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PROactive Management of Integrated

Services & Environments



Manaan Kar Ray

Clinical Director, Adult, CPFT

Co Founder PROMISE Global

Manaan is a joint lead for PROMISE. He is  a Consultant Psychiatrist at Fulbourn Hospital, Cambridge. He is also the Clinical Director for Adult Mental Health within CPFT. He trained in Psychiatry in Oxford. He is passionate about recovery and changing the power balance between professionals and patients. He has led a number of transformation projects with recovery at its heart. He is married and has two young children who keep him busy. When he does find the time he is a keen photographer and loves to travel. He also enjoys racket sports, badminton and table tennis and his kids are forcing him to learn roller skating.

PROCESS: PROduce Creative Effective Simple Solutions

PROMISE (PROactive Management of Integrated Services and Environments) is a paradigm of co-producing an alternative discourse in mental health care. A discourse that creates hope and agency and empowers patients to take the driving seat in moving towards life beyond illness. A discourse that empowers staff to ‘re-innovate the wheel’ and continuously improve on the small changes that make a big difference. A discourse in which patients and professionals can empower each other to eliminate reliance on force across the entire recovery journey.

However, engaging staff and patients in scripting and enacting this new discourse is a fairly complex affair. Creating a change story to eliminate reliance on force when staff who resort to it firmly believe they are acting out of necessity and in the patient’s best interest can be disheartening, divisive and a tricky affair, to say the least. Once patients are at the receiving end of such interventions they are usually extremely distressed and may be unable to draw on their inner resources. They too will struggle to see that there have been opportunities to influence the course of events. For both staff and patients a delicate balance needs to be struck between support and challenge. Acknowledging staff sensitivities without diluting the need to continuously push on the frontiers of humane care is not easy and does not fit neatly into any conventional change model. Also, the existing models do not pave the way for patients to see how co-produced solutions will enable them to actively shape the care they receive.  For leadership of other organisations who may have aspirations similar to ours we have tried to parcel our journey into bite size chunks. However, this is not meant to be a road map, just a compass which hopefully will help navigate through some difficult terrain.

The three key phases and their components are:

Envision: Insight to Ideas

Enquire:  what’s good and what could be better

Explore:  the contradictions at the heart of mental health

Empathy: help people imagine ‘what might be’

Enable: Ingenuity to Innovation

Empower: create a culture of personal responsibility

Exchange: celebrate innovations by replicating

Evolve: re-innovation for continuous improvement

Enact: Initiative to Implementation

Execute: make it happen

Evaluate: critically analyse the journey

Exposure: tap into synergies of pioneering partners