What could be different in mental health care, what helps, and what have you found to be useful reading?

[OwFriggingOw]

First off - this is a thread inspired by another thread - not about another thread.

I am a lecturer who teaches mainly MH nursing students, but also Adult, Child and Learning Disability field nurses about MH, and also occasionally medical students. I have no agenda for this thread bar a genuine desire to listen, share ideas, and have an open discussion about what is helpful / less so. I worked in NHS MH for 13 odd years.

In case anyone links the other threads that inspired this thread - I have been comissioned to edit a book about people's experiences (service users and carers / family / friends) within MH services and with MH issues. NONE OF THE POSTS HERE WILL BE USED IN ANY WAY, SHAPE OR FORM FOR THIS BOOK. You have my ABSOLUTE word on that. Similarly, NONE of the posts here will be used in any of my teaching.

My aim in starting this stems from several PM's and several on-thread comments about how this would be useful/ I hope it can be a helpful, supportive and productive meeting place for thoughts and ideas about what people have found helpful with regards MH care / services / support (statutory and non statutory) and what has been less helpful. Most importantly with regards the less helpful - what can be done differently?

And - beacuse I like books - maybe we can share reading ideas :)

Would it be helpful if I shared parts of my long thread from earlier regarding what I see as needed, without any other details from the thread?

I agree with FrothyOM about being entitled to a second opinion and being allowed to try a new therapist if one isn't working for you.

The amount of crap I've heard over my years of counselling/CBT from therapists basically trying to put you in a box and explain away your problems using situations and language that you cannot in any way relate to has always left me feeling terrible. The person-centred approach sounds like something really worthwhile (I've not tried it, but a therapist friend has spoken to me about it), as it seems to me that so many therapists don't realise there can be NO identikit approach for dealing with mental health issues. Two agoraphobics or sufferers of OCD will not experience exactly the same problems, and there will not be generic root causes. The 'six sessions and out' generic approach needs to change.

Sorry haven't been back garlic pc froze
"If people's distress weer properly heard and actions taken to address it "empowerfully" ,perhaaps there would be less pressure on the hospitals agree 100% , thank you

It wasn't the "I find myself defending my right to have an opinion " which I asked you to clarify , but "This is a perfect parallel of what mental health "services" do wrong "

My cognitive processes are often slow due to my physical health condition ( though I hope that doesn't look like me trying to say that's any more valid than if was caused by emotional distress or side effects of medication etc )

"Have you ever tried to state your needs or views to someone who insists you don't know your own needs or views , refusing to listen ?

Yes , year after year after year of trying to access basic standards of care for
physical & emotional health for myself and relatives ... soul-destroyng is not a strong enough phrase . I pay close attention to Mners whose attempts have been more successful & think this thread might explore these inconsistencies .

Completely agree, FrothyOM- very worried by the illogical attempts by some posters to silence debate and think Mn handled it excelletly

Very glad to see this thread has had positive effects , captainhastings..know just what you mean about threads having an effect that leaflets / websites can't Mn has helped me take action in all many areas of my life over the years & this is an important area of my life where I felt a gap existed on the mh board

Thanks for link , Ow , some brilliant book recommendations ...but I worry about the gap I've sometimes found between the revolutionary ideas students have access to in their (continuing )education , and the difficulty some -some !- mh professionals seem to encounter in treating their clients with the respect they know they should ? I'm sure you address the pressures of practice with your students / qualified practiotioners at great length ... might such problems stem from workplace politics , or is it more more about imbalance of power in the structure of health systems ? < needs v basic books on that >

sorry for typos

Future, I was unduly brusque in my reply and am sorry for that.

Yes to everything you've just posted!

Hi mentalcontinental -am guessing all of us here are going to agree with you on generic approach not being helpful.

I too would like to engage in person-centred counselling - any chance at all of it being available on nhs in our areas for our particular needs ? < determined not to be pessimistic >

Just a simple guide I liked , not a list of therapists as per the above
counsellingresource.com/lib/therapy/types/person-centred/

Am not knowledgeable enough to comment on your experiences except to say my own phobias certainly did not fit into most of the "boxes" on view!

I really appreciate your post , garlic , thank you , and any brusqueness is not surprising , these are very difficult topics and you have had a hard time helping them be aired .

Thank you for postive feedback & I hope to learn much , much more on this . It is helping me personally to hear positive stories from some , but of painful obstacles from others .. it's not just me / my friends & relatives / my health authority ...

To be fair to cognitive therapists, their type of therapy isn't ideal for six sessions either. It's simply that their therapy is more easily proven to be successful and that this is the shortest amount of time the govt can get away with funding. So it is the therapy of the day.

Most CT Ime expect to see someone for at least 12 sessions for fairly straightforward situations. They would need a much longer time to work effectively with a more complicated problem.

Thank you Perry , I can well imagine CT therapists feel frustrated having to provide such short courses .
I do peer at studies on the effectiveness of various therapies , but lack the academic understanding to feel confident they aren't skewed by , say , lack of enough people receiving therapy , due to financial constraints , thus no measurable benefits are proven in sufficient numbers, and so it goes on ...

Have the impression from reading that some professionals believe further studies would prove the usefulness of , say , person-centred therapy , and that some would like to offer it ? Sorry so simplistic . Can't remember where I've read basic guides on how studies are conducted - a GCSE textbook I think - but information no longer sticks long in my brain .

I suspect the core of mh provision atm is dictated by politics & finances , and structured so professionals can't effectively challenge shortcomings ... maybe too much of a tangent for today ! < off to library >

I don't think it's a tangent - I think all related posts there re the move from student's feeling positive, enthused and optimistic and translating that into practice. I think re the question above that it's a whole range of individual factors that lead to burn out and leads to less effective practice - but what I do think many health care professionals are struggling with (not just MH but all sorts of services) are feeling exhausted, the bite of staff cuts hitting in terms of workload, and frustrated with potentially not being able to work in more creative and less pressured ways if that makes sense - certainly something a lot of different practitioners have expressed on MN and in the media, as well as where I work.

But short of no recession, and investment in services, I have no answer to that either I'm afraid!

All students currently on the nursing courses where I am have specific lectures and a core ethos of person centred care (though not person centred therapy in a formal sense) throughout the course :)

Thank you Ow - can imagine the stresses from management in nhs and indeed in academia < shudders >

So I'll focus on trying to learn more about the individual factors you say can lead to burnout - would some of the the issues be covered in popular texts for mh nursing ? ( easier for me to find in library )
Not that books can explain the realities of the job , of course , but I need to start somewhere < adds to list of things to look up >

Many of these issues must be well-documented , plus there must be basic safeguards I 've heard of but know nothing about, like reflective practice , mentoring in some jobs ....(?)
Very good to hear that about your nursing course , as I have real worries about what happens when safeguards do fail ... not good for anyone ,and deters people from seeking help again
( ...sorry , I promise to make constructive suggestions of other things that have helped me , but my own positive thing today is to educate myself )

Typed a long dull wordy post

Anyway. Most therapy is "person centred" in it's approach but I'm glad to see mh nurses getting a decent grounding in it. Rogers is having a further run out to the sunlight!!

It's a pity there wasn't more funding for MH access to therapy as I believe a person centred approach can have very significant impact on a range of people where CBT isn't appropriate.
CBT is being used for Axis 2 now as well..With some success I believe.

Reflective practice, clinical supervision (sometimes with a peer supervisor, sometimes from management, sometimes with an independent facilitator - group and individual) all best practice, and taught and implemented on a range of different MH curricula - not sure how many give supervision while students in practice from the Uni side, but all students have this via a mentor in practice). Those issues should certainly be covered in most introductory MH nursing textbook :)

I those are a few factors that impact on burnout - just not having the head space for reflection and space to discuss bar in the regular handovers or team meetings - I think that's a really significant risk factor from my own experience.

Plus in any job the general life stresses can impinge on performance, ability and concentration massively - I guess if you're working in any kind of environment where the job itself is stressful and involves
significant contact with the public then that makes it more challenging still.

Academia carries it's own challenges - but massively easier than the NHS currently, in many roles I suspect!

Right from day 1 perry where I am - Rogers still there - all students get sessions around warmth, genuineness, empathy and unconditional positive regard, MH students have more applied and detailed work around person centred therapy too and some other approaches too (CBT principles etc etc).

I am far from perfect - no one is - and maybe it would have been better to start this thread without talking about my background. I wanted to start the thread by being honest to demonstrate that actually, many if not most professionals I've worked with have been really keento listen and develop and adapt things wherever possible. Maybe that was wrong. Maybe it would have been better to start this thread to JUST share links or pool resources. I don't know. I'm not arbiter of the boards, and it's not up to me to control what people can and can't post in terms of background - an I think people sharing experiences would have been inevitable perhaps however the thread was set up. If I'd tried to say 'just links and resources' then I'd have been accused of trying to silence people's experiences I suspect.

I don't know. I do know two things - that I'm certainly not an 'emotional vampire' - and that people here have repeatedly said this thread has been helpful in terms of them finding things they'd not come across before at least. That's all you can hope for for any thread I guess - that some hide it, some ignore it, some are critical, and lots find it useful. My aim was only ever for it to be positive.

Nice cop out there OwFrigginOw.

Whatever happened to 'look before you leap'?
Or 'First do no harm'?

To obliquely lure people to contribute to your thread by flattering them that
(1) their opinions matter to you as a professional in the MH field, and
(2) to hint by your description of your occupation and book that you are in a position to make their voices heard, is unethical and irresponsible.

GB 'Have you ever tried to state your needs or views to someone who insists you don't know your own needs or views, refusing to listen? Who, perhaps, requires you to stay positive instead of stating your needs and views? If you can't think how that feels, try watching a child attempting the same. No wonder there is so much anger.'

Have you ever heard a relative over the course of several hours on the phone state their needs and views as part of their massively logical argument against taking their medication, or going to their appointment, while you know they have not washed or eaten or slept for days and their windows are covered with tin foil?

Not all wants or needs or complaints about MH services are created equal, and there are two sides to this.

'If people's distress were properly heard and actions taken to address it 'empowerfully', then perhaps there would be less pressure on the hospitals.'

Some of the distress is in fact a symptom of illness.

Actually you should be directing your shouting at me, mathanxiety.

Because on the previous thread I explicitly asked Ow to be the one to start this thread, after she was one of several of us who commented that a general thread about general MH service issues might be useful. And I only asked her because I'm not very good at writing opening paragraphs, otherwise I'd have done it myself.

So this thread is not predicated upon Ow's professional position - but it is nice that she declared it for purposes of openness.

Sorry, Ow, I should have piped up and said that earlier.

'I have no idea why there should be any type of problem with this thread whatsoever. Exactly how can it NOT be a good thing to discuss what improvements can be made.'

Lots of research has been done. Lots of books have been published. Many have been recommended here by Ow herself, giving the lie to her claim that the sharing of experiences and insights here is useful.

The discussion of how MH services can be improved is already taking place, and it is taking place in forums where the discussion can actually lead to change.

This thread is redundant and unethical.

Can't you go and complain about the people posting about guinea pigs, Math? Most of their threads seem a waste of space to me. Because I don't have guinea pigs.

FFS math, how is REDUNDANT or UNETHICAL?

All I see is a bunch of women who've had difficult times offering each other links and reading material in order to maybe help them.

Like I said before, if you hate the thread so very much, why not just not post on it? No offence, but it's not like your views are so incredibly amazing that we can't live without them.

Oooh , thank you Ow and Perry . Your mention of needing space to discuss other than at handover is very interesting , and the need for head space to reflect, even more so - I mean , it seems obvious to you , but hearing that you find it important in your work is different to seeing it written down

I have heard of Rogers & would be very glad if that approach had
become central
Right- I will see if I learn much from reading up on the basics -or just generate more questions

( Ye gods , Ow if academia is that much less pressured than the nhs ...)

Thank you Perry , I like long & wordy too
Thank you Perry , very interesting that you think person-centred theerapy could be so helpful where CBT is not suitable .

math , I am not "flattered" by being able to post on this thread nor was I lured by the prospect of having my voice heard by an author .

I do not feel anything would convince you that I am very distressed by circumstances such as you mention , but more to the point , am very keen to help find better ways for someone in that situation to be helped

Ooops , sorry Perry , so many typos / notes left in

And , lovelyNilgiri , I too should have piped up earlier as I too did suggest starting a thread among the general melee on the Site Stuff thread 2 days ago .

Your attitude towards service users shocks me , math ... I feel your words will actively dissuade people from approacing mh services .