Crusading parents hope the death of their daughter can lead to a revolution in mental health services in Scotland.
Mark Smith believes daughter Joshi could be alive today if carers had been able to offer psychiatric treatment pioneered in northwest Italy.
He and wife Catherine are in talks that they hope will lead to the opening of a Joshi Project using the Trieste Model - novel rehab policy first used in the Italian region.
They believe similar hubs would tackle the rising tide of mental breakdowns, suicide and drug addictions claiming the lives of more people every year.
Joshi Smith, 24, died in the USA in 2020, seven years after the Smith family moved there to seek help when mental health services in Scotland failed.
The couple spent their life savings on treatments that saw Joshi given drugs that failed to help.
But their lives were turned upside down when Joshi died of a fentanyl overdose in the States, which they believe was the result of her self-medicating.
Mark, a journalist, said: “Joshi was a beautiful, inspirational daughter and there must have been a way of reaching her.
“I believe there could be tens of thousands of young people like Joshi who could be helped immeasurably by methods from Trieste.
“I didn’t accept that she was just beyond help, the way some professionals had made me feel.
“I went to psychiatrists in the NHS and private, we spent a fortune, more money than I care to talk about on both sides of the Atlantic, and they had nothing to offer to help Joshi.”
The family quit Scotland when a psychiatrist at Stirling Royal Infirmary told them: “We have nothing left for Joshi, nothing in our armoury we haven’t tried.”
Mark said: “Psychiatrists in Scotland are all stuck on this old ‘chemical imbalance’ model and were all limited by that because it was obvious that even if there was a medicine solution, they didn’t know what it was.
“They would tell Joshi, ‘the problem is your brain chemistry. And she kept asking, ‘Well, how do you know my brain chemistry is at the right level?”
“And they didn’t in the end, know the answer, and all the time she was getting more frustrated.
“She wanted to help herself and she was desperate. And that’s what led to drugs, as she was in no way a social user.”
Mark began to look at treatment systems worldwide and recovery outcomes.
He said: “I made myself a cursory league table, looking at what countries had good outcomes and what models work and which don’t.
“Scotland was pretty bad, well down the table.
“Here we’re stuck in this medical, biological model that rattles on about chemical input and output of the brain.
“But life is more complicated than input/output and that fact underpins some of the most successful systems, like that in Trieste.”
The Trieste Model is built on an “open-door approach” to a patient’s treatment and allows them a say in their recovery.
Mark’s dedication to the Trieste Model was solidified after he cold called the mental health department in the city and enquired and was put through to clinical director Roberto Mezzina, who is world renowned for his work.
He said: “I told him my story and he listened and I told him my daughter was a lover of Shakespeare, and she was a poet.
“She left behind a small mountain of her own poetry.
“He told me that one of the first ‘treatments’ he’d have looked to would have been getting someone to talk to her about Shakespeare or maybe getting a well known poet to engage with her as part of a therapy.
“I was shocked to the core by this because this was not psychiatry speech. This was somebody who was telling me something, for the first time, that made sense.
“It focused on people’s lives, what they’re good at, what their dreams are. And it didn’t it doesn’t have to be poetry
“It could have been the church, if that’s what you were into, or Hell’s Angels or football.
“And so I began to talk to a more and more and we and I realised this was a system that could have saved Joshi because that’s what she needed.”
Joshi’s family believe that all she wanted from drugs was a feeling of being normal after being plagued by anxiety and a compulsion to play out punishing OCD routines.
The family’s passion to bring the Trieste Model to Scotland was given a boost when they were contacted by community group, the Inverness Mental Health Recovery College, who wished to discuss setting up a Joshi Project in the city.
Mark said: “I would love to think there could be Joshi Projects all over Scotland and maybe Inverness could be the first one.
“We were introduced to the Birchwood recovery charity and I got a chance to outline my vision, which would be a 24 hour, one stop shop where people can go and be triaged, and be linked back into the community with counselling, psychiatric health, all the stuff that is missing from the current system.”
Mark would like any Joshi Project facility to be run by the NHS, using existing resources like psychiatrists and counsellors.
He said the aim would be returning to the community, looking to take support from family, neighbours, clubs, churches or anyone available to lean on.
He said: “I’ve spoken to so many people about the Trieste Model and, by God, it works.
“It’s astonishing. It seems so simple, and it’s cheap. And it works. And it will cost the NHS, half of what they’re spending now on nothing with almost no results.”
• More info on the Joshi Project can be found here
