The Respect Lacking from the Mental Health System

The more that I come into contact with ‘the system’, the more I discover the disturbing and unforgivable lack of respect held for patients. It should be a core tenet of a system looking after human beings that each person is treated with the respect that everyone deserves. If that one aim is not achieved, then any other perceived good is effectively null and void.

Unfortunately, even when individuals themselves appear to be particularly respectful, truly patient-centred and empathetic (and I know that there are many of these individuals working in mental health), it appears that the system often prevents, suppresses or causes them to disregard that in order to remain within it. Whether it be quotas, targets, perceived notions of how someone’s treatment/care/recovery/life ‘should’ progress, restrictions from ‘higher up’, lack of funding, understaffing, or any of the million other constraints faced by mental health services – the system frequently fails to show patients even basic respect.

I desperately want to change this; I think it needs those of us who’ve ‘been here’ to get involved and try to work out how we can help make changes; maybe one day I’ll manage to stick my nose in and affect ‘the system’ directly and tangibly, but for now the best I can do is write and hope that even a few people are helped, enlightened or empowered very slightly. So…

To afford patients respect is as simple as:
– discussing treatment and care options with the patient before decisions are made
– actively encouraging the patient to talk over the pros and cons of each option from their point of view, encouraging the expression of an overall preference
never acting upon assumptions of the patient’s thoughts, opinions, motives or wishes, rather than seeking patient input*
inviting, and giving weight to, the patient’s opinion (and their carer’s)
openly discussing the full range of opinions of the varied professionals involved in the patient’s care (never present a one-sided, united front from the full range of professionals if that isn’t true – this fosters extreme mistrust and breakdown in therapeutic relationships across the board, as well as simply being a lie)
explaining the logistical limitations that might prevent preferred treatment options being viable
– if the patient’s wishes cannot be carried out (and there are many perfectly valid reasons for this being the case), explaining clearly to the patient why alternative plans need to be made before they are implemented
– never agreeing plans with or making promises to a patient about their treatment only to subsequently do the opposite (this only fosters mistrust and breaks down therapeutic relationships), especially without warning or explanation
never informing the patient of dramatic changes in their care as an afterthought, at a stage where there is not even time for explanation or mental processing before changes are actioned
– never making snap decisions where time allows for discussion and explanation
– never intentionally lying to or about the patient or about views expressed to/by them

*This is especially important where ‘heated’ or emotional events take place, where a patient’s motives are in question, where there is concern for anyone’s safety, or where crucial decisions are being made. No matter how good, conscientious or empathetic a mental health professional is, no-one can read minds and it does everyone a disservice when the patient is not allowed to speak for and explain themselves. I cannot begin to explain the damage caused by something as simple, but insidious, as assumptions over patient consultation.

All in all, this boils down to one overarching rule: never allow a therapeutic relationship to become one way (through the failure to acknowledge or value the patient’s opinion, acting upon assumption rather than patient consultation, unnecessary non-disclosure of knowledge, exertion of power without discussion, or imposition of decisions without explanation and chance to come to terms with them). A patient needs to feel that they are respected and valued as an individual human being with trusting two-way therapeutic relationships with everyone involved in their care, rather than just being another lump of meat on a package line being squeezed into an ill-fitting box ‘just because’. Even if that ill-fitting box is the only option or if professional opinion strongly contradicts patient preferences, please explain that before taking action; we have a right to understand; more importantly, we need to know that what happens is in our best interests. We desperately want to be able to put our trust in the people trying to help us but secrecy, lack of clarity, unexpected changes, backtracking, no consultation, and no explanation can make this incredibly difficult. I also believe that this trust and system needs to be built on acknowledging that the professionals themselves are fallible humans – there will be mistakes, emotions, external influences, individual quirks, and personalities – this should be managed to a degree, but it’s also important to the well-being of both sides of the relationship that this factor is acknowledged and built upon, in the good and the bad. None of us are robots, none of us know everything, none of us do the right thing all the time, none of us are free from baggage – that means that the system is bound to have constant hiccups, and that’s okay. As long as that system is built upon respectful, open two-way relationships.

We are humans who have a right to be involved in our care as much as is safely and logistically possible. Often, as mental health patients, we have so little say in so much of our lives, at least let us have a voice with those looking after us. At least let us have the respect that we deserve.

Postscript: there are obviously times when the things I have discussed here are not possible for legitimate reasons, I am not denying that, however these should be exceptions to the rule. And, no matter what, someone treating a mental health patient should always, first and foremost, consider if the actions taken show the patient respect; it’s as simple as taking a few seconds to ask yourself how you would feel if it was you or your child/parent/partner in your patient’s shoes.

P.P.S. This is most definitely NOT a dig at our hardworking, undervalued mental health professionals – I am very grateful for the blood, sweat and tears that so many of you pour into your work to help the most vulnerable of society – however I also know that you face pressures and restrictions, so I hope that an ‘insider view’ of what it feels like from the other side can shed light on things that might not be apparent otherwise. I also know how restricted individuals are by the rules, funding, resources etc available. I just want to finish on a big thank you xxx

Edited 30/4/2016 at 7pm (because my brain never stops churning and I had more I wanted to say – nothing has been removed and no content has been changed, only added to!).

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2 thoughts on “The Respect Lacking from the Mental Health System

  1. I hear you, I’ve had dealings with some counsellors that were really disrespectful to me (treating me like a child and basically assuming that I’m just an attention seeking teenager) another counsellor of mine was very emotionally detached, which I understand you need to be in those type of jobs but she really intimidated me because of that. I think some things do need to be changed with mental health services and I agree with you that there should be people working in the system who have been where we are to increase understanding and respect. Hopefully one day we can change the system so that it’s like that xx

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  2. This is such an amazing, balanced view. I am so proud that you have been able to express this so eloquently and calmly. It is so, so true and affects your care and how you feel and react so much to what is happening with your care. It is a very very important part of mental health care the MUST be changed and incorporated.

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