Dr Andrew Greenland: 0:00

Hello everyone and welcome back to Voices in Health and Wellness. This is the show where we speak with the people shaping the future of care one insight at a time. Today's guest is someone I've really been looking forward to speaking with. Joining me is Mariam Medin, the founder of the SOC, a pioneering mental health and well-being clinic based in London. Mariam is a respected voice in redefining the therapeutic landscape, blending clinical excellence with a uniquely human-centered approach to care. At the SOAC, the experiences of the patient isn't just about the outcomes but the entire journey, how they're welcomed, the environment they're in, and how they're made to feel throughout. Mariam, it's been a delight to have you on the show. Welcome and thank you very much for your time this afternoon.

Maryam Meddin: 0:41

Thank you very much for having me. Happy to be here.

Dr Andrew Greenland: 0:44

Thank you. So, would you mind sharing a little bit about your role at the SOC and perhaps what originally inspired you to create a space like that?

Maryam Meddin: 0:52

Um, well, I'm I am, as you mentioned, the founder uh and and also the act as a CEO um in the sort of the running of the organization. Um I had a career in branding and communications, and actually my my first ever job was as a uh a waitress in a silver service restaurant, and I mentioned that because it played such an important part in uh my understanding or the development of my understanding of the idea of service. Um, so it remains an important um period of my life uh because it sort of set the scene for the way that I approached um the various roles that I've occupied throughout my career. Um so I worked in branding and communications and um in uh in the um early 2000s I experienced um mental health as a as a user uh mental health service. I I went to see a psychotherapist and I had a very negative experience. Um the starting point was that I didn't know where to look. Um it's a little bit easier now, uh nowadays uh with uh with the admont of the internet. Uh in those days I didn't have that luxury, but I think even now it's quite difficult for people, particularly if they are in a particular space where they're not at their best cognitively, to be able to sort of um wade through the many types of therapy that exist, the many sort of modalities, uh, actually, even uh the professions themselves. A lot of people don't know the difference between psychiatrists, psychologists, and psychotherapist. And I certainly didn't. So my first challenge was in finding someone. The next sort of challenge was in understanding whether or not this experience that I'd had, and it was a single appointment, it lasted for over two hours, but it was about understanding whether all the things that had happened in this two-hour um meeting were ethical, were proper, um, and that hadn't done me more harm than good. Um and again, I didn't know where to find those answers. Um, and I hadn't really spoken to anyone about it. I set off to learn a little bit more about my experience and ended up sort of getting stuck into the weeds of learning about psychotherapy. So I found myself training to become a psychotherapist. So it all started, as it often does with psychotherapists, with uh the journey towards trying to solve one's own problem. Um, and as I sort of trained and qualified as a psychotherapist, I realized just two things. One was what a mess it is, really, from both the perspective of a user and the perspective of a provider. Um there's there aren't a lot of middle people trying to make things happen well. Um and the second thing was I noticed the the discrepancy between what was being said in you know the wider world, and this is sort of going forward now a few years to when celebrities started talking about mental health, and the young royals, as they were then, started talking about mental health and so on, and there was a huge amount of encouragement saying, Go if you know, if you're struggling, get help. But there was actually nobody telling them, okay, what do I do now? I've decided I'm going to get help. How do I find help? How do I know that that's the right kind of help? And so on and so forth. So having come from sort of that branding and communications background, my first thought was that this whole sector needs rebranding. It it the communication needs to improve, the image needs to improve, the experience needs to improve. You know, branding is all about delivering on a promise. You know, when you're effectively promising people that if they are, if they look for help, they will get better or at least feel a bit better as a result of doing that. Um, you know, you've got to deliver on that promise. And sometimes the challenge of finding the right person and potentially having a quite distressing experience in that process actually might uh put them off looking for help again altogether, or might dissuade them from uh from taking another step sort of in that direction. So that's what led me ultimately to set up the SOAC and seeing and recognizing where there was a void and wanting to sort of slightly turn things on its head, on their head, and um introducing concepts that are commonplace, I think, in the commercial world, you know, we now know it doesn't matter whether you're a bank or a hairdresser's service is part of the experience that you have to provide in order to differentiate your organization from the organization down the road. By and large, most hairdressers offer the same thing, most banks offer the same thing. What might be different is how you feel in your engagement with them. So, and the mental health sector wasn't recognizing that, in my view. And so it became about creating an organization where the full experience of the client was taken into account from the minute that they might decide I want to get help to the minute that they hopefully walk out of their final appointment, thinking this was a worthwhile thing to have done. Every single touch point had to be considered, thought about, and redesigned if necessary, in order to sort of reduce suffering and ultimately promote human dignity. Um, that you know, it it that's what it came down to. Um it can be for people who have experienced mental health care, they may recognize in their own experience the fact that sometimes it can feel quite almost degrading. There's a huge power dynamic when you're feeling vulnerable, um, that unless sort of thought about and reconsidered in the way that the relationship is created and managed, um it can lead the individual not to feel entirely safe. Um so those that's a very, very long answer to your one question. I apologize, I've rambled on. But that's that's what that's what sort of that's how it started, and that's what it sort of led to.

Dr Andrew Greenland: 9:23

I always find the journey fascinating and the you know the how the journey leads to the inspiration for what you've created. So can you give us perhaps a few examples of the very tangible things that you've done in the SOAP to improve the different touch points that you referenced, just for people listening who might be running their own practices and perhaps get some ideas about things they could do to improve that journey and experience?

Maryam Meddin: 9:44

Well, I think that the starting point is to help people understand what the whole experience entails, the the clinical part of it. You know, this is so somebody says to you, this is what's going on with me, I don't know where to look. The very starting point is to talk them through um what is available in terms of you know what their their needs might be. Somebody might say, I think I need to go and see a psychiatrist. Well, actually, you know, eight times out of ten, no, you don't. Um, you don't need a psychiatrist. And here is why you don't need a psychiatrist, you know, talk therapy may be appropriate for you, or uh so on. So so sort of hand holding and talking them through their options and feeling like they have a sense of agency over what's about to happen is an incredibly important first step. So, in in practical terms, what we've done is we've introduced uh a fairly robust client services team, all of whom have experience in the mental health field, whose job is to speak to people and give them as much information and as much time as that conversation needs to ensure that by the end of the conversation that person feels like they are making an informed choice about what step they should take next. Now, not often people might not even be able or want to come to us, you know, we might get a call from someone in Cornwall, and we we do, um, asking if if uh, for example, you know, what they need and so on. And when it becomes apparent that they they need to have weekly care, and in certain cases, we might say, you know, we would like to deliver this care in person. For example, if somebody is self-harming or if they've got an eating disorder, we really we reluctantly provide remote care in those situations. Um, and we do insist on them sort of fairly frequently being seen in person. Um, but we we say to them you're much better off finding somebody locally. So even though we know that they're not going to sort of end up as our client, we still spend as much time as is needed helping them to find the right sort of care or determine what they need. So that's the starting point. The second part, I suppose, is our environment, which is um which has been designed not only for comfort, um, but it's also, you know, it's sort of a lot of people who come in, they sort of describe it as a bit of a sort of boutique, hotel, lobby type of place. You know, we don't have like a check-in desk. Uh, the reason we don't have a check-in desk is because we want people to come in and immediately feel at home, not as if they've got to check in somewhere and sort of declare their arrival. We go and greet them at the door. Most of the time we know who they are, especially if this is a return visit. So um, you know, we're able to greet them and sort of you know just make them feel safe and at home and relaxed. Um, and so that environment makes a huge difference. It also particularly was important to us to create an environment that didn't make them feel like they were entering a clinic. And this was significant when it came to young people, teenagers, children, because one of the things that we want to avoid is them sort of self-diagnosing and thinking there is something wrong with me. Look, I've been brought to a clinic, a hospital, and so creating a space where it feels a long way away from a clinical environment. We have a lot of uh people coming with their dogs, and the dogs are you know, can walk around, sit on the sofa, do whatever they want, even though we wanted it to feel sort of semi luxurious. We also didn't want there to be any rules. So it's not the sort of environment where you think, well, I can't move that book, or I can't, you know, bring my dog in, or I can't put my I don't know, wet umbrella, uh, bring it into the building. All of those things are part of that sort of lived-in homely feel that we encourage. Um so having that sort of the environment couples with coupled with the client services um team, that immediately sort of starts to make the experience feel very different. Uh, we then have taken other steps in terms of uh introducing, for example, pods. Um that came from again my personal experience where uh in in once I started to go to a very good therapist um who was actually based uh in Regents Park. And every time I came out, I had this wonderful sort of environment to step out into, which I felt was part of the therapy, especially in the you know, in the sort of milder months. You know, you walk out of your therapy and you feel like you you you know take a breath and take a moment and you know you process everything everything that's going on. So most people they step out of the therapy room and they step into the sort of the huss and bustle of the chaos outside. So we introduce these little pods, which are rooms where after your session you can go and have a lie down and take sort of some time to sort of relax, process, and tell us when you're ready to leave. Um, and you know, there are there are devices that we use here, uh sort of medically recognized devices, such as Alpha STEM, which is something that you attach to your earlobes and it it sends sort of mild pulses that help to relax you. Um, we've sort of introduced those little extras to make sure that when people leave the building, they do feel sort of relatively like their equilibrium is is settled. Um and uh and the team then also um reach out to clients to make sure that they were happy with the choice with the practitioner that was recommended to them, uh, that they know what their uh care plan is, all of those things are part about a part of building a relationship with the client. And I think when it comes to service and hospitality, it is ultimately do I or do I as a as a customer feel valued that they recognize and have put the time and effort into building a relationship with me? And do I, as a result, feel safe in their care? Never is that more important than in in mental health care. So those are the steps that we take to ensure that people do walk away feeling, yeah, I'm safe in their hands.

Dr Andrew Greenland: 17:54

Thank you. Um, how has your founding vision for the SOAC evolved over time, or do you think you are fully evolved at the moment? I just wonder if there's anything left that you're still working on or getting to kind of perfect your model.

Maryam Meddin: 18:08

Um it's it's well, I mean, it's uh it's a continually evolving uh thing, it's a dynamic thing. The the SOC and uh anyone who's run any business hopefully will agree that part of their responsibility is to make sure that they continue to evolve with it and evolve it. Um and for us that's no different, you know. We we want to make sure that not only are we keeping up with whatever developments and knowledge is out there um from one day to the next that we are introducing those uh new practices or or new discoveries into our work. So there's that side of it that you know we we can't rest on our laws. Um there is uh the other side, which is we we certainly have an aspiration to always innovate, and one of the ways in which we try to do that is by um the the combining of the various types of expertise that we have at our disposal. So we're now we're an organization of almost a hundred people now, and um I think about 75 of those are practitioners. So anything from psychiatrists, psychologists, psychotherapists to coaches to experts in grief, experts in supporting families of addicts. Um we've sort of tried to cover the and look at the entire sort of family unit structure and think, you know, if somebody's going through something, what does what do the other members of that unit need as well? So we try to um to accommodate the whole the the well-being of the whole unit. Um and we sort of realize that actually one of, you know, like any organization, our greatest assets are people, but our greatest asset is is that knowledge that if combined can really create amazing things. So putting together, for example, somebody from the family team with somebody who is an expert in trauma, with somebody who is an expert in corporate well-being, can hopefully lead to new and innovative approaches to dealing with workplace stress. Um, and I say that because you know, you've got the corporate culture person, you've got the family person. Most organizations at some point or another will refer to themselves as a family, especially the larger they are, the more often they sort of use that terminology. Okay, well, let's get a somebody who is an expert in systemic family therapy to be involved in that conversation and to tell us about the dynamics of the family and how they might be applied applied to the workplace. And let's look at the sort of the trauma expert and see how they can contribute to that conversation. So developing new products is certainly something that is an ongoing um process for us, and that we we are constantly looking at. So it's it's it can be a challenge because what we're doing is we're trying to do everything that we're doing well, but also you know, dividing up our attention to looking at what what's coming next and what can we do next, and how can we not be followers but leaders in that in the field. Um, so I don't know if that answers your question, um, but that's that's sort of our continuing aspiration. And of course, as an organization, we want to grow and we want to um we want to be able to create sort of centers of excellence in in perhaps different parts of the country uh where we can uh ultimately create an expectation in people that this is what mental health service should look like. And the point of doing that is to ensure that everybody else keeps up because uh there is there is a lot of uh of catching up with other industries to be done. And uh if people start to expect service as part of their health care, then all the providers will need to start uh start sort of taking that into consideration. And that that for us is an ambition to really change the landscape of mental health care beyond our own four walls, um, and as a as a sort of a cultural shift.

Dr Andrew Greenland: 23:11

Thank you. That very much does answer the question because it speaks to the whole growth and evolution of what you're trying to achieve and the direction of travel you're going forward. Would you mind telling us a little bit about what your typical day looks like? I mean, I know probably isn't such a thing as a typical day in your world, but do you find yourself most focused on strategy, team, patient experience, all of the above or something else?

Maryam Meddin: 23:30

Yeah, no, it is it is all of the above. Um I um it it I it's funny because the stuff I really enjoy, my favorite part is uh contact with with uh with the clients. Um and if I can sneak something like that in there, I do. I'm frequently sort of told to get back in my box. Um because there are now so many sort of people between sort of my role and you know, when when we first when we opened the doors, there was like I think four clinicians and four of us operational team. So I was always trying to uh personally welcome people to the SOAC and so on, and I still love that experience. So occasionally you will find me answering the phone um and and speaking to the people who are calling, asking for help. But my typical day um really is about um working very closely with uh our CEO um and to make sure that operationally everything is being considered. Uh he his name is George Brooke, and he came to the SOAC from working within sort of mental health um organizations. So he had a lot more experience about the operational side and the regulatory side of what we're trying to do. I came from it to it from sort of the I suppose vivent experience um communication side. So we need to work closely together to ensure that our two roles are complementary. Uh, and so there's there's a fair amount of time that's talking about what's going on on a day-to-day basis and what needs to be changed, what needs to be shifted, um, and also looking ahead at um what we might be doing sort of uh to to develop our services. I um also make a point every single day um to stop and speak to different practitioners. Um the culture of this organization I uh I consider to be my personal responsibility. And I'm very pleased to say that every single person who works here, particularly the clinician, say I've never worked anywhere like this before. So, and knowing who everybody is, knowing what their lives are like outside of their sort of profession, uh, is I think an important part of that. So I make time to get to know the practitioners, to spend time talking to them about what's going on with them, both personally and in terms of their aspirations, because the best way to hold on to your good people is to make sure that you are as invested in their career as they are in your organization. So, you know, we try, I try to make sure that I know what they want from their lives, both sort of bigger picture in terms of their sort of their whole life, including their family, but also in terms of their career aspirations and to see what we can do to make those things happen at the Soak, because that means they will, if they've got innovation, they will bring it to the Soak and they will do it through us. You know, if they are just simply brilliant at what they do and they don't necessarily want to change things, then they carry on just doing it with us uh and providing the care that we promise to our clients. And so uh uh some of some of my time is spent hanging around, sort of you know, watching people make coffee for themselves and just catching up. But I consider that to be an incredibly important part of my role, and uh we're also um in the process of opening our first international center. So some of our uh time and some of my time is taken up with dealing with uh with that. Our first center is opening in uh Malaysia in January. Um so there's a lot of communication with our Malaysian team pretty much daily as we get closer, it increases. And it can be anything from sort of talking to people about the renovation of the space to training on client services, uh, talking to the PR firm, um, who are looking after the launch of that centre. And we're also looking to grow here in the UK. So, for example, yesterday my colleague George and I went and looked at two different sites outside London to consider which might be the best uh for our next centre to open um outside the sort of metropolis. So there is no typical day. A typical day incorporates all of these things uh in different sort of uh orders and different demands.

Dr Andrew Greenland: 29:00

Thank you. Um what role does um client feedback play in how you shape your services? And are there any um patient stories or moments that have really validated your approach to how you've designed what you what you do at the SOC?

Maryam Meddin: 29:14

Yeah, I think um client feedback is incredibly important uh in two different ways. One is, of course, our outcomes and feedback in terms of how they have their well-being has improved or not, you know, we have to be real about these things. That obviously is very important to us clinically. Um so the in that sense, you know, being able to collect data on how they're doing uh really informs what we're doing from the clinical board and the clinical governance perspective. The other part, of course, is um feedback in terms of what their experience is like, and that also. So has been very important to us from, for example, our Care Quality Commission rating, where we were awarded outstanding in our first year, that was based partly on the feedback that our clients gave about us delivering on the promise that we had made to them. So it's a huge part of it. And as you can imagine, we rely largely on word of mouth. A lot of people will recommend a therapist, a psychiatrist. You know, I think it doesn't matter whether you're looking for a knee surgeon or a psychiatrist. Often the first place you go is people that you know and say, Do you know anybody who's good at this? So the feedback that they may not give us, but they give to other people, you know, we want to make sure it's it's positive. So it really does inform how we do what we do on a daily basis, you know, on a daily basis. And we try very, very hard to encourage people to give us feedback. We've got sort of, you know, note cards in reception, we've got uh, you know, we're registered with I Want Great Care, where they can go online and give us feedback, you know, whatever we don't mind how they do it so long as they give it to us because it's something, and actually, you know, the the people most reluctant to help us collect that feedback are our practitioners because they're uh that you know they don't want at the end of uh somebody's therapy session to say, How was that for you? You know, give us the thumbs up if you thought it was a good session. So um we try to do it with some sensitivity, but but it does really inform the way that we do things. In terms of particular um memories or experiences that I've had that have really been meaningful on that front, I I my favorite memory is coming into um sort of a relatively public area of uh of the building. This is about three years ago, and um being told to shush. So, you know, one of one of the team sort of just went, shh, and I said, Why? What's going on? And they said, Oh, so and so, this chap who who had been coming to us for um a number of, I think it by that stage it was months, not just weeks, it was probably two or three months. They said he's asleep in the pod. I said, What is he? This is this is not his day, because I knew exactly who he was and who his practitioner was. What is he doing here? And they said, Oh, he um he had a session in one of the pods and he slept so well, he has terrible insomnia. So for the past week, he's been coming here every day. And we basically we tuck him in, give him a cup of mint tea, and put on a um a white noise machine, and we just leave him to sleep there for as long as he needs. And the fact that somebody felt so safe here and so welcomed, uh, that he would go to his, you know, in Birch Thomas mental health provider for an afternoon nap, I think was the highest compliment that I could possibly have wished for. You know, this was this meant everything uh to me. But I think, you know, on a on a sort of you know, daily basis, seeing the engagement between clients and the the front of house staff and how comfortable they feel. Um, and uh, you know, that that interaction between them is it it really is heartwarming. It means that we're doing it right, that they come through the doors and they feel this is my space, and I can I'll be treated with warmth and generosity and the sense of belonging. Um, and you can just see it in their body language, and that's that means a lot, that matters a lot.

Dr Andrew Greenland: 34:18

Lovely, what an affirming story. Um what what are the um the broader shifts that you're seeing in mental health or well-being care right now?

Maryam Meddin: 34:27

Um well, I think one of the things that's that's constantly being talked about um both around me and and to me is about sort of digital health. Um and there is certainly a place for it. There's absolutely no doubt about that. But I think um from a point of concern, the the issue that I sort of ruminate over is is that the bigger that gets, the less quality control can be implemented. And so that's that's a huge shift. I think that the uh you know the number of people that have said to me that they have had sort of mental health conversations with Chat GPT, I can't tell you. I mean, every every dinner party I go to, somebody seems to mention that they've they've had a go and they thought it was pretty good. Um, and that's great. You know, if you are if you need a a pep in your step, get it from wherever you can get it. But if you have a serious problem, um make sure that you're getting you're seeking out the right kind of help, and then choose where you're going to get it from. But but don't automatically just just rely on this sort of uh this faceless divide to be where you get your your healing from, because it can be dangerous, it can be even good therapy, even the best therapy needs to be delivered in a considered and thoughtful and careful way. So, and that is a you know, one of the advantages of the way that we run things here, for example, is that we have a multidisciplinary team who every single day uh have a multidisciplinary team meeting. It's psychiatry-led, you know, we have a um safeguarding officer, we have other safeguarding members of the team who are uh who are trained uh members of the team who are participate in these meetings and who advocate for the client and who you know are there to ensure that the client's wishes are taken into account as much as sort of the clinical needs of the client. Um and therefore it's a very, very safe space in which to push clients, perhaps occasionally in the therapy room beyond their comfort zone to try to get them where they need to go. That being done through sort of a remote care, and sometimes you don't know where that remote care is coming from, what the qualifications of that person, even if you're not dealing with chat GPT, but you're dealing with you know some somebody who is um just providing sort of uh some sort of digital therapy, it's it's quite difficult to know how to ensure its safety. Um, so I think that's a shift that on the one hand, you welcome the fact that more and more people are receptive to the idea that they they might need to consult with someone with a third party, that's a very welcome development. But um the the sort of the enormous explosion of digital digital health products, I think is a little bit concerning. In the absence of good regulation, um it's it's concerning that anybody can call themselves a therapist and uh and it it can lead to dangerous outcomes.

Dr Andrew Greenland: 38:25

Definitely. Um so where are you looking to take the SOAC over the next sort of six to twelve months or so? I know you've talked about expansion, the international arm, but do you have any other services, formats, or client services you're look exploring to implement?

Maryam Meddin: 38:40

Um yeah, well, we're we are looking uh at having two sort of specialist centers potentially. Um, you know, one looking at uh child and adolescent care, the other potentially looking at sort of trauma and uh body and mind sort of um health care. Um so so we're looking at how we can sort of really sort of uh put our put our what's the saying, put our flags down as as being experts and uh in a in a particular niche area. Um and that means expansion, sort of geographical expansion, as of having specialist sort of centers. So that's something we're we're looking for. Um in terms of our existing operations, you know, over the last two years we have added sort of a neurodevelopmental uh specialist team who look at sort of autism and ADHD from children to nowadays, you know, there are people in their 60s and 70s who are looking for assessments and diagnostics. So we've had that, we've established the specialist sort of addictions team, we've established the specialist um eating disorder team. And I think looking at the practitioners that we uh have access to and seeing how we can bring together uh them together and create multidisciplinary teams, all of whom are focused on uh recovery from the same particular presentation is something that we're keen to continue to pursue. Um, and we will continue to do that within our existing operations.

Dr Andrew Greenland: 40:38

On that note, Mariam, I'd like to thank you so much for your time this afternoon. It's been such an interesting conversation hearing about your founding journey and how you've created and inspired the model that you have at the SOAC. Really, really interesting. Your um massive emphasis on service and the client experience. I think there's a lot that people listening to this could learn from in terms of what they bring into their own practices. But I would really like to thank you very much for your time. Very much appreciated.

Maryam Meddin: 41:03

Thank you so much for having me, and it's been a pleasure.