listening

Social media meanderings from Saltaire

Image by Dan Bailey

Saltaire

By the time you read this, I will have given what has been billed by my Twitter chum @PGTips42 at Bradford District Care Trust as a Social Media Master Class. 

In fact you would have to look hard to find someone who is less of a social media master than me. If they were paying me, the 60 attendees would by now have asked for their money back. Luckily, I am doing it for free. This gives me a chance to explore some recent thoughts with them and to visit the beautiful model village of Saltaire in West Yorkshire. The legacy of Sir Titus Salt could teach us a thing or two about philanthropic investment in social capital and infrastucture for the good of everyone, not just the richest.

Back to social media. One of the promises I made to myself when I retired from the NHS was that I would accept speaking engagements only when they were about something that really interested me, and that I would never again use Powerpoint. I’ve stuck to this for 2 1/2 years and it has served me pretty well. I did think about breaking the second rule for this session, as some screen grabs from Facebook and Twitter would have been nice, especially if they included kittens. But I decided against it.

Instead, I will have meandered through some personal insights, drawn from this blog and the references herein, and even better, found out what the attendees think.

My personal approach to using social media is how I tend to approach most things – I jump in and have a go, ignore wise advice and instead work out the rules as I go along. This isn’t the wrong way, but nor is it the right way. It’s just my way. But however you choose to get started, putting yourself out there via social media is undoubtedly scary. It is important to take care. I do highly recommend this very well constructed article by Annie Cooper and Alison Inglehearn. It will help you stay safe.

Once you have chosen your preferred social media platform – such as Facebook, Twitter, Instagram etc (and this can feel like a Betamax v VHS choice), here are an updated set of rules I shared in a previous blog that might help a social media novice get started.

  1. Do it yourself.
  2. Listen twice at least twice much as you speak.
  3. Don’t rise to the bait or post when angry or under the influence of dis-inhibitors.
  4. Share opinions but remember they are only your opinions. Others are allowed to disagree!
  5. Where possible, stick to facts and values.
  6. As in face-to-face conversation, seek common ground.
  7. Don’t believe everything you read.
  8. Don’t only talk to people you know you will agree with. Some people describe those who do as living in an echo-chamber.
  9. There ARE trolls out there. But not as many as you might be led to believe.
  10. Be kind, always – to yourself and to others.

It is possible, and great fun, to crowd-source a seminar, as I have now done a few times. Yes, it takes more time than the usual approach. (And it doesn’t finish on the day. It is important to thank people properly who have made the effort to help you.) The benefits are the potential to engage many times more not only with your direct audience but also with others via social media. And to widen your own learning in ways you could not have imagined. Most of what you see here has been achieved with the help of my social media friends. 

Given my passion about mental health, I must mention the impact of social media, which can either be overlooked or understated, in my experience. I thank my friends for reminding that social media is only a very small part of the world. It can be a source of solace and support, as I have sometimes found.  But it can also cut you off, if you let it. And it can be vicious, self-righteous and damaging. People can hide behind anonymity, so bad behaviour is invariably worse, goes more unchecked and can be more intrusive than in face-to-face interactions. I wrote this blog about Twitter  in 2014 which you might find helpful.

Blogging is not compulsory. If you like sharing thoughts in writing, you will probably enjoy blogging and learn to do it well. Like everything worthwhile, it takes practice. And if you don’t, you won’t. 

I would also mention that, however much you like the blog site you have chosen, unless someone (i.e. you and/or your readers) are paying for it, you and they ARE the product. The same applies to all social media platforms and indeed all publications, such as “free” newspapers. If we want original, independent writing to thrive, we MUST pay for books, journals, newspapers, even blog-sites. Otherwise it won’t be long before the only things available are products sponsored from a commercial or otherwise partisan perspective. And that is a very sinister prospect. 

Some people use social media platforms such as Twitter for swift repartee, and blog about more considered and complex thoughts.  I would argue that blogging can help us to work out what we think. And that we can use Twitter and other chat sites for this too. After all, there is no point getting involved in conversations if we have already made up our minds about something. Here is a bit more about why I write a blog.

Just to show that I have been thinking about social media for a while, here is something I wrote for the HSJ in 2012.

This slide deck on the role of social media in health is the extraordinary Dr Helen Bevan, @HelenBevan on Twitter. Helen is a genius in improvement methodology and practice as well as new ways of working, including using social media. 

And I thank another wonderful friend @AnnieCoops for introducing me to this lovely video poem about the social media imprint we leave behind us. Like all good things on social media, it will make you think really hard. Which is the best sort of thinking. 

Here are some of my new friends at Bradford District Care Trust. They were AMAZING!!!

And given that I mentioned kittens, here is William to wish you all well for 2017.

My nine lessons for Christmas 2016

  1. In November, my friend Sally took me to The Church of St Mary the Virgin, Putney and reminded me about The Levellers. As she read aloud from Thomas Rainsborough’s famous quote, I felt a shiver. “For really I think that the poorest he that is in England hath a life to live, as the greatest he. After this terrible year, surely we can remember this, and act accordingly?
  2. History shows that, when times are hard, false prophets can persuade those who are suffering to blame the “other” rather than the ones who are the true source of their misery. And cause them to use their precious vote in ways that challenge more liberal values. But if we merely condemn such choices, we have no hope of turning the ugly tide lapping our shores. After the results of Brexit and the US presidency, I have come to realise that we need to judge less and listen much more so that we can understand why people are so angry with the established order.
  3. This year we lost far too many extraordinary people, including the wonderful Jo Cox MP. She wasn’t afraid to work with those on the opposite side of the political divide nor to challenge orthodox views. I have concluded that members of political parties who spend all their time arguing or blaming one another rather than seeking common cause, as Jo did, are a major part of why so many are mistrustful of politicians.
  4. This month, the government announced that, as a society, we are not doing enough to prevent suicide. And that there will be league tables published soon to show which areas are lagging most. As one who devotes time to volunteer in suicide prevention, I find this extraordinary. We can do a great deal to reduce the incidence of suicide by tackling stigma, offering education and training and supporting voluntary services such as the Samaritans. But ignoring the main reasons for the rise in the rate of suicide is dishonest. Benefit sanctions, fitness to work assessments and cuts in social care support are causing hunger, homelessness, and shame from being a burden amongst the most vulnerable of our fellow citizens. And for a growing number, the only options at night are a tent, a homeless shelter or a shop doorway. No wonder that life feels increasingly unbearable to some.
  5. And while the government congratulates itself on low rates of unemployment, zero hours contracts and minimum wages are directly causing the rise in reliance on food banks, payday loans and other expensive credit. It is not refugees or so-called benefit scroungers we need to fear. It is people who “create value” (what a meaningless and loathsome phrase) from the misery of others. The Mike Ashleys and Philip Greens of this world. And the Rupert Murdochs and Paul Dacres who would have us believe that fear of the other, rather than compassion for our fellow citizens, is what should drive us. But I realise that grumbling to those who already agree with me is not enough. I’m going to do better in 2017.
  6. I have been learning how to apply the Myers Briggs Type Indicator (MBTI) to use in my practice as a coach. I could bore for Europe on this subject, but suffice to say, it has been a revelation. And the greatest insight of all has been finally appreciating at a very personal level what Carl Rogers meant in 1961 when he said: “What I am is good enough, if I would only be it openly.”
  7. I have also been learning how to be a Samaritan. I will be writing more about this next year. All I need say for now is that I gain as least as much as I give, and that the training and support for volunteers is absolutely wonderful. And with all that I mention above, and at this time of year, Samaritans are needed more than ever.
  8. This year, we lost so many wonderful people, including Twitter friends @GrangerKate and @GraceAndGloryDan. I would like to thank Zoe, courageous mother of Adam Bojelian. Adam sadly died last year. And Zoe reminded me that people who are bereaved value nothing more than being given the kindness of time to talk about the person they have lost.
  9. Finally, I have learned that people like pictures of cats. So here is William, my personal pet therapist, to wish you peace at Christmas. And may those who are lost, lonely or grieving find kindness among strangers as well as friends.

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.

 

 

 

 

 

Improving the NHS: with added tribute to Dr Kate Granger

Lisa 3 (002)

Last week I was introduced by Dr Kathy McLean, Medical Director at NHS Improvement to 180 people comprising senior NHS clinicians, managers, directors, chief executives, patient representatives and members of staff at NHS Improvement, including most of their executive team. And I wondered how my homespun talk about improvement, leadership, the universe and everything would go down.

As it turned out, quite well.

The cartoon above was drawn by Inky Thinking. I don’t know how they do it, but they capture everything you say that you want people to remember.

Here is a word-based precis:

  1. If you forget that culture always trumps strategy, your efforts to improve services will be ineffective. I’ve been there and occasionally done it the right way. But more often the wrong way.
  2. You can’t help others to improve unless you are OK yourself. I have form on not remembering this.
  3. Leadership in public services has never been harder with our 24/7 media, including social media, and the anti-public sector rhetoric that appears in most newspapers.
  4. Plus we live in a post-fact world – see this article by Guardian Editor-In-Chief Katherine Viner. People believe things that are not true, and don’t believe things that are. I’ve had personal experience of this. And it is horrible.
  5. Being an NHS leader is very lonely. Never more so than when you are awake at 3am. People get in touch to congratulate you when something goes well. But when things go wrong, people you thought were friends seem to melt away.
  6. There is never enough time to think when you are running NHS services because of competing demands, often from those who are meant to be there to help you make improvements. But you must create time to think or you will make bad decisions.
  7. Filling senior vacancies in the NHS is getting harder. And we should worry about this. Because if we aren’t careful, the only ones who apply to be in the firing line will be those who don’t care what others think about them. And that would be very bad for all of us.
  8. We cannot separate leadership from mental health. In my opinion, people who experience mental illness from time to time can make exceptional leaders. It is only one thing about them. Plus, they develop skills through therapy that are invaluable – such as managing their own mood, listening really carefully, and not making assumptions about others.
  9. I have experienced depression off and on since the age of 15. A nurse said something damaging to me when I was 22 and vulnerable which I absorbed deep into my psyche. For the next 36 years I stigmatised myself, despite being an active campaigner against the stigma of mental illness. It was when I finally came out about my experiences that I was able to address my self-stigma. I have made many friends since then. But if only I had done it before, I could have been a better, more authentic leader.
  10. Mental illness messes with your head. It affects 1:4 of us. But 4:4 of us should care about it, not just on humanitarian and economic grounds, but because almost everyone can be affected. We are all on a spectrum of resilience, and if enough bad things happen to us, especially at a young age, most of us will experience post traumatic damage.
  11. When I appeared suddenly to get ill with an acute onset of depression in 2013, it was a culmination of things. My own susceptibility, but also workload, loneliness, weariness as I approached retirement, not taking care of myself, listening too hard to my own negative voices, and putting a lot of energy into maintaining a positive front. It wasn’t caused by internet trolls. But they didn’t help.
  12. So please don’t do what I did. Get to know yourself. Talk to yourself honestly about how you are. Talk to your loved ones. Take care. Be the best version of you, but make sure that it is you. And try always to see yourself as an improvement project – this makes it easier to accept criticism without it cutting you to your core. I’ve only learned this in the last few years, and it is a revelation!
  13. I am lucky. I have dear family and friends. And I got great care. I was able to go back to a job that I loved, which was a major part of my recovery. I know it isn’t the same for everyone.
  14. Since the summer of 2014 when I finally hung up my chief executive boots, I’ve been helping others in various ways to be the best version of themselves. And I’ve written a book which I hope you will read when it is published later this year.

As I finish this blog, I think of someone who embodies improvement in everything she does. The talented, compassionate and extremely resourceful Dr Kate Granger. Kate is currently in a hospice in what are probably the final stages of a rare and awful form of cancer. But as well as sharing the intimacies of her progress through terminal illness via her wonderful talks and social media, Kate has also revolutionised the NHS and other healthcare systems around the world with her #HelloMyNameIs campaign. She has written several books, and completed amazing things on her bucket list. And not content with that, Kate and her husband Chris Pointon are urging people to make donations to the Yorkshire Cancer Centre, a small charity that helps improve the quality of life of people living with cancer. You can donate here.

Kate and Chris demonstrate that being a leader isn’t a job, it is an attitude of mind. That anyone can make a difference if they focus on something that matters, turn a great idea into an innovation and build support for it through honest endeavour. We can all learn about improvement from them.

May you go well, both of you.

25 July 2016 postscript: 

Chris has just posted on Twitter that his wonderful wife died yesterday peacefully in the arms of her family. 

I only met Kate once. I will never forget her. She had an extraordinary stillness and presence. I hope the knowledge of the difference she has made and will continue to make for many years to come will sustain Chris and all who loved her in the difficult times ahead. 

My heart goes out to all of you. May her lovely soul rest in peace.
 

 

 

 

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

 

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.