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Help improve mental health care in Scotland

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It’s time to change what doesn’t work…

By Mark and Catherine Smith

The Joshi Project is named for our beautiful, brilliant and gifted daughter, who died in January 2020, aged 24. Her tragic, final moments came after a lifetime of struggle against deep depressions, high anxiety and punishing OCD rituals, along with the persistent abandonment and failure of mental health professionals, who did not provide the care and support she sought and desperately needed to live. She was as smart and creative as they come, and surrounded by the love of everyone whose life she touched – but it wasn’t enough. We have no doubt that Joshi’s life could have been saved had she had access to the right kind of support.

The purpose of the Joshi Project is to introduce a more compassionate and flexible system of mental health care in Scotland, aimed at helping the thousands – probably tens of thousands – of people like Joshi, who have so much to give the world, but are stymied and oppressed by the confines of a system without vision.

The vision of the Joshi Project is to establish the “Trieste model” of mental health care in Scotland. This is a system of social psychiatry, based on a hugely successful model that has operated in the Italian city of Trieste for more than 40 years.

Our ultimate hope is that the Trieste model will be established to serve every community in the world, where every individual’s mental health needs are catered for by a system of care that is entirely focused on their recovery within their community. Scotland, the place where Joshi’s problems began, is another step toward this wider revolution.

What is the Trieste Method?
At its core, the Trieste model is a network of Community Mental Health Centres (CMHCs), which are interlinked with the community for the benefit of the individual’s recovery. CMHCs operate a 24/7, walk-in policy and provide single-point access in an informal but safe space, where individuals are treated with compassion and dignity, and given advice, treatment and counselling. Unlike the current system of mental health care, the needs of individuals – not a person’s disorders or diagnoses – are at the centre of each recovery plan. The focus of treatment is the individual’s life goals and long-term recovery, as opposed to a diagnosis and the management of symptoms. This is a system that works – at the psychiatric-treatment level and in its ability to reintroduce people back into their communities – by focusing on their aspirations and allowing them to live independent, fulfilling lives with the support they need. The designation of Trieste by the World Health Organization (WHO) as a “centre of excellence for mental health recovery”, along with the raw statistics on successful treatment outcomes in Trieste, provide the promise of what can be accomplished in Scotland.

Why Not Scotland?
Our initial aim is to establish a pilot CMHC in Glasgow and ultimately expand them throughout Scotland. It is worth pointing out that these are not simply the machinations of grieving parents. The Joshi Project already has a relationship with key figures who are helping to make this happen, including a professor of psychiatry at Glasgow University, who has already helped establish CMHCs in various parts of the world, and the former director of mental health operations in Trieste itself.

The extraordinary benefits of the Trieste model have already been recognized elsewhere in the UK. Hywel Dda University Health Board in southwest Wales is currently working toward setting up its own Trieste-style mental health services. And there are at least six NHS trusts in England that have established educational links with Trieste. The most advanced of these is York, which is already two years into a five-year plan to establish a 24-hour Community Mental Health Centre based on the Trieste model.

Spread the Word
Join our movement for change. We are pushing for a more dignified and compassionate system of mental health care in Scotland. Funds raised by The Joshi Project will go toward the establishment of an NHS-funded Community Mental Health Centre pilot scheme in Glasgow, as well as the specialist training of CMHC staff, and generally lobbying for a more holistic and compassionate approach to mental health in Scotland and around the world.


Cath Smith

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