Could this statement be the one that encapsulates the perception that mental health services are frequently unable to help people with mental health issues?
A research participant in a study I’m conducting into support networks of people with long term mental health problems outlined what she saw as some of the problems with her encounters with health professionals in the mental health system.
She is one of the many interviewed as part of the Network Mapping project being conducted by our CLAHRC. Mental health services appeared to be nowhere on her map of supportive and important connections and resources. In this she is not alone in omitting them and describing them as a hindrance rather than a help.
She adds to an increasingly long list, forming from the participant interviews, of difficulties they encounter with mental health services. Things that were identified as being less than helpful included: the focus on forms and form filling that is over complicated and takes a long time to fill in; opt-in appointments that have to be set up by phone, something she pointed out was incredibly hard when feeling mentally unwell; patronising group therapy; therapy sessions that run out after 6 weeks, or 12 if you’re lucky; being told you’re not capable to doing things you have been doing successfully for years e.g. working.
She said it felt like the systems are deliberately set up to be complicated so as to wheedle the weakest out, only those with a certain level of wellness would be able to take part. A bit of a paradoxical effect perhaps for a service that is intended to help some of the most vulnerable at times of crisis? If the weakest fall by the wayside they do not add to the statistics but are they in danger of becoming an ignored underclass of people struggling to survive with no help at all?
Another participant described herself as exactly this, she simply could not undertake all the tasks she was expected to do by a service which was supposed to help her until, on one occasion when she did manage to jump all the hurdles presented to her she found she was refused services because she wasn’t bad enough in the view of a practitioner who had taken very little time to get to know her. She states she is just surviving and very powerfully notes ‘I don’t want to just survive, I want to live.’
Perhaps time is the problem?
We know that people do not go into healthcare intending to be obstructive and that the intentions of clinicians and services tend to be benevolent, so what is going wrong? There are many theories. From these interviews, and this is supported by much current research literature, increasingly efficient services are not set up to facilitate time to get to know someone. This incredibly important step is often overlooked in the hurry to fill in forms, do risk assessments and write care plans. Surely though, all these things are almost meaningless if we cannot find the time to build a relationship with the individual in order to ensure that we are doing the right thing, making the right decisions for that person?
And here we reach another impasse
In direct conflict with the comments of the first participant mentioned above, why do we think we can do anything for people, how dare we have the arrogance to make decisions for other people?
Again, research consistently shows, and anyone who has worked in mental health for a while will know, that people get better (within services) when the timing is right for them, when they are given power over their own lives, when people are supported to make their own decisions, validated by supportive staff who are treating them like human beings and, perhaps most importantly, when individual clinicians are able to build a trusting, consistent relationship within which the person is able to grow.
So yes, time is almost certainly a problem and the Mental Health Act is another. I won’t get distracted here with the legality of the Act or the arguments around stigma and prejudice – but it is important to note that the kind of relationship described above is extremely difficult to cultivate whilst one partner in the interaction holds the power of detention over the other.
The increase in peer-led services and the increasing interest in these services is a movement that takes this participants words as being true. Whilst the government might be interested because of lack of money, it is an opportunity to think about doing things very differently in healthcare.
The network mapping tool we have been using in this project is one way we have been doing things differently, it is driven by the person who has the knowledge of their own network and it gives them the chance to link to resources in their communities that can support them in addition to statutory services. It gives them additional information about their social situation which can be powerful and facilitate them to see how they might like to change it, or how it is supportive in ways they hadn’t noted before. Key in this work is the fact that, although facilitated by another it is done by the individual and they remaining firmly in charge of the process.
The title of this article came from a lady who was actively managing a mental health crisis, she was still working, she was intelligent and she was still able to manage her own decisions.
A new approach
Imagine if we, as services, started to listen to what people say they need instead of deciding what they can have? What if we saw those who are psychotic as having important information that needs to be understood? What if we recognised that all of us have mental health and all of us need to manage it on a daily basis? What if services recognised that the individual holds the answers to their problems and that our role might be to support people to develop so that they can figure out these answers for themselves? In doing this we can fully realise the potential of ‘There’s no better person to help you than you’ whilst also recognising that there are times when all of us need a bit of extra support to keep going, to find answers and realise our potential.
I think we should do it.