Steps and Tenets

To be true to the spirit of ShrinkTank, all of these steps and tenets are dispensable. That is to say, they may be amended or even junked at any time. The problem, which may turn out to be a fatal flaw, is – how should it be decided to change, relegate or drop an idea which, at birth, seems integral to its survival and health? Organic change is generally the most durable so ShrinkTank will be both consistent but dynamic, and reliable but adaptive.

ShrinkTank’s 12 Steps 

• The most experienced and able staff should have the most contact with patients
• Careerism should not be rewarded at the expense of vocation
• Psychiatry should primarily be an illness service (social inclusion and social engineering, employment finding and training, and so on should be the concerns of institutions or organisations outside the NHS)
• The language of the market (service users, purchasing, commissioning, performance indicators) and all the infrastructure necessary for this, should be abandoned in NHS psychiatry
• Multi-disciplinary teams should be multilingual not monolingual (i.e. using only the language of medicine)
• The concepts of compliance, concordance, adherence and insight should be removed from the mental health lexicon. The Mental Health Act should be amended to make it unlawful to give someone insight against their will
• The brake on professional inadequacy or excess should generally be peer vigilance and exposure to feedback rather than control or censure from the centre
• Psychiatry and its institutions must be flattened and democratised. Hierarchical organisations create hierarchical relationships between staff and those who use their services
• Vested interests (e.g. specialists, lead professionals, promoters of new brands and models) should be kept at arms’ length
• The depot* mentality (“we have something beneficial which one way or another you must accept”) has no place in mental health care
• Professionals should first treat their organisation, secondly themselves and finally the patient (“mens sana in corpor[ation]e sana”)
• In psychiatry, conformists should be encouraged to be subversive and subversives to conform (NB if you take away the creativity, you take away the cure)

ShrinkTank’s 10 Tenets

• Psychiatry is a combination of art, skill and know-how: it cannot be reduced to guidelines or algorithms
• The message may be medication but the medium is the relationship
• CPA at best impedes normal good practice: at worst, it is a perversion of it
• Procedure is a symbolic reference point which is mainly used defensively. It rarely, if ever, changes practice.
• Diagnosis is what doctors do: it is not a universal truth
• Complex typologies are primitive attempts to re-order disorder
• More does not always mean better
• Risk assessment often increases risk
• The main task of psychiatry is problem-solving (there being a subsidiary one of public protection)
• Good mental health practice is primarily about asking the right questions rather than providing the right answers