Complementary medicine

A volunteer befriending scheme for people with mental health issues is making a lasting impression

• Mark Gould
• The Guardian,
• Wednesday March 26 2008

There is an explosion of pink outfits in the office near Southend seafront where Linda White and her friend Jacqui Herbert are having the full works - hand massage, manicure and nail art. The dress code and treatments are to celebrate the achievements of a local befriending service that has reduced the loneliness and isolation of people with mental illness.

White, 50, shows off her jewel-encrusted fingernails, as she explains how Good Companions has changed her life. "I was unable to work and on benefits due to mental illness, and I wanted to put something back, help somebody else. Because I have had my own difficulties with things like depression, it's something I'm good at." She nods to Herbert. "Jacqui knows she can ring me any time for a chat or if she wants to go out for an hour."

Herbert, 39, was referred to Good Companions by her social worker. "I have anxiety and depression and didn't go out much," she says. Her only social outing was a trip to the mental health drop-in centre, which meant she was meeting only other people who were ill. "This," she says, looking around the room, "is just about being normal."

Eight years ago, Veronica Grocutt, 67, was being treated for depression, anxiety and panic attacks when she was referred to Good Companions. She still has a befriender, but has since become a befriender to Barbara Shipton, 63.

"Even if you only go out for a cup of tea and a chat, it's a break," Grocutt explains. "We've been to Yarmouth together. I've been there for her, and she's been there for me."

Shipton agrees: "People do steer clear of mental illness. I have had people I've know cut me dead - they think it's contagious. But I met Veronica eight years ago and it's brilliant we have got on so well."

Good Companions was set up 10 years ago by the Southend branch of the mental health charity Rethink to tackle social isolation in Southend and surrounding areas of Essex as far west as Brentwood.

Volunteers undergo Criminal Records Bureau checks and then a four-session training course over four weekends. The course explains what Rethink does, the main mental illnesses, and their signs and symptoms. It also gives a brief overview of mental health services, medications and treatments, as well as explaining the Mental Health Act.

There are 200 service users on Good Companions' books referred by GPs, community mental health workers, social workers or following a care review. At any one time, there are around 100 volunteer befrienders, who commit to a minimum one hour a week. That could be a trip to the cinema, pubs, an outing, or simply going out for a cup of tea and a chat.

Alison Williams, Good Companions' volunteer recruitment and mental health promotion officer, says a lot of emphasis in the early stages of training is placed on understanding the stigma that mentally ill people face, and dispelling some of the more lurid myths about psychosis and other conditions.

Williams's role has recently been extended to include outreach and recruitment work in schools, colleges, with the local police, fire brigade and local authorities. "We spoke to 800 people last year, dispelling myths and attacking stigma," she says. "People come away realising that people with psychosis aren't mad or violent. They realise they need help and support."

The scheme's manager, Neil Harding, says befrienders get an expenses allowance, but it is not often taken up. "People say: 'I was going to the pictures anyway and I just went along with a friend. Why should I need expenses?'."

Befrienders also act as a sounding board of their friends' mental health. "Someone might say something to their befriender that they want dealing with in terms of their care, and they know it will be raised with one of our staff," Harding says. "Volunteers get access to one of our staff until 10pm every night, even weekends, so if they are worried, or something happens they think the mental health team needs to know, they can get in touch."

Good Companions pays a lot of attention to awareness of boundaries and ensuring relationships are appropriate. Where problems crop up, one of its staff involved in the initial matching will discuss the situation with both sides. The scheme, which employs 10 full-time staff, is run under contract from South Essex primary care trust.

Williams says she is touched by the level of response to appeals for volunteers. "It's heart warming. People think that everyone today is out for themselves, but we hear so many people say they want to give something back."

goodcompanions.org.uk

Complementary and Alternative Medicine (CAM):

For Mental and Emotional Health

Historically, traditional Western medicine has approached healing in just the body or just the mind. It also tends to view the source of a problem as external, in a "disease" or "disorder" model. For centuries, Eastern medicine has taken a very different direction, viewing the mind and body as unified, with energy fields both inside and around the body seen as part of the total health system, and approaching healing as an internal process.

Many kinds of Eastern medicine have begun to find their way into Western culture. In addition, other non-traditional approaches have become more visible in addressing what may be viewed as both physical and mental dis-ease. Many are being integrated into traditional mental health settings as their safety, effectiveness, and scientific validity are recognized.

What is complementary and alternative medicine (CAM)?

The sections below focus on several types of mental healthcare practices previously considered outside the scope of conventional Western medicine, many of which are now commonly incorporated in treatment. In general, these approaches may be divided into two broad categories:

• Complementary or integrative approaches (working along with traditional medicine)
• Alternative approaches (working in place of traditional approaches)

Complementary and alternative approaches often see life experience and an individual's coping mechanisms as the source of difficulties – that it is not what has happened to a person that is the problem, but how the person perceives and deals with what happened. It is apparent that what one considers to be the source of a problem (genetics, disease, internal energy imbalance, or life experience) will affect what treatment options are considered to manage or rectify the problem.

There are many types of complementary and alternative treatments, which tend to fall into such areas as:

• Alternative medical systems
• Creative arts therapies
• Nutritional or other "balancing" approaches
• Energy therapies
• Mind-body approaches

Why would someone consider complementary or alternative treatments for mental and emotional problems?

Most people in our society are familiar with mainstream, Western medicine. At its best, Western medicine can diagnose and treat many problems that otherwise might cause devastating effects in a person's health. However, mainstream medicine also has limitations. In recent years, there has been an increased interest in approaches from other parts of the world, or from other perspectives. Eastern medicine often relies on concepts that are outside Western understandings. For example, most Eastern approaches view disease or disorders (including mental conditions) as indication of blocked energy in the body, while Western medicine is more likely to want "scientific proof" that this energy even exists.

Some reasons people consider complementary or alternative treatments are:

• Feeling that Western medicine is too mechanical, dogmatic, or compartmentalized
• Belief that Western medicine is fine for what it is, but does not go far enough
• A perspective that the cause of a problem may lie in life experiences, rather than in genetic defects or diseases
• Concern about the safety of medications, particularly those used to treat mental or emotional problems
• Seeing CAM as less invasive than Western approaches and wanting to try it instead of, or at least prior to, seeing a medical doctor
• Objections to what they see as "instant fix-it" or "pill-popping" attitudes
• Being "turned off" to traditional treatments, because of a lack of trust in doctors, or bad experiences with the medical world
• Religious beliefs that preclude drugs or surgery
• Desire for a sense of spirit or human depth that seems missing in Western approaches
• Desire for engaging more of the "whole" person in treatment
• Interest in exploring practices that have been in use for thousands of years in other parts of the world

Most traditional psychotherapy approaches are based on memory and cognitive reasoning. But current research indicates that the source of anxiety or depression may be unrecognized trauma in a person's life, and that emotional trauma may result in only fragments of thought or sensations, rather than cognitions. For this reason, healing – whether from one traumatic event or a series of events – may not lend itself to the more traditional therapies.

In deciding about the use of complementary or alternative approaches, an individual or parent should become educated about available options in order to make the best choices for their particular needs. For example:

• Some might want to see a medical doctor or take psychiatric medication to relieve the most severe symptoms of anxiety or depression, while considering other alternatives for ongoing treatment
• Some might prefer to avoid physicians and medications entirely and pursue different means to address symptoms
• Others might want to try a variety of alternative approaches to find a good "fit" for the specific problems in their lives.

What are some types of complementary or alternative approaches to mental health treatment?

Alternative Medical Systems

There are many other medical systems in the world, beyond the standard Western system. Cultures throughout the world have a variety of healers or shamen. These systems are well-developed, with a 5,000-year old track record for healing, and many are gaining wide acceptance as alternative or complementary approaches in the West. Each of these systems addresses human suffering in different ways, but generally they seek to re-establish a balance or harmony within the body and in the lifestyle of the person being treated. Because they tend to view mental or emotional difficulties as part of a larger matter of balance and overall health, they are included here:

• Ayurveda ("Science of Life" Traditional Medicine from India) is the oldest medical system. The focus on energy and balance rather than symptoms seeks to restore wholeness in the mind-body-spirit system. Disease is viewed as an outgrowth of mental conditions. Each person has a particular combination of physical, mental and emotional characteristics – distinct bioenergetic types known as Vata, Pitta, and Kapha – that are genetically determined and prenatally influenced. Different causes and treatments of physical and emotional disorders are based in part on this individual constitution, with the kind of patient being more important than the kind of symptoms. Physical and mental health is achieved by balancing diet, exercise, sleep, and sexual activity. Some of the tools of Ayurveda include a variety of stress management techniques, meditation, aromatherapy, yoga, and massage.
• Traditional Chinese Medicine (TCM), in use for more than 4,000 years, is based on the flow of vital energy (qi or chi, pronounced "chee") throughout the body. In a healthy state, the yin and yang (negative and positive energies) are balanced, while a disease state results from an imbalance. Thus, the use of herbs, nutrition, meditation, acupuncture, and exercise are intended to restore balance and return the body, mind, emotions and spirit to health.
• Native American healing is thousands of years old and combines religion, spirituality, herbal medicine, and rituals to treat medical and emotional problems, including trauma and addictions. Because there are hundreds of tribal nations, the practices vary, but generally include purifying ceremonies, chants, sweat lodge, and other tribal customs. Healing rituals can last for minutes, days or weeks and may involve a combination of dance, chanting, body painting, and prayer.
• Homeopathic Medicine ("like cures like") was developed n the early 20^th century. It does not treat a "disease" or disorder by name (such as depression) but rather by specific symptoms (including things that affect symptoms, such as sounds, smells, tastes, moods, energy, time of day or temperature when symptoms are worse, etc.). Small, highly diluted quantities of specific substances are used to cure symptoms which would actually be caused by larger doses of the same substance.
• Naturopathic Medicine sees physical and mental health as arising from a healing power in the body that establishes, maintains, and restores health. Many other treatment modalities (such as Chinese medicine, homeopathy, etc.) are incorporated to support this healing power, along with nutritional and lifestyle changes.

Nutritional or other "balancing" approaches

• Vitamins and supplements: Many people may suffer from both physical and mental conditions that arise from inadequate nutrition. Nutritional deficiencies often first appear in the form of mental symptoms. Some r