I recently came across the blog below, entitled ‘A better future for mental health care: acceptance, choice and dignity’ and published at the end of January 2013:
‘So it is time to think differently […] I am all in favour of that. I’m all in favour too of echoing the theme of shifting power back to patients, but that is a tricky issue when you are talking about people in a mental health crisis. I mean a real crisis, when the mind is scrambled, the meltdown is happening, and it is hard to allow or expect the person at the centre of that crisis to make lots of rational decisions.
This is when talk of rights, choice and control tends to go out of the window. Sometimes, that can be understandable. But it doesn’t always have to be so. There are still ways of respecting the knowledge and views of the patient in crisis. Sometimes it happens. Often it does not.
Crisis tends not to happen suddenly. There are warnings; there is a build up. If the warnings and the build-up are spotted, then hopefully preventive action can be taken […] If you know what helps and what doesn’t, this will be trusted as valuable expertise and will shape the care you receive if and when crisis comes. In fact you’ll have a crisis plan that you’ve negotiated with your care team and signed off yourself that sets out what you want to happen and where you want to go when you’re in crisis. It won’t happen in every set of circumstances. But it could happen in many more situations than it does now.
This may sound obvious, but Mind’s crisis care inquiry found that too often people are turned away and struggle to get help. Their crisis calls may go unanswered or they are told they are not ill enough to qualify for help. But the fact that they are there at all means they could be well down the road towards crisis already. Too few people have a crisis plan, and those who do are often not involved in deciding it, or say it is stuck in a filing cabinet and rarely referred to. The Care Quality Commission prioritises care planning as something that needs to improve for detained patients.
In a better future vision of health care, your definition of your own crisis will count, and the plan you have co-written will determine the care you get. The benefits of peer support from other people with experience of mental health problems will be obvious and the people providing it will be valued as equals by other health care workers.
Alternative models of service that are massively valued by the people who use them – including Leeds Survivor Led Crisis Service and Maytree – will spread rather than being rare and isolated examples. It’s an overused term, but with the right changes, the postcode lottery of good access to crisis care beyond hospitals will end. And when you go into hospital or other services you’ll be treated with courtesy as a welcome guest. Boredom, insecurity and abuse on wards will be a thing of the past. Cultures of restraint will be replaced by respect and dignity.
How do we get to that vision? This is partly about health service cultures, but wider society sets the tone. Attitude change – underpinned by law – is fundamental. We need to see mental health as being about ‘us’ not ‘us and them’ – to end the stigma and discrimination. There is still a long way to go, as the three-quarters of people with a mental health problem who lost friendships as a result know too well, and those who lose their jobs – or never get one – because of it know even better.
But there is hope too. For instance, last year, MPs in Parliament and Assembly Members in the Welsh Assembly spoke about their own experience of mental health problems. They didn’t know when they took that step that their colleagues and the media would respond warmly. The fact that their stories were so well received shows that as a society we are slowly moving in the right direction.
Parliament is important but it isn’t in people’s daily lives the way that employers are. When it comes to helping people understand mental health and how to look after it, employers have a big part to play. Creating a mentally healthy and open workplace where employees feel supported enough to discuss a problem – that’s another marker of progress that is good for business as well.
Which brings me back to the staff–patient dynamic in health care. The NHS is a huge employer and its staff are rightly expected to care for people using clinical skills, respect and kindness – often in very high-demand situations, which in mental health settings include the risk of self-harm or suicide.
If we expect people to be kind and empathic in their work, that is how they should be treated by their employer too. If we want staff to work in partnership with patients, respecting their wishes and knowledge of their own needs, they should feel safe enough to discuss their own mental health. And if a small organisation like Leeds Survivor Led Crisis Service can provide staff with supervision, reflective practice groups, experiential training and individual wellbeing budgets we should expect the NHS to support its frontline staff just as well.
The journey to achieve a better future for mental health care is too slow and too long, and the time for change is now’.
When I finished reading the blog presented above, I thought that it must have been put together by somebody definitely committed to progressive – one could almost say radical- ideas concerning mental health care; somebody who seems to me to depart from what could be viewed as ‘mainstream’ (I know though that defining ‘mainstream’ is far from straightforward) approaches to issues at the very heart of mental health care.
The blogger’s ‘better future vision of mental health care’ appears to encompass principles, priorities and themes that I understand to be endorsed and campaigned for by the psychiatric survivor movement, including:
- the need for a different way of thinking
- shifting power back to patients but at the same time recognising that people experiencing acute mental distress may have limitations when it comes to rational and responsible decision making
- the need to support people in (mental health) crisis to exercise their rights, choice and control as much as possible
- the critical importance of respecting the experiential knowledge and views of people in (mental health) crisis
- the need for the theories of people concerning how their mental health crisis is to be defined and understood, as well as people’s experiential knowledge regarding their areas of vulnerability and risk, their support needs and protective factors in their lives, to be trusted as valuable ‘expertise’ and used to determine their mental health care at times of crisis
- the critical importance of people having crisis plans that have been negotiated and co-produced with their mental health care teams; the need for crisis care planning to be viewed by mental health staff as a meaningful and necessary activity and not merely a paper exercise
- the value of peer support from other mental health service users/survivors and the need for peer support workers to be treated as equals by other mental health workers
- the need to recognise and expand the use of alternative models of support
- the need for mental health services (both inpatient and community services) that are welcoming, stimulating, respectful of people’s dignity and relationally secure [i] therapeutic environments, characterised by collaborative staff-service user relationships; environments where staff are appropriately trained and refrain from abusive and coercive treatment of service users whilst showing kindness, empathy and compassion towards them
- changing mental health service cultures in the context of wider attitudinal and legal changes in society with regard to mental health and mental ill health as a prerequisite to achieve a better future vision of mental health care and end mental health stigma and discrimination
- creating mentally healthy and open workplaces where employees feel supported enough to openly discuss problems with their mental health
- the critical importance for the NHS to provide adequate support to frontline staff in mental health settings, so that staff feel comfortable to openly discuss their own mental health in the context of supervision and reflective practice.
I guess the fact that the blog presented above was actually written by Alistair Campbell for the King’s Fund website (http://www.kingsfund.org.uk/time-to-think-differently/blog/better-future-mental-health-care-acceptance-choice-and-dignity) came as a surprise to me. Just to refresh people’s memory -Alastair Campbell is a journalist, broadcaster and writer, best known to the British public for his role as Labour Prime Minister Tony Blair’s spokesman, press secretary and director of communications and strategy between 1997 and 2003. With regard to mental health Campbell has been an ambassador for Time to Change, England’s mental health anti-stigma programme run by the charities Mind and Rethink Mental Illness, and in 2009 he was named Mind Champion of the Year in recognition of his work to fight mental health discrimination. I first came to know of Alistair Campbell when – back in 2008 I think- he spoke openly on a TV programme about his own experience of mental health difficulties, i.e. his depression and alcoholism.
It came as a surprise to me that a mainstream politician like Alistair Campbell presents a rather radical future vision of mental health care – that Alastair Campbell who has been portrayed as ‘New Labour attack dog, bully boy and Machiavellian master of “spin”, i.e. deception and manipulation (Patterson, 2008) [ii] appears to defend values such as respect, acceptance, equality, dignity, open/honest communication, empathy, compassion, kindness and collaborative relationships within mental health care. How could one make sense of what could be viewed as ‘a paradox’? I am wondering to what extent Alistair Campbell’s own experience of mental health difficulties and his public, open disclosure of such difficulties, as well as his work with Mind and Time to Change in fighting mental health stigma and discrimination, may have played a part in determining Campbell’s evident commitment to rather radical ideas concerning mental health care. Finally, I am wondering whether this ‘paradox’ may need to be viewed simply as one manifestation of the complexities, contradictions, inconsistencies and ambiguities that tend to characterise all of us – especially when it comes to such a contested area like mental health care.
[i] Department of Health (2010) ‘Your guide to relational security-SEE, THINK, ACT’; Kennedy, H. G. (2002) ‘Therapeutic uses of security: mapping forensic mental health services by stratifying risk’, Advances in Psychiatric Treatment, vol. 8, pp. 433-443
[ii] Alastair Campbell: ‘I can’t change what I am’ – Interview by Christina Patterson – The Independent, 2008 (http://www.independent.co.uk/arts-entertainment/interviews/alastair-campbell-i-cant-change-what-i-am-980007.html)