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Tidal offers support to:
http://www.amnesty.org/
http://www.wateraid.org/
The Tidal Model is one of the few recovery models to have been
http://www.mindfreedom.org/ evaluated rigorously across different settings, in different cultures.
www.rnli.org.uk
Please consider lending
The Tidal Model is:
The first mental health recovery model developed conjointly by mental
health nurses and people who have used mental health services
The first recovery-focused model of mental health nursing recognised
internationally as a significant mid-range theory of nursing.
The first model of mental health nursing to be used as the basis for
interdisciplinary mental health care.
The first model to focus beginning the recovery journey when the person
is at their lowest ebb
The Tidal Model  is a philosophical approach to the discovery of mental
health.             By philosophical we mean, a way of thinking about how
people might reclaim their personal story, as a first step towards recovering
their lives.
The Tidal Model is an approach to recovery. It is not a rigid system. Each
of the many Tidal projects across the UK, Ireland, Australia, New Zealand,
Japan and Canada, are  exploring different ways that people can discover
their mental health, in a personally, socially and culturally meaningful way. 
The Tidal Model's main focus is on helping individual people, make their
own voyage of discovery. In that sense, the only real 'evidence' of
usefulness, is what happens - or is 'discovered' - for the individual person.
 your support.
c
Everyone faces serious challenges, at some stage point in their lives. The Tidal Model is
  focused on helping people decide what needs to be done, now, to help address their present
difficulties, and so continue living as full and meaningful a life as possible.

  Our dear friend and colleague, Mike Consedine, died on Friday

  25th January, 2008 at home in Christchurch, New Zealand. 

We have prepared our own short 'appreciation' of Mike's life and

work, by way of thanking him, for the generous friendship he
shared with us over the past 15 years.

Phil and Poppy

(Click here to read more)

This is the official internet site for the Tidal Model. Here you can learn more about the Tidal
Model from Dr Phil Barker and Poppy Buchanan-Barker, and their many colleagues
involved in its international development and delivery.

 
 

 
 
     
 
The Model of the Person

In the Tidal Model the person is represented, theoretically, by three personal domains: Self, World
and Others . A domain is a sphere of control or influence:: a place where the person experiences or
acts out aspects of private or public life. More simply, a domain is a place where someone lives.

The domains are like the person’s home address. Their house or flat has several
rooms, but the person is not to be found in each of these rooms all the time.
Sometimes the person is in one room, and sometimes in another. The personal
domains are similar. Sometimes the person is mainly spending time in the Self
domain, and at other times is mainly spending time in the World or Others
domains.

The Self Domain is the private place where the person lives. Here the person experiences thoughts,
feelings, beliefs, values, ideas etc, which are known only to the person. In this private world the distress
called ’mental illness’ is first experienced. All people keep much of their private world secret, only
revealing to others what they wish them to know. This is why people are often such a ‘mystery’ to us,
even when they are close friends or relatives.

In the Tidal Model the Self domain becomes the focus of our attempts to help the person feel more
‘safe and secure’; where we try to help the person address and begin to deal with the private fears,
anxieties and other threats to emotional stability, which are related to specific problems of living. The
main focus is to develop a ‘bridging’ relationship  and to help the person develop a meaningful
Personal Security Plan. This work becomes the basis of the development of the person’s ‘self-help’
programme, which will sustain the person on return to everyday life.

The World Domain is the place where the person shares some of the experiences from the Self
domain, with other people, in the person’s social world. When people talk to others about their private
thoughts, feelings, beliefs or other experiences known only to them, they go to the World Domain.

In the Tidal Model the World Domain becomes the focus of our efforts to understand the person and
the person’s problems of living. This is done through use of the Holistic Assessment . At the World
Domain we also try to help the person to begin to identify and address specific problems of living, on an
everyday basis. This is done through use of dedicated One-to-One Sessions.
The Others Domain is the place where the person acts out everyday life with other people—family,
friends, neighbours, work colleagues, professionals etc. Here the person engages in different
interpersonal and social encounters, within which the person may be influenced by others, and may—in
turn—influence others.

The organisation and delivery of professional care and other forms of support is located in the Others
Domain. However, the key focus of the Tidal Model is on three dedicated forms of group work—
Discovery, Information-Sharing and Solution-finding .

By participating in these groups, the person develops awareness of the value of social support, which
(s)he can both receive from and give to others. This becomes the basis of the person’s appreciation of
the value of mutual support, which can be accessed in everyday life.

The Inevitability of Change

In Tidal we accept that change is inevitable. Nothing lasts! Neither our misery, nor our joy. The fickle,
fleeting nature of human experience is the very ingredient that makes it so special. The pain of
emotional distress only feels as if it is unceasing.

The euphoria of genuine happiness deceives us into thinking that it is anything more than 'momentary'.
But, nothing lasts. If only we could hang on to this enduring wisdom, we might begin to live in, and for,
the moment.

The Uniqueness of Human experience

In Tidal we also accept that we can never know another person's experience - either of joy or pain. the
same is true of what we call mental distress, which is something that has to be experienced, to be fully
understood. For those of us who think that we have never really been 'mad' or 'seriously mentally ill' ,
the best that we can do is to develop our sense of empathy.

We try to fit ourselves, as much as we are able - or as much as we dare - inside the experience of
those who really 'know': those whom we call 'patients' or 'clients' of the psychiatric services.
 Sally Clay knows a lot about madness (1) - and what it is like to be treated as a
hopeless and chronically 'mentally ill' person. As one of the USA's most notable
consumer-advocates, her 'career' in the mental health system spans more than
30 years.
For Sally, the experience was primarily a human and spiritual problem. Sadly, her
'carer's assumed that her madness was 'enduring', rather than 'passing'. They
had not come to appreciate that nothing lasts - not even madness.

www.sallyclay.net
Being 'mad' was all about being Sally Clay. The long and arduous process of recovery which Sally
described in her writing on Madness and Reality was all about recovering a sense of what it meant to
be human and to be Sally Clay. Sally wrote:
"Everywhere these days we see people living lives of quiet desperation - lives, as Kierkegaard noted, of
'indifference, so remote from the good that they are almost too spiritless to be called sin, yet almost too
spirited to be called despair'. We who have experienced mental illness have all learned the same thing,
whether our extreme mental states were inspiring or frightening. We know that we have reached the
bare bones of spirit and of what it means to be human. Whatever our suffering, we know that we do not
want to become automatons, or to wear the false facade that others adopt"
Many people today are afraid of talking about the human nature of mental distress, and think that
'spiritual' either mean religious, or some kind of New Age weirdness. Sally Clay knows that the
experience of madness frightens us - even when we refuse to admit that we are frightened.
"Whether we have had revelations or have hit rock bottom, most of us have also suffered from the
ignorance of those who fear to look at what we have seen, who always try to change the subject.
Although we have been broken, we have tasted of the marrow of reality. There is something to be
learned here about the mystery of living itself, something important both to those who have suffered
and those who seek to help us. We must teach each other".
The lesson that Sally Clay learned from her experience of swinging wildly and frequently between
'Madness and Reality' is meaningful for everyone - but will benefit only those with the desire to listen
and, perhaps, have the courage to feel something of what Sally herself felt.
As Harry Stack Sullivan said: "We are all more simply human than otherwise'. There is much that we
can learn about ourselves in trying to learn something about the experiences of others.

Next page

 
 
   The Importance of Metaphor (Cont'd)  

The Metaphor of Change

The Tidal Model acknowledges that the experience of health and illness is fluid, rather than stable.  In
mental health, the factors associated with a psychiatric crisis, or its more enduring consequences, can be
diverse as well as cumulative. The Tidal Model assumes that the only constant is the personal
experience of change. This is hardly a new perspective on human affairs. As Euripides observed:  

"All is change; all yields its place and goes".

It comes as no surprise that Euripides was also interested in how so-called irrational or abnormal states
of mind were portrayed in Ancient Greece. Not a lot has changed since his day. His contemporary,
Heraclitus also was aware of the impermanence of the world, as well as our place within it.

"Nothing is permanent but change."

The genuine reality of everyday human experience is change, change, and yet more change. The idea
that people could be 'stuck' in states of so-called madness, or 'mental illness', is a crazy notion. People
change, often like nature or the the seasons, which grows itself from the leftovers of past. People often
seem to do likewise, using the relics of their past, to generate new futures. In this simple appreciation lies
the hope of regeneration and recovery.

However, people can, and very often do, resist change, which often appears to bring many threats in its
wake. As Andre Gide remarked,:
 "Loyalty to the past stops us seeing that tomorrow's joy will come

only if today makes way for it".

Although the Tidal Model is focused on change, it recognises that change is a metaphor, and also is
impermanent. This leads us to ask people how they experience change. To help people grow their
awareness of the change process, which is going on within them, we need to be curious about the nature
of change itself. How do people change? What is happening within them, around them, and especially in
their relationships with the world of others? 

The Tidal Model acknowledges the critical importance of metaphor, both as the means of framing
experience, but also for establishing what might ultimately be called regeneration or recovery. One of the
key metaphors in the Tidal Model is the idea of 'psychiatric rescue'. When people experience their
greatest human crises they need a special kind of 'lifesaver' - someone who will help pull them from the
myriad threats inherent in their present situation. However, this is only one, important stage, in the Tidal
process. After the 'rescue' comes the detailed examination of how the person came to find themselves in
such threatening conditions and, more importantly, what needs to happen NOW ?

Losing Our Minds

The layperson assumes that mental illness involves some loss of reason — most outrageously when
people appear to lose touch with 'reality'. This notion is wholly false. However, many professionals
subscribe to a similar concept of true madness and the retreat from ‘reality’. It seems more appropriate to
observe that some people are more aware than others of reality. Reality just is for all of us. We can no
more lose touch with reality than we can lose touch with the air that supports us. We can, however, lose
our awareness of breathing and of air; hence our panic when we think that we cannot breathe and have
‘lost’ contact with the air. As people begin to find the form of words to express something of their
experience, they begin to develop awareness of where they are situated in the great Reality. As a result,
that awareness releases Reality to begin to work the change process on and through the person. All they
need to do is to ‘unfold awareness’. In so doing, they discover that the rest would come. No mean feat,
but an essential one.

By finding an echo of their own voice in that of the helper, the person begins to make more sense of their
story. It is essentially a case of more sense, since I believe that the story always made sense. Perhaps it
was just not the kind of sense that would satisfy most people. For the story of mental distress often
embodies experiences that are untranslatable, because as soon as the patient begins to talk about it she
starts cutting up — dismembering — her reality, or feels obliged to add or subtract something to make
herself understood. Little wonder that the business of making themselves understood became such a trial
for so many people. Ideas dismantle the whole of the person’s experience. As soon as we try to
transpose our vision, sense, intuition of ‘total experience’ of Reality into a story with common concepts,
the whole thing starts to fragment. Words can give us so much, but can rarely give us a whole sense of
the Reality of our experience. They only point, crudely. They act as signposts to that place in our hearts
called Reality. The finger pointing at the moon should not be confused with the moon itself. Words do
have a great power, but much of that power is illusory.
As Mark Twain observed, ‘It was so cold that if the thermometer had been an inch longer, we would all
have frozen to death’. This betrays the magic of words — their inherent ‘as-if-ness’. Anthony de Mello
retold the story of a Finnish farmer who lived on the border with Russia. When the border was being
redrawn, he was asked by a Russian official whether he wanted to be in Russia or Finland. Anxious not to
upset them, he said ‘ it has always been my desire to live in mother Russia, but at my age I wouldn’t
survive another Russian winter’.

Learning From Reality

Many of us live our lives as if our words had such strange power to change things. In truth, reality just is,
and all our attempts to represent it are glorious failures. But still we persevere, trying to make ourselves
heard and hoping that in so doing we shall be understood. Ultimately we come to the realization that we
can no more change ourselves by changing the words we use than we can change our handwriting by
changing pens. The story of our lives is really within us, and any change will come from within; it will be
an educational experience, as we educe the reality of our circumstances.

As our awareness of that core truth grows, we develop what is often called ‘insight’. Regrettably,
psychiatric professionals talk too much about insight — We often pretend to know whether or not people
(patients) have become more insightful about themselves and their lives. I would have to ask the person
to answer that question, since I can never know another’s insight. Such an abstract ‘thing’ can only be
educed by the person herself. When people draw out from within themselves (educe) that realization
called ‘unfolded awareness’, they become their own expert. As people watch themselves, they grow in
awareness, picking up feelings and sensations, giving them names, cataloguing them for future
reference. Ultimately, they reach a point where they may believe that they have found a way to explain it
all. Then, and perhaps only then, do they have to deal with the real villain of the piece — self-
dissatisfaction and self-condemnation; all those challenges that dislocated them from awareness of
Reality in the first place. They risk believing, as Sullivan noted, that ‘the self is largely a verbal edifice

Maybe people learn that language is alive and growing, and is not permanent. Through that lesson they
unpick the riddle of the change process: that, as Confucius observed, ‘the one who would be constant in
happiness must constantly change’. They discover that it is not simply the case that nothing lasts — that
all truths are provisional — but also that the story is itself in flow. Like the words used to express it, the
story is not a static thing that can be ‘caught’ in words or phrases, far less by the terminology of
psychiatry and psychobabble. It is living in every phrase that trips from their tongue or that is scrawled by
their pen.

There is no goal to reach. Reaching, in life, is its own goal.

 
 Home

 
   Key Philosophical and Theoretical Influences  

An Acknowledgement

Our development of the Tidal Model has been influenced by many people we have met and worked with down the

past 40 years in the mental health field. Some were colleagues and mentors; others were the people who were,
temporarily, in our care. They are too numerous to mention, but we acknowledge here our gratitude for their support

and inspiration.

Key Influences

We have chosen here seven key influences on our development of the Tidal Model.

The Japanese psychiatrist Shoma Morita referred to his ‘patients’ as students,

believing that his role was not to fix or change them, but to help them learn
something directly from life. Morita’s most famous maxim - ‘do what needs to be
done’ –occupies an important place in the Tidal philosophy. Over 80 years ago,
Morita reminded us that, although change is rarely easy, if we are to live more
effective and meaningful lives, we must act, not just sit around talking about what we
think or how we feel about life
Morita's philosophy is perfectly suited to today's uncertain world: accept your
feelings - whether 'good' or 'bad', they are no more than passing signs that you are
alive; know your purpose - rather than being driven by our 'moods' or 'whims', we
Shoma Morita
1874-1938 need to accept that our feelings and thoughts are like the weather, they come and
go. Finally, we need to stick to our purpose, and 'do what needs to be done' - our
behaviour is all we have dominion over. 'Action' is a sacred responsibility. We need
to act carefully and wisely..
 

The American psychiatrist and psychoanalyst Harry Stack Sullivan first developed his
interpersonal relations theory in the 1920s. Sullivan was the first analyst to pull his chair
up alongside the 'patient' and begin a conversation. He was also the first psychiatrist to
use specially-trained 'attendants' to provide peer relationships, which Sullivan believed
were fundamental to their growth and development.
Sullivan's interest in relationships probably stemmed from his Catholic upbringing in a
non-Catholic area where he experienced isolation and rejection. Later he was also
isolated by his psychiatric colleagues when he was rumoured to have had a 'breakdown'
Harry Stack and was thought to be homosexual. In this sense Sullivan pre-dated the contemporary
Sullivan notions of the 'wounded healer' by more than a half century.
Sullivan coined the expression 'problems in living' as an alternative to talking,
1892-1949
specifically, about psychosis. He believed that people (called 'mentally ill') experienced
problems in living with themselves, and in living with other people. As a result, other
people experienced problems in living with them. This focus on 'living' and its 'problems'
 is a far more realistic outlook than talking in the abstract metaphors of 'mental illness'.

Our friend and mentor Hilda Peplau was known as the 'mother of psychiatric nursing' in
the US. Following her experience of working with Sullivan at Chestnut Lodge, she
developed her own interpretation of his Interpersonal Relations theory, and applied it to
nursing. She also pioneered, and named,  many of the nursing practices now taken for
granted, - the 'nurse-patient relationship', the 'one-to-one session', the 'milieu' and
'groupwork', among many others. 

Hildegard E Hilda offered us wise counsel over the last 15 years of her life and we believe that we
Peplau have extended some of her ideas about 'relating' in a direction of which she would have
1909-1999 approved.

Like all our other influences here Hilda was more interested in 'persons' and their
'problems' than 'patients' with 'illnesses', and was interested in how nursing might help
such 'persons' grow and develop. In that sense, she anticipated the contemporary
interest in 'recovery' by many years.

Our friend and mentor Thomas Szasz is, without doubt, the greatest philosopher of
psychiatry of the modern age. His exposure of the metaphorical nature of 'mental
illness', and his emphasis on 'problems in living', is now widely accepted, as all kinds of
professional abandon 'mental illness' in favour of talk about 'mental health problems'. He
was also the first psychiatrist to publicly challenge (in the 1950s) the idea that
homosexuality was a form of 'mental illness'. This challenge led to the its eventual
Thomas S Szasz removal from the DSM 15 years later. His writing on the 'psychiatric will', from 30 years
1920- ago, led to the development of the 'advanced directives', increasingly popular today .
Contemporary mental health work stands in the towering shadow of the work of Thomas
S Szasz. Should any form of 'mental illness' ultimately be shown to be biological in
origin then, as Szasz noted fifty years ago, it will become a 'physical illness'. As he has
  noted, we do not coerce people with 'physical' ailments into receiving 'treatment'.
Like Morita, Tom Szasz is an existential behaviourist - believing that we create the
meaning of our lives by the actions we take. His learning and vision is matched only by
his humanity and gentility. In human relations we can only 'care with' our fellow women
and men. To do otherwise risks coercion and containment.
 Dr Loren Mosher established Soteria House in the early 1970s (Soteria from the
Greek for 'deliverance'). He believed that the violent and controlling atmosphere of
psychiatric hospitals and the over-use of drugs hindered recovery. The Soteria
Project closed in 1983 when funding from the National Instiute for Mental health was
withdrawn. An illustration of psychiatric politics.
Loren Mosher insisted that people could recover from so-called severe psychotic
states without drugs, and pioneered the kind of work that is now called 'early
intervention'. In the mid 1980s he established another crisis house, McAuliffe House,
based on Soteria principles.
Loren Mosher worked closely for years with many advocacy groups, including the
Loren Mosher
psychiatric survivor group MindFreedom International. In 1999, he famously
1933-2004 resigned from the American Psychiatric Association in disgust at its 'unholy alliance'
with drug companies. When we first met him in the mid 90s we were struck by his
gift for story-telling and obvious interest in people. Without a sense of 'story' how
could we discover an interest in people?

The psychiatrist and psychoanalyst Edward Podvoll began his career as a staff
psychiatrist at Chestnut Lodge Hospital and went on to become the Director of the
graduate program in Contemplative Psychotherapy at The Naropa University from 1978
to 1990. He was the founding Medical Director of Maitri Psychological Services, the first
Windhorse centre. Ed Podvoll described the Windhorse Project in his groundbreaking
book, Recovering Sanity Shambhala Publications, 2003; (first published as The
Seduction of Madness by HarperCollins, 1990). In 1990, Ed Podvoll entered a long-term
meditation retreat in a Buddhist monastery in France, returning to Boulder to resume his
teaching, writing, and consulting activities.
Ed Podvoll showed how we might 'make sense' of even the most extreme human states,
illustrating vividly the importance of 'being with' people. More importantly, with his
Windhorse colleagues he showed how people could recover in ordinary home settings.
Edward Podvoll
1936-2003 We are fortunate to have visited the Windhorse project in Northampton Massachussets,
and witnessed the reality of Windhorse recovery at first hand. As he wisely said: "The
bottom line is: what would you want if you, or your child, were crazy? Would you want
any other kind of treatment?"
We would plump for care and compassion. What else is there?

The American social worker, jazz musician and psychotherapist Steve de Shazer was
one of the key contributors to what has become known as 'solution-focused therapy'. We
first met Steve in Glasgow, and were attracted by his cautious approach - especially
when it came to pretending to 'know' what people's problems were. We do not believe
there can ever be 'solutions' to the problems that life throws in our path (we can only
learn better how to live with them). However, we value Steve's contribution towards
recognising that people have their own 'resources', which they can bring to the possible
'solution' of their problems in living.
 Solution-focused thinking is more talked about now, if not actually accepted, than it was
when we first met Steve twenty years ago. The idea that we might need ONLY to help
people help themselves, is a belief held dear by all the 'influences' listed here. It points
towards a 'democratic psychiatry' that has long been hinted at, but still remains
overshadowed by the false god of 'biopsychiatry' and foolish notions like
'psychoeducation'.
Steve de Shazer People are their own 'experts' - pure and simple. We may not approve of the lives they
1940-2005 lead, and the decisions they make, but these are their lives and their decisions after all.

 
   
Tidal Materials

The following pages provide a range of materials for the student, the
practitioner or the researcher. We hope you find these to be useful
 The mind and the sea New Tidal Model Training Manual (Read an extract)
Jack's Story - DVD illustrating the Holistic Assessment (More details)
I hate to be near the sea, Books - The Tidal Model: A Guide for Mental Health Professionals (Read
and to hear it roaring and
raging like a wild beast in
extract)
its den. It puts me in mind Irene's Story - Film about one woman's search for everyday wisdom (More
of the everlasting efforts of details)
the human mind, struggling
to be free, and ending just
where it began.
William Hazlitt
Free papers and articles
 
Tidal reference list

  Books - Spirituality and Mental Health: Breakthrough

Tidal evaluation report

Tidal pre-evaluation format

Tidal post-evaluation format

Example of a leaflet for service users

Example of a 'Solutions Group' leaflet

Example of a staff leaflet

Advanced directives materials

 
  

 
    
 
Advanced Directives/ Statements & The Tidal Model
Graham Peace and Tracey Ellis © 2006

South West Yorkshire NHS Mental Health Trust, England

 email: Grahame.Peace@swyt.nhs.uk
 
Professor Phil Barker and Poppy Buchanan Barker have noted that traditionally, the ‘persons’ story’ is
written by various professionals - in case histories, notes, records, letters etc. Usually this leads to
various suggestions as to how people ‘should’ live their lives. These ‘biographies’ are usually
unauthorised, and often disputed by the person whose life is under the microscope. The Tidal Model
aims to help the person reclaim their life story, which has been colonised by professional workers, and
sometimes by family and friends. This simple act of reclamation is the first step on the voyage of
recovery. Having reclaimed the story of breakdown and distress, the person can begin to map a new
course – one small step at a time.

People with major problems of living need the right conditions (safe haven) under which to work on their
problems. At times of great distress, people need support, which comes in a variety of 'therapeutic'
disguises. Traditional ideas about the value of various therapies - whether in the form of drugs,
hospitalisation or one of the countless 'talking cures,’- suggest that someone else might know what the
distressed person needs. The Tidal Model assumes that the person has the knowledge of what needs
to be done, within them. Consequently, people do not need expert therapists, they need supporters. All
of us - whether professional agents, friends, family members etc should remember that the best that we
can become is genuine supporters. As such, the task of the helper is to provide the conditions under
which people may heal themselves.  

The Tidal Model recognises that all helpers -however respected, qualified or seemingly expert - know
little of what is actually happening within the person's experience of mental distress. As a result, we
know little of what might need to be done, to address, and resolve the persons’ problems. That vital
knowledge lies, perhaps dormant, within the person. Therefore for the person who has suffered major
problems of living, developing an Advanced Directive/Statement gives them the opportunity when well,
to use their wisdom/knowledge to guide their care in a crisis, also allowing health and social care
professionals to value the voice, develop genuine curiosity and become the apprentice as stated in the
Tidal Model 10 commitments. It also helps to reduce the distress caused by an admission to hospital
and helps the person to establish an empowering therapeutic relationship with health and social care
professionals from day one of their admission.

Within our Tidal Model Project here in Calderdale, West Yorkshire, Advanced Directives/Statements
were originally discussed at M Power a service user led involvement project, some five years ago. M
Power and its members campaigned tirelessly to raise awareness of the Advanced
Directives/Statements and to have them implemented in Calderdale. An opportunity came with the Tidal
Model Project and we were able to incorporate Advanced Directives/Statements in to the Tidal Model
Awareness Training day; not only was the Tidal Model an opportunity to focus on new ideas about
nursing but it also completely embraced all the concepts of Advanced Directives.

A member of M Power delivered the training to Mental Health workers, Community Mental Health, Crisis
Resolution Home Treatment and Assertive Outreach Teams, in addition, to Doctors, Psychiatrists,
Service User Groups, Day Units, Occupational Therapy Staff and Student Nurses attending the
University of Huddersfield as part of the Tidal Model Awareness Day. The Advanced
Directives/Statements training is delivered from the perspective of someone using Mental Health
Services and has proved very powerful in promoting their use within the locality. Many people who use
services have now started to develop an Advanced Directive/Statement which we have found works
hand in hand with the Tidal Model. People are starting to be seen as the experts of their illness and
condition, and are able to plan for a crisis in advance.
Advanced Directives/Statements are an opportunity for the person to assist health care professionals in
a positive way in the planning and delivery of their care. They need not be complex documents but are
an opportunity for the person to focus on what has worked in the past, what hasn’t worked and ultimately
how things can be made better (The Toolkit), in addition to any domestic arrangements that need to be
addressed in their lives.

Developing an Advanced Directive/Statement helps the person to cope with any worries, concerns and
anxieties about becoming unwell and is a very useful tool in helping the person focus and reflect on their
situation. Advanced Directives/Statements are very empowering helping to create a truly person centred
experience.

It takes time and effort to complete an Advanced Directive/Statement and remember as stated in the 10
commitments that Change is Constant. So ultimately as in life the Advanced Directive/Statement will
need to be constantly updated due to life events, personal circumstances etc. We wish you every
success in getting to work on your own Advanced Directives/Statements so that you too can reap its
benefits, become more empowered and be recognised as the expert on your truly unique journey
towards recovery.

We detail below specific information on Advanced Directives/Statement with an example of a template

you may wish to use.

Grahame Peace
Senior Nurse Manager

Tracy Ellis
Service User Representative.

The Government's White Paper to the Mental Health Bill, 2003 promotes the concept of advance
statements. 

“Clinical teams will be expected to help the person develop advance agreements.”

As already stated an advance directive/statement gives the opportunity for a person to indicate, when
well, the way he/she would like services to respond if they become unable to make decisions for
themselves.

What are advance statements?

Advance statements are a means, which allow the person to have a greater influence on their care and
treatment.  They allow for a person with mental health conditions to prepare for a crisis in advance. They
embody the spirit of the Human Rights Act. I.e. In Article 3 -protection from inhuman and degrading
treatment, Article 8 - respects for privacy and private life, and Article 10 - freedom of expression.
Advanced statements, with the exception of Directives (see below), are not binding in law i.e. those
health workers responsible for the person do not have to follow an advance statement.  However, they
must demonstrate that the person’s wishes have been taken into account and failure to do this is
unlawful.

Types of Advance Statement

I) a directive.  Advance directives relate only to consent to medical treatment, However, the Tidal
Model sees the person as an expert within their own mental health, this can be demonstrated within an
Advanced Directive i.e. the person can explain and justify why they do not want to receive a specific
treatment or type of care.  However, they cannot direct that they are given a specific treatment. An
Advance Directive is binding in law, although this can be overridden if the person is subject to detention
under the Mental Health Act.

ii) The appointment of representative.  The person appoints another person to be consulted about a
healthcare decision when he/she is incapable of deciding for themselves.  The named person must
reflect the person’s wishes.

iii) A statement of general beliefs: on various aspects of life which the person values. This statement
contains no specific request or refusal but attempts to paint a picture of the person and how their care
can be more person centred.

v) A combination of any of the above i.e. refusal, request, appointment of a representative, or who
should be given a key to their home, have their pets etc.

The legal doctrine of necessity

When a person does not have the capacity to make decisions for themselves and does not have an
Advance Statement, those responsible for making decisions on behalf of that person must apply a
principle called the legal doctrine of necessity.

The person who has the power to make the decision and whom has been appointed by the person (the
decision maker) must consider what decision the person would make for himself or herself, if they had
capacity to do so. The Tidal Model is all about empowering the person before during and after a crisis.
The existence of an Advance Statement embodies this process.

In some circumstances the doctor could become the decision maker; they are not bound to follow the
Advance Statement, however they must show that they have taken the Advanced Statement into
account. Failure to do so would be unlawful. In deciding not to follow the Statement the decision maker
must justify the reason for this decision. Again, failure to do so is unlawful.

The elements of the legal doctrine of necessity are:

I) It must be necessary to make that particular decision and consideration must be given to the
identification of safe, less draconian, intrusive or restrictive alternatives.

ii) The decision must be a reasonable one.

iii) It must be in the best interests of the person.

Advance Statements are sometimes concerned with the refusal of life sustaining procedures in the
event of a terminal illness. They have nothing to do with euthanasia or suicide, and cannot authorize a
doctor to do anything which is illegal or which a person with capacity could not request a doctor to do.

Adults with capacity have the right to accept or reject medical treatment. Such a decision does not either
have to be reasonable or to be justified to anyone apart from the individual who is making the decision.

Advance Statements empower the person who can then potentially exercise this right, by defining in
advance the medical procedures to which they would or would not consent, should they have become
incapable of making or communicating that decision.
People detained in hospital under the Mental Health Act 1983

Advanced statements are based on the common law, not legislation.

Accordingly, the terms of the Mental Health Act 1983 take precedence and prevail over Advance
Statements when it comes to treatment for mental disorder (as opposed to treatment for physical
disorder) if the Act is applied.

Where the person is subject to compulsory detention and treatment under the Mental Health Act an
Advance Statement is still legally binding.  Although through the use of the Mental Health Act, the
Responsible Medical Officer is not bound to comply with this. However, he/she must demonstrate that
they have taken the Advanced Statement into consideration when deciding upon an appropriate
treatment plan for the person. 

Informal (voluntary) admissions

If the person is admitted to hospital on an informal basis either with or without capacity they can only be
treated under common law, therefore where there is an Advance Statement health care workers must
comply with it.

Storage of an Advance Directive/Statement

The person, and if appropriate the persons’ carer has a copy of the Advance Statements. In addition,
they are filed in the persons’ notes.  An alert sticker is attached to the notes, which readily informs health
workers of the existence of the Advance Statement.   If an electronic system is in existence, the
Advanced Directive/Statement can be placed on the system with an ALERT for staff to its existence.

References for Further Information

1 Making Decisions – The Government’s Proposals for Making Decisions on Behalf of Mentally
Incapacitated Adults

2 Advance Statements about Medical Treatment: BMA 1995

3. The Mental Health Act 1983

4 The Human Rights Act 1999

Shown below is an example of documentation that can be used by the person to produce their
Advanced Statement/Directive. This can be done by the person alone our in conjunction with a relative,
carer, friend or health or social care professional. It is important to remember that the Advanced
Directive/Statement is the persons’ document.

ADVANCE STATEMENT FOR MENTAL HEALTH CARE

This is my Advance Statement in case I have a mental health crisis and am unable to participate in
decisions about my care

My Name:

My Address:

My Date of Birth:

Name of professional with whom this was discussed: ________________________and his/her

signature_______________________and date_______________

Contact Address:

Contact Tel No:

Name of a family member, friend or advocate who knows and understands about this Advance
Statement.  He/she has given permission to be contacted and will speak for me in a crisis/dispute
Contact Name: _______

Contact Tel No: _

Contact Name: _______

Contact Tel No: _

I confirm that I am over 18 years of age and understand that this document remains effective until I
make it clear my wishes have changed. (The wishes of people under 18 years will be taken into

Consideration but are not legally binding)

Signed:

Print Name:

Date:

You should have your Advance Statement signed by at least one, and preferably two witnesses:

Independent Witness:

Signed:                                                                       Date:

Name:

Address:
Independent Witness:

Signed:                                                           Date:

Name:

Address:

Copies of this Advance Statement are held by:

Name:………………………………………………………………………………………………

Address:……………………………………………………………………………………………

………..……………………………………………………………………………………………

……………………………………………………………………………………………………..

Name: …………………………………………………………………………………………………………

Address: ………………………………………………………………………………………………………
………..……………………………………………………………………………………………

………………………………………………………………………………………………………

If applicable please complete the following:

This agreement has been discussed with the following:

          e.g. Doctor/GP/Consultant

Signed:…………………………………………………………………………………………

Name:……..……………………………………………………………………………………

Address:..……………………………………………………………

………..……………………………………………………………… Date: ……………………

 2                      Signed: …………………………………………………………………………

Name:..……………………………………………………………………………………

Address:..……………………………………………………………

Date: ……………………

PART ONE
 

ADVANCE STATEMENT FOR CARE & TREATMENT

I declare that my wishes are as follows: (please feel free to continue overleaf if necessary)

          My wishes regarding medication and treatment are as follows:

(It is helpful to give reasons why)

          When I was receiving care before, the following worked well for me:
          Things that have not worked well in the past are:

PART TWO
 

ADVANCE STATEMENT REGARDING MY PERSONAL AND HOME LIFE

WHEN I AM UNWELL

 
I declare that my wishes are as follows:

          I would like the following people to be told immediately that I have been admitted to
hospital

         Other people to contact and tell that I am not at home, e.g.

Milkman/home help/work

3          I would like the following people NOT to be told

          I would like to be consulted before people are told how I am etc
        YES  

        NO  

          Needs that are special to me, which I would like those caring for me to know about e.g.
diet/physical health/religion

          Children or Dependants

Complete this section if you have children or dependants at home and would like them to be
cared for in a particular way

a)         I would like the following people to care for my children or dependants
 b)         When someone explains where I am to my children I would like them to be told the
following:

          Pets

Complete this section if you have pets to be cared for

8 Securities and My Home

a) I would like the following person to make sure my home is secure

b) I would like them to hold a set of keys

        YES
  

       NO  

          Any other information I would like to make known

Advance Statements

Guidance Notes on the Worker’s Role

If you are approached to help someone make an Advance Statement:

·        Nothing substitutes working in partnership and making an effective agreed care plan with
someone.

 
 ·        Explain how Advance Statements work and explain what might happen to the form

·        Suggest where the person might receive “independent” advice or advocacy e.g. MIND,
Mental Health Action Group or a Solicitor (there may be a cost for this although legal aid is
available to those on low incomes)

·        If the person requires a lot of help and you are very involved in their care it might be useful
to consider whether a colleague from your team might be better placed to give impartial
advice.

When someone is in the process of making an Advance Statement

·        You can encourage them to discuss the contents with all those involved in their care
particularly if the person requires someone to undertake a task.

·        You can encourage someone to be very clear about what it is he/she would like and to
provide clear reasons as to why they have reached this decision.

·        You CANNOT tell the person what to put in and what to leave out. It is their document.  Nor
must you apply pressure in any way to influence the person’s decision.

·        You can provide information to help make informed choices.

·        If you are unsure about the person’s capacity, you can discuss this and the possible
implications of this.

 
  

If you receive an Advance Statement relating to someone for whom you care:

·        Check with the person that it is a document that still reflects the person wishes.

·        Ensure it is shared with all those to whom it relates e.g. the multi agency care team, carers,
GP, consultant.

·        Any obvious conflict with a current or proposed plan of treatment or care must be openly
discussed with the person and the team providing care as soon as possible.

·        Remember in some cases, an Advance Statement can be overruled e.g. when a person is
subject to certain sections of the Mental Health Act 1983.

·        You must record that you have assessed the persons’ capacity and feel it is sufficient for
them to make a binding statement.

Advanced Statements

Frequently Asked Questions

Q.        Are advanced statements legally binding?

A.        Yes but there are important caveats.  Remember, there are many types of advanced statement,
which you can make.  Importantly, an advance statement can take the form of a directive.  A directive is
a command, which tells doctors/care workers specific treatments and other care, which you do not want
to receive, in exactly the same way as you might refuse to consent to a treatment.  This is legally binding
and can only be overridden if the person in receipt of care is detained under the Mental Health Act,
1983.  Even in these circumstances, the doctor must demonstrate that he/she has considered the
directive and is prepared to defend his/her reason for not complying with it.  You cannot direct that you
do not want basic care.

A statement may also indicate the type of care a person would wish to receive in the event of him/her
losing capacity.   The persons providing such care in this instance do not have to comply with such
requests, but again they do have to demonstrate why they feel such care is not in your best interests at
the time.

Q.        Can an advance statement be overruled?

A.        Yes.  As mentioned above there are a limited number of ways in which an advance statement
can be overruled.

1.      If the advance statement directs that care workers do, or do not do something which a
person with capacity could not request.  For example, a person cannot direct a doctor to
do something that is illegal.

2.      Where there is evidence to suggest that when the person made the advance statement,
he/she did not have mental capacity.

3.      Where a person is detained under treatment sections of the Mental Health Act, 1983 and
the responsible medical officer feels that a particular treatment is in that person’s interest,
even where there is a directive stating that he/she does not want that specific treatment. 
However, the doctor must demonstrate that he took the directive into consideration.

4.      Where a person has made a non-directive statement which care workers feel is not in that
person’s best interest.

Q.        Who should make an advanced statement?

A.        Anyone who has capacity can make an advanced statement.  Advanced statements are merely a
means of making known to care workers the sort of treatment and care you would like in the event of a
future physical or mental condition incapacitating you.  Advance statements are particularly useful for
people who suffer from serious mental disorders where there is a chance of relapse.   Advance
statements provide the opportunity to review a period of ill health and record the aspects of care, which
worked well, and those, which did not.  Care in this respect can mean not only medical and nursing care,
but also wider social issues, for example, who should look after a pet.  From this it is clear that a good
time to make an advanced statement is at the end of a period of in service user care, as part of the
discharge planning process.  

Q.        What is capacity?

A.        Capacity - the ability to understand a proposed action.  Taking into account, the broad nature of
the proposed action, its outcome if carried out and not carried out, weigh the information in balance and
arrive at a decision.

Q.        I have made an advance statement, where should I keep it?

A.        Obviously, advanced statements are only of any use if those who are providing care for you know
of their existence.  Of course it is up to the individual concerned to decide with whom the statements are
shared.  If your advance statements relate mainly to the possibility of mental health problems and you
have received specialist treatment in the past, then it would be wise for the hospital where you normally
receive your care to have a copy.  A copy of your advanced statement can then be filed in your case
notes, and the file marked to alert doctors, nurses and others that you have made an advance
statement.   

You do not have to provide the hospital with a copy of your advance statement.  If you choose not to, it
is important that someone else knows of its existence e.g. your husband/wife/friend, and is able to
provide the doctors and other health care professionals with your statement if you become
incapacitated.
 Q.        My advance statements have been placed in my case notes, but I want to change some aspects
of them (or withdraw them altogether) how do I do this?

A.        If you want to change your statement, you must complete another one entirely.  Ensure that the
old one is destroyed – clearly the existence of two contradictory advanced statements must be avoided. 
Send a copy of the new statement to the medical records department of the hospital where you normally
receive treatment.   Similarly, should you no longer wish to have an advanced statement, write to the
medical records department giving your name, date of birth and address, asking for your statement to be
destroyed.

Q.        Do doctors or other health/social services staff have to be involved if I wish to make an
advanced directive?

A.        No.  You should have someone witness your advanced statement who can validate that at the
time of writing it you had the capacity to make the statement, but this person can be anyone who knows
you.  Health care staff do not have to agree with your advance statement.
 
 
 

 

Recovery means:
"Regaining possession,
use or control of
something". That
'something' must be some
'thing' that is important to
the person concerned.
Reclamation means:
"Seeking the return of
one's property." The Latin
root of reclamation was: 'to
cry out against'. To reclaim
our lives and personal
identity, we must 'speak
up' and 'speak out'. In that
way, we take possession
of the telling of our story -
the first step in recovery.
 
The concept of recovery has become the popular 'buzzword' of 21st Century mental health
services - beloved by survivors and politicians alike.
However, the notion of 'recovery' is hardly new. Alcoholics Anonymous (AA) and
Narcotics Anonymous (NA) talked about 'recovery' more than 70 years ago.
Two things are of particular interest about the influence of these social movements (AA and
NA). First, they believed - rightly or wrongly - that 'alcoholism' and 'addiction' were 'illnesses'
or 'diseases', both of which were part of the lottery of life. Second, they believed that people
could deal with such overwhelming problems, by talking about them; by asking for support
from their fellow women and men; by acknowledging that they were powerless to resolve
such problems. Within such humility (powerless) lay great strength (the human collective).
However, AA and NA  found it very difficult to solicit support from the mainstream 'scientific
community for their philosophy of recovery. Undoubtedly, this was because of their
associations with religious ideals. It is clear, however,  that AA and NA, and the different '12
step' programmes' which they promoted, have been great successes. They 'believed' that
people with alcohol and drug problems could recover. All they had to do was accept that
they had a problem, seek the support of fellow 'sufferers' and allow their 'god' to guide them
back to meaningful living.
Clearly, the contemporary mental health 'recovery' movement is a child ( or grandchild) of
AA and NA. Mental health survivors have, in different ways, gathered together, shared their
'stories' of distress, difficulty and inappropriate 'treatment', discovering within this 'story
telling' great comfort, companionship, mutual support and hope. The similarities to AA and
NA are clear.
We believe that the key to 'recovery' is to be found in 'story telling'. By 'bearing witness', or
'telling my story', people discover the 'personal truth' of their own life - as opposed to the
artificial, theoretical 'truths' offered by different psychiatric professionals.
 By talking about what has happened to us, how it affected us and what it meant to us, we
begin to move towards talking about what might 'need to be done' to deal with, respond to, or
otherwise overcome the problems of living that others call madness, mental illness or
psychiatric disorder.

People 'reclaim' their own story as a first step towards recovering the life that they have lost.
Reclamation is the necessary work of the recovery project. By reclaiming the fundamental
story of our lives, we take back everything that we are - as persons; the good, bad and
indifferent. We reclaim all of 'who' we are, so that we can begin to establish what we can do
for ourselves and what we need help with. No person is an island so there is no shame in
accepting support. However, to ask for help we need first to know we are alone, and we
need to know that we are in difficulty. The hard work of recovery involves 'letting go' our
distress and difficulty, as much as trying to control or contain it.

 

Isak Dinesen
The cure for anything is
salt water - sweat, tears, or
the sea
 
Goethe
The sea is flowing ever,
  The land retains it never.
  Beginner's Guide  
The Tidal Model is an internationally accepted theory for the practice of
mental health recovery.
The Tidal Model has developed a specific theory of personhood, based around the
'storytelling' process involved where people talk to themselves (Self Domain), share
something of the story of their lives with others (World Domain) and enact the living of their
lives, influencing others and being influenced in turn by them (Others Domain).
These three Domains also provide the theoretical basis for the key individual and group-
based processes of the Tidal Model: the Holistic Assessment; the One-to-One Sessions;
the Personal Security Plan; and the three forms of Group Work - Discovery, Solutions
and Information-Sharing.
Since its launch in the mid 1990’s the Tidal Model has generated over 100 official projects in
the UK, Ireland, Canada, Japan, Australia and New Zealand.
These projects range across the complete mental health care spectrum: from home-based
care and outpatient addictions, through acute, rehabilitation and forensic units, to the care of
older people with early stage dementia. Beyond the mental health field, practitioners in
palliative care are exploring the Tidal Model as an alternative philosophy for the care of
people who are dying.
The Tidal Model is a philosophical approach to the discovery of mental
health.
Tidal is philosophical in the sense that it is a way of thinking about what people might need in
the way of help. Tidal asks: What might need to be done to help people reclaim the story, and
eventually recover their lives?
Tidal emphasises the discovery of mental health, as its meaning varies from one person to
another. We hope that people will discover what mental health means for them – as unique
persons.
Tidal assumes that recovery must begin when the person is at their 'lowest ebb'. In practice,
this usually means beginning the work as soon as possible after people have been admitted
to any form of psychiatric care, continuing and developing the recovery-focused care as the
person moves through the care system, and eventually carrying this over into everyday life
back in the community.
The Tidal Model helps people reclaim the story of their problems of human
living, as a first step towards recovering the story of their lives.
Tidal aims to help people reclaim the personal story of their distress, by recovering their
voice. By using their own language, metaphors and personal stories people begin to express
something of the meaning of their lives. This is the first step towards helping people recover
control over their lives. 

As people, all we have is our story. All we can ever be is framed by the story of our lives –
the events that have occurred, and how we responded to them. This story charts not only the
changes that have occurred on our voyage from birth, through childhood and adulthood and
eventually into death but also the growth and development that has taken place within us.

The Tidal Model focuses on helping people deal with their problems of
human living.

When people experience problems of human living they are described as being ‘mentally ill’
or affected by some ‘psychiatric disorder’ or ‘psychological dysfunction’. Frequently, the
person’s story is overshadowed by stories of ‘illness’ or ‘psychological disorder’. People often
talk less about the ‘person’ and talk more about the ‘patient’, ‘client’, ‘service user’ or
‘consumer’.

Tidal focuses explicitly on the person’s story. This is where the person’s problems first
appeared. This is where any growth, benefit, or recovery will be found. Tidal also focuses on
the problems that are affecting the person in living an ordinary, meaningful and fulfilling life.

The key Tidal question is :

What needs to be done to help the person begin to address, resolve or come to terms with
this problem, and so begin to recover her or his life?

The Tidal Model was developed through the unique collaboration of mental
health nurses and users/consumers of mental health services.

Most ideas around recovery were developed either by mental health professionals or by
former users/consumers of psychiatric services. All the processes within the Tidal Model
were developed conjointly with people who either had been 'psychiatric patients', or who
were defined as 'service users'. These people acted as 'user consultants' to the field testing
of the original model and we continue to seek support and guidance from similar 'consultants'
in the further refinement of the Model.

The Tidal Model is a person-friendly approach to mental health recovery.

Tidal has no age, class or cultural boundaries and at present is being used to facilitate
recovery as easily with younger people, as with adults, or with the older person, across a
wide range of societies and cultures. 

Tidal actively avoids the use of professional or technical jargon, focusing instead on the use
 of the natural language of the person.

Originally developed as an alternative model of mental health nursing, the Tidal Model
continues to be practised mainly by nurses, but also finds support within psychiatric
medicine, social work, occupational therapy and psychotherapy. Increasingly, Tidal is viewed
as an important alternative approach to helping people use their natural voices as the key
instruments for charting their recovery.

The Tidal Model helps the person to navigate her or his own way to
recovery.

The concept of ‘recovery’ means many different things to different people. Tidal aims to help
people clarify what is distressing or disabling about their problems of human living, as the
first step towards clarifying what needs to be done to begin to move away from, or overcome
those problems.

The Tidal Model uses specific human values to guide the helping and
enabling practice of mental health recovery.

The Tidal Model has a value base - the Ten Commitments - that guides all the practical
process of individual and group work within the Model. These values emphasise the
importance of genuine person-centred care that is respectful of culture and creed, and which
recognise that belonging and membership are vital to our personal identity as social beings.

The Tidal Model is a philosophical and theoretical template upon which to

build and develop the practice of mental health recovery.

From Tidal theory we have developed a range of ways of working with people - individually
and in groups - that can be adapted to fit the person's changing circumstances. We have
developed ‘examples’ of how practitioners might work with people individually or in groups.
These are examples or illustrations —not rules.

“The golden rule is that there are no golden rules” (George Bernard Shaw)

Nurses, and other practitioners, around the world are using the philosophical and theoretical
principles of the Tidal Model to develop their own practice to suit the unique needs of the
many individuals within their service.

 
 
  

 
    
Free Papers and Articles
Clarifying the Value Base of Recovery: The 10 Tidal Commitments,
Buchanan-Barker and Barker, Scotland
Post-psychiatry: Good ideas, bad language and getting out of the box. Phil
  Barker and Poppy Buchanan-Barker, Scotland
 
What is a therapeutic relationship?  Mike Consedine, New Zealand

Bridging – talking meaningfully about the care of people at risk Phil Barker
and Poppy Buchanan-Barker
Clinical Supervision: Value and Possibilities  Mike Consedine,
Christchurch, New Zealand
Uncommon Sense: The value base of the Tidal Model Poppy Buchanan-
Barker, Scotland
The Tidal Model: Psychiatric colonisation, recovery and the need for a
paradigm shift in mental health care. Phil Barker and Poppy Buchanan-
Barker, Scotland

The Healing Potential of Metaphor in the Narrative Phil Barker, Scotland

Beyond Empowerment: Revering the storyteller Phil Barker and Poppy

Buchanan-Barker, Scotland
 The Philosophical Basis of Effective Care and Treatment in Psychiatry Phil
Barker, Scotland
The Tidal Model in the context of a Regional Forensic Service Ngaire
Cook, Brian Phillips and Diane Sadler, New Zealand

A Feminine Economy of Caring: Gifts and Wrapping Peter Wilkin, England

Interview: Phil Barker talks to Chris Hart Chris Hart, England

The Ivy Dunn Address to the North American Launch - Ottawa, 2003 Ivy
Dunn, Canada

My perceptions of the Tidal Model James Lynch, Ireland

The Tidal Model: The Maori Context Jacquie Kidd, New Zealand

A selection of the comments from the User-Focused evaluation at Tosnú,

Cork, Ireland

The Tidal Model: Humility in Mental Health Care

 
 

 
 
    Tidal Model Publications  
 
Books

Barker P and Buchanan-Barker P (2005) The Tidal Model: A Guide for Mental Health Professionals. London and New York,
Brunner-Routledge

Brookes N (2005)  Phil Barker: The Tidal Model of Recovery and Reclamation. In AM Tomey & MR Alligood (Eds) Nursing
Theorists and Their Work (6th Edition) St Louis: Mosby

 
Papers

Barker P (1996) Chaos and the Way of Zen: Psychiatric nursing and the uncertainty principle. Journal of Psychiatric and
Mental Health Nursing 3, 235-244

Barker P (1997) A meta-theory of nursing practice. Mental Health Practice 1(4) 18-21

Barker P (1998) Its time to turn the tide. Nursing Times 94(46) 70-72

Barker P (2000) Turning the tide. Open Mind 106 Nov/Dec

Barker P, Leamy M and Stevenson C (2000)  The philosophy of empowerment. Mental Health Nursing 20 (9) 8-12

Barker P (2000) The Tidal Model of mental health care: personal caring within the chaos paradigm. Mental Health Care 4(2)
59-63

Barker P (2000) The Tidal Model: The lived experience in person-centred mental health care. Nursing Philosophy 2 (3) 213-
223

Barker P (2001) The Tidal Model: Developing an empowering, person-centred approach to recovery within psychiatric and mental
health nursing. Journal of Psychiatric and Mental Health Nursing 8(3) 233-40

Barker P (2001) The Tidal Model: A radical approach to person-centred care.  Perspectives in Psychiatric Care. 37(2)

Barker P (2002) The Tidal Model: The healing potential of metaphor within the patient's narrative. Journal of Psychosocial
Nursing 40 (7) 42-50

Barker P (2003) The Tidal Model: Psychiatric Colonisation, recovery and the paradigm shift in mental health care.
International Journal of Mental Health Nursing, 12.
Barker P (2003) Putting acute care in its place. Mental Health Nursing 23 (1) 12-15

Barker P (2004) Uncommon sense: The Tidal Model of mental health recovery New Therapist 33 (Sept/Oct) 14-19

Barker P and Buchanan-Barker (2001) Apologising for our colonial past. Openmind 112 Nov/Dec p 10

Barker P and Buchanan-Barker P (2003) Death by assimilation. Asylum 13 (3) 10-13

Barker P and Buchanan-Barker P (2003) Beyond empowerment: revering the storyteller Mental Health Practice 7 (5) 18-20

Barker P and Buchanan-Barker P (2004) Bridging: Talking meaningfully about the care of people at risk Mental Health
Practice 8 3 12-16

Barker P and Buchanan-Barker P (2004) Caring as craft. Nursing Standard 19 (9) 1718

Barker P, Jackson S and Stevenson C (1999) The need for psychiatric nursing: Towards a multidimensional theory of caring.  Nursing
Inquiry 6, 103-111

Berger J L (2006) Incorporation of the Tidal Model into the interdisciplinary plan of care - a program quality improvement project.
Journal of Psychiatric and Mental Health Nursing 13(4) 464-67

Brookes N Murata L and Tansey M (2006) Guiding practice development using the Tidal Commitments. Journal of Psychiatric and
Mental Health Nursing 13 (4) 460-63

Buchanan-Barker P (2004) The Tidal Model: Uncommon sense Mental Health Nursing 24(3) 6-10

Buchanan-Barker P and Barker P (2002) Lunatic language. Openmind 115, p 23

Buchanan-Barker P and Barker P (2004) Compassion: More than a feeling Nursing Standard 19(11) 18-19

Buchanan-Barker P and Barker P (2005) Observation: The original sin of mental health nursing. Journal of Psychiatric and
Mental Health Nursing 12(5) 541-9

Buchanan-Barker P and Barker P (2006) The Ten Commitments: A value base for mental health recovery. Jl of
Psychosocial Nursing and Mental Health Services   Vol. 44 No. 9, 29-33

Buchanan-Barker P and Barker P (2008) The Tidal Commitments: extending the value base of mental health recovery
Journal of Psychiatric and Mental Health Nursing 15, 93–100

Cook NR, Phillips BN and Sadler D (2005) The tidal model as experienced by patients and nurses in a regional forensic unit 
Journal of Psychiatric and Mental Health Nursing 12 (5) 536-40

Fletcher E and Stevenson C (2001) Launching the Tidal model in an adult mental health programme. Nursing Standard 15
(49) 33-36

Gordon W, Morton T and Brooks G (2005) Launching the Tidal Model : Evaluating the evidence. Journal of Psychiatric and
Mental Health Nursing 12 (6) 703-12

Lafferty S and Davidson R (2006) Person-Centred Care in Practice: An account of the implementation of the Tidal Model in
an adult acute admission ward in Glasgow. Mental Health Today  (March) pp 31-34
 Stevenson C, Barker P and Fletcher E (2002) Judgement days: developing an evaluation for an innovative nursing model. J
Psychiatric and Mental Health Nursing 9(3) 271-6

Stevenson C, Jackson S and Barker P (2003) Finding solutions through empowerment: a preliminary study of a solution-oriented
approach to nursing in acute psychiatric settings. J Psych and Mental Health Nursing 10 (6) 688-696
Free papers and other material may be downloaded at the Tidal Model
website.

Stevenson C and Fletcher E (2002) The Tidal Model: The questions answered. Mental Health Practice 5(8) 29-37