The systemic is sort of individual

You can either be on the stage, just a performer, just going through the lines… or you can be outside it, and know how the script works, where the scenery hangs, and where the trap doors are.

Maskerade by Terry Pratchett

I was engaged in a Twitter conversation that really distressed me. I had Tweeted something that wasn’t that controversial to me along the lines of ‘Most mental health professionals are pretty incompetent and out of their depth‘. I just believe it is true, it’s my view, born out of my experience.  I was also responding to someone’s comment about an insensitive remark by a mental health professional and felt momentarily despondent. Actually, as it was someone else sharing their story I think a professional who commented said something much more helpful than I managed to. I will learn and I am learning. But really context people! So when another Tweep added in their view that ‘People generally attempt to do a good enough job‘ and they are not ‘bad people’. I had quite a strong reaction.

It boils down to that suggestion, which she expanded on in her blog post, just being beside the point. It is beside the point that she has a dual role as a professional and as a service user/ client/ patient, that she has (in her current service) had a good enough experience of care, that she feels (right now) that she has a voice in her care, just as it’s beside the point that I too agree that many professionals are well-intentioned and doing their best. It’s beside the point because the system still does a lot of harm and that harm happens precisely because it is the system that is doing the damage as much as individuals.

So it is hard to convey systems understandings in a tweet, or even in a blog post. We seem to believe in systems as machines, arranged with the management organising things and a body of workers that carries out the actions of the system. This means our cultures believes lots of things like:

  • if we tell people how to change, they will use those instructions to change
  • if we criticise and frighten people in organisations they will be motivated to change
  • that problems happen because the organisation is not designed correctly

In a way this gets individual mental health workers off the hook. If the problem is that the organisation is not designed correctly, then the organisation is experienced by them as either neutral or something that stops them doing their job the way they would like. If everyone else agrees with them, then they are an actor on the stage. The play is set, they just carry out the scripts. They don’t need to think about the stage or the production. There is an alternative view. That people make organisations because organisational systems are created by people’s relationships with one another. They are living human systems. The beliefs associated with this are different:

  • appreciation of what people are trying to do helps them to grow towards that appreciation (this is not the service users’ responsibility, or the outside observers’ responsibility by the way)
  • as we interact with the organisation/ professional culture we are likely to produce a change in the organisation
  • how we talk about our organisations changes things, though unfortunately, we tend to see the world as we talk about it
  • imagination can be used to create desirable objectives and this makes changes in behaviour as it becomes organised to achieving that outcomes
  • language is creative and can create change
  • the stories we tell about our organisations matter

The system is it not quite individual. It happens in the networks of spaces between people.

The people who really run organizations are usually found several levels down, where it is still possible to get things done.

Small Gods by Terry Pratchett

So if I get frustrated with ‘It’s not why we trained’ or ‘See it from my point of view’ (see blog post It’s not why we trained)  it is because these conversations aren’t  just a one-off, they are repeated and they create organisational cultures. I am not part of your culture, or your mental health service, as a user or as a professional. In terms of ways I can influence, I’m fairly far down the food chain. All I can do is pick up the patterns on Twitter and say- Why don’t Mental Health Professionals centre the concerns of users? Why do you centre positive experiences when at times people need to think about how to make sense of and respond to negative ones? Why don’t you even acknowledge that negative interactions happen?

If you are telling stories about; how in Mental Health Services professionals are powerless to do better, or that professionals are powerless to do what they trained for, or powerlessness to act ethically, or powerless to stop their human rights abuses, or stories which say that however many stories there are of hurtful practice, well, there are other places where bad things don’t happen, then those stories have power. Oh and yes- it is not all Mental Health Professionals. I’ll get onto that later. I am starting to find ways to (gently- I hope) cast a light on all those organisational stories. I would add that many professionals who I pretty much feel do an honest and committed job contribute to these stories in ways that I think are problematic.

And I maintain that if the issue is one of Professional Abuse, Mental Health Professionals have no opt outs, it is an ethical obligation (if not yet always legal one) that you act to stop the abuse. There are no excuses on that one.

So if you are a professional, in order to start to change the conversation, why not stop with the ‘It’s not all mental health professionals’. Instead take a breath.  If you want to talk about how good your practice is – great. If you have a dual role and want to talk about having had good experiences great. Start a thread, write a tweet, post a blog. It’s useful to know that some people have good experiences or are committed to good practice. However, take your defensiveness, whether you have dual role or a single role and park it. Think about how in that conversation you can change what is being done to replicate the culture of Mental Health Services. You know what? Practice choosing not to engage with those powerful stories. Learn to change them. I cannot do that for you, you have to do it yourselves.

If you are a Mental Health Professional here are some tips:

  1. Offer empathy and understanding. Dare to recognise the poor practice in clear, unequivocal words. ‘I believe you’, however it is expressed, matters. Acknowledging what happened and the impact it had it important. Try expressing empathy for people’s feelings of being harmed or hurt. Try actually feeling the pain not pushing it away because it is uncomfortable for you. I do notice when professionals do this. Examples from professionals on Twitter:                                                                           Oh my. That was so scary. That was a very insensitive and unhelpful remark.                                                         That is not care, that is abuse.                                                                                                     You should not have had to experience that.                                                                             It is sad that I have to acknowledge that I have colleagues that I would not want to be cared for by if I became distressed.
  2. If you have a dual role, before you tweet, try thinking about which role you are speaking from. Identify that and which role other people might think you are speaking from. Think about where the person you interact with is coming from. I am clear that I am speaking as someone harmed. My twitter handle is pretty unequivocal.
  3. Create your own space to blog about your own good practice, or start your own threads about good practice. It’s good to hear about it. A good example is @drmikepsych.
  4. Ask some more interesting questions instead. Recasting the conversations as ‘What can I do to improve what I do in every interaction‘. Try asking people who are talking about their experiences what is giving life to the system from their point of view, not your old ‘See it from my point of view‘ stance. Be careful with this as it is not people’s job to educate you when they are on Twitter. Develop your questioning skills so you don’t ask questions instinctively, but thoughtfully and yes! this can work even on Twitter. Who knows, you might actually learn something. For me, I know sometimes people have good experiences. Too many people don’t. If people are talking about a ‘not so good’ experience,  I’m not that interested in hearing about good times elsewhere just then – I’m interested in thinking about what might change things so the bad parts of the system are less bad. Try questions that are reflexive (yes, there are questions other than open or closed ones);

-If a professional were to impress you with how they handled a concern, what would they be doing?

-If you could offer a piece of advice to me about how to respond better, what might it be?

-What might professionals need to do to convince you that they welcome feedback?

-If I was able to convey to you how important it was to me that we got it right, what might that be like?

and (if someone happens to be talking about a time they  felt a professional handled a concern really well)

-What sticks most vividly in your mind about that time? What might move me/ my team towards working in that way more?

If you think my interactions aren’t that good, this is my response it, I AM NOT A MENTAL HEALTH PROFESSIONAL. I am not claiming to be one. My other point is that I am practicing talking about extremely difficult subjects, ones where anyone with any human understanding would get that it will be hard for me. I will improve. Watch this space.

And by the way, if I have to write a blog post like this, well I feel quite justified in my comment ‘Most mental health professionals are incompetent and out of their depth‘. I have set the bar high. The professional needs not only to understand things at the individual level, the service level and the organisational level, but also the systems and systemic level. They also need to have the courage to do something about it. I absolutely believe that if they are not doing that they have not earnt the trust they demand from the people who need them. Some professionals on twitter show the skills they need. Most don’t. Just saying.

 

References

Appreciative Enquiry for Change Management: Using AI to facilitate organizational development by Sarah Lewis, Johnathan Passmore & Stefan Cantore

 

 

Author: Valid Consent

Promoting trauma informed care

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