forgiveness

Beaten. But not broken

 

The Chattri, near Brighton

The Chattri, near Brighton

Dear Everyone

There are five stages to grief, as explained by Kubler Ross.

  • denial
  • anger
  • bargaining
  • depression
  • acceptance (sometimes called accommodation)

We do not progress through the stages in a linear fashion. Some may have to be repeated. If we are not careful, we can get stuck at any of the first four, and never fully achieve the final one, of acceptance.

Today, those of us who voted Remain are feeling some or all of the first four stages. Only a few have reached the fifth by now. Some never will.

We have a right to feel angry. The referendum was unnecessary. Some time ago, David Cameron made a promise to appease certain members of his own party. He probably never expected to have to keep it.

After the result, the only honourable thing he could do was resign. As he did so, he was trying hard to appear to have achieved acceptance. But the catch in his voice gave the game away.

And he may never achieve it. Political careers in high office almost always end in failure. But this is failure of a most awful kind. Perhaps we can be kinder if our current Prime Minister shows statesmanship over the coming weeks and begins to chart the way through unprecedented choppy waters.

The reason many voted Leave was not about immigration or perceived European bureaucracy. It was a protest vote against the greed of big business, the banking crisis which has affected poor and vulnerable people much more than those who caused it, and a political ruling class that seems dangerously out of touch.

Can we listen really carefully to those who feel this way? We need to heed their voices, as well as the cries of anguish from those who voted Remain. And listen to both groups above the triumphal clamour of the minority who believe we have “got our country back”.

It is going to be very hard. Once hatred has been unleashed, it is hard to put it back in its cage. The rise of far right politicians and alliances are real and present dangers.

The size of turnout demonstrates that when people feel their vote will count, they are more likely to use it. So maybe we have to rethink our position on our current electoral system that disenfranchises so many.

And perhaps those towards the centre or on the left politically, if indeed such definitions are even valid in this context, can stop fighting one another and think about what matters? And who our real enemies are?

In the early stages of grief, it is important not to make momentous decisions. Words or acts of anger, hatred and blame will not help us.

So let’s hold on. Let’s be kind, to ourselves and to others. We are beaten. But we are not broken.

Yours, in solidarity with the human race

 

Please join my social media experiment

I haven’t done a blog like this before. I’m trying what I hope will be a relatively simple experiment to help me run some seminars on Thursday 3 March 2016 for the East Midlands NHS Leadership Academy.

And you can help me!

  • If you read the blog before Thursday, I would love to have your comments at the bottom of this blog to help me help the people in the seminar groups think about the use of social media in the NHS.
  • And if you read it afterwards, you can help me to think about it some more. Comments would be really welcome from seminar participants and others. Because like all of you, I am a lifelong learner.
  • I intend to use this blog as my main audio-visual aid for the seminars. It is therefore shorter than usual and presented mainly as
    • Bullet points!
  • As well as seeking your comments in bold, I will be encouraging comments and discussion from the attendees.
  • I plan to start by asking people where they are on scale of 1 – 10
    • 1 = a social media virgin
    • And 10 = social media savvy warrior
    • I am pitching the seminars and the blog towards the people who place themselves towards the lower end of this scale, but I will try to engage the more informed attendees by inviting their comments, as I am inviting yours.
  • How does that sound to you?
  • I will then introduce social media as a form of media where the control lies with the individual.
  • I will illustrate my point with a newspaper story that ran about me recently (two blogs down from this one if you haven’t heard about it) and how I was able to redress the balance myself via Twitter, Facebook and my blog.
  • Is the above example too self-indulgent, do you think? And if it is, can you think of a better one?

I will then list the different forms of social media thus:

Social media products:

  • Facebook: An early product. I use it to stay in touch with family + friends. But people use it very successfully for work, even instead of a website
  • Instagram – good for sharing photos, I am told.
  • Linked-In: For keeping in touch with people at work, finding jobs, making connections. Again an early product. I don’t like the interface. But I’ve missed some important messages from people who have tried to contact me that way, so be warned!
  • Skype: Free video calls. Can be erratic. But great for interviews or meetings with people far away. Much cheaper than video conferencing
  • Twitter: Admission time – my favourite. I love the discipline of the character limit.
  • Viber: Similar to WhatsApp. Also free calls
  • YouTube: used by President Obama, Justin Beiber and me!

  • WhatsApp: Great for staying in touch with individuals and groups. And free phone calls!

Does that sound overwhelming? Any glaring omissions? And does expressing my preferences help or hinder?

Benefits of using any/all of the above:

  • Control
  • Thrift
  • Contacts and connections
  • Equality

Things to look out for:

  • No such thing as a free lunch – you are the product for the companies providing these “free” services
  • Warning: social media can be addictive
  • Loss of privacy with some formats (see my blog On Forgiveness)
  • Trolls and other monsters (see my blog Please Take Care, Twitter can be Cruel)

Again, your thoughts please?

Blogging

  • Why do it? (see my blog called Why do you Blog?)
  • And why not do it? (hint: there are lots of good reasons)

This is where I hope we will have the richest discussion.

I’d really welcome your comments here too please.

Some NHS-inspired bloggers that I think are worth following:

  • Zoe Bojelian Wonderful mother of a brilliant boy who we will never forget
  • Annie Cooper Senior nurse + social media genius – she will be at the conference
  • Andy Cowper The most original writer on health policy I know. Also v funny
  • David Gilbert Writes in a brilliant, challenging way about patient leadership
  • Paul Jenkins Ex CE of Rethink, now runs a mental health trust. Deep thinker
  • Liz O’Riordan A breast surgeon with breast cancer. Stunning
  • Charlotte Walker A mental health patient (like me). Writes in real time. Gutty, startling insights
  • John Walsh My personal compassion guru
  • Rob Webster A brave, wise leader who shares generously

The list is of course not exhaustive, but I’d love your thoughts – who would you add?

My plan is to share this blog via the seminars, including all comments received, to stimulate discussion. And I will invite those who take longer to decide what they want to say, to add their comments after the event.

My final question to readers of the blog is this:

  • Would you find a seminar structured in this way useful?
  • And if not, and I really want your honest answers, please tell me how you would improve it.

I promise to incorporate your ideas. And I will also let you know how it goes.

Thank you very much indeed for joining my social media experiment!

 

 

 

 

 

 

 

 

A mixed week: updated Sunday 21 Feb 2016

It’s a good thing we don’t know what the future holds. Otherwise we might never get out of bed.

On Monday, the long-awaited Mental Health Taskforce Report was published. And it made grim reading. Behind the awful stories about people being let down or receiving no treatment at all is the spectre of stigma. How else can it be that government ministers have spouted forth about No Health without Mental Health and Parity of Esteem whilst at the same time services have seen real terms reductions to funding far greater than other parts of the NHS. And despite referral rates continuing to rise? The suicide rate is rising again too, even among groups not previously considered to be at high risk.

The coverage was wide and mainly pretty fair. (I say mainly; the Metro managed to annoy almost everyone on my Twitter feed with an offensive headline.) I was impressed by what Paul Farmer and all my other friends on the taskforce have achieved, and by the measured response of NHS England and the Secretary of State. But instead of feeling proud to have played my tiny part, and girding my loins for the sustained effort that will be needed to hold the government and the NHS to account, I noticed my mood gradually getting lower throughout Monday. By the evening, I was overwhelmed with sadness that it has taken so long for so many people to be heard, and that many lives have been lost along the way. And I was assailed with despondency and a sense of utter failure for what I hadn’t managed to achieve in all those years I was running mental health services and had so much opportunity and influence.

Things got worse on Tuesday. I woke to find myself the subject of an article in my local paper, the Brighton Argus, along with a massive photo of me with a long-forgotten hair colour. It said that 19 staff at Sussex Partnership, the trust I used to run, had received severance pay-outs totalling several millions in the past four years, and that I had received the largest sum, £275k, in 2014.

It was wrong in every respect. The highest payment was £27.5k not £275k. And I hadn’t received one at all. And I felt tearful and scared and powerless and all the other things I remember about being public property for the 13 years I was a chief executive.

I minded most because leaving the trust caused me great anguish. Anticipating it almost certainly led to my last serious depression. Going back to work after my breakdown for another 8 months was very hard. It mattered greatly to me that, having managed to do so, I should leave on my own terms.

A few phone calls later, I was reassured that the story had appeared because of a combination of cock-up and further cock-up. Thank you to everyone concerned for your honesty; mistakes are always forgivable when people tell the truth. By the afternoon, The Argus had removed mention of me from their website and agreed to publish a correction the following day. Which they did. And today they published a letter from me here (there may still be issues with this link if you are on a smartphone. Try Argus Letters in your preferred search engine and ask your browser to use the Argus desktop site. Or try this link directly with the trust website http://www.sussexpartnership.nhs.uk/whats-new/no-severance-package-former-chief-executive-note-lisa?platform=hootsuite)

As I left the house yesterday afternoon somewhat surreptitiously to do some local errands and keep an appointment to give blood, I wondered what people must be saying behind my back. And I was reminded what it felt like to have no place to hide.

However, the week wasn’t all bad.

I was asked to appear on Radio Surrey and Sussex this morning to talk about the stigma of mental illness as part of the BBC #InTheMind series. You can catch me, Danny Pike and the wonderful Sue Baker of Time to Change here 1hr 10 mins into the programme.

Our choir has been rehearsing for a charity concert on Saturday afternoon – details here https://twitter.com/slondonchoir/status/699507596353499136 All welcome.

Brighton and Hove Albion drew away on Tuesday night with Championship leaders Hull and are now third from top, and only one point away from an automatic promotion spot to the Premiership.

And I have at last finished the first draft of my book, which is about being a chief executive who occasionally experiences doubts and depression.

One day I hope you will read it.

Update: I spoke too soon, which after 21 years following the Seagulls, I’ve found it’s easy to do. We got stuffed 4-1 yesterday by Cardiff City. Have a feeling this season could go right to the wire, just like every other year!

But the choir concert was – well I don’t have enough superlatives. Life – affirming will do. And today I helped my lovely husband Steve, who supports me in all my endeavours, to raise money for The Tall Ships Trust, a youth development charity to which he is very committed, via a jumble sale of boat stuff. The two of us were up at 5.00 am. By 2.00pm, we had made just shy of £1,000 which will help kids from disadvantaged backgrounds to experience the joys and lessons that can be learned through sailing.

And I’ve heard from hundreds of people who’ve said kind things. Which for someone like me means more than I can possibly tell you. On Tuesday I was in the depths of despond. Today, on balance, I’m really happy to be me.

Thank you.

 

The hardest thing of all

I’ve been watching the desperately sad story unfold of the awful, untimely, preventable death of a young man with learning disabilities. Only those most closely involved can comment on what led to his death. But what happened afterwards has become extremely public.

Having done the job I once did, I feel the need to share some thoughts.  I know this may provoke strong reactions. But to be silent suggests complicity about unfair discrimination of vulnerable people, lack of compassion and the opposite of openness in how the NHS too often deals with mistakes. And I am not complicit.

The media, including social media, can be a massive force for good. The media can shed light on things that need to be uncovered, especially where the interested parties are far apart. And in the case of campaigning journalists like Shaun Lintern, they can help families eventually get to the truth. Although they really shouldn’t have to.

The NHS is at long last waking up to the fact that the public understand bad things can happen. The public know that the NHS is staffed by humans who, by dint of being human, make mistakes. And that there are risks inherent in almost everything that the NHS does or doesn’t do. They know some mistakes occur because staff are careless or stressed or tired or overstretched or poorly trained or badly led. And they are realistic; they also know that a small number of staff do terrible things deliberately. But the NHS still needs to appreciate that the public will not accept cover ups.

Below are some of my lessons on running services for vulnerable people, learned the hard way, by experience. And by not getting things right myself all of the time.

  1. Running NHS services is very, very hard. The hardest part is when things go wrong and patients are harmed or die in circumstances where this could have been prevented. It is what causes those in senior positions, like the one I once held, sleepless nights and to question our own fitness to lead. If leaders don’t have sleepless nights like this, they are almost certainly in the wrong job. Being a decent leader in one of these very hard jobs starts with having respect and compassion for those we serve. And the humility to admit mistakes.
  2. Leaders in the NHS need to be curious and ask questions. They need to seek the truth, however hard this may be. They should surround themselves with others who are curious too and not afraid to challenge their leader. They need clinicians of the highest integrity with deep knowledge of the care they are responsible for to advise them. And although NEDs and governors who pose difficult questions may occasionally be wearisome, good leaders know that such people are invaluable at questioning what might seem obvious and to upholding core values. I may not always have shown this, but it is what I truly believe.
  3. Some time after I left, I noticed that my old trust had been criticised for apparently taking too long to complete serious incident reviews. And I recalled my own occasional frustration at the length of time it took to receive outcomes from a review when I was desperate for answers. But now I’m thinking again. Investigating something properly takes time, especially when extremely distressed people are involved. Those investigating must be open minded and objective. They need to be released from other duties. They must not take everything they are told at face value. And they need the remit and backing to do whatever is needed to get to the facts. Timeliness is important, but not at the expense of uncovering the truth.
  4. I recall an attempted homicide by a patient. We were so concerned to find out whether we risked a recurrence that, rather than an internal investigation, we immediately commissioned a specialist independent organisation to investigate and report to us, with no holds barred, on the care and treatment of this patient. This informed us about some changes we needed to make. This approach was later commended by the coroner. But when a statutory independent review was eventually carried out more than three years after the incident, the reviewers devoted space in their report to criticising us for having commissioned that first report, even though they broadly concurred with the findings. There is no rule book for NHS leaders. You must work out what to do yourself. And often only learn with hindsight whether you got a decision right or wrong.
  5. The media onslaught that can occur after a serious incident can be all consuming and deeply distracting. The worst thing that can happen is that you are diverted from the real job, of providing good care and rooting out any that is less than good, into so-called “media handling”. I have been very close to getting badly distracted myself on occasions. My saving grace was probably having been a nurse first. But I don’t think that being a clinician is by any means essential to being a good NHS leader. Caring about what happens to patients is the only essential qualification.
  6. Apologising is never easy. But it can mean so much. Apologies should be sincere, whole-hearted, unqualified and platitude-free. They may not be accepted initially. They may have to be repeated, sometimes many times. The hardest meetings for me and those I worked with during my 13 years as an NHS CEO were with families whose loved ones had come to harm in our care. But I am so grateful to those people for giving me the opportunity to listen really carefully to them and to apologise to them in person. It may take a long time to achieve such a meeting, and sometimes several are needed. The effort is really worth it.
  7. The NHS is a microcosm of society and is institutionally discriminatory towards those who experience mental illness or have a learning disability. This is manifest in poor staff attitudes, low expectations, inadequate investment, silo thinking, paucity of data including comparative benchmark information on incidents, and the negative way the rest of the NHS treats those who raise concerns about such things. I’m doing my tiny bit as a volunteer to improve matters but there is so much more for all of us to do.
  8. Talk of “numbers” without benchmarks and other good quality comparators can also be a distraction. Every unexpected death of a vulnerable person needs to be investigated to see if it could have been prevented. And that takes resources, which are in short supply in mental health services these days where the brunt of cuts have been made despite all the rhetoric about “parity of esteem”. Coroners are also overwhelmed; it often takes years before inquests into such deaths are completed, which is agony for the families.

It really shouldn’t matter whether the person who died was young, talented, beautiful, courageous, funny or anything else. They were a person who mattered. My heart goes put to anyone who has lost a loved one, and especially to those whose deaths were in some way preventable. You have to live with “if only” for the rest of your lives.

And that is the hardest thing of all.

 

I’m sorry. No ifs and no buts.

Last night, I glanced through a well-written Guardian Healthcare piece about the distress experienced by a psychologist over the death by suicide of a patient. It touched a nerve deep in me, and I tweeted this:

Those who rush to judge mental health staff should read this honest piece. In my exp, every loss is as keenly felt
https://t.co/WGM0S2lALL

It got 15 retweets, 9 likes, some positive comments from people who work in mental health services but also a few more questioning ones from people who I would describe as experts by experience. And it was these, plus my initial reaction to the article, that have had me thinking rather hard over the past 24 hours.

I want to make some unequivocal apologies:

  1. I am sorry for my initial tweet. It is sadly not true that all such deaths are so keenly felt. Many are, but by no means all. I desperately wish they all were.

  2. I apologise to all those staff at the mental health trust I once ran who experienced the death by suicide of a patient and who didn’t get the support they needed to help them cope with such a loss or learn valuable lessons that would help them and other patients in the future. Despite my sincere wishes otherwise, I wasn’t always as consistently effective as I intended to be in this regard. I am so sorry for this.

  3. The people I was referring to who “rush to judgement” and look for people to blame after a death by suicide are NOT people who have experienced care, good or poor, or their families. In my not inconsiderable experience, such people are often the most moderate, thoughtful and compassionate towards the staff.  Those who DO rush to judgement are some, not all, of the media; some, not all, politicians; and a tiny but vociferous minority of the general public. It can nevertheless feel overwhelming to be under such an onslaught. I have experience of this. But I should have made what I tweeted clearer. I am really sorry that I didn’t,  because I upset and hurt people whose feelings matter very much to me. I may have done so inadvertently, but I was careless. And I am truly sorry.

  4. This stuff is particularly painful to me because of my own experiences many years ago when I made an attempt at suicide. What the nurse in A and E said to me, that I was selfish and a waste of space and keeping him away from patients who were really ill, had a deep and lasting impact. It took many years before I confronted my shameful secret and quite a few more before I came to accept that he had been wrong. So I am especially sorry that my tweet wasn’t well-constructed. Of all people, I should know better.

  5. It was after I returned to work in 2014 after my worst-ever depressive breakdown that I fully confronted the reality that staff who work in mental health are not all as compassionate as we might hope. There are many wonderful people, but there is still some downright cruelty, some poor attitudes and practices and some not inconsiderable compassion fatigue. I have written about this and my contribution to changing things here and about how challenging it is here. Today, we had a really good, honest project working group meeting, which I chair. This is extraordinarily difficult stuff. It cuts to the heart of things that matter deeply to me and to all the others around the table. So I am especially sorry about my tweet. As a writer, I should be more precise and thoughtful. As a chair, I have responsibilities. As a human, I should have taken more care.

I thought about just deleting the tweet. But that won’t make what happened go away. An unequivocal apology seems a better response. That, plus continuing the work with Time to Change to tackle what we know from countless surveys to be true, that stigma and discrimination are still alive and kicking within mental health services. And if we allow ourselves or anyone else to go la-la-la-la-We’re-not-listening, we, indeed I, are/am complicit in letting it continue.

You will be hearing more on this from me and others in due course. Our work will, I hope, feature in the upcoming Mental Health Taskforce report and in the future work plans for Time to Change.

The death of anyone by suicide casts a long and painful shadow. It is right and to be expected that staff should feel distressed. But they also need compassionate support so they are able, eventually, to carry on being compassionate themselves. And the ones who can’t be compassionate need to be helped to find something else to do.

One of my big lessons in life has been that I can’t be truly compassionate towards others if I am not compassionate towards myself. This means forgiving myself for making mistakes. I hope the people who I carelessly hurt by my tweet will forgive me too. Eventually.

PS In fact, within a couple of hours of posting this I had heard from all those mentioned. I feel deeply blessed to know such kind and forgiving people :):):)

Welcome back

Hullo you.

So you’re back, are you? Please forgive me if I haven’t exactly laid out the red carpet. It’s just that the last time you were here, you caused havoc. It took me a year to deal with the consequences. You wore me out. My family and friends were extremely glad to see the back of you. My own feelings, as you well know, were more mixed. Because I recognised that you had, quite literally, become part of me.

What I can tell you, as you so cleverly insinuate yourself back into my life, is that I’m better prepared for you this time. I’ve done a lot of soul – searching. And I’ve had professional help. I have slowed down my thinking, and learned the painful lesson of sharing, with a few trusted people, that I’m not always OK, and in particular the devastating effect you can have on me if I don’t take care.

I’ve also made some new friends, who know you too, or someone like you. At great personal cost, they have developed ways of living in harmony with their cruel demon. I am indebted to the generosity of these new friends. I am even grateful to you, because, were it not for your last, most shocking visit, I would never have met these extraordinary people.

I have again only recognised your arrival with hindsight. A disapproving little voice whispering in my ear at my 60th birthday party, at the very moment I told those closest to me that I had finally got my mojo back, saying: have you? Have you really??

This makes me question myself. Was I pretending, all those months after I thought you’d left? Faking it till I baked it, as the saying goes? I don’t think so. Because faking is almost impossible with you around. My razzle-dazzle, such that it is, fades in your presence. My smile becomes less convincing when it is painted on. Plus, and this has been a very important lesson, pretending not only hurts me. It does damage to others.

This month, you appear a few times, in the small hours, when I should be turning over from the first refreshing sleep of the night and falling quickly back into the next slumber. Instead I become alert and watchful. At these times, you make me go over past failings, magnifying them out of all proportion. In the mornings, there you are again, a dank blanket, ready to spoil the day. Not every day, but enough of them to make me worried that soon, you might not be leaving.

Most wicked one, you mess with my head. You have ways of making me feel responsible for everything that has ever gone wrong that I have had remotely anything to do with, and for not doing enough to solve the ills of the world. You force to me go over and over stuff that makes me feel bad or sad, and guilty for my luck at any of the good things that have come my way. You tell me I am undeserving, selfish, lazy, intellectually weak, self-indulgent, tedious and evil.

And I believe you, to some extent, but not quite so much as before. Because I have learned about your psychological tricks. In a straight fight, I know you will always win. I need to listen to you, because occasionally you are right. After all, you are merely an extension of my conscience, aren’t you? I just mustn’t try too hard to placate you, or listen so much that I stop hearing others who speak more kindly to me.

As I’ve grown older, I’ve tried to take myself less seriously. To be less certain and to listen with greater care. And I’ve learned that to be kind to others, which after all is the whole point of having been put on this earth and being human, I must first be kind to myself. So I’m trying more of that now, mainly in my internal world, but also by sharing how I am feeling with those close to me and some of my newfound friends.

I’m not going to try to banish you from my life. I can’t; you are a part of me. But please don’t get big ideas. You are only a part. Despite your mean little voice telling me I don’t deserve professional care, I have again sought it. It is already helping. But in the end it’s up to me, and only me, whether I allow you to become my defining feature. I am determined that you won’t be. To achieve that, I must also never again pretend that you don’t exist at all. That is why I am writing this blog, for all to see. I will face you, and not allow you to win by making me feel ashamed of your occasional visitations. There should be no shame.

Welcome back, my friend. Today the sun is shining, and you are quiet. But I know you are still there, waiting for me in my weaker moments. And I’m ready for you.

I hope.

 

 

Lisa’s ten mental health rules

Rules are made to be broken. And anyway, these days we have far too many of them. Those who work in public services have little hope of remembering them all.

Despite all that, I wrote this list in tribute to the wonderful work of @nurse_w_glasses. And Moses. It applies as much to regulators, commissioners, leaders in NHS trusts, local authorities, private providers and charities as it does to frontline staff.

And all humans.

  1. Thou shalt always remember that the mind and the body are intrinsically linked. There is no health without mental health. And mental health is everyone’s business.
  2. Thou shalt always present a positive image of people who need help with their mental health. It is nothing to be ashamed of.
  3. Do not take the name of people who experience mental illness in vain. Never use terms such as nutter or psycho, even in jest. We may pretend we get the joke, but inside we weep.
  4. As with religious practice, working in mental health requires humility. Do not be dogmatic or rush to judgement of others. Instead, practise acceptance and loving kindness.
  5. Honour the people who choose to work in mental health, whatever career you personally have selected. They have not chosen the easy road.
  6. Killing other people is illegal. Killing oneself is not, but it carries huge stigma and casts a terrible shadow over those left behind. Learn how to help prevent suicide. And never condemn those who might consider it. They need your understanding if they are to seek help.
  7. Mentally ill people can be trusting and vulnerable. They may lack inhibition. Never abuse a position of power physically, sexually, financially or psychologically.
  8. Never treat people who experience mental illness with anything other than compassion and patience. If they make you feel angry or mean, get some help yourself.
  9. Try to tell the truth about mental illness and the current state of services. This is neither easy nor straightforward. They need serious attention and investment in the UK. There are no quick fixes. But relatively little will go a long, long way.
  10. Be hopeful about mental illness. Those who experience it from time to time can lead full and rewarding lives, with just a bit of love and support.  Like me.