Saturday, 9 February 2013

The trouble with care

It's been well over a decade since I was sectioned (committed) under the Mental Health Act for being psychotic. I was only in hospital for a couple of months but within that time three members of staff were suspended for abuse. I wasn't personally involved with any of them but it serves to illustrate just how weak some safeguards can be. Although to the hospital's credit it acted swiftly and decisively by suspending and then dismissing staff, presumably reporting them to the police too.

It raises an important point of who is employed to deliver care and medical services. At the top end of the profession due to copious amounts of investment in training the risk tends to be reduced, but the same is not true of ancillary staff and there is an inherent danger that I believe still needs to be addressed with regard to who is suitable to join the caring and medical profession in the first place.

So what type of people do these professions attract? What are their motivations and interests for embarking on such careers. Any place where vulnerable people are homed or cared for must surely be a gold mine for perpetrators of abuse and although the checks are made for any evidence that they have been abusers beforehand, that still let's in those who have not ever been caught or those who are cunning enough to disguise their true histories. Far better I think to invest in psychological assessments of all new staff embarking on such careers.

While this would help prevent the intentional abuse (physical, sexual and financial) of the vulnerable, it would not necessarily prevent other forms of abuse such as neglect or psychological abuse. The reason is that people also need to be vetted about their understanding of what service users need and want. To give an example, the simple act of selecting what clothes a person wears can turn into an infringement of a patient's right to choose for themselves.

On my travels, not just in an out of the mental health system, but also through exploring other forms of disability and disadvantage I've noticed another group of people who are attracted to the care and medical professions. The ones who start with the assumption that they already know what is best for any individual. It's a delicate balancing act between encouraging someone to engage with activities that would help them find out what they might enjoy and dictating to them what is thought to be best for them.

Staff simply do not have the right to force people into wearing clothes that they would like to see them in, any more than it is right for a parent to force a child to take up violin lessons when they would prefer to do a sport. It is the role of staff to offer options (and the more the better), and respect the choices of the services users wherever possible. These 'I know best' merchants can all too easily cause great distress and deep psychological damage. The name of the game is to guide and empower people to reach their full potential according to the service user's preferences. And so long as those service users are not a danger to themselves or others those preferences should always be respected and encouraged.

We are all human and we are all very good at playing the amateur psychologist or psychiatrist but we all need to notice when we are making assumptions and do something about it and that something is... to simply stop and ask.

The other great problem rife in all health care work is the lack of feedback and debrief sessions. Gradually it's less common among mental health care services than those services for the elderly and disabled and those of disadvantage in my experiences so far. In all though the focus still tends toward the 'label' of a condition and it's management rather than who that individual is. Yes a person may have trouble moving, but they still need stimulus for their minds. They may have trouble with their emotions but they still have brains that think and still have likes and dislike, interests and hobbies given the chance.

Staff without regular assessments and supervision are prone to mental health problems themselves, so I fully advocate regular discussions for all such workers to not only help identify what really is of benefit to their service users (with their consent), but also to help them cope with what can often be challenging and distressing behaviour. I have often found that service users themselves are much better at supporting each other than staff are art supporting each other.

It all boils down to whether or not people are capable of not just listening but hearing others and acting upon what they hear in agreement with those they are looking after.

There are superb health care professionals, but if we are to ensure that the number of fantastic staff increases then I for one would advocate much better vetting and much better training. Perhaps that would also lead to a greater level of respect for those who genuinely want to help others and who knows the salaries they richly deserve when they do so properly. Pay peanuts and you get...? Trouble. 

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