We talked to Brian about how the thematic review will change the way care is delivered.
The publication of the thematic review – and it’s coverage in the media – made me think that I work for an organisation that wants to have honest conversations.
It's really sad that most of us have grown up in a system that isn't used to saying sorry. Too often, the kneejerk reaction when something goes wrong is to find someone to blame. But if we make people frightened of being at work they will be frightened of putting their hands up when things go wrong. If that’s the case, we will never learn from our mistakes.
The review criticised our staff for too often viewing our patients as victims and not as potential threats. And it is great we have staff who are extremely compassionate and caring in their roles. However sometimes when we form therapeutic relationships with individuals we can also develop blind spots.
We have some of the most caring people working in our community teams and our inpatient services. What they might not always do is think 'what is the worst thing that could happen here?' It is extremely rare for people with severe mental health problems to harm others. That’s not to say it can’t happen but, statistically, it’s not common. If we were to treat everybody as if they might commit an awful crime we might also be criticised for not being compassionate. It is about getting that balance right, being aware of our potential blind spots and putting in place protection against potential harm.
One of the things we are taught very early on in our career is the importance of confidentiality. So, many of us are concerned we have to hermetically seal the information a patient tells us. It is a patient’s right to have their information kept confidential and they have to trust us. They need to know they can talk openly about what’s concerning them. This could be a mother who is concerned if they talk to us their children will be taken away. Or it could be someone who’s worried they will be locked up if they tell us what’s going on in their minds.
However, if we know there is a suspicion or clear risk that someone is going to get harmed, we have to act on that.
And if someone says they don’t want their family involved or spoken to we need to be asking why not. For example, a person with depression might not want their partner to know because they feel they have let them down, they have lost their job, they are using alcohol to cope with their feelings. If that’s the case, this person is ticking every box to alert us that there’s a risk they could harm themselves. We need to be talking to them and explaining how depression can hamper our ability to talk openly about our feelings. At our best, what we are really skilled in mental health services is getting people to talk.
And if a person is clear they don’t want their family spoken to, maybe for very good reasons, then that is their absolute right. We have a duty to respect that. We need to be talking to those family members, saying 'this person doesn’t want you involved at the moment but that could change'. And we should keep checking in, seeing if it has changed.
We do have to work differently but we have to remember that there are no machines in mental health to read minds. The care we provide relies on trust and the ability to have difficult conversations. I’m an advocate for training, policies and procedures, but they need to be built on us listening to people who have used services.
What the newspaper headlines don’t always show are the times where we get care right. We should be proud of our work which enables people to lead better, more meaningful lives and helps them stay in recovery for longer.