Leapfrog is a global game, but the English word for it, playful and descriptive, conjures the sheer joy of jumping over another’s back and flying in the air. It is something that we have talked about in our team that we want to do with our mental health innovation, Mental Snapp, as a metaphor for the technological leap we want to achieve. A Google search revealed we’re not the first. Steve Jobs used it in his keynote speech in 2007 to introduce the first iPhone, which he described as ‘a leapfrog product which is way smarter than any mobile phone has been’. Pulling on the playful element there, he epitomises the way that Apple users feel passionate about their tech. It is not a metaphor that has been applied in the past to psychiatry, but I do believe that we may have come to a point in the history of psychiatry where it may have relevance.
The origins of the psychiatric system are that it was largely developed and brought to scale at the turn of the last century. Originally mental health was the domain of the church, and it was events such as the madness of King George, and the mass mental health crisis caused by World War I, that catalysed the growth of the profession and its growing respectability. The population saw and experienced that mental health was not just something that happened to the individuals who were in the workhouse or part of the great unwashed that were somehow the preserve of the church. It could happen to their kings, or their soldier heroes, and it seemed fitting that they should be cared for with the latest scientific developments.
However, there is an inherent imbalance in status in the psychiatric model. The psychiatrist has the scientific understanding, has studied the brain and its chemicals, and is in the position to administer drugs. The patient has the experiential, less privileged, knowledge, without the benefit of the formal study of how they acquired that knowledge. This knowledge, however, is starting to gain credibility and status, as the power balance evens out. It is my experience that getting to know one’s mental health involves understanding the way that one’s body and mind interact in highly idiosyncratic ways and ones that are not possible to study more generally. For example, I know that my mental health and my blood pressure are linked. When I am at the beginning of a manic surge, my blood pressure soars to near dangerous levels. It is a useful physical warning sign, and an objective measure to me of my mental health at a time when I might be tempted to ignore early warning signs. It is also specific to me, and I have frequently surprised and baffled so called ‘experts’ by my blood pressure surges.
It seems to me that we are ready for a leapfrog in our relationship to our power experts. As mental health service users, we can soar over their backs. Rather than being Newton, and standing on the shoulders of giants, we can fly over them. Putting the patient first in mental health is the obvious and progressive thing to do. Doing it on an individual level is possible and desirable. However, doing it in an organised and systemic way throughout the NHS is difficult, and involves mass organisational change. I am attempting to initiate these kinds of changes in the NHS with my company Mental Snapp. The idea is that service users should be able to contribute to their mental health record. A simple idea. But in order for it to be commissioned by the NHS, it has to save them time and money. I believe that it will, in terms of increased health outcomes.
I would suggest that one of the fundamental things that working in partnership requires is an acknowledgement that it is not the story of the psychiatrist that we are telling, but the life story of the individual. As such, they should lead and be empowered to tell their own story, on their official records, and in their lives. Being prescribed psychiatric medication, being told there is something wrong with your brain, is a disempowering experience. It can lead one to believe, on a subconscious level, that it is not your own life story that you are telling, but one in which the experts have the lead or hero role. Giving the hero role back to the service user is fundamental to the leapfrog that we need to do in order to help people to take charge of their own lives.
So, this is the leapfrog in technology and attitude that we are attempting to undertake with Mental Snapp. In order to demonstrate that we will save the NHS time and money though, on a trust by trust basis, we are forced to put the cart before the horse. The pilot studies that we are looking at involve organisational change in order to make them effective and successful. Organisational change in the NHS is clearly necessary on so many levels, but it also dooms a pilot study to failure. We may be attempting to play leapfrog with a unicorn.
The way round this that we have worked out is to work outside the health record system for the moment, to encourage people to share their stories with a mentor or a small group in a recovery college. We hope to instigate pilot studies in the NHS as a result of successful pilot studies here. The NHS is a big beast, but a real life one, not a mythical being. It can change, and it is being forced to change by the government in many ways at the moment in a top down directive. Maybe it can respond to a gentler, patient led revolution as well. I hope so. I can see us leapfrogging our way to success in the long term, fingers crossed we are not playing leapfrog with a unicorn.