Adventure Therapy

Michael Kissoon is a senior occupational therapist and service manager at aspire, an early intervention in psychosis team based in Leeds. Michael discusses the impact that adventure therapy can have on people living with psychosis

Burnished skies atop an endless sea are the dramatic backdrop to fervent activity on deck. A change in the wind means a change of sail for a weary team. Working as one, pulling on ropes to the call of the bosun, winching at speed and watching as the sail gets ever closer to the top of the mast. Sinew now straining as the last few pulls are eeked out with cries of “heave, heave, heave”, the final knots securing the hard work in place; all ready to re-do in a few minutes time. This is not a professional crew: these people are living with psychosis, and this is the first time they have ever sailed. This is adventure therapy.

aspire is the early intervention in psychosis (EIP) service in Leeds, working with people who are suspected of, or experiencing their first episode of psychosis. We work with around 500 clients aged between 14-65. The aspire team comprises around 65 staff, including occupational therapists, mental health nurses, psychiatrists, therapists (drama therapists, family therapists, CBT therapists), social recovery workers and other specialist workers. There is a range of NICE recommended treatments for the first episode of psychosis, including medication, talking therapy and social recovery. It can be reasoned though, that a life event as impactful as psychosis, requires an equally immense intervention. Adventure therapy (AT) is just such an intervention. The premise of AT is the use of a challenging and unfamiliar environment, typically in nature, to create an intense physical demand, new social interactions, and the learning of new skills. With a shared purpose, teamwork, bonding, adversity and practical skills provide an accelerated experience where clients push their limits to new horizons. It can be a catalyst for pursuing and developing meaningful occupation in the future and the evidence base is growing, particularly for young people. COLLABORATION

Pre-pandemic, aspire linked with other EIP teams around the country (led by the enigmatic Mike Jackson) to collaborate on planning a sailing trip, in relay, to circumnavigate the UK. In spite of a year of COVID delays and a plethora of challenges, the aspire leg of the ‘Voyage to Recovery’ was completed between the 6 - 11 September 2021, from Hartlepool to Ipswich. Nine clients and four aspire staff, guided by the expertise of three experienced sailors; Pippa the skipper, Davide the first mate and Jake the bosun from the Cirdan Sailing Trust. For six days and nights, the handsome 75ft Faramir was our new home, providing small bunk beds, an everswaying galley kitchen, seemingly endless ropes (“don’t touch that one or you’ll get hurt”), two tiny toilets, and no shower. Some of the challenges faced by all were cramped conditions, a near miss with an oil tanker, some sea sickness, lots of bumps and bruises, lack of sleep, a lot of physically demanding activity and did I mention, two tiny toilets and no shower? On the plus side, we got to sail through two nights, using the stars for navigation, marvelled at the phosphorescence in the sea water as it was parted by the bow, bonded over adversity, had some great food, and witnessed the most amazing sunsets and sunrises you could ever wish for. Sunrise at Runswick Bay at anchor will live with me forever. THE IMPACT

On the coach trip back from Ipswich to Leeds, I could hear stories being shared, bruises being compared, laughing at photos and the swapping of telephone numbers. A group of relative strangers were now buoyed by the strength and support of each other. Everyone had endured healthy physical and mental hardship and realised they were stronger than they once believed. We met again as a group on the 7 October 2021 and these select quotes from clients speak for themselves: “Because this was such a unique experience, it destroyed the loops I was in… it really worked for me… I am now two years ahead of the process (of recovery).” “I now know that I can achieve more than I thought… I’ve applied for a new job since returning because I feel more capable.” “Saw a part of myself that I like, that I hadn’t seen for two years.” “It was an amazing experience.” PRACTICALITIES

An intervention such as this is not thrown together in an afternoon. It took ongoing liaison with Cirdan, ‘build-up’ events where staff and clients got acquainted (bouldering, walking, campfire, lunch in Leeds), contingency plans for when staff and clients withdrew, food shopping, transport and overall, about £10,000 in costs. All risks needed to be considered and mitigated, promotional material needed preparing and we scheduled planning meetings regularly for months beforehand. The COVID lockdowns were out of the ordinary, but a good example of how a project of this scale can be challenged in myriad ways. My advice for anyone wanting to instigate AT is to surround yourself with a great team, be prepared to go the extra mile, don’t be afraid to get things wrong and delegate, delegate, delegate. REFLECTION

For me, as an OT working in mental health, if I was ever in doubt about the efficacy of occupation, this experience will shine as a beacon of justification. I witnessed unparalleled commitment to the task at hand, to the detriment of any psychotic symptoms that dared to get in the way. I will always remember the bravery of being with someone as they fought through a panic attack, knowing that they could not escape to their comfort zone, because there was no comfort zone. Getting the sail changed to support the team was what really mattered in that moment and that is where the power of meaningful occupation is at its greatest. For further information visit commlinks.co.uk and search for “aspire”. You can also follow them on Instagram @aspire_eip_leeds. For more information about the voyage or aspire, you can email Michael at mkissoon@nhs.net.