1975 to 1986 St Charles Youth Treatment Centre; my experiences.

Following on from the case of Mary Bell, a child who killed other children (ref) an inspired Social Services Inspectorate came to the view that there are likely to be a significant number of children who commit violent crimes but might benefit from a therapeutic regime which would be highly preferable to being committed to the prison system where the recidivism rate was known to be very high. They purchased a site in Brentwood, Essex which had been designed as an approved school, and made it more secure. Then it was handed over to a Director who was a consultant psychiatrist and staff drawn from teaching, nursing and residential social work; all of whom were expected to have a grade equivalent to charge nurse or head of department. The Inspectorate suggested that this staff group should work out how to achieve a suitable therapeutic milieu and suggested that reference to psychoanalysis and therapeutic communities would be helpful.

The first attempt closed within a year and the focus on the model moved from psychiatric towards therapeutic.

When I arrived as part of the second attempt (1975), the Director was Treve Edwards, whose background was approved schools. I still use him as the best example I’ve ever worked with of an inspired senior manager.

……..

In 1978, just as I was preparing to follow the hippy trail to India, the job of manager of one of the therapeutic houses came up. One of the advisory staff, our Consultant Psychiatrist, ? – who almost immediately left, suggested I should apply and for reasons that I don’t understand I did. To my immediate shock and subsequent horror, I was successful. I have written in my book about what happened next (ref) but the point of this brief biography is how this led to my first innovation. It was the job of the senior staff to build a model of how to work with these young people. I was helped enormously by following another senior colleague’s advice and getting a training in organisational consultancy at the Tavistock Clinic. Here I discovered the ubiquity of projective identification and developed and understanding both of it’s potential power (put simply: you cannot exaggerate the power of PI). My colleagues at St Charles made me realise that I had a special skill for conceptualisation; I discovered that I was able to understand very complex ideas and convey them in a digestible and helpful form. Gradually it fell to me to draw together what would become the model for how to work with these difficult adolescents.

Projective Identification

1. Can’t exaggerate the impact
2. Consequence is that the closest approximation to truth about a client is the narrative that takes every staff member’s view as accurate.

Containment and security

1. The containment provided by a secure building is artificial and the only security it offers is for the public, not the young person
2. Security for the young person derives from that sense of containment in which they feel cared about and are the object of a benign enquiry.
3. This is a dynamic containment; breakages are always capable of repair and the repair always provides an opportunity for growth (on both sides).

This led to the concept of a secure therapeutic environment in which walls were replaced by relationships.

And it worked.

Teaching

1. The best teachers prepare their lesson and then locate themselves alongside the students during the delivery so that they can understand how the student is engaging with and understanding the material
2. The worst teachers prepare their lesson and then keep it between themselves and the students so that it becomes the student’s responsibility how much they can learn and the teacher feels personal attack when the student rejects their lesson.

The consequence is a principle that I have taken into every aspect of my work, the principle that the learning of the ‘student’ (or client or patient) is the responsibility of the teacher (or consultant or therapist).

Decision-making

1. The best organisations benefit from the delegation of authority to make decisions to the lowest sensible level.
2. This only works if the person given this authority is expected to provide an account for his activity to his manager.
3. This only works when the manager is committed to a benign enquiry; this is because all accounts deliver both a conscious component and an unconscious one, the latter is always in the form of anxiety.

So, I discovered the principle which would become the centre of my model of the Healthy Organisation Model; namely that health organisations pass authority (to make decisions) downwards and receive anxiety upwards in the knowledge that all work has an unconscious impact on the worker that manifests as anxiety but can be turned into information through the process of a benign enquiry.

This model, which has been refined and developed over the years has been the basis for all my work.

I was helped towards this model by the observation and the relationship with Treve Edwards, the Director of St Charles Youth Treatment Centre, who provided this sort of leadership as part of his personality.

The Youth Treatment Centre functioned very well, violent incidents were reduced to a rarity because staff knew that they would be backed in their decision-making about the work with the young people, especially when they were able to sense the unconscious communication from the residents and, therefore, act to provide containment before the adolescent in question was forced to escalate his behaviour in an attempt to be heard and held.

However, this required a sophisticated level of work and that depended upon experienced staff. Margaret Thatcher considered the cost of this ‘so-called expert’ opinion too much and was convinced by people like Masud Hoghughi, who ran an approved school called Aycliffe Centre for Children on behalf of County Durham, that a behaviour modification programme would work just as well but didn’t need staff to be so highly trained because they would be following a behavioral plan. This led to the setting up of a sister Youth Treatment Centre, called Glenthorne, in Birmingham that was set up to follow Hoghughi’s model. It also meant increasing pressure on St Charles to reduce costs. I might, at a future date, described the consequences of this for both YTCs but, for now, this is simply about my ideas and innovations and I shall leave it here that my experiences led to the innovation of an alternative to prison for young people that could be described as a way of working in which relationships between staff and young people provided both security (replacing the security apparently provided by the physical building) and the conduit for therapeutic treatment based on a psychoanalytic understanding of the mind.