mistakes

Take good care of yourself

Leaving flowers

Leaving flowers 2014

Another longer blog based on a talk, this time for Point of Care Foundation Community Conference on 27.10.2016

These days I usually introduce myself as a writer, coach and mental health campaigner. Sometimes I say I’m a charity trustee. I might talk about Grassroots Suicide Prevention and how we help to save lives by training people in mental health awareness and suicide prevention techniques. Or the Mary Seacole Trust and that now we have achieved a beautiful statue to the first named black woman in the UK, we intend to smash the glass ceiling that still holds back the careers in business and in public life of women and, even more so, BME people. Occasionally I mention my voluntary work with Time to Change, or that I am training as a Samaritan. And I might say that I love writing fiction, cryptic crosswords, cycling, making jam, Brighton and Hove Albion FC, the Archers, and my family and friends.

Only if relevant do I refer to my 41 year NHS career as a nurse and health visitor, then manager. I prefer not to be defined by what I used to do. I don’t want to live my life in retrospect. I may be over 60, but I feel I have so much more to do and give.

However, for the purposes of today, I need to explain that I was chief executive of a mental health trust in Sussex for 13 years, from 2001 – 2014. And now I am a recovering chief executive. I have Professor Sir Simon Wessely, President of the Royal College of Psychiatrists to thank for that description. And he is right; it describes me well. I have been writing a book about my experiences. I thought I had finished it. But then a few things happened and now I’m less sure. Nonetheless, I have insights I want to share with you.

The main one is this: please don’t do what I did as far as looking after yourself is concerned. I didn’t always make a good job of it. And it wasn’t only me who suffered.

It started with that over-developed sense of responsibility that many of us who choose a career in healthcare seem to have. We are often the first child in the family. If not, we are the one who looks after our siblings, even our parents. In my case, I was also the only girl. Being caring and helpful was expected, and the best way to evoke praise.

People with certain personality preferences have a tendency to choose a career in a caring profession. Another tendency of those with these profiles, and I am one, is to find it hard to say no. We also tend to take criticism personally, we can be overwhelmed by setbacks, and we can experience guilt more readily than those with other profiles. We are also find it very hard to tell others when we are not OK. None of this is set in stone, of course. They are only tendencies; one can learn to modify one’s responses.

The classic personality profiles for people in senior leadership roles are different. They tend to be confident go-getters, driven by vision, analysis and logic rather than feelings of responsibility. They like making decisions, challenging others and being challenged themselves. And so the tendency of leaders who do not fit such a profile is to try to act as though they do. And to pretend not to mind things that they actually mind very much.

I struggled a bit as a student nurse. But once qualified, I got huge satisfaction from clinical practice. I loved helping people, especially those down on their luck. I always will. 

I eventually moved into management via a series of lucky accidents.I had no long-term plan to become a chief executive, even a director. It just happened. I fell in love with the trust I eventually ran because of a chance meeting with some adults with learning disabilities who I had known as children many years previously. Their care wasn’t terrible. But it could have been so much better. And then a senior colleague told me that mental health services were a backwater and that if I took such a job, I would never escape to do anything else. And that was it really; I was hooked.

For the most part, it was wonderful for me to be able to influence the care received by people who were usually at the bottom of the pile, to challenge stigma and discrimination locally and also nationally, to be busy and in demand, and to have the opportunity to work with a bright, engaged team I had the good fortune to build from scratch. Whilst we were all different, we each cared deeply about providing care that we would be happy to receive ourselves or for a member of our own family to receive. And when the care we provided failed, we minded very much and did whatever we could to put it right.

But I also got some things wrong. I can ignore details if they don’t tell me what I want to see or hear. And I wanted every project to go well. So I sometimes reacted badly when not all of them did. I was often overwhelmed by self doubt and imposter syndrome. I had sleepless nights, especially after incidents when things went wrong for patients. I felt very lonely at such times, but I didn’t feel I could tell anyone – I thought I had to tough it out. And this was counterproductive because trying so hard to appear competent made me less approachable to others who were also struggling.

I also wanted my team to be one happy, harmonious family. Without breaking any confidences, I would overreact to disagreements and try to play the peacemaker when what we needed was more discussion and debate. It took me a long time to realise that I had assumed the role of parent or older sister, when a more adult to adult relationship would have served us better. I am grateful to those who persuaded me eventually to see this – we got there in the end.

Although suicide amongst those using mental health services accounts for only a quarter of such deaths, it is, very sadly, not an infrequent occurrence. It took me a long time to admit to myself that the reason I found it so distressing was because I knew something of how desperate those who took that step must have been feeling. And even longer to admit it to others. Although I worked hard not to show it, I found it almost unbearable to be criticised by regulators or via the media for failing to stop someone from taking their own life. I felt guilty both that we had failed, and that I wasn’t always successful in defending the efforts of the staff, who had often kept the person concerned safe for many years and were themselves also devastated. I also know that the effort of hiding my own distress sometimes made me less sensitive to theirs.

Risk assessment, of which much is made these days, is an imprecise science. Some believe it has no scientific validity in preventing suicide or homicide by someone who is mentally ill. And yet people lose their jobs, even their careers, over not applying it correctly. They are judged by those privileged to look at the full facts of a case at leisure, with the benefit of hindsight. Rather than under pressure in real time in a busy hospital or clinic or on a difficult home visit. And without enough of the right resources. Families can be led to believe, sometimes erroneously, that a chance event that has changed their lives forever might somehow have been predicted or prevented, and that someone must therefore have been at fault. Unless NHS staff have erred deliberately or been recklessly careless, it is seldom the right thing to do to blame them, whether they are a junior nurse or a very senior manager. It is cruel and reductive and unlikely to bring about positive change. In fact it is likely to make people fearful and to drive poor practice underground.

I am extremely grateful to those who helped me to understand a more nuanced way of thinking about suicide, especially to Dr Alys Cole-King of Connecting with People, my friends at Grassroots Suicide Prevention, and Samaritans. I also thank John Ballatt and Penny Campling, whose book Intelligent Kindness enabled me to understand what was wrong with the traditional NHS approach to serious incidents, as well as a few other things. And to the Point of Care Foundation, whose outstanding work helps professionals to nurture their compassion and non-judgemental curiosity, despite the challenges of today’s NHS.

Some people reading this know that I saw my first psychiatrist aged 15, and have been troubled off and on with anxiety and depression throughout my life. I am still trying to make sense of why i felt so ashamed of this for so long, and how I managed to get through 12 of my 13 years as a chief executive of a mental health trust without blowing my cover. All I can say is that I am well-practised at pretending to be OK when I am not. 

I eventually began to talk about it the year before I retired as my personal contribution to reducing stigma. It was even more painful than I had expected. I felt exposed and brittle. I couldn’t sleep or think straight. I was forgetful, jumpy and irritable and my judgement went downhill. I wondered if I was going mad, and in a way I was. I had such terrible stomach pains that I thought I might die. It would honestly have been a relief. And then I started to cry, and couldn’t stop. Driving home, I nearly crashed the car on purpose into the central reservation. It was only the thought of the fuss it would cause for others that stopped me. For the next 8 weeks I huddled in the dark. Slowly the kindness of my GP and psychiatrist and that of my family, closest friend and work colleagues made me realise that perhaps I wasn’t the worthless pile of ordure I had thought I was. 

Although I will let you into a secret; it wasn’t until I had been back at work a few months and had undergone a course of therapy that I finally accepted that I hadn’t been faking my latest bout of depression. And that I wasn’t the selfish, lazy, waste-of-space I was called by a nurse when I made an attempt on my own life many years earlier. His words stayed with me because I agreed with him.

If speaking up was hard, going back to work in January 2014 was harder. But it was also part of my recovery. It felt liberating to be able to be open about why I had been off. I found conversations with clinicians, managers and most of all patients were deeper and more meaningful. I was a better listener, and I wasn’t rushing to solve everything, as had been my wont. I found that I could listen properly to criticism, and appreciate what the other person was trying to say without feeling the need to defend the trust or myself. My final eight months before retiring in the summer as planned were the happiest of my whole 13 years.

If you have the sort of tendencies I have, here are five tips from me to help you take care of yourself.

  1. When something goes wrong and you or those for whom you are responsible make a mistake, try not to be disheartened. Allow yourself time to process what happened and why. Apologise wholeheartedly. But do not be rushed into snap decisions. Treat yourself and your team as a work in progress.
  2. When someone offers you criticism, try hard not to be devastated by it. But also try not to reject it out-of-hand. Take it for what it is, just an opinion that may or may not be useful.
  3. Don’t pretend to be someone or something that you are not. It is exhausting.
  4. Exercise is important, and so is eating well. But sleep is healing. We all need it or we can’t function. If you are having trouble sleeping, then you deserve some help. This advice from Mind is a good starting point.
  5. Remember that being kind to yourself is not selfish. It is actually extremely unselfish. Because it is only through being kind to yourself that you can truly be kind to others.

It was Carl Jung who initially wrote about the wounded healer. There is nothing wrong with being motivated to help others partly because one has issues oneself; such experiences can help the care giver to be more empathetic. But if we truly care about others, as I have learned at great cost, it is very important that we do not pretend to be OK when we are not.

Because, as Karl Rogers, a successor of Jung said: what I am is good enough if I would only be it openly.

 

 

 

 

 

Advertisements

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.

 

Blessings

books

Books that have inspired me this year by @Suzypuss @jamestitcombe and @molly_speaks

 

 

 

 

 

 

To keep depression at bay, it helps to count one’s blessings. My Twitter friends are a very big blessing. Here are some thank you messages for 2015:

  • To campaigning journalists @andymcnicoll and @shaunlintern for supporting underdogs including mental health care and people with learning disabilities. Please never stop.
  • To Adam and Zoe Bojelian who lost their dear son @Adsthepoet in March 2015 but keep his legacy alive via Twitter. You are in our thoughts as you face a first Christmas without your wise, beautiful boy. We will never forget him and what he taught us.
  • To @JamesTitcombe who lost his baby son and has courageously campaigned for greater openness over mistakes in the NHS, despite some vile online abuse. I treasure my copy of Joshua’s Story. And I thank James for all he continues to do to make the NHS safer for patients and their families.
  • To all who bravely act as patient representatives, such as the indomitable @allyc375, and remind regulators, commissioners, managers and clinicians what the NHS is actually for. Only they know the cost of speaking up. Go Ally, @anyadei @ianmcallaghan @DavidGilbert43 and others who’ve earned the right to call themselves patient leaders.
  • And to @HSJEditor for taking a risk and running the first HSJ list of patient leaders. Thank you Alastair. I think it was a game-changer.
  • To those who’ve grasped one of the most feared conditions and are making life better for those living with it. I mean you, @dementiaboy and @dr_shibley. To you and others like you, thank you for refusing to leave dementia in the too-difficult box.
  • To @Liz_ORiordan who is generously sharing her experiences of breast cancer care, which for a breast surgeon is a pretty massive deal. And for some other stuff.
  • To @EastLondonGroup, who introduced many of us to a group of previously little known landscape artists from the early 20th Century. Sunday Morning, Farringdon Road has become a landmark of my week.
  • And to @penny_thompson, for pointing me to ELG and for always being true to her values.
  • To poet @Molly_speaks for painting pictures with words in her lovely new book Underneath the Roses Where I Remembered Everything
  • To @HPIAndyCowper, for his excoriating, original analysis of the NHS, and for his support to me in my scribblings.
  • To @clare_horton for running the excellent @GuardianHealthCare and even including some of my pieces. This meant so much.
  • To @seacolestatue @EAnionwu @trevorsterl @thebestjoan @pauljebb1 @joan_myers and many others for plugging away in the face of seemingly impossible odds. The Mary Seacole Statue will rise in 2016 as a permanent memorial to someone who showed how, if something matters enough, we should never give up.
  • To @nhschangeday @PollyannaJones @helenbevan dani_ellie @jez_tong @LydiaBenedetta @cjohnson1903 @WhoseShoes @fwmaternitykhft @DaniG4 @damian_roland and so many others for including me in NHS Change Day 2015. I was meant to be helping you but I gained many times more than I gave.
  • To @TimetoChange @suebakerTTC @paulfarmermind @carolinewild @danbeale1 @2gethertrust @NTWNHS @rethink @mindcharity and a whole raft more for being a major part of my life this year, working together to tackle the stigma that still exists within the NHS towards folk who, like me, experience mental illness from time to time but are so much more than our diagnoses. Here’s to you.
  • To @nurse_w_glasses @anniecoops @drkimholt @gourmetpenguin @AlysColeKing @DrUmeshPrabhu who show by words AND actions that compassion is alive and kicking amongst health professionals
  • To wonderful women leaders such as @SamanthaJNHS @BCHBoss @JackieDanielNHS @ClaireCNWL @CharlotteAugst @KMiddletonCSP @Crouchendtiger7 @DrG_NHS @VictoriBleazard @JaneMCummings @CarolineLucas @juliamanning @TriciaHart26 @clarercgp who stick their heads above the parapet and make the world a better place
  • And folk like @NHSConfed_RobW @ChrisCEOHopson @cmo @profchrisham @ProfLAppleby @WesselyS @nhs_dean @NHSE_Paul @ScottDurairaj  @stephen_thornton @jhazan @rogerkline  who prove that leaders on Twitter don’t have to be women to be fabulous
  • To bright, bubbly new leaders like @anna_babic and all those I’ve met via @NHSLeadership, who fill me with hope for the future. And to @Alannobbs @kirsti79 @NoshinaKiani and all the other great folk at the NHS Leadership Academy. You do stunning work.
  • To @GrassrootsSP and everyone who works to prevent the long shadow cast by suicide. Thank you.
  • To everyone who supported me in my bike ride for @samaritans in the summer. Especially @NurseEiri and @JackieSmith_nmc. They know why.
  • To @Suzypuss whose book The Other Side of Silence has inspired me to get on and finish mine.
  • To wise owls @johnwalsh88 @TelfordCC @KathEvans2 @gracenglorydan @timmkeogh @RecoveryLetters @profsarahcowley for being beacons when the world feels a bit too hard
  • To friends who also experience mental illness from time to time and who share their thoughts and feelings so generously. Thank you @BipolarBlogger @Sectioned @BATKAT88 @annedraya @clareallen @corstejo @schizoaffected @rabbitsoup_zola and many, many others. On a not-so-good day, yours are the tweets I look out for. You bring me hope.
  • If I could, I would add everyone else I’ve chatted with on Twitter this year. To everyone I follow and who follows me: Twitter is 97.5% good for my mental health, and that’s because of all of you. Thank you all so much. I wish you all much love for 2016. You rock :mrgreen: :😎💃❤

 

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.