Posted: Wednesday 14 July 2010
A guest post from Social Action for Health Executive Director Elizabeth Bayliss.
Here at Social Action for Health we've just published a report called Hear I Am.
It describes a pilot project that began as a means of exploring new ways of engaging patients in their own care planning, applying a community development approach.
In order to fulfil our brief we planned to introduce patients on a men's acute psychiatric ward in East London to Multi Media Profiling (MMP). Multi Media Profiling is a creative way for people to communicate their needs and potential using video, stills and sound. We hoped it would help patients to engage with their care planning and to tell their stories in their own way at CPA meetings.
We produced profiles with two patients, with positive benefits, and are keen to explore the potential of these further. However, something else was happening too. During regular reflective sessions, the project team found that their attention was focused more and more on what they were witnessing on the ward.
What they were seeing was guys who were bored, with very little going on. The men were frustrated and spent a great deal of time just hanging around waiting hour upon hour for someone to accompany them outside for a breather. They saw how quickly the men's spirits and expectations were raised by something as simple as bringing in fruit to share. But what the project team found themselves reflecting on most was the lack of engagement between ward staff and patients.
The men were clearly hungry for dialogue. They wanted to talk and exchange with other patients and staff, and yet ward life was almost totally arelational. Dialogue was not the norm.
The usual rules of social life did not seem to apply. Ordinary greetings like "hello" and "how are you" were not used. Questions were ignored and answers were not followed by action. This lack of any meaningful engagement between staff and patients made life difficult and stressful for all.
This was an emergent project, so we were free to change our focus. We decided that since the context of ward life is such a key aspect of care planning for in-patients, we could legitimately reorient ourselves. Now during our twice-weekly visits we simply aimed to build relationships with the men. We listened, talked, chatted, laughed and played games. We wanted to understand what it meant to be a human being in the mental health system.
We saw that the wards were separated, segregated airless places that weren't doing anything other than suspending people while they took their medication. The patients didn’t seem to be in therapeutic relationships. They were not involved in a process, they were just hanging around.
By the time the project ended after 12 months we had concluded that this way of conducting ward life aggravates and enervates both patients and staff, rather than creating the sort of stabilising and empowering situation that promotes care and recovery.
Our response was the Hear I Am report. It says that things need to change fundamentally and essentially around the way people on our mental health wards are related to. Patients need to be given the chance to talk and to be listened to.
In order for this to happen the wards need to be more permeable so that people can come and go and talk about ordinary things like the football or weather. Put simply, the wards need to open up.
Elizabeth Bayliss, Executive Director of Social Action for Health.
Very interesting.
Such a shame that the system is like this. It really hit home when you wrote,
We saw that the wards were separated, segregated airless places that weren't doing anything other than suspending people while they took their medication.
This is very true. It must be unbearable at times. As an outpatient I sometimes feel like they rely too heavily on medication, and not enough on social interaction. I understand that they may have reasons to not want to excite the patients, but still, humans need some mental stimulation!
This would be fantastic if it ever came into fruition. I have been on wards and the psychiatrist says that we should talk to staff but when we do , it is oh we are too busy. I cannot see this working as already cuts are looming and time is only available for the staff to do their parework etc. I fear for the system. Maybe bring back the old sanitoriums. That way they would not have to spend too much money and have less staff.
Why am I so dispondent ?
A brilliant study and let's hope your findings do encourage the powers that be to "open up the wards", even in these times of great financial cuts within the health service.
I think that this report confirms my suspicion that Psychiatry is in most cases at best irrelevant and at worst, harmful.
People who are mentally distressed are frightened and confused. The thing that we can all offer people who are frightened and confused is a reassuring presence and meaningful conversation. If the psychiatric system has not learnt this by now then I can see no reason for it to continue.
If the training, management and day to day practices on wards do not promote these simple practices when it has been shown in study after study that these are the principles of recovery from mental distress then I see no reason why the psychiatric system will ever learn that basic humanity is what is needed.
Psychiatric workers have secure, well paid careers but are either irrelevant or harmful to the people in there so called care. I want public money to be better spent.
Commenting is now closed.