Tidal Model

Introduction

• Tidal model is a mental health recovery model which may be used as the basis for interdisciplinarymental health care.
• It was developed by Phil Barker and Poppy Buchanan-Barker of  University of Newcastle, UK.
• It is considered as a mid-range theory of nursing.
• The main focus of the model is on helping individual people, make their own voyage of discovery.

Definition

"The Tidal Model is a philosophical approach to the discovery of mental health. It emphasises helping people reclaim the personal story of mental 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 helpingrecover control over their lives".  - Barker

• The Tidal Model provides a practice framework for the exploration of the patient's need for nursing and the provision of individually tailored care. (Barker P, 2001)

Theoretical Sources

• Tidal Model draws its core philosophical metaphor from chaos theory, such that the unpredictable - yet bounded – nature of human behaviour and experience is compared to the dynamic flow and power of water and the tides of the sea. (Barker P, 2001)

Assumption

The tidal model is applied through six key philosophical assumptions:

1. A belief in the virtue of curiosity : the person is the world authority on their life and its problems. By expressing genuine curiosity, the professional can learn something of the ‘mystery’ of the person’s story.
2. Recognition of the power of resourcefulness, rather than focusing on problems, deficits or weaknesses
3. Respect for the person's wishes, rather than being paternalistic.
4. Acceptance of the paradox of crisis as opportunity
5. Acknowledging that all goals must belong to the person
6. The virtue of pursuing elegance—the simplest possible means should be sought

Description of the model

• In the Tidal Model, the person, the individual is represented, theoretically, by three personal domains: Self, Worldand Others .
• The theory suggests that our mental wellbeing depends on our individual life experience, including our sense of self, perceptions, thoughts and actions.

The Ten Commitments
The values of the Tidal Model can be distilled into Ten Commitments.

1. Value the voice – the person's story is paramount
2. Respect the language – allow people to use their own language
3. Develop genuine curiosity – show interest in the person's story
4. Become the apprentice – learn from the person you are helping
5. Reveal personal wisdom – people are experts in their own story
6. Be transparent – both the person and the helper, Professionals are in a privileged position and should model confidence, by at all times being transparent and helping to ensure the person understand exactly what is being done 
7. Use the available toolkit – the person's story contains valuable information as to what works and what doesn't
8. Craft the step beyond – the helper and the person work together to construct an appreciation of what needs to be done "now"
9. Give the gift of time – time is the midwife of change. The question that should be asked is, "How do we use this time?"
10. Know that change is constant – this is a common experience for all people

The Twenty Competencies

• Competency 1: The practitioner demonstrates a capacity to listen actively to the person’s story.
• Competency 2: The practitioner shows commitment to helping the person record her/his story in her/his own words as an ongoing part of the process of care. 
• Competency 3: The practitioner helps the person express her/himself at all times in her/his own language.
• Competency 4: The practitioner helps the person express her/his understanding of particular experiences through use of personal stories, anecdotes, similes or metaphors.
• Competency 5: The practitioner shows interest in the person’s story by asking for clarification of particular points, and asking for further examples or details.
• Competency 6: The practitioner shows a willingness to help the person in unfolding the story at the person’s own rate.
• Competency 7: The practitioner develops a care plan based, wherever possible, on the expressed needs, wants or wishes of the person.
• Competency 8: The practitioner helps the person identify specific problems of living, and what might need to be done to address them.
• Competency 9: The practitioner helps the person develop awareness of what works for or against them, in relation to specific problems of living.
• Competency 10: The practitioner shows interest in identifying what the person thinks specific people can or might be able to do to help them further in dealing with specific problems of living.
• Competency 11: The practitioner helps the person identify what kind of change would represent a step in the direction of resolving or moving away from a specific problem of living.
• Competency 12: The practitioner helps the person identify what needs to happen in the immediate future, to help the person to begin to experience this ‘positive step’ in the direction of their desired goal.
• Competency 13: The practitioner helps the person develop their awareness that dedicated time is being given to addressing their specific needs.
• Competency 14: The practitioner acknowledges the value of the time the person gives to the process of assessment and care delivery.
• Competency 15: The practitioner helps the person identify and develop awareness of personal strengths and weaknesses.
• Competency 16: The practitioner helps the person develop self-belief, therefore promoting their ability to help themselves.
• Competency 17: The practitioner helps the person develop awareness of the subtlest of changes – in thoughts, feelings or action.
• Competency 18: The practitioner helps the person develop awareness of how they, others or events have influenced these changes.
• Competency 19: The practitioner aims to ensure that the person is aware, at all times, of the purpose of all processes of care.
• Competency 20:  The practitioner ensures that the person is provided with copies of all assessment and care planning documents for their own reference.

Applications of the Model

1. Young BB. Using the tidal model of mental health recovery to plan primary health care for women in residential substance abuse recovery. Issues Ment Health Nurs. 2010 Sep;31(9):569-75. http://www.ncbi.nlm.nih.gov/pubmed/20701419
2. Fletcher E, Stevenson C. Launching the Tidal Model in an adult mental health programme. Nurs Stand. 2001 Aug 22-28;15(49):33-6. http://www.ncbi.nlm.nih.gov/pubmed/12214392

Conclusion

• The Tidal Model assumes that nurses should only do what is absolutely necessary to meet the person’s needs. This emphasis on ‘doing what needs to be done’ might help avoid fostering dependence or otherwise institutionalising people. (Barker, 2000)
• Tidal Model of mental health recovery has been recognised and practised in several different countries. 

References

1. Official internet site for the Tidal Model available at http://www.tidal-model.com/
2. Buchanan-Barker P . Clarifying the Value Base of Recovery: The 10 Tidal Commitments. Journal of Psychiatric and Mental Health Nursing 2008: 15, 93-100.
3. Barker P. The tidal model: developing a person-centered approach to psychiatric and mental health nursing. Perspect Psychiatr Care. 2001 Jul-Sep;37(3):79-87
4. Barker P. The Tidal Model: Theory and Practice. University of Newcastle, 2000.
5. Barker P.; Barker, PJ (2008). "The Tidal Commitments: extending the value base of mental health recovery". Journal of Psychiatric and Mental Health Nursing 15 (2): 93–100
6. Tidal Model Publications - visit at http://www.tidal-model.com/Publications.htm