Slí Eile: A community project enabling mental health recovery. Yes, there is another way

by William Pattengill

Slí Eile (Irish for ‘another way’) in its present incarnation is a residential treatment center for those living with mental illness, as well as an organic farm and bakery, centered around a venerable former manor house in rural north Co. Cork. It is designed to offer an alternative recovery option for those who might otherwise be spending time in psychiatric care, using a three-fold path of supported community living, real-world social enterprises and person-centered care planning.

Anyone suffering from mental illness can apply for tenancy at Slí Eile; a referral from a medical professional is not necessary, though a report from an applicant’s mental health team is required after initial meetings with staff members to ascertain fitness for residency. Applicants are required to have reasonable physical mobility, as there is some physical labor involved, and are screened for suicidal ideation, self-harm, and active addiction. Previous addiction does not rule out acceptance because there can be a strong correlation between mental health issues and addiction There are counsellors, social workers, and a psychologist on-site, but tenants keep in contact with their own off-site psychiatrists or mental health team while in residence.

Recovery at Slí Eile is what one might call an immersive experience: it begins with tenants waking early to make breakfast and wash dishes, which is all part of embracing the structured lifestyle encouraged there. Then it’s off to work, either in the bakery or in the fields and plastic tunnels on the farm. Work is a vital part of the programme, fostering teamwork, responsibility, and providing structure for the day. The person-centered approach to recovery means that each tenant has a daily programme tailored to their individual needs once they arrive, and it is only with the safe environment provided that recovery can take root and grow.

As the past century came to a close, Joan Hamilton of Co. Cork, owner and creator of a successful food-processing business, was at her wit’s end. Her daughter was now a young adult and her progress in learning to cope with mental illness was agonisingly slow, if one could even call it progress. She had been in and out of hospital since her teens and found it difficult to maintain her mental health without frequent relapses that required repeated re-admissions; as her mother discovered, this was true of nearly three out of four young adults at the time in the mental health care system. In her exasperation Hamilton thought to herself, “There must be another way….” and thanks to her creativity and many years of effort, there now is just that.

Joan Hamilton’s journey to find her “other way”, like many other pioneering endeavors, did not proceed in a straight line. With no experience in the field of mental health except as a frustrated parent, she first started a network lobby group that evolved into the Cork Advocacy Network (CAN) to explore options for alternative social housing. A conference she organised called “Is There Another Way?” attracted 700 attendees and led to a television interview and further exposure which boosted her fundraising reach. With help from the Irish Council for Social Housing, CAN set up a housing association, and then in 2004 Hamilton founded Slí Eile as a separate venture on her own.

The initial version of Slí Eile was located in Charleville as Villa Maria, with 6 full-time residents, beginning in 2006. Their recovery practice was based on a range of traditions, including William Glasser’s Reality Therapy and that of Hopewell Community Farm in Cleveland, Ohio.

Hamilton’s background in the food industry guided her to test the feasibility of setting up a bakery which became Cuisine Slí Eile, supplying bread and scones to local businesses, which soon expanded to include the local SuperValu after another televised documentary that received national exposure (McCarthy, 2011). Research undertaken as part of the 2012 HSE Report of the Expert Group on Mental Health Policy,showed that the venture was performing well in tenant progression, as well as overall cost-effectiveness.

Growth continued in 2012 when a lease was taken out on Burton Park manor house with an existing 50-acre organic farm on the property in Churchtown, near Mallow in Co. Cork, and space for 12 tenants (the preferred term for residents, as opposed to “patients/clients”). This became the primary center for Slí Eile, and the farm was developed as a second social enterprise with the help of a leading horticulturalist, Jim Cronin. The farm project was officially opened in May 2013 by Minister Kathleen Lynch and Jeremy Irons, like Joan Hamilton a resident of West Cork, who was invited to be a patron by Hamilton.He was supportive of her vision and believed the health care system was too reliant on drugs, saying “It has to be about a way of building self-confidence. How can you be self-confident if you’re a case number?” (Jennings, 2015). More recently, in his address at the Cork Person of the Year Award presentation to Hamilton, Mr. Irons said:

We can’t just put away people who don’t fit into our pattern of life. What Joan Hamilton is doing - getting people back into the community where they are self-sufficient, self-reliant and giving them back a life, is tremendously important. (Jennings, 2015)

Joan also sought to develop a working relationship with the village, establishing a weekly farmers’ market and occasional seasonal festivals featuring local crafts and other food products. Tenants participate in setting up and helping staff at these events.

In 2017 Hamilton retired from her position as Chief Operating Office, nearly two decades after beginning her search for “another way.” In 2018, the HSE, which had supported Slí Eile since the early days with 90% of its funding, conducted a major operations review and recommended enhanced support for an expanded programme of activities. This advanced the two key strategies of their earlier work - supported community living and social enterprise - and added a third in the form of personal progression coaching. Tenants are encouraged to understand what brought them there, how it affects them today, and how to manage their mental health for a better tomorrow. Regularly key working as well as individual person-centered care plans improve chances that Slí Eile tenants can learn to manage their mental health and to go on and have that good life.Every week there is a group educational meeting to learn about family dynamics, boundaries, and assertiveness to name but a few of the topics addressed.

Wellness Recovery Action Plan (WRAP) is another recent addition to Slí Eile practice which also prepares tenants for their return to independent living after the standard 18 month stay. The goal of WRAP is more self-awareness of one’s own strengths and weaknesses, who and how to ask for help when needed, and how to live well with their diagnosis once back in the community. People can leave earlier if they feel ready - if there are concerns in such situations staff will offer them but they will not prevent anyone from leaving. Similarly, extenuating circumstances may warrant a longer stay, as the programme understands each person is different and their needs are also different.

The next step upon leaving the main house is a stay in the cottage which is also on the Burton Farm property. Here the tenants are living on their own, without staff present, but still within reach of support if needed. The main danger in returning to the wider community is the temptation to stop taking medication when a sense of well-being arises that may be short-lived or illusory. The main risk for people returning to the wider community after a stay in Slí Eile is if they stop taking their medication, sometimes this can come on the back of the confidence and well-being that has been achieved through the programme but it runs the risk of a relapse in their mental health. The last phase of recovery is a short term of residency at the transitional house and garden in Charleville, where tenants put their new-found skills to the final test by beginning activities in the community. After graduating from the programme, post-tenancy support is available for varying lengths of time as needed.

Over the last few years, Joan Hamilton’s successors have enriched the Slí Eile recovery process with their own training and experience. In January of 2021 Jess Angland became Chief Operations Officer and has contributed her knowledge of social care, self-care, community development, and most importantly, trauma informed care to the Slí Eile programme. She emphasised that an awareness of the subtle underlying effects of their own trauma should be explored by staff members, and that understanding the legacy of trauma enables staff to better meet the needs of the tenants and increase their understanding of the people they are supporting. Training delivered by Dr Jacqui Dillon in 2021 assisted tenants and staffto identify the link between internalised voices and trauma, and learn how to better cope with them.

Another milestone on Slí Eile’s journey was being named winner of the 2022 Royal Dublin Society Rural Social Impact Award (The RDS, 2022). This award celebrates the work of individuals, farm families, and organisations who are enhancing the economic, environmental, and social development of Irish agriculture and rural communities. In addition, they were also honored at the 2022 Bord Bia National Organic Awards for the commercial success of their farming enterprise which also helps fund mental health work. Their “Other Way” has been an inspiration for at least one other “therapeutic farm” to date: still a work in progress, Kylie Farm in Kildare is to be based on similar principles with the addition of private insurance and a higher level of clinical care on-site. It remains to be seen how far and how fast this alternative to traditional institutional recovery will grow, however the development of their strategic plan over the next five years will see further growth and development. Their mission statement of Grow together continues to be very important as tenants, volunteers, staff, and community work together to develop another way to support those with severe mental challenges.

Thanks to Jess Angland C.O.O who was kind enough to be interviewed for this article.

is a member of the editorial board and an occasional contributor to Inside Out. After retiring from the home renovation business, he has enjoyed the opportunity to return to his roots as a journalist.

References

Jennings, M. (2015, February 5).Getting back to good mental health on a community farm. Irish Examiner https://www.irishexaminer.com/lifestyle/ar

McCarthy, K. (2011, Sept 20). SlíEile: RTE Nationwide Feature. [Video]. YouTube. https://www.YouTube.com/watch?V=jvkwM

The RDS (2022, Sept 5).RDS Rural Social Impact Winner 2022 - Sli Eile Farm, Co. Cork.[Video]. YouTube. https://www.youtube.com/watch?v=5kENtPbe318

IAHIP 2023 - INSIDE OUT 99 - Spring 2023