that cannot save our loved ones when they are at their most vulnerable.
In January 2020, my beautiful and gifted daughter died at the age of 24, after a lifetime of struggles against deep depressions, high anxiety and punishing OCD rituals, along with the persistent abandonment and failure of mental health professionals. Her name was Joshi.
Nowhere was she given the care and support she sought and desperately needed to live. Sure, they provided her with the standard CBT treatment, and from the age of about 12, they started prescribing her increasing doses of various antidepressants. Off the top of my head, I remember Fluoxetine, Cipramil, Zyban, and Cipralex. In the US, they prescribed Xanax, which as some of you may know is highly addictive. There were other drugs I can’t remember.
None of them helped. In fact, she hated them. They seemed to dull her senses, and when she complained about them, they simply waved it away and told her it was impossible because these drugs didn’t work like that. But Joshi understood very well that they took away the spark that made her
the extraordinary person that she was.
She was naturally smart, creative and highly analytical, and she showed truly astonishing language skills from an early age. She left behind a small mountain of poetry and she was a lover of Shakespeare. Her potential seemed limitless.
The psychologists and psychiatrists in Stirling, which was near where we lived at the time, were very frustrated with her. She just didn’t seem to respond to their treatment. The message from them continually was that she was not trying hard enough, especially when it came to CBT. To them, it was somehow her fault their treatment didn’t work.
After a few years of this, along with ever-increasing doses of antidepressants, and still no progress, I asked what else might be available to help Joshi – some other therapy, some alternative outside the drugs, CBT and the blame model. I remember the head psychiatrist literally threw his arms in the air in front of us and said, “We have nothing left in our armory for her” and then he proceeded to warn us about the dangers of anything else – as if these drugs and failed CBT sessions were not dangerous in themselves.
I am forever haunted by this memory, because Joshi was standing listening to this man explain that there was no way to help her. Her mother and I had no idea how to help her.
Nor did we have any idea of the mortal danger that lay ahead, and neither did Joshi.
What did this chief psychiatrist think would happen next? I can tell you what happened. Before long, she began to self-medicate with street drugs, a practice that ultimately led to her death.
The hard reality here is, there should have been much, much more in their armory. But the uncompassionate arrogance of this man is really just a footnote. It shouldn’t be down to luck whether you get a good or useless practitioner. The real villain here is the system itself.
If we are to truly help people with their mental health, we need to broaden our understanding of it. We need a model that’s not a model – something non-rigid, that’s open to flexibility, compassion, human dignity and the recognition that there is much more than brain chemistry at play.
The problem of reducing mental illness – whether it’s depression, addiction, bipolar disorder or anything else – to the level of biology alone is
that it turns the condition into the individual’s problem, as if it’s somehow their fault. It narrows and oversimplifies a complex problem that by nature is a chronic, recurring and relapsing condition, which requires the support of family, friends and community to heal.
We need an open process of recovery that’s awake to a wider picture of mental illness and all its social determinants, one that points us toward the universal human struggle with self-control, psychotic pain and often the breakdown of reason. In this sense, mental illness is profoundly ordinary and contiguous with all of human suffering, and it should be treated as such.
People have said to me they are wary of models, like the Trieste model, that claim to have all the answers to our problems with treating mental illness.
But for me, the beauty of the Trieste model it’s not a model at all. It’s the application of principles based on human rights and human decency that incorporates the widest possible range of opportunities and hundreds of different systems. In other words, whatever works. The big difference is that the individual, not the disorder, is always at the centre of these options.
Descriptions of mental illness often imply that people who have these problems have no capacity for choice or control. That’s not true. What we need is not fatalism or dehumanization, but hope and a continually wider variety of choices.
My simple point is that the vast majority of people with mental health problems do not need to be shunted through the psychiatric system, which we must admit too often does more harm than good. There are more effective ways to help people– and it begins by offering this wide range of real-world therapeutic choices that only they can choose.
I say to any mental health practitioner here: let us take your burden so you can focus on those who you can truly help. Imposing help on anyone, especially through the narrow confines of the brain chemistry model, is almost certainly doomed to failure.
So, when the paralysis of Joshi’s loss slowly lifted, I found myself angry and frustrated. I became desperate to know if anything could have been done to save our daughter. I refused to accept that Joshi could not have been saved.
With the cold eye of an investigative journalist, which I was, I began to look at how other systems operated around the world, along with their recovery rates. I had thought we were getting Joshi the best care possible, but it turns out that Scotland and the US – the two places where she received care – are a long way from being the best places to suffer any form of mental illness.
Too late, I discovered several fully-functioning mental health systems that achieved consistently impressive outcomes. These included Finland’s Open Dialogue methods, Luxembourg’s Positive Education program and Germany’s easy therapy access and financial support for patients with mental health problems.
Then I discovered Trieste, a city in north-eastern Italian that is probably the best place in the world to have a mental illness.
Their recovery system is based on therapeutic principles of human rights and individualised recovery plans.
It is centred around 24/7 walk-in community wellbeing hubs – just like the Joshi Hub we hope to persuade the NHS to pilot with us here in Inverness, and then roll out across the Highlands and throughout Scotland.
These hubs don’t just offer open doors, they offer hospitality and real hope. They are interlinked to a myriad of community services, incorporating employment, job training, the arts, sports, recreation and, probably most importantly, the life aspirations of sufferers. We are already beginning to connect our potential “Joshi Hub” to many organizations and groups in the Inverness and Highland community – some of them are here today – and we want to connect with as many as possible. The more community groups we can connect with and offer in our range of opportunities, the better.
This is what they mean in Trieste when they say the most important thing is for individuals to “negotiate their own recovery.”
It’s also important to stress that Joshi hubs are not just for those with mental illness, but also for everyone in the communities they serve. This way, the paths to recovery and the community are one, so they can serve and strengthen each other.
When I contacted Dr Roberto Mezzina in Trieste – you’ll be hearing from him later – and told him Joshi’s story, I had mentioned that she was an enthusiastic poet and a lover of Shakespeare.
His response shook me to the core. I’ll never forget it.
He said: “Well, one of the first things we would have done would have been to bring a Shakespeare or theatre expert, or even a poet to talk to her. It might have helped.”
It was immediately clear this was no ordinary psychiatrist and that the Trieste model was no ordinary mental health system. It’s recovery rates also showed that it worked far better than anything we have here in Scotland. I wondered why it wasn’t in place everywhere. I confess I still don’t fully understand the answer to this – assuming that the primary goal of any mental health system is surely to help patients recover.
I knew almost immediately that this system of long-term, holistic support could have guided Joshi to recovery, helping her find inspiration, hope and her place in the world. Had she had access to this kind of model, I continue to believe her life could have been saved – and by extension, the lives of thousands like her across the Highlands and the rest of Scotland.
For the past two years, I’ve been saying this to anyone who’ll listen:
The Trieste model is not some far-flung, airy-fairy, hippy dippy obscure theory. According to the World Health Organisation it’s the absolute epitome of best practices. And it’s not some weird shamanistic system from Outer Mongolia. You can fly to Trieste from Edinburgh in about 3 hours. It’s methods and principals have been emulated in more than 30 countries, including Canada, Spain, France, Australia, Brazil and parts of the UK – including at least half a dozen NHS trusts across England and Wales.
Why are we not doing it here? Why are we not helping more people? Why are we not saving more lives? Why are we perpetuating a model that we know all too well, comes up short of the good that is surely intended?
Instead, why are we not adopting a model that’s been proven to dramatically cut suicide rates and mental relapses, gets hundreds of previously sick people back into work – all at a fraction of the budget, beds, psychiatric drugs and involuntary treatments relied on by outdated and ineffective mental health systems?
But we have the power to change – all of us do – and so do outmoded systems. And we have the power and the strength of community to do it here.
We are here in Inverness, because Joanna Kerr, a long-time Inverness resident and now a board member of The Joshi Project – wrote to us with the power of imagination and asked the simple question: “Why don’t we have Joshi Hubs in Inverness and the Highlands? We really need it!”
So, I ask you all just to imagine it and help us create something truly extraordinary, right here in Inverness and the Highlands. Just imagine it and make it happen. Imagine Inverness.