Dr Andrew Greenland: 0:03

Hello everyone and welcome to Voices in Health and Wellness. This is the show where we dive into the real stories, strategies, and shifts shaping the way we care for people today. I'm your host, Dr. Andrew Greenland, a functional medicine doctor here in the UK, and I created this podcast to give health practitioners a space to share what's working behind the scenes, how they're adapting to changing client expectations, and what the future looks like in real-world practice. Today I'm incredibly honoured to welcome Mike Delaney to the show. Mike is a true veteran of mental health care with a remarkable 50-year career that spans psychiatric nursing in the NHS, clinical leadership in addiction recovery, and pioneering work in holistic therapies. Over the years, he's introduced equine facilitated psychotherapy and somatic breath work as a powerful way to access trauma non-verbally, long before these modalities were mainstream. With that, Mike, I'd like to welcome you to the show and thank you so much for joining me this afternoon. Thanks for inviting me, Andrew. Glad to be here. So, Mike, you've had a rich um journey in this field. Could you talk us through your how your career began and what led you from psychiatric nursing to more holistic person-centered therapies?

Mike Delaney: 1:13

Yeah, it's it's been a long, but my mother always said colourful, I had a colourful life. So I'll I was never happy with just mundane. I was always looking for something better and how to improve things. So I started off in 1976 as a care assistant in the local hospital. Um, and I loved it. I loved that the kind of the culture at that time that was in the old mental hospital system. I know it gets a lot of bad publicity, but there was a lot of good things about it as well. And we've got rid of it, we haven't replaced it with anything. So mental health services today are appalling compared to what they were many years ago. So I I trained and I qualified in my local mental hospital here, which was a kind of 1200-bedded unit, um, large kind of 60-bedded wards. So it was a baptism of fire. Um and I remember being a student nurse and got on duty one day and nobody had turned up, no staff, and I was the only one in a 60-bedded ward to try and manage that whole system. So you learn you learnt how to firefight back then. So I did that and then I moved to England. Um I fancied a change of scene. So I I was a charge nurse in a large hospital down in Surrey, which is now closed. Every hospital I've ever worked in is now closed because I've sold it off, and um most of them are housing estates now. So it was um St. Lawrence's that was in Caterham in Surrey, another 1200, 1,300 bedded place. Um and I didn't realise, but as as time was growing and I was getting busier and working harder, the stresses and strains were getting to me at that time. We never had the support that you had today, we never had clinical supervision or anything like that in place. Um you just had to work and do what you had to do and and just get on with. So my dependence on alcohol um started to increase. Going to the pub after work every day and meeting other people and kind of processing and having supervision with each other, but alcohol was a factor. Um, and that gradually got worse. I moved into central London then um and I became a CPN. I was a CPN in East London for a number of years. Again, it was community nursing was in its infancy then, so we didn't have the safeguards that we do now. There was no loan working policy, so I was put in real danger at times, you know, going up into tower blocks and going to visit people who we had very little information about. So a few times I was I was met with knives and things like that. But again, there was no supervision, you just dealt with it, and then we all met again in the pub. And by that time, I knew social workers and other mental health professionals, so there was a gang of us. But again, me particularly, the alcohol and the recreational drugs were on the increase. Um, so eventually I I kind of I got to a point where I couldn't go on anymore, and I was um actively suicidal, serious depression, um made serious attempts on my life. This was in 1996, so uh I finally got funded and I went into rehab and I spent five months in rehab, um, which was a real game changer for me. It was life-changing because I had 20 years' experience as a nurse. I went into this clinic and was able to sit and watch how they operated so differently from how I had been trained. Um there was kind of they were forcing the clients into facing up to what they need to face up to. There were um drugs and everything. I was trained to dish you drugs, you know. I mean, oh, they've got this, give them this tablet, and suddenly they were saying, you know, getting drugs, talk to your group, talk to your therapist. Um so eventually I was fascinated by this different way of working, and I saw people around me who were absolutely broken, and as I was, and but I could also see other people transforming. It was like watching a butterfly um coming out of the cocoon and leaving after so many weeks, completely different people. I was in for five months, I stayed in for five months because I at one point I was frightened to leave. I just felt so safe and so contained. So when I came out of there, I I relocated to the area down in the southwest west of Supermare. I relocated into that area and um and decided to retrain and um get away from the caretaking role that I had been in within nursing. Um and kind of felt that I would be better at empowering people and guiding people and supporting people to find their own way. Um so I retrained, I started working initially as a nurse therapist in a large rehab facility in Bristol. So again, it was a kind of prison probation. Most of the funding was coming from mayors, so most of the patients, the clients were ex-prisoners or they were on probation for drug-related offences. So again, it was baptisma fire, but it was an amazing, it was amazing work. I was there for a couple of years learning how to manage this kind of this type of client. Um, and again seeing transformation, seeing people who had been in an empty prison for years suddenly finding a new way of living and kind of relocating and starting again. Um the one thing I noticed from my own experience and from working there was at that time there was a one-size-fits-all model. Um trauma wasn't looked at, childhood stuff was touched on, but not very much detail. So the philosophy then was deal with your addiction first, and later on, when you're sober, you can deal with your trauma. And even back then in my early days, I was thinking this this is the wrong way around for me. You know what I mean? That people need to be able to deal with a trauma in order not to drink or use drugs because that's what they use on, they use on that pain. Um, it's an escape from how you feel. Um, so I was always trying to find other ways of of developing that and tweaking um the 12-step programme. I mean, the 12-step program got me well, and I went to meetings for years, and I'm totally grateful to that um philosophy. But I've learned over the years as a therapist that it just doesn't work for some people. Um, it doesn't work for a lot of people because things like trauma and abuse and all that aren't managed within that um framework, if you like. So I've uh I did develop new, I opened a few different rehabs over the years. I set up a place in Jersey called Silkworth Lodge, where we started shifting towards a more trauma-focused approach. Um then I opened a place in Gloucestershire called Steps, where we again did things differently, and that's where I introduced um equine facilitated psychotherapy. That was 2004. Um, so that was the first time a huge change like that had been made, where um horses were an integral part of the recovery programme, and and going down and being with horses, and that's where we started to realise that horses had this ability to unhook trauma and allow trauma to emerge during the session. We didn't know that in the early days because there was nobody teaching us. We were kind of pioneering this thing and learning on our feet. So sometimes we'd go, What's going on? Why is a horse doing this? And eventually we realised this is trauma coming up, and the horse senses it, and the horse approaches and wants to kind of help with that. Um and then we started working particularly with London Underground. I had a contract with so drivers, drivers in London Underground have quite often got trauma because people jumped in front of their trains. Um, we had some drivers following 7-7. Again, people were frightened to go to work because they had been bombed. Um, and people started using drugs, so some of the London Underground staff who hadn't been previously doing anything like that had started because the stress of going to work was was very high, thinking, Am I going to survive today? So we started getting this kind of trauma coming through the doors. Um, and we started saying, right, let's put the addiction on hold at the minute and let's manage this trauma. And it very quickly one underground contacted us because they had four or five providers in the UK, and they said to us, What are you doing differently? Because people are coming back from your place in a better space than they were coming back from other places. And it was echoing, it was that non-verbal, as you mentioned at the beginning. Um I've never I've never known another therapy that's able to somatically manage someone's trauma, hold that space, allow that release, and without me as a therapist, having to ask them what happened. So lots of people I've worked with who've got well, I still don't know where the trauma was, but the horse did. The horse was there and the horse helped them to manage that. So that was a kind of a big driver then for me moving forward. Um we formed an organization called LEAP at that time. So we were still working in the rehab, but we realized that the horses were a powerful treatment that we could use for other conditions as well. So LEAP was set up and we started working with young people, we started working with perpetrators of domestic violence, victims of domestic violence, people with other mental health conditions, um, just various groups of people that we started saying, right, let's let's work with that. And it was really effective with all of them. Um it was a it was a hard struggle at that time because everybody poo-pooed it for me. Started actually going out and trying to get funding and trying to get clients. Um it was like horses, what are you doing with horses? And there was this kind of cynicism about it. Um I kind of got laughed at the few meetings. But we persevered and eventually some forward-thinking people started saying, This sounds interesting. Some psychiatrists started getting on board, some social workers started getting on board, so we started to get contracts with different authorities working with different client groups. So within LEEP, we built up a huge clinical base of what we had done and what we had experienced, and we developed strategies about what to do and what not to do, and we understood it so much better. So eventually we created um LEAEP became a training organization, and we created the first diploma in England for mental health professionals to be able to do equitherapy, and that's been running now for maybe 10, 12 years, something like that. There's there's a lot of practitioners across the country now. Um I've started another, I took over an organization actually that was specifically for doctors. Um it was called Babery, and it was um it was set up specifically for healthcare professionals, doctors, anaesthetists, vets, um, nurses. But it wasn't it wasn't making enough money. They contacted me and said, could I come in and kind of troubleshoot and get it back on track? So I did that, and what I did was opened up, um I stopped it being exclusively for doctors, and I kind of opened it up and made it more generic. But we had a specific healthcare professional program because there's a whole different set of um issues when you deal with healthcare professionals. I think you probably know that a lot of doctors obviously have studied for many years and they intellectualize rather than feel a lot of stuff. So getting them into rehab and and doing it in a way that they understood and it got them out of their head and back into their body was another thing. You know what I mean? Um it's quite complex. And there used to be again, there used to be a lot of people go, well, it should just be a normal rehab. You know what I mean? What's this special and different kind of stuff that's going on? Um and I used to say, well, it's special and different because they are different, their upbringing's different, they've been in education for years and years and years before they start kind of functioning outside as doctors or whatever. Um and they've got a specific set of issues that the general public don't have. So um we created that programme and then we were able to have an integrative model where they were seen and they were dealt with sometimes in separate groups, and they were still given what they were needed, but we had generic clients coming in as well that um increased the income and made it um more manageable. It wasn't hugely profitable, but it was washing its own face, um, and it's still going, it was um sold on and it's still functioning down in the Midlands and doing the same kind of work. I don't know if they're still seeing so many doctors as they were, but um I think they're more of a mainstream facility. Um and then after that, I was kind of thinking I was trying to sit back and think of taking a rest. I had a private practice in Harley Street, I had a private practice in Birmingham. I was busy um just in my day-to-day clinics and things, um, and enjoying it. You know what I mean? I was able and and my one-to-one work, I was still doing trauma work, I was doing one-to-one equine work with people, so um it was variety, and I was enjoying that variety. And then I was approached by um a gentleman called Martin Preston, who I had met previously. He was uh kind of an addiction, like a landing page. People used to go to him, and then he could signpost them to anywhere that was suitable for them when they were looking for rehab. And he had decided he was going to build the first purpose-built rehab in the country and wanted me to um head up. And I was like, I've just got my private practice and all that running, I don't want to get involved. Um, and he came to my office in Birmingham and he unrolled the plans for Delame on my desk. And when I saw the plans, I just went, oh my god, I can't I can't resist this, it's too tempting. Um so I signed up for that. That was in um 19, I think, 2019. Um so they had a a site in Cheshire with an old Tudor, mock Tudor building, which had been uh some kind of unit for autism, um, and they demolished that. It took months to demolish that, and then they they built this amazing facility. Um so meanwhile, in the background, I was trying to create a brand new way of working my addiction, completely different from anything that was out there. So we kind of had the 12-step program was there if people wanted it, but we were looking at a completely person-centred, trauma-informed model of treatment. So we created what's called Stop Start Grow, um, a three-phase treatment program. Um, and it's been amazing actually that the transformation in people, the way that people have come in, and immediately exactly what I imagined, the conditions were safe, the building was safe, the staff were trained to be empathic and compassionate, and um, and immediately we started seeing people unable to hold the trauma. It started coming up and emerging because they were in a safe space. So, for the first time in their life, this stuff was emerging right away almost when they were coming in. So, over the past few years, that that program's been developing and improving. Um, there's a lot of focus on the staff as well, there's a lot of kind of staff training and staff support. Um, and so that's been a really exciting phase. Seeing that comedy life at the minute, they've just got planning commission for the second Del Mere facility, which is going to be in Nottinghamshire. Um and it's been full since we opened at the start of COVID, um, and we were full right through COVID. But we had all these procedures to admit and isolate and all that kind of stuff. And because it was a modern design building, we were able to do that. A lot of rehabs are old buildings that have been converted. Um, so they're not always suitable, um, and they're not always conducive to getting well. You know, if you're in an old building with cheap IKEA furniture and the place is falling to pieces, it doesn't really invite you to get well. Do you know what I mean? It makes you think, look at what I'm living in. Um rather than you go in this place and it's luxurious and beautiful, and it's not any more expensive than the other mainstream rehabs that aren't like that. Do you know what I mean? It's it's a fantastic place, and the investment in the staff and the the program is huge, and that's where we introduced breathwork, um, yoga, equine, everything somatic is built into the weekly programme so that people are getting the opportunity to release their trauma in different ways, not just um through talking therapies. Talking therapies have got a place, but as far as trauma goes, um it's usually an inaccessible part of the brain, and when you try to start talking about it, your frontal lobe shuts down, your speech and language becomes difficult, you start going into fight or flight, so it makes dealing with it very difficult. Um but luckily we understand trauma much more now than than we did 20 years ago, either. Um so there's a lot of more um accessible help for people who have got trauma. So that's where I'm up to as far as um professionally. I moved back to Scotland in 2018. I moved back up to Scotland again, thinking it'll quieting down. And then I met a lady called Julianne Griffith, and we set up Equiscotia, which is a Scottish um equine facility, so we also did work with different groups, but um then we did the first Scottish qualification. There's uh an off-call um regulated qualification now in Scotland, a diploma in equine facilitated therapy and learning. So I teach that and get involved in that as well. Um but then I had some health issues of my own. In 2020, I actually got COVID in the very first wave. I was in Barbados on a holiday for my 60th birthday, and I got COVID, and it was before the lockdown, um, and when before I went, I was guaranteed there was no cases in Barbados. I would be able to go on my holiday and and get back, and everything would be fine. But when I got there, I tested positive. Um Barbados introduced martial law, so I was um Taken by force and placed in a quarantine camp in an army base, and I wasn't allowed out until the virus cleared my system, but it was no treatment, so the virus was allowed to attack my system and it remained in my system for 30 days. So there's been a fair bit of damage done. We don't really fully understand that yet. I've been getting treated for long COVID for a number of years, but then about 18 months ago I had a heart attack, and I've been left with quite severe heart failure, which I believe goes right back to the COVID. I never had any problems with that at all prior to COVID. So I'm now I've got an implanted defibrillator in my chest, and I'm better than I was. I'm kind of it's more about I've got my head into a better place than anything's physically changed because I'm still in the same position. But even the defibrillator is a bit of a kind of feel-safe, so I've now got this fear of dying. It was that's a strange thing. I saw so many doctors over the past year, and almost every one of them said, you do realize you're at high risk of sudden death. And I I had to say to one doctor at one point, you should do some training on giving bad news to people because you're not very good at it. So that's where I am at the minute, Andrew. I'm kind of a I've re-evaluated, I'm looking at this year slightly differently. Um, and rather than trying to do too much and prove that I'm okay, I'm reining in how much I do and trying to just stay on top of that and kind of enjoy my life a bit more again.

Dr Andrew Greenland: 23:51

Thank you, Mike, for sharing such a, like you said, colourful, um interesting, and deeply personal story. I find it very interesting that you know some of your experiences being on the patient side of the fence have shaped what you've able to, what you've been able to then create and develop in terms of things that have helped other people. And I think that's a really interesting theme on this podcast, the kind of patient journey that a lot of practitioners experience themselves and how that shapes what they do. So thank you for sharing that. It's been really, really interesting. You've touched on COVID a couple of times, and I just really wanted to ask you because I know you said on a conversation we had before that you've seen a huge rise in ADHD and autism diagnoses post-COVID. And I just wonder what your take on that was and what you think is driving that shift.

Mike Delaney: 24:31

It's it's a really interesting thing, and I've thought long and hard about it because even some people that were my clients before COVID and after COVID developed all these other kind of symptoms, and and sometimes I've been on Zoom calls and I've suddenly noticed things and I've said, Are you ever been tested for ADHD? Have you ever been assessed for ADHD? And they go, No, and then they go and do it, and they've got it. And it's I was thinking, how come a pandemic happens and then all this stuff emerges? Do you know what I mean? It wasn't a biological thing that's um that COVID causes in that sense. And the only thing I can come up with because it's it's been tangible, there's been so many, and there's been so many new referrals, and it's the first thing I see on the screen is this kind of behavior and inability to focus and things like that. My thoughts were that um the lockdown caused people, they were all stuck together. There was no no getting out of the house, no way to distract people distracting from their own feelings and thoughts and behaviours. And I think a lot of people um mask their symptoms. A lot of people have um neurodivergent stuff happening, um autism spectrum disorders, ADHD, things like that, but they've learned how to mask it and hide it because um they feel embarrassed or ashamed about it. And I think lockdown made that impossible for a lot of people because they were stuck in the same house with the same people day in, day out. They didn't have the distractions and the activities outside of the house to enable them to wander and do other things, they were just in that position, and I think that became very difficult for a lot of people to hold that stuff and manage that stuff. That's the only kind of thinking that I have that that could have caused this. Um because it's not just me, I speak to other people and it's everywhere. Um and services that I mean services for ADHD and autism are overwhelmed right across the country because the the referrals have gone up so high. Um so it's interesting, and it's interesting because you have to kind of shift your way of working. So a lot of my clients now I have to work with differently because of that. You know, I mean, a lot of people assume that an ADHD diagnosis means they have to go on medication. So I'm always saying to people, get a test for medication, but don't assume that you're going to need it, and don't assume that it's going to change your life because the people I've worked with that are on the medication, it took a long time and experimenting with different drugs and try training it to different levels to get what they need. And also a lot of my clients have got addictive personalities, and the ADHD meds are very addictive. Um so there's a whole thing about I kind of recommend that if you've got a partner or a parent or whatever, you give them the meds and you get them to dispensing so that you don't have access to them because that's another another problem if somebody's in recovery from addictions and you suddenly give them amphetamine type drugs, and it can be really problematic. So there's there's learning, a lot of new learning happening now around that stuff as well. And how even within within gelamine or within rehabs, you're looking at the same thing, people coming in being assessed as they arrive, and you can see and feel the ADHD is present or um ASD is present because there's certain little things that you notice that maybe you wouldn't have noticed before. And this group of people, because of the neurodivergence, they need different ways to operate. An example would be when I was I was physically working in Del Amir at the time, and a gentleman came in, and in the first session with him, I could see the ADHD, it was so evident. And I stopped him and said, Have you ever been assessed for ADHD? And he said, No, my mother wouldn't pay for it, she wouldn't pay for the assessment. Um, but I think I am, and I said to him, right, well, because normally when you come into a rehab, one of the first things is you write a life story, you write your kind of interpretation of your life, and it gives a kind of playing field then to start looking at areas that were problematic or whatever. Um, but that's normally written and then presented. Um, but for somebody with ADHD or artistic spectrum disorder, this guy in particular I said, I want you to do your life story in a form that you want to do it in. I know that maybe writing it out longhand isn't for you. Um, you can do it in a dictive phone if that helps, or you can do it in a way that we'll meet you where you are, and then you explain to us what that means. And he came back the next week to present his life story, and he had a pile of papers, and he had his own symbolic scribbles and things on each page meant nothing to me, but when he held it up and showed me what each thing meant, I was with him where he was. It's a thing about um meeting your client where they are rather than trying to peel them into where you are. And it was fascinating and it was really in-depth, and all these scribbles meant things to him. Um and at the end it you said, you're the first person in my life that's ever asked me to explain things from my viewpoint. Um, and I think that's what happens a lot with neurodivergents. We we assume that they understand us. Um, and it made me realize at that point sometimes it's a bit like a a different language. And for a for a neurodivergent person to function in society is like being a translator. They have to listen to what we say to them, translate it into what they understand, translate it back then before they respond. So it's it's interesting. Um and it's interesting. I love the creativity of trying to find ways around um people's issues and supporting them with their challenges, and seeing the the kind of happiness in them when they've been acknowledged for having differences rather than being a problem.

Dr Andrew Greenland: 31:20

Thank you. I wanted to sort of transition from ADHD to emerging addiction issues, and there's been a growing concern around ketamine use, particularly um amongst younger younger people. I just wonder what you're seeing on the ground in terms of the health consequences and the support needs of these people.

Mike Delaney: 31:36

Absolutely um shocking and frightening what's happening. And as young people, as people 16, 18, 20 years old, um, and they don't come forward until it starts being problematic. And mainly what I see is the bladder. Um so people who are 18 years old, unable to sit, even when they come into rehab, they can't sit in a group long enough. They're going out to the toilet all the time because the incontinence is there, the urgency, the bladder's been damaged so much that um and it's very, very painful as well. People don't realize when they start using ketamine how awful the symptoms are when it gets to that stage. Um and it has epidemic, I think one one month last year, 68% of the inpatient population was ketamine. So you're talking about teenagers in early 20s. I mean, when you see them healthy young people screaming in agony and saying, I can't do it, I can't sit here, I can't stay, I've got to go to the toilet, it's constant and it's really awful. And the psychological stuff as well, you know, it's it's a kind of a ketamine's like a dissociative drug, so you can actually get away and separate yourself from whatever your trauma or pain is. Um and initially, like most addictive behaviors, initially it worked, so we wouldn't do it. So it starts off and you go, well, that really works, that's really helped me. Um, but then very quickly it becomes a problem, you know, as you say, emerging addictions. I think it's changed the whole the whole outlook's changed. Lots of pubs are closed and lots of um alcohol isn't a big thing now with young people. Ketamine is, you know what I mean. People are not going to the pub and and they're not in that culture. When I was young, it was the pub, the pub, the pub. Everybody was in the pub. Now there's hardly any pubs. Um there is in bigger cities, but in your rural communities, you're lucky if you've got one now in a small town. Um, so that community hub's gone. Um ketamine is quite an isolated drug. I mean it's we take it in clubs, but a lot of people I've worked with shut themselves in a bedroom and take it. Um and so they're just sitting in a kind of daze for hours on end, and it prevents them also. They lose confidence, they lose that ability to mix and socialize. Um so it causes lots of problems and for the families because you know, addiction usually takes a long time to cause pain, um, especially alcohol, it takes a good few years before you start having consequences for your drinking. Um, drugs is normally a bit quicker because um things like if you're addicted to heroin and cocaine, it you need money, and so eventually criminality comes into the picture, and shoplifting and all that kind of stuff starts having consequences. Um, ketamine very quick, very quick indeed, that the consequences happen and it's the physical and emotional stuff together. Um and it's it's very scary for that generation. Um and they've just there was a a kind of a lot of pressure to try and make it a class A, but they haven't done that, they've kept it as a class B, which means it's going to be still easier to get hold of for a lot of people, and it's cheap. And that's when you have problems, when drugs and stuff are cheap and easy accessible, then it becomes the go-to. Um even when I've sat in groups of young people and spoke about it, and you can see then that'll know how to me kinda. And I get that when I was 18 drinking, um, I felt invincible. I never thought it would ever become a problem for me. Um, but it does, it does, and ketamine is the number one concern at the minute.

Dr Andrew Greenland: 36:04

And do you think um traditional recovery models are really equipped to deal with this new wave of addiction?

Mike Delaney: 36:11

No, I think I think you have to um tailor, you know, young people don't. I had this argument a long time ago when when um we were starting with well, actually before Delame, when I worked with young people, parents would come and say, My son is 17 and he's using drugs and we need help. And I used to say, you need to be realistic. A 17-year-old is never going to believe that he needs to be absent for the rest of his life. So you have to find a new way of giving that information and supporting people. Um I worked for young one young boy a few years back who was in a terrible mess with um benzodiazepines, but he was only 17. Um, and so I devised this whole program for him to be able to do some controlled drinking because he was getting to an age of going out with his friends and doing this and doing that, but we're trying to get them to come away for the drugs. Um so his program was about safe drinking, and rather than working with him about absence, which would never have worked, he's never going at that age. The temptation and the culture is so strong to go out clubbing and doing this and doing that. Um so we arranged a lot of education and he created a plan that he followed, basic things like um eating before he went out, no drinking drinks straight after each other, having consecutive soft drinks, so ways of harm reduction. Um and I'm not a great harm reductionist. I think um harm reduction is great for government because it it makes it look as if thousands of people are in treatment, but they're not. They're visiting a drug worker every week and telling them usually lies about how much they've used. Um the only thing I like about harm reduction is it it keeps people alive long enough to come into proper recovery and find out what life can be like without any drugs rather than substituting, you know. I mean, and I think when you when you talk about methadone, for example, um it's harder to come off methadone than it has to come off heroin. Um it's quite a toxic drug and um it's difficult to get past the methadone. So once you're part of methadone, you're there for years and years and years. Um but it keeps the statistics low and it allows the government not to do what they need to do in order to get people well. There's a big argument up in Scotland here at the minute because we've got the highest drug death rate in Europe. Um and it's bad, it's a lot of people who shouldn't be dead that are dead because there isn't any, there are virtually no rehabs up here, there's no statutory funding to get you into rehab. Um so people don't get the option of abstinence, they get the option of harm reduction, or that's it, you know what I mean, or if you go private. Um and that's why most of the addiction services are private. There's very few statutory you can get a detox in a hospital, and some mental hospitals have a detox ward, some units, but generally there's very little in the NHS. Um home detox where a nurse coming in and prescribes Librium or whatever you need, but there's very little encouragement to come off altogether, which I still find sad because people don't get that opportunity that I got. You know, I mean I was lucky I didn't get that. I had to pay for some of it. Um I had to pay a kind of top-up because I was working, but generally people don't get that opportunity, and most people you speak to, even on the metadone programs or whatever, they're very unhappy. Um, they don't get the support they need to feel as if they're part of society.

Dr Andrew Greenland: 40:24

Thank you. So shifting over to your sort of clinic and your practice as more of a business, because it is, um, what's working particularly well from a kind of a business perspective in the work that you do at the moment?

Mike Delaney: 40:35

Um I think I've I've got a kind of um flexible way of working. So I'm able to work with people. I don't like working with people over a long-term period. I prefer to say, right, we've done three months, let's review what we've done, and then you go away and try and function, and if you get into any problems, contact me and we'll pick it up again. Um, so I like that kind of flexibility. I don't like people feeling dependent on me. You know, I don't like in Harley Street when I was there, there was a lot of people with um, and they were high net worth individuals, um, but they couldn't function very well. They were kind of dependent on everything, they were dependent on cleaners and this and that to keep them, to keep their lifestyle. And therapy was a part of that, and a lot of them came in every week and very little changed. There was very little motivation to to make a big effort because the people around them kind of enabled them all the time. So um I'm a very honest therapist, and I think when you when you've come from a place of addiction and you work with addictions, um you can be quite challenging in a therapeutic setting. Although I'm person-centered training, um if I see something, I'll name it. I'm not gonna sit and pretend that um you're doing great. You know what I mean? I'll actually say, well, I think we need to look at this and look at that because this is what I see. Um most people respond well to that, some people don't like that. Some people will say, I'm gonna go with someone else. Um and there's a lot of therapists out there who just nod their heads and don't challenge anything. Um and the same clients going to them every week for the same issues for years and years. I had a client came to me once in Harley Street um and said, Can you start seeing me? I've been seeing a therapist further up the street for 21 years and she was still drunk. You know what I mean? She had been going to this person for all that time and was still drunk. Um so there was very little change happening within sessions. Um if if there's nothing happening within my sessions, then I have a kind of discussion and say, I think it's time to call it a day, or is there something else you want to look at? You know, I mean I'll just bring it right into the the dialogue. Um and I kind of I have an expectation with my clients that they'll do the work they need to do in order to get well. Um so I give them homework and I give them assignments and I ask them to do the assignment and send it to me, and then we'll talk about it in the next session. So there's there's lots of ways of engaging people. I think when you just see somebody once a week or once a fortnight, very often you end the session and you don't think about it then until the next two weeks has gone past. So there's very little to bring to the table. Um it's actually another another benefit of um equity. It's when your room-based stuff is coming to an end, and you think, well, we've worked on that. If you have an equine session, it often brings up a lot more stuff again. Stuff emerges that then you can do another set of room-based stuff looking at that. It's very interesting. And that it's interesting the way the horse does that and and the way it comes up. You know, suddenly maybe the horse won't move, and the person loses confidence because they can't get the horse to do anything. And then that brings up childhood bullying, school teachers, you know, all that kind of it's an interesting thing because it brings up, it's the only thing that I've watched with where the answers absolutely come from the client. Their perception of what's happening comes from them. I don't say the horse is doing that because they tell me I know why the horse is doing that. Because it's it's a non-verbal thing that happens for them and they find what it means. They tell you what it means, and then they then say, I want to fix this, I want this to get better. So it's it's very interesting. When you can flip between the somatic and the room-based stuff, it's um it's much healthier, I think.

Dr Andrew Greenland: 45:25

Thank you. On the other side of the coin, what are some of the challenges in running a clinic business in the moment in 2026? Whether it's operations or aligning team members or anything else within the business kind of aspect, what what what are the challenges or maybe things you've had to overcome in the work that you do?

Mike Delaney: 45:42

Yeah, it can be difficult. One of the difficulties is that um a lot of people, particularly when they're in the throes of addiction, is they haven't got money left. You know, they've they've disposed of a lot of their money due to the addiction, particularly gamblers. Um alcohol and drugs, you can go a long time. When you get when you're gambling heavily, um it's not until you lose your last £10 that you think I need help. By that time, you're not able to fund a group of sessions or a rehab or whatever. Um, so that's a problem. Um culturally as well, there's uh there's still a shame attached to um having an addiction and going into rehab. Um I don't care about it, but lots of people do, lots of people are ashamed and don't want people to know. Hence lots of the fellowships are anonymous, you know, alcoholics anonymous, cocaine anonymous, narcotics anonymous, and that's all based on um people not knowing your business. So you don't there's a kind of shame attached to having an addiction. I think we're getting better. I think that the culture's changing. Um if you go to America, it's just mainstream. You know, people go, oh, it's my lunch hour and I'm going to my meeting, or um, they talk about the therapist or whatever. It's just a normal part of life over there. It's getting better over here, but that is also an issue is um shame. I think financially, particularly for rehab, because it's a big outlay, um, when you go privately, when you think it's something in the region of 20 grand for 28 days, um, which seems a lot of money, but the the amount of input and um professional help you get in that period is phenomenal. You know what I mean? So I think it's great value. And sometimes when when I've got clients that need it um but don't want to pay for it, we have this conversation about right, what would you do if your car broke down tomorrow? You'd find the money, you would get it fixed, and you would you would be mobile again. You need to invest in your life, you need to, if you've got an addiction and you're not getting funding and you can't get a service, you need to go private. Then you need to look at a loan, you need to invest in your wellness. Um so sometimes it's about taking out a bank loan or going to family members and saying, Can you help me with this? And sometimes I talk to family members and say it seems like a lot of money, but if if it works and he's absent, then he's going to have a good life, and that money's going to be paid back in droves. London Underground, as I mentioned, they did a survey because they had a really fantastic drug and alcohol service that kind of looked after people at their work, and then if they needed rehab, they funded the rehab. Um, and their their research showed that for every pound they spent on treatment, they got five pounds back in um function and um loyalty, and people came back for rehab and didn't go in the sick and remained clean, and so they had this kind of um reward for that investment. And if a lot of if a lot of companies were more open about that, they would see that investing in your staff is worth it in the long run because you get better productivity, more loyalty, a better standard of work, because people are grateful when you look after them, when you take care of them. So there's there's lots of little issues like that. There's um the cost of living crisis was a big thing where I sort of had quite a few regular clients, but when you go into struggle and start struggling financially, then things like therapy are the first thing to be chopped from the menu. Um obviously other things are important, but that was a problem at the time. It took a while to rebuild after that. Um the same was back in 2008 with the financial crash, it was the same thing, everybody was suddenly counting on money and panicking about money. And then my move up to Scotland was um because I came from London professionally coming up here, there was less disposable income. Um wages and things are less up here, so affordability is lower. Um but then I've got a mixture of local clients and longer-term clients because of Zoom. This has been a great thing, I think. One of the positive things from um COVID is that Zoom sessions started, which would never have really taken off before, but now they're really popular because people don't need to leave home. Um and you can do as much work in this kind of relationship than you can in a room. I mean it doesn't really matter. I used to think you need to be in the room, you need to feel the energy and observe the body language. But once I and I started when I was in quarantine in Barbados, I was bored, so I started doing Zoom stuff then, and that's when I went, oh my god, this is interesting. This can this can be um this can work. And again, it's you can charge less because you don't have the outlay of a room, an office, all that kind of stuff that you do if you're seeing clients one-to-one, like in Harley Street, it was expensive to be in Harley Street. Um, so you have to charge a lot of money to pay for that side of the business.

Dr Andrew Greenland: 51:44

Um Mike, what's next for you? Um, going forward perhaps the next six, twelve months. What are any plans on the horizon? Things you're looking to go into develop? What's the kind of on the what's on the horizon?

Mike Delaney: 51:57

Yeah, I'm looking at the minute uh um developing some equine stuff because of my health. I haven't been around horses much for the past year. And I've really missed being around them because they help me as well. I like I like the energy of that work. It slows you down, it makes you more aware of your own stuff as well. Because if you're not looking at your own stuff, the horse can react to that and make sessions difficult. You know what I mean? I've been in sessions where the horse is ignoring the client, and it's more interesting what's going on for me. So getting back to that kind of where I need to be um fully aware of what's happening for myself. And there's I've had some opportunities to look at retreat style weekends where people come and they do equine and they do other somatic stuff, breath work, um mixed with some corporate stuff. Um one of the things I did in the early days because nobody would pay for egg wine because it was expensive. So I used to do corporate days like leadership, management, team building, things like that. Very powerful when you do it with horses, um, and it's very profitable because companies have got training budgets and will will pay £2,000 per a day for um six staff to come and do something. You know what I mean? That's it's affordable. And that money then allows you to do other things for people that have got less of a budget. So there's always a kind of a balance. Um but I'm looking at doing we've found a facility near Glasgow which has got everything. It's got a hotel on site, it's got a bar, a restaurant on site, um, it's got different areas you can work within the facility. So we're looking at um some training days, some retreats, um, and that's interesting. It's it's less pressure. Um sometimes when you're doing therapy work all the time, it can get really tiring. And especially now with my heart and things, I'm trying to do less strenuous, um, emotionally draining stuff, and doing stuff that's lighter and easier to manage and let go of at the end of the day. Um so that's what I'm I'm heading for. I've had two books published. Um I'm looking at a third book now, kind of part one in my biography is out and it's been out for a couple of years, and I want to follow that on because it ends when I get sober. So I've got 30 years of sobriety that I can write about as well. Um, and many things have happened during that time, so I'm kind of playing with that as well. I quite enjoy the writing process because it isn't about therapy, it's about telling a story that's going to be interesting for people to read. Um, and that's a different mindset than um into therapy and talking about what happened. You know what I mean? It's when I was doing the last one, I was it was fascinating that I was telling a familiar story for me, and then thinking, how can I make this more interesting and help people to understand what this means without it being a a kind of dictionary of therapeutic terms. So I've tried to I try to write in a way that takes a person there with me. Um and I write about what it felt like at that time. It was confusing at first because my brain was going, I better explain that, I better explain that. And then someone said, No, just tell me what that young person was feeling and thinking. And so that's what I started doing, and it works, it works better, and it makes it less difficult for me to write about difficult things.

Dr Andrew Greenland: 55:55

Mike, I wish you were the best with that. And I'd like to thank you so much for joining me this afternoon. It's been such an insightful, grounding conversation, deeply personal, very interesting to hear about your journey. I think listeners are really going to get a lot out of your perspective, especially the long term view of how mental health has changed. And obviously, your pioneering work with the equine therapy has been fascinating. So, thank you very much. Really appreciate it.

Mike Delaney: 56:19

Very welcome. Thank you, Andre.