“Teamwork is
the ability to work together toward a common vision. The ability to direct individual
accomplishments toward organizational objectives. It is the fuel that allows
common people to attain uncommon results.”
Andrew Carnegie
In 2021, the Care Quality Commission (CQC) conducted a mental health themed review in acute settings. From this review, CQC made three massive recommendations: that mental health care in acute settings should meet nationally recognised standards and that acute staff should have the training to feel confident in meeting mental health needs as well as being able to support their own wellbeing. Then, the third recommendation was that acute Trusts should have a Mental Health Strategy that has board level oversight and clear governance over administration and monitoring of the Mental Health Act. And so, NUTH set about creating a Trust-wide Mental Health Strategy, and almost immediately, they knew that including service users would be incredibly useful to the creation of the Strategy. I was honoured to be chosen to be in the ‘Expert Refence Group.’ This collaboration post will celebrate today’s official, internal launch of their Strategy by sharing my thoughts on all the steps NUTH staff have taken to ensure that it is service user approved. I do this, with the sincere hope that the Trust’s service user approved Mental Health Strategy will inspire others to adopt a similar approach in their Strategy creation processes as well as perhaps developing ideas to take even more action around mental health within their own organisation…
“… It was made clear, and has been apparent
throughout, that our opinions and experience were a key factor in developing
the mental health strategy…”
From a member of the Expert Reference Group
The first thing NUTH really did around getting the Strategy patient-approved, was as a result of their recognition that harnessing the qualities and experiences of service users could be vital in the entire creation of the Strategy. So, NUTH sent a request out amongst members of the Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (CNTW) Involvement Bank. I absolutely loved this almost natural thought and acceptance that NUTH had around actually benefitting from working with service users. So, I think it really says a lot that they actually acted upon that ethos from Day One of the Strategy creation. As some NUTH staff and service users pointed out, so many organisations launch campaigns and Strategies without the input of those who ultimately should be benefiting from them. They just do all of it then sort of spring it on service user, almost like: “this is what we’re doing to you” and not “here’s what we want to do with you.”
That attitude NUTH appeared to have, as well as my personal experiences with NUTH’s services (I’ll talk a little about them in this post, but for more details; read our collaboration in February 2023 here) meant that I eagerly applied to be a part of the creation of the Strategy. NUTH actually received so many applications – which I feel really illustrates the genuine passion service users hold for creating such a Strategy – that all the applicants needed to have a chat with some of the key NUTH staff involved in the Strategy creation. The Trust explained that this was to ascertain the roles within the creation of the Strategy that each person would be more suited to.
My chat was with Gemma Norman, a Patient Experience Coordinator, and Doctor Sarah Brown, the Honorary Associate Medical Director for Mental Health. This was particularly nice because Sarah had actually been my Community Psychiatrist back in 2012(!) and her idea for me to have an Advanced Directive became lifesaving in numerous instances. With meeting Gemma… I’m one of those people where I feel that I don’t judge a book by its cover, but I do experience some sort of an instinct when I first meet someone. And all my instincts told me that Gemma is a kind and compassionate person who has a real passion and investment in her work – and particularly in the Strategy – to a degree that is unparalleled to that which I have seen in others who are in a similar role. Having that bond and positive relationship from the outset made me even more eager to help the work on the creation of the Strategy.
I wasn’t alone in these thoughts and opinions of NUTH staff because in the service user feedback form, there was actually a question to comment on the engagement each service user who was involved in the Strategy’s creation felt they had experienced in working with the staff who were key in collecting our insight, thoughts, feelings, and opinions. So, other comments and answers to this question from the service users in the Expert Reference Group, included:
“… We were always listened to, we were always encouraged to make our views known, and above all we were treated with kindness, respect and empathy…”
“… Keep up the amazing work you are doing…”
My own answer to this question was:
Thank
you for…
· the
respect – it is more than completely mutual!
· the
inspiration for all the blog content.
· the
opportunity to better my abilities in the communications and marketing side of
things.
· the
rewarding responses to the work I’ve put in throughout this project.
· the
validation and lack of judgment or stigma when it comes to talking about mental
health.
· always
being so understanding during difficult moments.
· trusting
me in granting me with hugely important responsibilities.
· the sense of humour and all the hilarious banter we have shared over this time.
Building that positive relationship or bond between staff and service users is also a massively useful tool in tackling the detrimental causes that the us vs them culture can have. I believe that this culture is particularly rife in the mental health industry, but that it can go on to include general healthcare Trusts and other. It enables service users to see that professionals aren’t robots; they don’t all just do their shift and fulfil their job description because they’re obligated to. Some of them truly care and are thoroughly dedicated to the purpose of their role and to the work that they do; and in creating a Mental Health Strategy, I feel that those qualities are particularly important.
For a service user to believe the staff who are involved in the Focus Group have the most genuine thoughts, feelings, hopes, and intentions; will encourage them to feel more open in sharing their experiences. I feel that the whole purpose of having a Focus Group is two-fold:
1. It’s a way of hearing both their negative and positive experiences of the organisation and both will then inspire and provide important learning opportunities. With negative accounts, I feel like typically – especially where a complaint is made – most professionals and even organisations on a whole, will respond by either completely dismissing the reason for the complaint by either becoming really defensive and claiming there’s been a misunderstanding, or providing numerous, flimsy excuses that are sometimes just downright patronising and condescending! One of my frustrations with this sort of response is that for years, mental health services – particularly the Crisis Team – have encouraged me to take responsibility for my actions, and now that I finally do that, it’s hard to have those same professionals not do so. So, rather than have a negative experience cause staff to be defensive, it can actually allow staff to gain an understanding and awareness of what needs to be changed or improved in the organisation, their staff, and the services they provide. Positive stories will then also provide a lesson; but on what they are doing right and should therefore be doing more of it or building upon it and taking it as inspiration to create new initiatives and projects.
2. The Focus Group can also be a good opportunity to talk about the ideas the staff have come up with because they will then receive better insight into how those ideas could affect service users. For example, the phrasing or the language used in a Strategy or any projects which are particularly related to mental health, might seem easily understood by professionals, but service users might require or prefer more simplistic and clear wording. A service user’s thoughts, feelings, and opinions on something the organisation are planning to do, might be things which the staff would’ve never thought of or have even contemplated it. A massively powerful example of this (which I draw upon often when discussing this sort of topic) was when I attended the opening of a new psychiatric hospital and another ex-service user and I were given a tour and he actually spotted that some of the positioning of the furniture in patient bedrooms actually created the opportunity for them to be able to attempt suicide. This was clearly not something the staff had recognised or considered because they didn’t have that insight or experience.
In talking about what services – or NUTH in this instance – can learn from poor experiences… Well, I like to think that one quality myself and therefore I’m NOT Disordered has (which is something that I feel massively contributes to my blog’s popularity) is honesty. So, I want to provide some honest insight into the impact of that having poor experiences in interactions with an organisation’s staff because it can not only shape a service user’s opinion of the entire organisation, but it can also contribute to service users making assumptions and being prejudice toward the organisations other staff. To me, this is a completely understandable response and if staff/organisations fail to understand this, then it goes back to my point about responsibility and being lectured to take it from the very people who weren’t doing so themselves.
I say this because, over the years, I have felt repeatedly pigeon-holed and pre-judged by numerous professionals who have typically done this in a way that has been centred around my old (a Psychiatrist has now deemed me to have recovered from it and it is now being phrased as ‘historic’) diagnosis of Borderline Personality Disorder. Over time, I’ve come to recognise that a lot of those judgements and instances of stigma, and discrimination, have very likely stemmed from a lack of training, knowledge, and understanding of Personality Disorder. It meant that their attitude and responses weren’t as personal as they felt; but I don’t know if that actually makes things worse because that would mean they were treating so many other people poorly too!
The point, however, is that professionals – very frequently – put a lot of mental health service users into the same box in so far as if they’re treated one way by someone with a particular diagnosis then others with the same diagnosis, will have the same attitude or exhibit the same actions. This also means a huge misunderstanding in so far as to what is helpful for each individual and so may services will have the attitude of ‘well inpatient care didn’t work for her, so let’s not do it for him.’ I felt that for a long time, I had to actually fight to be seen as a person with a diagnosis and not a diagnosis that has a person somewhere amongst it! With those experiences in mind, you’d have thought that professionals and services would understand or appreciate why service users might assume that all staff in one Team are as unhelpful and rude as the one they’ve just met. And this illustrates a huge need for a Mental Health Strategy because it will serve as encouragement for all staff within an organisation to have a similar approach, attitude, understanding, response, and compassion around mental health and interacting with those who have a mental illness. That all staff will treat all patients equally and with respect.
An additional important quality which I think the NUTH staff really exhibited in creating the Strategy with service users, was around respect and equality. In mental health services, I feel that it’s incredibly – and sadly – common for a service user to feel dismissed, in significant, and inadequate in their relationship or interactions with professionals (not even just in mental health services by healthcare and the emergency services e.g. the Police, too!). Personally, my feelings of this nature are typically influenced by my own thoughts rather than actual comments the staff have made. So, for example, I struggle when a professional seems to be younger than me because it leads to me thinking ‘what have I done with my life?! I could be a Doctor by now!’ And that sounds strange because I don’t even want to be a Doctor(!) it’s just highlighting that feel inadequate and unequal can often come about by creating comparisons. And sometimes those comparisons can be about asking for help; you might find yourself feeling weak for recognising that you can’t do something by yourself and often, the thought born from that notion is that the person you go to for that help and support is better than you in some way. That they’re well, stable, and safe. And it can lead to asking “what’s so wrong with me that I can’t be that successful too?”
I think that the fact inadequacy can often come from your own spiralling thoughts, is an indication that professionals really need to ensure they’re not doing or saying anything that’s even remotely enhancing or which can be deemed as providing any kind of evidence that supports those thoughts. Some professionals might argue that the service user needs to take responsibility for having those unfounded and unevidenced thoughts and feelings – that it shouldn’t be their place to have to try to correct that. To me, those professionals could be considered as being in the wrong job – like, most professions who are relevant to this issue, are ones whose job description is – or at least it should be(!) – ‘helping others!’
“… I felt of equal value to all staff involved in the strategy meetings, I felt that the focus groups which I also attended, were fantastic and they allowed the focus group to have their say and made sure that everyone was heard…”
Finally, a huge thank you to Gemma from the Patient Experience Team and Rachael, the Associate Director of Nursing for Mental Health. I am so very grateful to have been given all the opportunities that I have with both the creation and the launch of NUTH’s Mental Health Strategy. Your faith in my abilities mean the absolute world and you are both a truly incredible representation for the Trust and provide so much reassurance and comfort to know there are people like you working for the Trust. You should both be regarded as hugely inspirational examples and role models for all the other staff within NUTH. Thank you for having the sheer dedication, determination, courage and passion to speak up for all those with mental health problems who can feel powerless and silenced when it comes to bettering an NHS Trust. If I could pick any person to speak on my behalf, it would be the two of you. Thank you.
NUTH
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