compassion

What would Mary Seacole do?

Professor Elizabeth Anionwu and me

Professor Elizabeth Anionwu and me

On difficult days, I ask myself what Mary Seacole would do.

Those who seek to denigrate her memory are more than mean – spirited. They not only question her nursing contribution in the Crimea –  for which she was honoured by the British Army, the Times newspaper, Her Majesty Queen Victoria and 80,000 members of the public who attended celebrations in her honour. They also question whether she actually was a nurse. They say that she wasn’t really black. And having campaigned as hard as they could to undermine the Mary Seacole Memorial Statue Appeal, they now say that it is OK for there to be a statue to commemorate her, as long as it is small and not in a prominent position.

I will not stoop to naming these people nor to referencing the nastiness they have whipped up. Articles in The Independent and The Guardian have helped set the record straight. And today my dear friend Professor Elizabeth Anionwu CBE, Vice Chair of the Mary Seacole Statue Appeal, pictured with me above, will be on Woman’s Hour talking to Jenni Murray about the importance of Mary’s memory to all who believe in equality.

And today is the day that Mary’s beautiful statue, created by renowned sculptor Martin Jennings, will be unveiled outside St Thomas’ Hospital in London. Mary will proudly face the Houses of Parliament across the river. And she will be the first statue to a named black woman in the whole UK.

This is what will be written underneath:

“I trust that England will not forget one who nursed the sick, who sought out her wounded to aid and succour them, and who performed last offices for some of her illustrious dead.”

Sir William Howard Russell, War Correspondent, the Times Newspaper, 1857

We need Mary’s legacy now more than ever. The referendum campaign has unleashed xenophobia and racism. The poster of people with dark skin queuing for refuge with that hateful slogan underneath said it all. Some hoped such ugly days were over. Many knew this was not so. Fear and hatred for “the other” lie behind words such as “I’m not a racist but….”.

The NHS is not immune to racism. Or sexism. I have nothing against able and honourable white men. But when the NHS workforce is 70% female and 20% BME, why does the top look so male and so white?  This excoriating report by Yvonne Coghill and Roger Kline tells us a lot. About unfairness and disadvantage and about how NHS staff who experience these things can lose hope. It was published earlier this month. It is in danger of sinking without trace unless we do something different now.

I have no personal experience of racism, although I have seen it in action. Sometimes I have done something about it. And sometimes I have not. For this I am ashamed.

I do have experience of anti-Semitism, of being teased for having a “funny” surname, and of sexism. I know about the stigma of mental illness. And I know that, had I stayed where I started, at a London teaching hospital, I would not have become an NHS chief executive. My face would not have fitted.

It was for these reasons that I, a white woman, felt I had something to contribute to the Mary Seacole Statue Appeal.

Trevor Sterling, new charity chair, Leon Mann, ambassador and me last year at the site where Mary's statue will be unveiled tomorrow morning

Trevor Sterling, new charity chair, Leon Mann, ambassador and me last year at the site of the statue

And now, trustees of our new charity, the Mary Seacole Trust, chaired by the brilliant lawyer Trevor Sterling, will be calling on Mary’s legacy to inspire those at risk of disadvantage. In schools, universities, communities and workplaces including the NHS. We will encourage people to work hard and do their best. To be compassionate AND entrepreneurial. To aspire to great things. To speak up for what is right. And never to give up.

Despite not bring born in the UK, Mary Seacole never gave up playing her part in helping those from a country she loved. Throughout her life she remained proud of her dark skin and her heritage.

I urge anyone in despair or need of inspiration to visit Mary’s statue. It depicts her coat furling around her as she strides defiantly into the wind to meet her destiny.

These are very difficult times. Let us join Mary Seacole. And let us never give up.

An earlier version of this article was published in the Health Service Journal. I have updated it for my blog and to increase access beyond the NHS. I will update it again with photographs of the statue.

 

 

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

 

Ten reasons we are #StrongerIn. But whatever the result, we must take care on Friday

On the eve of the EU referendum, some thoughts:

  1. In 2012, the EU was awarded the Nobel Peace Prize for promoting peace + protecting human rights
  2. Voting out is not a protest vote against big business. It’s a whimsical vote against future generations
  3. If the economy tanks, as experts predict, it will be the poor + vulnerable who will suffer
  4. We are part of Europe and part of humanity
  5. The EU is run by politicians we elect. And they appoint officials. Because bureaucracy is good for civilisation
  6. David Beckham says we are stronger in. So do Billy Bragg + Paloma Faith. And John Barnes, who was so angry about being misrepresented by Michael Gove that he phoned national newspapers and wrote this stirring piece on immigration and racism for the Guardian  
  7. Vote Leave have Boris Johnson, Nigel Farage + Michael Gove. have  
  8. Leaving the EU would cause havoc to the NHS. We would lose vital staff + face massive cuts because of recession
  9. Not all who vote Leave are racists. But all racists are voting Leave, according to . And I agree
  10. The British public are fighters. We are not quitters. We must stay in + fight to make the EU even better  

One final thought. Things have been said that are hurtful, even threatening. People have been told they are stupid, that they don’t know what they are doing. One politician has lost her life. Millions have been made to feel unwanted and unwelcome. Whatever the result on Friday, a great deal of damage has been done. It will take a long time, kindness,, compassion and forgiveness to enable us all to heal.

So let us have no triumphalism. No crowing. And no blame. And let us remember that the majority of public servants are good hardworking people. They do not gamble our pensions, live offshore in tax havens, or pay their staff below the living wage. This includes the politicians who are elected by us, the people, to make decisions on our behalves.

We live in a democracy. And that is a wonderful thing.

 

 

Be inspired #Confed2016

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This time last year, I wrote a blog for newbies going to the NHS Confederation Conference. I decided to do an update for #Confed2016.

These are my top ten tips for having a fruitful time. By the way, you don’t have to be going to Manchester to make use of it 😉

  1. Don’t try to see and do everything. Be choosy. Treat the conference like a festival. By all means tweet about what you hear. But do also give the events you choose to attend your undivided attention.
  2. If you only seek out sessions and speakers to confirm your views, you will waste time and money. Arrive with an open mind. Ask questions. And be prepared to learn new things and to unlearn old ones.
  3. Some people need no encouragement to network. But if you aren’t confident about bounding up to someone you admire with an outstretched paw, don’t worry. Practice saying #HelloMyNameIs to people who look like you feel – perhaps a bit lost or lonely. And remember what Dale Carnegie said: You can make more friends in two months by becoming interested in other people than you can in two years trying to get other people interested in you.
  4. Dress for style AND comfort. These are not mutually exclusive.
  5. Never forget you are at work. Stay out late if you must. But if someone makes you an offer you feel you cannot refuse, say No. And mean it. What goes on at conference does NOT stay at conference.
  6. Take breaks. Go for a walk. Have a rest in your room. Do shopping or emails or visit the Lowrie. Drink coffee.
  7. At the same time, stay focused on why you are there. The NHS is in a bad way. It is not only being slowly starved of cash. Services are overwhelmed because current methods of doing things are unfit to meet the demands of so many people with multiple problems. We need leaders like you to find two or three changes that will make the most difference. And to devote their careers to making these things happen.
  8. Remember that innovation is as much about stopping things as starting them. That there are no quick fixes. And that culture eats strategy for breakfast*.
  9. You will meet folk having a hard time. Please don’t avoid them. Despite all the talk about compassion, our beloved NHS has become less compassionate. There is too much focus on inspection, compliance and performance. And insufficient attention paid to recovery, renewal and support. Please spend time with people working in very tough places. Listen if they seem angry or frightened. One day, this could be you.
  10. Take a look around you. Notice the top of the NHS. How very white and very male it is, despite the NHS workforce being 70% female and 20% BME. Ask yourself why this is so. And if you think it matters, do your bit to help to change it.

I’ve been to a few conferences. And been inspired. I hope you will be too. Have a wonderful time xxx

*This was never actually said by Peter Drucker or Edgar Schein, to both of whom it has been attributed. But it was what they meant. Sort-of.

Open dialogue

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I went to a conference in Nottingham yesterday to learn about a technique called Open Dialogue. I wanted to know more because of how it has revolutionised the care of people who are in crisis in parts of Finland and the US, reducing demand on mental hospitals and transforming lives.

I care deeply about mental health services, although I don’t run them any more. These days I campaign to make them better. I volunteer in suicide prevention. I chair the Time to Change mental health professionals project. And sometimes I need help from services myself.

I wish you could have been there too. Some massive pennies dropped, not just for me but for everyone who hadn’t already appreciated the possibilities. We learned that Open Dialogue is about being with people rather than doing something to them. And we realised that here was a way to mend things that previously seemed unfixable.

Let me explain.

There are some who say that the NHS is broken. And that mental health services are badly broken.

I’m not sure that broken is a helpful way to describe things. I prefer to think of them as badly wounded. And when someone is wounded, you take care of them.

I believe that people in highly influential positions do care about mental health. They are just unsure about what to to do, other than saying they care. They know that mental health services around the country are buckling under the strain of increasing demand. Referral rates have never been higher. And continue to climb. Services find it increasingly difficult to discharge people because there is nowhere for them to go. Staff are overwhelmed, and there is a growing recruitment and morale crisis.

Added to which, successive governments say one thing about the importance of mental health but allow the opposite to happen regarding funding. Despite the fine words and promises in the response to the Mental Health Taskforce report published in February, we heard just a few weeks ago from NHS Providers that mental health trusts are not seeing the promised investment and some are reporting funding cuts in 2016 – 2017. Parity of esteem? Actions speak louder than words.

How might Open Dialogue help?

Firstly, it isn’t simply a technique for listening really carefully to people who experience trauma and distress AND their families so that together they can work out their own solutions, with support. It is also an extremely respectful way for people to relate to one another, in teams, across teams, organisations, health care systems and society. Even the NHS.

Secondly, Open Dialogue is the antidote to what is sometimes called the biomedical model, when doctor knows best and patients are compliant. This works when there is a fairly simple problem and solution. For example, a broken leg. It doesn’t work for the vast majority of health conditions in which people need to become the expert themselves if they are to lead fulfilling lives. And it certainly doesn’t work in mental health. Mental health professionals know this. But we organise and regulate mental health services as though we were fixing broken minds instead of legs.

Open Dialogue builds on what some call the Recovery Model, based on hope and fulfilment rather than simply diagnosis and treatment. It provides a method to apply a recovery-based approach, involving the whole family and team. It is the antidote to outpatient clinics and ward rounds.

Thirdly, Open Dialogue provides the basis from which to challenge many of the perverse incentives and restrictive practices that have grown up in mental health care out of fear of incident, media criticism or what a regulator might say. Such as staff spending more time documenting care than in giving care. The absolute adherence to risk assessment even though successive independent investigations show it to have limited predictive value. And risk management, which taken to extremes means that those who might possibly pose a risk to themselves or others, are cared for in inhumane conditions with no privacy or dignity, no sheets, cutlery, shoelaces, phone chargers or indeed any other item that someone somewhere has said might pose a risk. And yet we know that ligatures and weapons can be fashioned from almost anything. And that people who are ill, frightened and alone can be driven to do increasingly desperate things. The greatest risk management tool available is compassionate, skilled attention. Open Dialogue offers high quantities of that.

Open Dialogue is being used in a growing number of services in the UK. A research bid has been submitted and passed the first round of scrutiny. If successful, it will explore human, clinical and cost effectiveness, as well as developing a model that is scalable and sensitive to local circumstances.

I want to thank everyone at the conference for opening my eyes. Including Tracey Taylor, Simon Smith, Pablo Sadler, Lesley Nelson, Jen Kilyon, Russell Razzaque, Mark Hofenbeck, Julie Repper and Steve Pilling.

And to Corrine Hendy, who I first met at an NHS England event about putting patients first last year: Your journey from being locked in a mental hospital to becoming a skilled mental health professional, public speaker and highly effective advocate for Open Dialogue, is more inspirational than any you will hear on X-Factor. I want to repay the inspiration you have selflessly given.

I’m going to do what I can to spread the word.

 

In memory of Sally Brampton. You are not alone

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I was saddened to hear of Sally Brampton’s untimely death after a long battle with depression. She was 60, the same age as me. From my own experiences of depression, I know a little of how things must have been for her. My heart goes out to all who loved her. May she rest in peace.

Next week is Mental Health Awareness Week.

For those who are struggling, I say this. Mental illnesses mess with your head. They make you believe bad things about yourself. That there is nothing wrong with you other than laziness, moral cowardice, being hateful and lacking what it takes to lead a normal life. That you are not worthy of help. And that you must face this awful, isolating thing alone.

But struggling on alone is not a good idea. Nor is pretending to be OK when you are not. I know this from my own past, effective but wrong-headed attempts to keep how I was feeling to myself. In the end, keeping secrets just causes more damage. It can be really bad for you and those you care about.

If you are overwhelmed by negative or frightening thoughts, if life feels grim or even just pointless, please, please ask for help.

  • Talk to a friend or someone else that you trust.
  • Make an appointment to see your GP.
  • Check out the Grassroots Suicide Prevention StayAlive app – available free to download to iPhones and Androids.
  • Phone Samaritans on 116 123 or one of the other helplines.

If you don’t know what to say at first, or feel embarrassed or tongue-tied, it doesn’t matter. If you are afraid that the words won’t come, try writing it down.

Social media has been a massive help to me. I have made friends online who always seem to be there. They have been to those evil places. Not the same as mine, because we are all different, but their own terrifying versions. They know how lonely it feels.

Contrary to what you may hear, there are wonderful services available and treatments – medicines, many different sorts of therapy and other practical techniques – that work for most people. It can take time to find the right ones, of course. And it will take a lot of courage and effort on your part. There are no miracle cures. But I promise you, seeking help really is worth it.

Believe me, you are not alone.

What mental health means to me

I took part in a Twitter chat recently on the above topic. Thanks to @AnthonyLongbone for encouraging me to join in. Below are some thoughts I shared in advance.

What does mental health mean to me?

  1. Mental health is the most important part of health. And it is integral to physical health. You can’t look after your body if your mind is in a poorly way.

  2. Mental health is a continuum with optimal wellbeing at one end of the spectrum and mental illness at the other. Some people seem to be able to take good mental health for granted. For others, maintaining our mental health requires almost constant vigilance and care.

  3. Facing up to my tendency to depression has been the most important self-help step I have taken in my life so far. I’m hopeful I won’t ever sink as low as I did in 2013. But I’m not making any assumptions. And I do not plan to judge myself negatively if I do experience another bout either.

  4. Judging myself – or indeed others who experience mental illness – is the least helpful thing any of us can do. Who knows why I or anyone else has this tendency? What does matter is what I do from now on to help myself and allow others to help me. Which includes understanding my own triggers and warning signs.

  5. All serious illnesses require some degree of courage, so that we can face the pain and the treatment required to help us get better. But mental illnesses can be harder to bear than physical illnesses . They mess with your head.  They make you believe bad things about yourself and others. They take away your hope and they affect your judgement and even your personality. They make you isolated and afraid. Some people hear the voices of others telling them bad things. In my case, I only hear my own voice. When I am poorly, my internal voice is harsh, judgemental and cruel. It tells me I am worthless and evil. I am still learning how to notice that voice when it starts whispering to me, and how to answer it.

  6. Since I decided to be more open about my own experiences, I have made some extraordinary friends. Our mutual support during rocky moments via social media undoubtedly saves and enhances lives. I love the equality and the loving kindness of these relationships. We all have something to bring.

  7. It’s because of all this that I know how amazing other people who experience mental illness are. How courageous, funny, honest, thoughtful and kind – hearted.  And this is how I know, beyond all reasonable doubt, that people who have had such experiences have assets that should be applauded and sought by others. Rather than deficits to be pitied or avoided.

…………………………………………………………

After the chat, I felt a bit overwhelmed. The people who joined in were just amazing. Brave, honest, intelligent, thoughtful, generous and kind. I am in awe of them. They have far more of merit to say than I do.

In conclusion, what mental health means to me is being part of a group of wonderful people like the ones I was talking with tonight. They are helping me to become the best version of myself, which includes being kinder to myself. Through this, I can become kinder to others and do my tiny bit to help them too.

And I’m really grateful to be on that journey.