The mental health workers’ audio guide – now available

It’s been a while coming but The mental health workers’ audio guide is now available for purchase from The Care Guy shop for less than the price of a lunchtime sandwich. The first 4 of 6 parts are already available and the final two will be out soon. Scroll down to view the contents of each instalment.

You can The Guide parts 1-6 accompanying tables and references containing the contents list for all 6 parts, various diagrams and charts as well as references here……


Part one – clinical basics

What’s a mental health worker worth?

Three models of mental health and disorder

The biological (medical) model

The social model

Merging the two (stress and vulnerability)

The importance of physiology

The meaning of psychiatric diagnoses


The psychology of anxiety


The psychology of depression

Psychosis (introduction)


Delusions part 1

Delusions part 2

Thought disorders

Part 1

Part 2 – The dementias

The dementias

Types of dementia – Alzheimer’s

Types of dementia – Vascular

Types of dementia – Lewy Body

Types of dementia – Parkinson’s

Types of dementia – Korsakoff’s

Types of dementia – Fronto-temporal

Types of dementia – Mixed

Orientation and memory


The CAM scale

Working with the limbic system


Part 3 – Personality and recovery

Personality disorder

High Expressed Emotion

Sympathy is not usually helpful

More on the Stress & Vulnerability model of mental health and disorder

The invalidating environment

The Self-fulfilling prophecy

The meaning of recovery in mental health

The three types of recovery


Part 4 – In practice

Duty of care: A slug in a bottle

‘Hanged if you do, hanged if you don’t’ – a duty of care myth

There is no ‘us and them’

People are just people

Coping skills develop slowly

Lapse is different from relapse

Don’t expect your service user to perform perfectly.

The word ‘support’ is meaningless in and of itself

“It’s just behavioural” (A workers’ excuse for lazy thinking)

Challenging behaviour means….

Behaviours that harm the individual

Behaviours that harm other people

Do we need help?

Consequence, learned behaviour and the need for boundaries

Maintaining the problem

The whole team approach

Firm Boundaries

No ‘Pedestals’ and Staff Safety

Effective, Consistent Care

‘Corporate’ Identity – “You’re All The Same.”



Part 5 – risk issues


Self-harm as a response to trauma

Responding to a person who harms themselves

Individual v Organisational risk (Risk-free is impossible. Manageable risk is the way to go)

Don’t flap (more haste – less speed)

The saviour fantasy

You’re probably not an emergency service – don’t try to behave like one


Part 6 – Thinking styles

Unhelpful thinking

Ignoring the positive

Exaggerating the negative



Arbitrary inference


Selective abstraction

Global thinking

Dichotomous thinking

Magical thinking (the Wizard did it)


Socratic dialogue and ‘the razors’.

The sticks we use to beat ourselves

Who put us in charge?

Final words

Models of mental health and disorder

The world of mental health care can be confusing – especially for those new to the topic. Often the different theories and professional approaches seem to contradict each other. It’s almost as though different workers speak different languages,

That’s not quite true but they do often come from different theoretical perspectives. That’s why, for example, a social worker and a psychiatrist will give you two completely different explanations for the same person’s problems. They’ve been taught radically different ‘models’ that they use to understand mental health and disorder, its causes and its treatments.

This little table isn’t intended to cover all the different models in depth. Instead think of it as a very basic list of models that can guide you in understanding why people focus upon different things. There’s more to it, of course but it’s a start for newcomers trying to get to grips with the contradictions they come across in practice.

The Care Guy Models of mental health and disorder

I just love this stuff

Today I was in Halifax in beautiful W. Yorkshire. It was great.
I arrived last night and met up with a former colleague for a catch up over a curry (& beer of course).


Then today was spent with around 20 of Calderdale’s finest mental health & social care workers talking about psychosis and interventions for people who hear voices. It’s amazing what a really enthusiastic group can get through in a single day. We covered basic principles of psychosis, a little philosophy of mental health care, models of understanding and normalisation in the morning. This afternoon was devoted to meaningful activity and validation, socratic dialogue, delusions and perceptions and principles of risk. These people really got their money’s worth today!

The group was great fun to work with and they really seemed to enjoy the day. Hopefully they’ve got some useful new skills to take away too.
Even better, I think a few of them will be contributing to Care To Share Magazine before too long as well.

All in all it’s been a really successful day. And now it really must be ‘beer O’Clock’!

What a cracking day!

Mental Health and Social Care

Don’t forget about my other book – also available from The Care Guy website.

MH and SC simple lessons meme

This easy to follow book has been written with social care support workers in mind. It’s jargon free and packed with reflection points, tips and exercises to guide you through the social care process from basic principles to support planning and relapse profiling. What’s more – it only costs a tenner. You can download a sampler here.

The author, Stuart Sorensen has many years experience of working in mental health and social care. Drawing on past experience of ‘real world’ care services he boils down the complicated theory of mental health care into the fundamental principles of best practice. The result is an easy to follow book that explains what mental disorder is, what recovery really means and what social care staff can do to help

Fallacies 9: The ‘single cause’ fallacy

Everyone has a place in the world. They don’t always like it – but they have a place none the less. And everyone arrived ‘where they are’ because of a complex combination of circumstances, choices and characteristics that all contribute to whatever it is that makes us who we are.

For example….

I am occasionally asked why I chose to become a mental health nurse. The usual answer I give (the shorthand version, if you like) is that I find mental health work (either as a practitioner or a trainer) both fascinating and rewarding. But actually there’s more to it than that.

To really understand why I drifted in to mental health care you’d need to know how a number of very different causative factors came together to bring me to that point. These include…

Lincoln YMCA

Lincoln YMCA

Volunteering as a teenager in an elderly care day centre (primarily because I was bored);
Not being talented enough to realise my teenage dream of becoming an actor;
Leaving home in search of a theatrical career and becoming homeless;
Living either on the streets or in hostel accommodation during my early twenties;
Eventually finding employment in the hostel I lived in (Lincoln YMCA);
Being ‘thrown in at the deep end’ with a number of mentally disturbed hostel residents;
Witnessing a woman jump to her death from a multi-storey car park near the hostel;
Subsequently taking a series of care assistant jobs in mental health, elderly care and learning disabilities services;
Meeting and becoming engaged to a care assistant who was about to begin nurse training;
Following her into nurse training (to be together);
Entering mental health nursing (mainly because I didn’t fancy adult nursing).

So you see, although the shorthand answer is that I love mental health work the actual answer includes many more causes than that alone. In truth I drifted into this field as much by chance as anything else. I would never have imagined myself doing anything like this when I was at school. And that’s how it is for most people.

There is no single cause!

Of course we all understand this when we think it through. Almost nothing significant happens because of a single event. There are always other underlying conditions that make it possible. Unfortunately though we all tend not to think it through quite so often as we should.

Continuing for the moment with the theme of mental health I’d like to pose a question….

What causes schizophrenia?

If you were to ask 100 people that question you may not get 100 different answers but you’d find that a number of contradictory themes kept cropping up over and over again. Let’s look at two of these themes….

“It’s a biological brain disease”

This means that schizophrenia (the tendency to experience hallucinations, delusions and thought disorders) is caused by something in the person’s body or brain. Different people will offer slightly different versions of this explanation – some will talk about genes and heredity whilst others will attribute schizophrenia to chemical processes resulting from substance use or dietary processes. What brings them all together is the unifying belief that hallucinations, delusions and thought disorders are caused by physical issues and so physical remedies are required. The ‘single cause’ is assumed to be biology.

That’s why doctors prescribe medications for people diagnosed with schizophrenia. It’s a chemical remedy intended to ‘fix’ or ‘manage’ a chemical problem.

“It’s caused by social exclusion”

People who believe this will not focus upon trying to alter the workings of the brain and/or body. They’ll concentrate their efforts upon more social, cultural and environmental variables and try to solve the problems service-users experience through interaction and coping skills development.

There is extremely good evidence for this sort of intervention and it really can work wonders.

The problem with both of these approaches, at least in my opinion is that they are too superficial and self-limiting. They both fall into the trap of the ‘single cause fallacy’ and because of this they are both essentially inadequate explanations. There is more to schizophrenia than just biomedical (nature) or socio-cultural (nurture) causes in isolation and until we abandon single cause explanations and explore the totality of causes we’re doomed to fail . More significantly we’re also doing our service-users a major disservice. I’ve explained more on this topic in my commercial blog:

Why I’m not ‘anti-psychiatry’

But that’s not really the topic of this entry – it’s just an example. Another example comes from the world of politics and the ‘single cause’ explanations that politicians of all stripes would like us to accept. For example…

A little over a year ago the United Kingdom (or at least England) was blighted by riots in several major cities. The reasons for this seem complex and almost certainly include (among other things):

Poverty and alienation;
An increasing sense of hopelessness;
Disregard for the rights and welfare of others;
Lack of cohesion within the larger community;
The psychological need of desperate people to scapegoat ‘the other’.

Nick cleggThe leader of the Liberal Democrats, Nick Clegg famously predicted that there would inevitably be riots if the Conservatives won the 2010 general election. He understood the link between the ruthless capitalism of Conservative ideology, widespread poverty and the desperation of the masses all too well.

And yet both during and immediately after the riots (and after he’d led his party into coalition with those same Conservatives) he conveniently forgot all that in favour of the party line about ‘lack of respect’ and ‘mindless yobs’. Even when directly asked to comment upon any other possible causative factors he declined to do so.

Whenever someone tries to convince you of a ‘single cause’ for a serious event ask yourself :

What aren’t they considering?

The more we allow ourselves to be drawn into the ‘single cause fallacy’ the more vulnerable we become to manipulative arguments from others, be they politicians, internet bloggers like me (yes I can fall into the same traps as everyone else) or the bloke ‘holding court’ in your local pub.

So the next time someone tells you that disabled people are all benefit scroungers who don’t want to work or that the global economic crisis was caused by the UK’s previous prime minister stop and think for a moment before you fall victim to their particular brand of superficiality.

What aren’t they telling us?

Of course, as another blogger reminded me earlier this week, ‘We don’t know what we don’t know’. It can be difficult to work out just what the other person isn’t telling us because, by definition, we don’t know. But there are a few questions you can ask yourself that may help:

If this was a debate what would the other speaker have said?
If I had to explain this what would I have said?
Does this explanation fit with what I already know about the world?

The trick, as ever, is to think for ourselves. The single cause fallacy isn’t only widespread – it’s dangerous too.

About the ‘Fallacies’ series

The ‘Fallacies’ project was built up from a series of instalments that first appeared online during the summer of 2012. It is republished as part of a larger set of changes intended to rationalise the contents of several different blogs into just 2. The other remaining blog focuses mainly upon social care and mental health related issues. It can be found at

#TwentalHealth (Twitter) awards

How cool is this? I’m joint runner up in the 2013 #TwentalHealth awards in regard to my Twitter account @StuartSorensen. It’s an honour I share with the wonderful @MrsGracePoole whose twitter feed is well worth following if you’re into mental health and/or nursing.

The winner in the nursing category was @Nurse_W_Glasses, creator of the now extremely famous 20Commandments for mental health workers. I’m especially please to see that NWG won the nursing category award, having interacted with her online for some years now and even collaborated on a longer elaboration of her 20 Commandments a couple of years ago.

So well done to NWG for taking the big credit – an honour she richly deserves. And congratulations to Grace (AKA Alison) who, like myself has the honour of displaying the 2013 runner up badge on our blogs and online profiles.
twental health 2013 runner up

The Care Guy’s back!

What do freelancers do when they’re not trading?


I have long believed that for a trainer or consultant to stay relevant he or she must keep their practical skills up to date. I know from experience that my clients think so too. From learners in training sessions to managers in consultancy you want the person you’re talking with to understand the real world of practice. You want him or her to understand your world and the challenges you face. You want him or her to ‘know’.

That’s why the best freelancers make a point of staying in touch. But spending time in practice is only half the battle. How that time is used is just as important.

Freelancers in practice need to take note of changes and understand new challenges. We need to think strategically and come up with practical ways to meet the demands of the real world. And we need to use that experience when we return to work with our clients.

There have been some changes to my services

For almost a year now I’ve been working as Quality Development Lead for a large UK social care provider. During this time I’ve come to grips with a range of real world challenges and worked with staff at all levels to meet them. It’s been a remarkable and illuminating year.

The net result of all this is a bigger range of services based upon the most up to date principles of social care, organisational strategy and personal development.

Click the links below to see what’s new.

Support for organisations
Personal development and coaching

It’s good to be back!


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