nhs

BEING AN NHS CHIEF EXECUTIVE…

No blogs from me for a while because I’ve been finishing my book Being an NHS Chief Executive.

In these early weeks after publication, it is nice to talk to a few reviewers about the book. Here are some of the questions I’ve been answering.

Why did you write it?

Because I felt I had something to say, about our attitudes to mental illness, and about suicide and abuse. I wanted to speak directly to those who devote their lives to public service. I also wrote it for a bit of catharsis. I haven’t had a work dream since I finished it, so that plan seems to be working – so far…

Is there still stigma about mental illness?

You bet there is. It will take more than a few people in the public eye talking about their own experiences to rid us of that terrible stigma. It manifests itself in the way people who are mentally ill are portrayed in the media, although have seen some progress. But more in how society (including government, who are elected by the people and in effect do their bidding) treats people who experience mental illness. There is unfair discrimination in access to decent housing, welfare benefits, support in finding meaningful employment, and to timely, compassionate, effective health care. Here in the UK, people with the most severe forms of mental illness die on average 20 years earlier than the general population. That should be a national scandal. The fact that it isn’t seems to me to be cast-iron evidence of the stigma that still exists.

Why did you decide to come out about your own experiences of anxiety and depression, having kept quiet for 58 years?

Until I was in my early forties, I wouldn’t have described my experiences as that. My self-stigma was so great that I viewed my inability at times to face the world, simply as personal weakness or flaws in my character. And then, once I began to accept my experiences for what they really were, I felt that talking about them would be self-indulgent, given the good luck I seem to have had with my family, friends, education, home and job.

This is something that people like me must always look out for. When I had my last major depression and was huddled in the dark wanting to be dead, I didn’t have to worry about being made homeless, having no money and getting no treatment or support. So I should watch my privilege.

What is your biggest regret?

Probably not dealing with all the above sooner, so that I could have used my understanding to help tackle the stigma that mental health services experienced throughout my 13 years of being in a position of influence. In fact, cuts to services are increasing as I write this, despite all the government rhetoric.

As well as being cruel, this is a false economy. Most mental illnesses start when we are young. If young people get the right advice and treatment straight away, the chances are they will be able to resume their education and personal lives fairly quickly, growing up to become full participants and contributors to society. It doesn’t mean they will necessarily be cured, but it does mean that the disabling impacts of mental illness will be avoided or kept to a minimum. Imagine if we said to people with cancer, look, your tumour isn’t causing you enough problems yet. Go away and manage it yourself and only come back when you are dangerously ill. There would be an outcry.

But just having regrets is wasted energy. So I’m doing what I can, writing blogs like this, talking about it to anyone who will listen, and using the book as an introduction to a having a different sort of conversation.

What are you writing now?

A novel set in a choir school. It is half done but I am trying to concentrate on it properly now. When writing fiction, you need to let the creative juices run, which for me means starting to write as soon as I wake up. Some days I am in still in my PJs at 3 o’clock in the afternoon. At least that’s my excuse!

If you want to read my book, you can get it in paperback or on Kindle here.

Baby boomer meets digital natives

The organisers @DanielOyayoyi and @RebsCullen and me

On Friday I spent a morning in Leeds with 100 trainees from the 2015 and 2016 intakes of the NHS Graduate Scheme. They had arranged a conference about digital media #NHSGetSocial. Thank you @DanielOyayoyi and @RebsCullen for inviting me to talk about raising awareness via social media. That I, an ageing Baby Boomer, should address a group of Digital Natives on this subject felt hilarious. As so often these days, I gained much more than I gave.

En route to the event I did a bit of crowd sourcing via Twitter to help illustrate my session. This was the first response:

The audience seemed to agree. They could think of examples of leaders who seemed uncomfortable with social media using it poorly, mainly to broadcast rather than interact.

There were also differences between how those with extrovert and those with introvert personality preferences interact with social media. Some had very sensible anxieties about tweeting first and regretting later. And others were honest about how hard they found it to decide what, if anything, to say via social media.

So I shared my social media tips:

Do it yourself.
Don’t rise to the bait or tweet when angry or under the influence of dis-inhibitors.
Share opinions but remember they are only your opinions. Others may disagree.
Where possible, stick to facts and values.
Don’t believe everything you read.
There ARE trolls out there. But not as many as you might be led to believe.
Be kind, always – to yourself and to others.

And I shared some of the responses I had received that morning, including these from @nedwards1, @forwardnotback and @anniecoops

The audience also seemed to agree with the Twitter response to my second question. We talked about the Daily Mail and other media that love to name, blame and shame politicians and those who work in public services but seem much less keen to call out wealthy tax avoiders or those who “create value” by paying minimum wages and offer zero hours contracts. And how even when they get things wrong they rarely apologise.

We talked about agent provocateurs and others who make things up and then either delete them or simply deny they have said it, even when there is photographic evidence to the contrary. The conspiracy theorists who lap this stuff up. And the anonymous characters who lurk on comments pages and bang on about no smoke without fire.

And we talked of the damage this all does to those who dedicate their lives to working in public life, but also how clinicians and managers can work together to call this dishonesty out, live by their values and counteract the post-fact world poison.

My other three questions were about patients and a paperless NHS.

Again, although hardly a representative sample, my Twitter replies accorded with the audience. They said that attitudes mattered as much if not more than IT. I told them the story of a medical colleague who would write to me every six months or so during my 13 years as an NHS CE listing everything that he felt was wrong with how I was leading the trust, including the inadequacy of his secretarial support, in a 3 -4 page letter typed, somewhat ironically, by his secretary. I would always reply, by email. By contrast, my own psychiatrist, a world renowned professor at another trust, personally typed his update letter to my GP during our consultation and gave it to me to pass on. He would have used email but it wasn’t yet sufficiently secure.

We also discussed the pros and cons of clinical staff spending increasing amounts of time away from patients collecting and recording data that someone somewhere thought might be useful. And that the gold standard of a fully connected wireless NHS when patients and staff freely shared information via iPad or other tablet device would happen one day. But that given the current state of connectivity, they probably shouldn’t cancel the contract for supplying paper and pens anytime soon.

Finally, I shoehorned in a reference to my muse Mary Seacole. I said that she, a 19th century health care entrepreneur, would have loved social media. And I gave Daniel and @HPottinger, in the picture below, my last two Mary Seacole enamel badges.

At the end I said that I would be writing a blog about the day. And I really hope some of them read it. Because those 100 young people made me think. Despite the financial challenges, morale problems, almost infinite demands plus the debilitating impact of our post-fact world, I think the NHS may be OK.

And you know why I think that? Because these young leaders, and thousands of other clinicians and managers like them, will make it so. With shining integrity, stunning academic AND emotional intellect, insatiable appetite for understanding, capacity for working smart as well as hard, courage to speak truth to power, and wisdom far beyond their years, they will do it. They will help our creaking NHS adapt for the new era. Whilst holding hard to our core values of high quality, safe care for all, regardless of ability to pay.

And as one who is likely to need a lot more from the NHS in the future, that makes me very happy.

Take good care of yourself

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.

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.
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.
Don’t pretend to be someone or something that you are not. It is exhausting.
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.
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.

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

On the eve of the EU referendum, some thoughts:

In 2012, the EU was awarded the Nobel Peace Prize for promoting peace + protecting human rights #10Reasons #StrongerIn
Voting out is not a protest vote against big business. It’s a whimsical vote against future generations #10Reasons #StrongerIn
If the economy tanks, as experts predict, it will be the poor + vulnerable who will suffer #10Reasons #StrongerIn
We are part of Europe and part of humanity #10Reasons #StrongerIn
The EU is run by politicians we elect. And they appoint officials. Because bureaucracy is good for civilisation #10Reasons #StrongerIn
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 #10Reasons #StrongerIn
Vote Leave have Boris Johnson, Nigel Farage + Michael Gove. #Remain have @CarolineLucas @sarahwollaston @SadiqKhan #10Reasons #StrongerIn
Leaving the EU would cause havoc to the NHS. We would lose vital staff + face massive cuts because of recession #10Reasons #StrongerIn
Not all who vote Leave are racists. But all racists are voting Leave, according to @billybragg. And I agree #10Reasons #StrongerIn
The British public are fighters. We are not quitters. We must stay in + fight to make the EU even better #10Reason #StrongerIn

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

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 😉

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.
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.
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.
Dress for style AND comfort. These are not mutually exclusive.
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.
Take breaks. Go for a walk. Have a rest in your room. Do shopping or emails or visit the Lowrie. Drink coffee.
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.
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*.
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.
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.

Respect

With growing frustration, I watch how friends who are “experts by experience”* are increasingly being treated by the NHS and the various bodies tasked with inspecting and improving it. Such as being invited to be part of an inspection as an equal member of the team. But being paid many times less than anyone else, possibly even less than the living wage. Or being asked to join a group to produce guidelines or develop a new treatment or service change, bringing knowledge, skills and experiences that no-one else around the table can possibly have, for nothing or for a fee that is so close to nothing as to be insulting. Or being invited to speak at a conference but being told that “we have no budget for speakers” when clearly the conference is a commercial event AND the other speakers are being paid either by virtue of being in full time employment or a handsome fee.

I had an NHS career spanning 41 years, including 13 as a chief executive. My career as an expert by experience only began officially in 2013. But I have the benefit of an index-linked pension, which allows me to live well (although not as well as some might think because of decisions made when I was young and poor). Plus I can still earn money doing other things. So I can make choices about how I respond to people who invite me to speak at their events or otherwise draw on my experiences.

But many of my friends do not have that luxury. Opportunities to develop careers have been fractured by illness, disability and arcane, terrifying benefit rules which are themselves disabling. Their earning potential is therefore limited.

And my friends find that their generosity, goodwill and desire to help others is increasingly being abused. Despite rhetoric about patient centred care, co-production, peer-learning and a whole load of other worthy aspirations spouted by leaders in and around the NHS, those very same organisations are showing an increasing lack of respect and value for the only people who can truly help them achieve their improvement aims.

I’ve done it myself. Years ago, when I saw the size of the budget allocated to service user involvement on an important capital scheme, I knew it would be the first place I would have to go to make savings, should any be needed, despite it being a pittance compared with the professional fees being paid to architects, quantity surveyors, lawyers and the like. I did it, and at the time I rationalised it because I felt I had no choice. Looking back, I feel ashamed.

Why do we, as a society, place so little value on what matters most? Why do we pay the person who cares for our loved ones when they are dying barely enough to cover the rent on a pokey flat, whereas a man running some oil company gets £14 million a year? And why we do only see success in terms of earning potential, rather than the gifts a person brings to other humans and the planet?

I can’t change societal values. But I can make an impact on what we do in the NHS. I am lucky to have a voice. And I’m going to use it.

Wise managers understand this:

If you can save money and achieve the same outcomes, that is a cost saving
If you spend the same amount of money but do something better, that is a service improvement.
If you spend more money to achieve a better outcome, that is a service development
If you spend less money and achieve less, that is a service cut
But if you spend less money and pretend you are doing it to make an improvement, that is usually a lie and a cop-out

So to the people who say that they’d love to pay experts by experience what they used to pay them, or even anything at all, it’s just that the money is really tight and it’s getting even tighter, I say this. Please think again. What else are you spending that public money entrusted to you on? What really matters to you? And if you must make draconian savings, why not try being as parsimonious with your auditors, your bank, your staffing agency, all your other contractors for professional services, your regulators. Even your directors and your staff.

And let’s see what happens.

And to my expert by experience friends I say this: we have something that the NHS should treasure, our personal intellectual property. Let’s continue to be generous and compassionate in how we share it.

But let us also expect respect.

*Post Script: I understand that the term “expert by experience” is of itself problematic. It implies that all the person brings is their experience of a condition and the treatment for that condition, rather than a much wider set of skills and attributes that, almost certainly, will bring richness and intelligence to the debate and from which those who work in the system will benefit in ways they had never envisaged. If, after conversations with wise people, I can work out something useful to say on this, I will. For now, I apologise about the paucity of the term.

Post Post Script: It is less than 48 hours since I posted this blog. It has been looked at 700 times, stimulated over 500 responses via Twitter, and comments such as the ones below. It seems that I have touched a nerve both for those affected by the things I have written about, and for those working in organisations that describe one thing in their values but seem to act in a different way. That was the purpose; there is no point blogging if there is no subsequent debate.

I am grateful to all of the commentators, but especially Alison Cameron @allyc375 who helped me over the terminology and with whom I am hopefully going to be doing a double act soon on this very subject – watch this space. To Dr Shibley Rahman @dr_shibley whose original thinking brightened my Saturday evening. And to David Gilbert @DavidGilbert143 who reminded me that Patient Leadership is a useful way of thinking about this. He kindly agreed to me referencing this series of articles co-written by him and Mark Doughty @markjdoughty which I would urge anyone who wants to think more deeply about this to read.

Time are indeed tough. And in tough times, it helps to know who our friends are, and whether the values they tell us they espouse are really their true values.

I send loving kindness to everyone reading this.

The ones who matter

It was nice that 12,500 people read my two recent blogs on the mental health angle of a current The Archers storyline.

But it wasn’t all good. I am a sucker for positive reinforcement, including WordPress stats. And I doubt I will ever again get 4,500 views in a single day.

And that’s the thing about maintaining one’s mental well-being if you are one of the 1:4 people like me for whom it is sometimes a struggle. I’ve been a bit down since those two blogs. I’ve questioned whether I’ve got anything interesting left to say. And yet I know I need to write about stuff to work out what I think.

Here’s what I’m thinking about today.

Someone said to me recently, with real sincerity, that the tide is turning on the stigma of mental illness. They said they thought that the battle had been won because people like me can stand up and say that we sometimes need help from mental health services. And not be judged.

But I thought hmm.

Because it doesn’t feel that way. Not to me, nor the friends I’ve made through social media and in real life. Especially not those who haven’t been as fortunate as me and are forced to grind out an existence on state benefits juggled with occasional paid work. The positives from such work are overshadowed by arcane, dis-empowering rules of which it is almost impossible not to fall foul. Nor does it feel that way to those who live in fear of losing their homes, or who haven’t even got a place to call home. Current government policy feels deeply discriminatory and the exact opposite of therapeutic for those already experiencing the potentially crippling challenges of mental illness.

It doesn’t feel that the stigma has gone away for the people who can’t get the right mental health treatment, or even any treatment at all. As a wise person recently said, imagine telling the parents of a child with early stage cancer that they have to wait until things seriously deteriorate before they can see a specialist. And even then, the care will be rationed and probably not what is recommended. That’s the reality in many parts of the UK, for children and adults too.

I heard a senior commissioner say the other day that they would love to invest more in mental health, but the evidence just isn’t strong enough (my italics). What planet are they living on?? True, spending on mental health research is woeful. But there is nonetheless masses of really good evidence about what works. And it starts with intervening early via properly funded local services delivered by highly trained, well-supported staff.

What also doesn’t help reduce stigma is the almost constant service redesign and reconfiguration. Indeed, the billion pounds of “new” money announced by Jeremy Hunt after the Mental Health Taskforce Report was published is not, in fact, new at all. It has to be achieved through efficiency savings. I know from experience that such initiatives rarely achieve all that is promised. And they almost never take account of the collateral damage to staff well-being.

Not to mention competitive tendering, which mental health services face at disproportionately greater levels than other parts of the NHS. Plus the drip-drip reduction in mental health funding and the erosion of national data collection so that it takes the skills of investigative journalists to uncover the ongoing cuts that have been made over the past 6 years despite government rhetoric about parity of esteem for mental health.

And what adds further to the stigma is that the media rarely mention mental illness or mental health services except when something appears to have gone wrong. Where are the motivational stories like the ones about people who have “beaten” cancer? Even when no mistakes have been made, the finger of blame gets pointed. Imagine how this feels to staff who work in these services, being pilloried for doing a job that most people couldn’t begin to contemplate because they don’t have the skills, patience, courage and compassion needed to work in mental health. They should be lauded and supported, not ignored and criticised.

So no, the stigma of mental illness is not a thing of the past. It is ugly, cruel, destructive and ever-present. Like racism, sexism and homophobia, it will never truly go away. We have to be vigilant. And we have to keep working at it.

Despite the job I once did, it took me until I was 58 to get over my own self stigma and admit that I experienced clinical depression from time to time. Coming out about it was the hardest but also one of the best decisions I ever made. I take my hat off to others who have got to that point sooner than me. You are braver than anyone who hasn’t been there will ever know. Showing the world that people who experience mental illness have hopes and ideas and other wonderful human assets to share is the best way there is to make others want to join us and change the way things are.

Writing about mental health and The Archers was fun. Writing this piece was harder but far more satisfying. I will try not to care how many people read it.

Because the ones who do are the ones who matter.

How are you doing today?

I love talking about mental health. What could matter more? This blog is drawn from ideas I have developed (and squirreled) while thinking about well-being at work for a slot I did at the Health at Work Conference in Birmingham last week, and in advance of an NHS Employers webinar on staff well-being yesterday. I used an earlier version of this blog to give my talk, and I warmly thank everyone who contributed. Your questions and comments were wonderful and you will be able to see that i have made some changes because of them.

And what an exciting day yesterday was. Because the Girl Guides Association announced their first mental health badge. It has been developed with the excellent charity Young Minds. It uses theories about emotional literacy and resilience to help young people take care of themselves and help others. If only they had done this 48 years ago was I was a Girl Guide. And wouldn’t it be great if such an approach could be rolled out across all schools and colleges and youth groups? What a brilliant start this would give young people facing the world.

At the conference last week, we heard from companies large and small who are putting employee wellbeing front and centre of their investment strategies. And this isn’t because of any sense of duty or even kindness. They know that it pays. They want to know the best ways to help staff achieve optimum health and how best to work with employees who have physical or mental illnesses to manage their conditions and get back to work quickly and well.

If we consider the NHS as one employer, it is the largest in Europe, many times bigger than even the largest multinationals at that conference. And yet we seem slow to follow suit. I say we…I don’t work for the NHS any more. But having done so over a period of 41 years, I feel deeply concerned for its staff. So I was very grateful to take part in the NHS Employers webinar.

Well-being and resilience are the new buzzwords. They are being used everywhere. I like them. But I also have a few issues with them. If we aren’t careful, well-being strategies can feel as if they place responsibility on the individual. And I see well-being as a partnership between the individual, their employer, their co-workers and anyone else they choose to invite to help them achieve their optimum health.

I like the Maudsley Learning model of mental health very much. It shows a series of steps and explains that we are all on a spectrum of mental wellness. I like the way it removes a sense of us and them.

But there are nonetheless inherent dangers in such models. Unless you have felt the terrifying symptoms of psychosis, clinical depression, an eating disorder or any of the other hundreds of mental illnesses, you might think that mental ill-health is merely an extreme version of the distress that anyone might feel when something bad happens. Using well-intentioned euphemisms like mental distress, intended to reduce stigma, can add to the isolation felt by people who experience mental illness. It’s important to say that most people won’t ever experience mental illness, just as most people won’t ever experience cancer or diabetes.

But 1:4 of us will. And we need skilled help from our employers if we are to go back to work at the right time and give of our best. The last time I was ill, I was lucky that I got the right help. Not everyone does. And that is why I do the work I do now, campaigning to improve things in the NHS and beyond for patients and staff.

I shared two specific insights at NHS Employers webinar. The first is that we separate mental and physical health for laudable reasons but at our peril. Obesity might get more sympathy if it were treated as an eating disorder; the most effective treatments combine diet with psychological support, including CBT techniques. Exercise is known to increase endorphins and improve mental wellbeing as well as physical health. People with serious mental illnesses die on average at least 20 years too soon, mainly because of associated poor physical health. And there is an increasing evidence base that people with chronic physical conditions such as cancer, heart disease and strokes have a greater tendency to experience clinical depression. Which comes first doesn’t really matter.

Employers should, in my view, use this knowledge of the inherent links between mind and body to devise their wellbeing strategies and make this explicit. Bringing the mind and the body back together needs to become the next Big Thing.

And secondly, I am increasingly of the view that people who experience mental illness, who are open about it and learn to live well with it despite the massive challenges it poses, can become even better employees than those who don’t have these experiences. I’m talking about people like many of the friends I have met since I came out about my own depression. Such people show extraordinary resilience, compassion for themselves and others, patience, creativity and highly developed social skills that would be valuable in any workplace. They are truly amazing. I try not to have regrets. But one of mine is that it took me far too long to realise that my experience of mental illness could become an asset, if I let it. So now I’m trying to make up for lost time!

I want to share links to my other blogs that I think might be helpful to anyone thinking about wellbeing at work.

This one is about taking the plunge and talking about your own mental health, perhaps for the first time.

This is my plea to be kinder about obesity, because what we are doing now simply isn’t working.

This is about the things you can say and do to help a friend or colleague who is experiencing mental illness. And the things that really don’t help.

These are my ten commandments for working in mental health

This is a blog in which I thank people who have helped me in my journey of self discovery – still very much a work in progress.

And this is my Letter to You. Which you might want to suggest to someone who you think may be struggling.

Life is hard for most employees these days. Working in the NHS holds particular challenges. Stress at work doesn’t have to make people ill. But it can. Employers can make a difference. And so can co-workers.

Please take a moment to think about your colleagues, especially the ones who are having a tough time, seem a bit quieter than usual or not quite their usual selves. Ask them how they are. And really listen carefully to what they reply.

And if you are one of the 1:4 of us who experience mental illness from time to time, I say this: go us. Because we rock. 😎😎😎

Wishing and Hoping and Blogging and Tweeting

Bad selfie with 2 lovely Twitter chums @AgencyNurse and @AnnieCoops

Last Thursday, 3 March 2016, I facilitated a couple of seminars at the East Midlands Leadership Academy social media conference. Two days before the seminars, I invited anyone who felt so inclined to help me prepare via Twitter and a blog. I then used an updated version of the blog I had initially written as my audio-visual aid for the seminars. It was my very own small action research social media project.

Thank you to the 450 people who read the original blog, commented on it and/or joined the two seminars. I called the seminars Wishing and Hoping and Blogging and Tweeting, which hopefully gave attendees a hint that I’m no expert and that I take a don’t-wait-for-permission-but-ask-for-forgiveness approach to my own use of social media.

You can see the first blog and the comments on my blogsite directly below this one. Thank you very much indeed to Zoe Bojelian, Liz O’Riordan, Chris Richmond, John Walsh, Phil Jewitt, Annie Cooper, EM, Natasha Usher, Sian Spencer-Little, Lloyd Davies, Linda, Vicki W and Laura Hailes for taking the time to comment on the blog.

I apologise to Fenella Lemonsky, Gill Phillips and anyone else who tried to comment but were stymied by WordPress and/or their own social media platforms. I don’t know how these things work, but I know how annoying it is when they don’t.

I also warmly thank everyone who helped share my requests to get involved or commented themselves via Twitter, including @bipolarblogger @hpiandycowper @davidgilbert45 @AgencyNurse @whoseshoes @jbmccrea @kirsti79 @andrew_davis @noshinakiani @carolinewild @LindsayHobbs51 @HubTube @OrganicLemon @LisaMillerVC @NHSE_PaulT @AlysColeKing @PeterMEnglish @HollowDave @MargoJMilne @endless_psych @JYoolz @QueerAndConcise @ethicConsult @allyC375 @HealthWKTD @ pgtips42 @LearnHospice @alisonleary1 @Lindawr45160138 @Lucy EMLA @LucyMorley1 @JennyTheM @PatientOpinion @DaniG34 @JOMWLever @emetalic @DanileOyayoyi @MConroy09 @GeorgeTruSATCGirl @AMKane87 @ImtiazGiriach @ElizabethJSays @DebElSayedd @GeorgeJulian @LyndsayShort1 @NickiH @bigronstevenson @wendynicholson @andrewbeee @rosgodson @wendyJNicholson @gremlin2C @mynameisAndyJ @sara_J_Brown @penny_thompson @jackiecassell @claudemmx2 @roz_davies @sweeternigel @nonnazoo74 @garethpresch @anyadei @beckyOT @claudia_writes @spencer_sian Sincere apologies to anyone I have misspelt or missed out.

Most of all, I want to thank the two sets of participants at the seminars. When I asked them where they were on a scale of 1 = social media virgin – 10 = social media warrior/maven, the lowest score anyone gave was a 4, and I think that person was being overly modest. There were lots of 7s and 8s and quite a few 9s. Given I would put myself at 6.5, it felt rather like a master-class in reverse. Which is the story of my life.

I’ve drawn my personal learning points from all of this into a list below, and included some references for you.

It is possible, and great fun, to crowd-source a seminar, even a podium address in the way I’ve just done. 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. I hope I have paid enough attention to this. 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.
My personal approach to using social media is how I tend to approach most new things – I jump in and have a go, and 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. However you choose to get started, putting yourself out there is undoubtedly scary. It is important to take care. If you are in a high profile role and/or a health care practitioner, this very well constructed article by Annie Cooper and Alison Inglehearn is just great. It will help you stay safe.
My session last week was about using social media as an individual who may (or may not) happen to work for an organisation. NHS social media guru Joe McCrea (@jbmccrea on Twitter) gave a fascinating presentation at the same conference about the use of social media by NHS organisations. He is about to publish a seriously interesting report – please do keep an eye out for it on his wesbite.
The mental well-being side of social media can be either overlooked or understated, in my experience. I thank several folk for reminding me to remind others to be aware that social media is only a very small part of the world. It can be a source of solace and support, as I have often found. But it can also be vicious, mean, self-righteous and damaging. And because people can hide behind anonymity, 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 last year. I think what I said then still holds true.
Lots of people want to share their ideas by blogging but have yet to get started, and are keen to choose a good blog-site. I can’t recommend any specific sites because I’ve only used WordPress. I do like it, but like all software, it has downsides. I would just remind you that, however much you like the site you have chosen, unless you are paying for it, you and your readers ARE the product. If we want independent writing to thrive, we MUST somehow pay for books, journals, newspapers and maybe even blog-sites. Otherwise it won’t be long before the only things available to read are the ones that carry adverts or are sponsored from a commercial or otherwise partisan perspective.
Quite a few people have pointed out the difference between posting comments on social media sites like Twitter, and blogging. Which is that the former is for swift repartee, and the latter is for more considered thoughts. I agree. But I would also argue that blogging helps us to work out what we think. And 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 blog.
This slide deck on the role of social media in health is from my extraordinary friend Dr Helen Bevan (@HelenBevan on Twitter – if you don’t know who to follow, follow Helen). Helen is a genius in new ways of thinking, including social media. She presented this at a social media get-together event at the beginning of last week. I’m sad I couldn’t go, because it looked highly informative and fun.

Finally, I thank Annie Cooper for sharing this lovely video poem about the social media imprint we leave behind us. Like all good things on social media, I promise it will make you think really hard. Which is the best sort of thinking.

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.

Lisa Says This

Using what I've learned to help others

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