Practical issues and solutions

I have blogged previously about the strange contradiction between what everyone says they want to see Mental Health services become, and what actually happens in practice. Everyone, without exception, wants Mental Health services to be more flexible, less prescriptive and more person-centred. They want the way we support people to be less medical and to aid recovery through ensuring people are in control. Everyone also thinks the support offered to people is impersonal, dominated by a medical model of support, overly risk-averse and lacking in flexibility and that changing this requires more people to be on-board. Go figure...

I agree with Tim that one of the key problems is culture and the dominance of the medical model of support. My experience is that all the goodwill and new initiatives in the world won't change traditional working methods, and the culture that goes with them, without a fundamental change in 'how' we work with people on the most practical level. What conversations do we have? What questions do we ask at assessment? How do we find out what people need? How do we record and use what we find out?

If these things don't change, then as soon as we are pushed for time, as soon as we are short staffed, or as soon as there is a crisis, we are likely to revert to what we know. We head steadily backward, if not to square one, then certainly away from where we want to be.

Throughout the findings published last week by the Five Year Forward View Mental Health Taskforce, there are a number of issues which point to the need to change the way services interact with people. Respondents want to have the right information to make 'meaningful decisions about their treatment' and wanted their care plans to be co-produced between themselves, carers and professionals. Respondents 'reflected the view that, too often, care was 'done to' them, rather than shaped with them and that health professionals did not systematically listen to them or take their concerns seriously'.

I sincerely doubt that there is a single health professional in the country who would think that they systematically don't listen to the people they work with. So something is going wrong in the process. We are not working in a way that makes people feel listened to. And this is something that needs to be fixed as a major priority, or we won't even begin to get where we want to be.

Making changes which can address this fundamental issues requires processes to be redesigned, paperwork to be rewritten, staff to be retrained and then supported to practice what they know.

At the most basic level the solution is simple - we can start by building in simple but highly effective person-centred practices into our core processes. For example, if you want people to feel that they are listened to, then the best way to achieve this is to ask them and their carers what is important to them, what they need support with, and what the best way for us to provide that support is. Does anyone doubt that starting assessments in this simple person centred way would feel different and better?

If we want to make sure people feel that their care plans are co-produced and involve the people who care for them, then we can use person-centred techniques to make sure everyone has the chance to contribute, and for their opinions to be considered with equal weight to the professionals in the room.

When we provide services we can do more to find out from people what characteristics they look for in a member of staff before we allocate them someone to work with. Everyone knows that we are more likely to engage with activities if we are doing them with someone who shares our enthusiasm.

Being more person-centred needs practice and support, but it's neither difficult, nor beyond the reach of any service provider. It's also not 'additional work' or 'another form' - the twin fears of overstretched teams. It's a different approach, rather than an additional one.

Some of the issues highlighted by the Taskforce do require whole system change, and as Tim says, it would be great to see a stronger emphasis on personal budgets as a means to addressing some of these. However, the issues I have highlighted can be addressed simply and locally, requiring leaders in organisations to provide a bit of impetus for the introduction of simple and effective techniques to make basic practice more person centred.


Add your comment

Leave this field empty