When I started in Clinical Psychology, my main aim was to stick rigidly to the text books and the manuals. Follow this simple rule and the belief was that the young people I would go on to work with would all show improvements in their mental health and wellbeing.
That was what the research assured me would happen. In addition, they would see that because of my title of Clinical Psychologist, by seeing the various letters after my name, that this would instil a confidence in them to automatically follow my advice to the letter. The naivety of this would in time become apparent to me.
Perhaps my own internal anxieties about the validity of my conferred expertise betrayed me at some point or perhaps I began to recognise that assisting young people in building resiliency was not something I could construct in isolation or by direction. I think what thankfully became apparent at some point in my career was that the journey of recovery was a journey which needed to be walked together, not prescribed from an “expert” pedestal. Youth by definition are often resistant to direction by those in positions of authority. Weren’t we all at some point in our lives?
A realisation began to emerge that if you truly want to support young people in their challenges with their mental health and to be by their side in their journey to functional independence and mental fitness, then you need to get down off your pedestal and be their partners rather than their directors.
At times of increasing waiting lists in mental health, pressures to achieve “throughput” are constant. The downside of such pressures are that mental health services can feel almost mechanical, like they are going through the motions. In such an environment, the voice, wishes and needs of the person accessing the service can unfortunately become lost.
Many of us who work with young people routinely ask their views about a wide breadth of topics, do they want to come back, would they like a male or female therapist, what time would suit you, what frequency of appointments would suit, what do you think your level of risk is? My impression of their response to such questions is usually one of surprise. Someone in a position of authority is interested in their views, could that be really true, can I really trust them?
I recognise that while there are many clinicians around the country that are heavily influenced by, and practice a collaborative and strengths based approach with their clients, the experience of some clients of the wider mental system is not always so positive. Many have reported being fearful of reporting their dissatisfaction with unhelpful practices, of noting their difficulty with multiple staff changes, of not having a trusting therapeutic connection with their assigned therapist.
What fuels this fear? For many it is heavily influenced by having waited for significant periods to access the service in the first instance. They often report fearing that should they give honest feedback on the service received that it could result in that service being withdrawn from them. This I believe is a sad reflection on how mental health services can sometimes position themselves, that the most vulnerable do not feel empowered to be collaborative participants in designing the care plans which would best meet their particular needs.
My own individual faith in the mental health system I work in has been restored somewhat by one particular initiative which has placed service users and carers at the heart of the system that they have had experience of. The ‘Cooperative Learning: Service Improvement Leadership for Mental Health‘ is an initiative involving service-users, carers and service-providers who together can devise and implement new plans to improve the experience of those who access the service. This initiative also recognises the importance of placing the service user and carer in positons of responsibility, i.e. they sit alongside senior management on management committee of the service they use. This initiative in particular provides young people with an authentic voice in the development of child and adolescent mental health services. Other non-statutory organisations such as ReachOut and Jigsaw / Headstrong have been leading lights in promoting genuine inclusion for youth in the services they provide and strong champions for meaningful advocacy processes. In time my hope is that statutory agencies will also consistently embrace and embed such inclusionary practices in how they work.
A positive first step in promoting more consistent inclusionary practices came with the release in June 2015 of the new Standard Operating Procedures for Child & Adolescent Mental Health Services which is hoped will result in much needed systemic consistency. In particular I am heartened by the recognition of the need for young people and their families to be active partners in the planning and delivery of services. This is particularly evident in the emphasis on developing with each young person and family an Individual Care Plan that is:
- Collaborative
- Strengths-based
- Goal-oriented
- Based on a recovery model
However, as with any policy, procedure, strategic plan, they are only as effective as those who enact them. On an individual clinician level, on a management level and across the wide spectrum of mental health services we need to wholeheartedly embrace genuine collaboration. This will not be achieved through rhetoric but by creating a confidence through direct experience that mental health systems can be sensitive and responsive to the needs of those who use it. If such necessary systemic changes do not occur then we all need to stand up, individually and collectively and answer why.