The next big thing will be a lot of small things
| Pages | 197-200 |
| Date | 14 August 2017 |
| DOI | https://doi.org/10.1108/MHSI-06-2017-0024 |
| Published date | 14 August 2017 |
| Author | Rachel Perkins,Julie Repper |
| Subject Matter | Health & social care,Mental health,Social inclusion |
Rachel Perkins and Julie Repper
The next big thing will be a lot of small things
In April, we were invited to speak at a conference at the University of Tilburg in Holland entitled
“The next big thing will be a lot of small things”(to be exact, Julie was invited to speak and
could not do it, so I was asked in her place!). We had been asked to talk, as mental health
professionals, about our own lived experience of being on the receiving end of mental
health services. The title of the conference resonated with our own experience of using services
and really got us thinking about the challenges facing our mental health services.
Too often, when we think about improving services we think about the big things. Anyone who
has worked in the health and social care arena will have experienced many reorganisations, the
merging, establishing and demise of services and changes in structure, accountability and
responsibility. In developing services that better support people in rebuilding meaningful, valued
and satisfying lives “ten key organisatio nal challenges”have been developed by the
Implementing Recovery through Organisational Change[1] programme (Sainsbury Centre for
Mental Health, 2009). These have spawned numerous, positive, service developments including
the establishment of dozens of Recovery Colleges, the employment of hundreds of peer support
workers and changing approaches to risk. Yet the first of these ten key challenges “Changing the
nature of day-to-day interactions and the quality of experience”(Sainsbury Centre for Mental
Health, 2009, p. 2), while probably the most important, remains the most elusive. This challenge
involves thinking not about structures and services but about all the relationships within those
services, and thinking about every little thing we do.
It is often the little things that are so demeaning and demoralising. A few words, a gesture,
a seemingly insignificant practice can really pick you up or slap you down.
Like trying to get through those locked doors and key pad systems to get to an outpatient
appointment –and when you finally get through the receptionist (if they have not been cut in the
last round of “cost improvements”)–is protected from you by a very high partition and/or glass
screen lest you take it into your head to leap over and attack them. Talk about reinforcing images
of dangerousness and unpredictability! We know there are concerns about safety, but let us face
it, everyone going for an outpatient appointment has been into local shops and a range of other
community facilities and they do not have such barricades for protection –even Job Centre Plus
have dispensed with them in an effort to appear more welcoming.
Like mental health workers minimising your distress (“look on the positive side, it’s not really
that bad”). This either makes you feel particularly useless on account of your inability to cope
with a not bad situation or it makes you rehearse how bad things really are to try to persuade
your disbelieving interlocutor of the grim realities of your situation. Or worse, completely ignoring
your distress. One of us well remembers sitting there crying on a ward and staff simply walking
past –in fact the only person who stopped and sat down was a student nurse (clearly he had not
been fully trained yet!). This does little to inspire confidence and serves to make you feel alienated
from those very services that are supposed to be able to help you.
Like separate toilets (and crockery, cutlery, etc.) for staff and patients. What messages does it
convey to those of us already feeling inadequate and ashamed because of our mental health
problems to find that we are not fit to use the same toilets? Frankly, if the toilets are not fit for staff
to use then how can we be fulfilling our duty of care to expect people using the service to use
them? Can we really talk about treating people with dignity and respect when such separate
facilities for “them”and “us”prevail?
DOI 10.1108/MHSI-06-2017-0024 VOL. 21 NO. 4 2017, pp. 197-200, © Emerald Publishing Limited, ISSN 2042-8308
j
MENTALHEALTH AND SOCIAL INCLUSION
j
PAG E 19 7
Editorial
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