The ‘Tree of Life’ is an approach based on Narrative Therapy that uses a tree as a metaphor for someone’s life. The metaphor is extended to the forest of life to describe how trees support each other and are stronger together in a forest. It was pioneered in Zimbabwe by Ncube and Denborough to support work with traumatised communities (REPSSI, 2007). It is a collective narrative practice that offers a culturally more appropriate response to social suffering.
It has been adapted to work in the acute wards, and represents a change from the norm of asking people about their problems first; to invitations and questions that appreciate resources and strengths. This can help people to stand on a firmer foundation and support talking about difficult experiences during a mental health crisis. This is of particular value on a ‘problem saturated’ mental health ward where the mental health diagnosis dominates and can neglect the person behind the problem.
The Tree of Life approach has been shown to be valued by Black and Minority Ethnic (BME) groups, whose stories are often marginalised. It provides an opportunity to reconnect and share empowering stories from cultural heritage to enable people to tell their stories in ways that make them stronger and not feel alienated, by the NHS models of expertise.
The strengths-based approach and valuing of culture has enabled tree of life workshops to be available and accessible to all on the acute wards, which is fairer than a model of inpatient psychology care based on a few selected for individual therapy. The practice embodies togetherness and equality, and promotes human connection as a powerful therapeutic process.
Another key aim of the tree of life workshops on the acute wards is the building of collaborative relationships by inviting both staff and people admitted to the ward to the workshops as equal participants. In addition, the workshops are co-led by service users to promote recovery stories and fight stigma in mental healthcare, by breaking down the barriers between us and them. The SLaM tree of life practice ‘acknowledges the importance of working collaboratively with service users and recommends this collaboration be a key defence against poor inpatient experience, and the development of damaging cultures’. SLaM also recognises that to provide compassionate care, there must be a commitment to looking after staff and promoting positive relationships with service users.
The tree of life has made an extraordinary impact on staff and service users on the inpatient wards of SLAM. It is a hugely effective way of addressing service user engagement and recovery.
The SLaM Tree of life practice on inpatient settings therefore has these 5 key aims:
- Address crisis and trauma from a position of strength
- Promote recovery through talking about service users as people not just problems/diagnoses
- Build relationships between staff and service users by inviting both to the groups
- Offer a psychological model that is open and inclusive of ALL on the wards rather than a select few for individual therapy; especially given the scant resource of psychology on inpatient wards.
- Value stories of culture and heritage by inviting people to talk about them and see them as a resource in their lives.
SLaM’s tree of life practice on the acute wards was adapted from Ncazelo Ncube’s community model; which typically takes 1 full day to run. This was not possible on a busy and dynamic acute ward; trying to accommodate multiple complex needs and varying levels of distress. The acute tree of life workshops run for approximately 2 hours to fit within the parameters of the ward daily schedules. The workshops are an opportunity for staff and service users to get to know each other in a safe and protected space. Information shared can be used to help develop collaborative recovery plans, improve cultural understanding and challenge stigma in mental health. The tree of life acute work in SLAM won a national award for ‘promoting equality and diversity in mental health services’ in 2015.
SLaM have been running tree of life workshops on the acute wards since 2012. There are 4 tree of life workshops running every week across the trust and it is now a fully integrated part of the acute psychology model of care. SLAM also employs 2 part time service user/peer tree of life facilitators and every workshop is run by a psychologist and a service user facilitator in the true spirit of co-production.