‘Consultation is not co-production’ in the development of a suicide prevention strategy

Emma Goodlad, Grants and Impact Officer at the Health and Social Care Allliance Scotland (the ALLIANCE) blogs for the Academy this week. Emma powerfully makes the case for meaningful public involvement and co-production in the development of a suicide prevention strategy. 

New statistics published earlier this month reflecting the impact of suicide on people in Scotland were somewhat worrying, with a sharp increase in deaths by suicide in 2016. With suicide being the leading cause of death for young people in Scotland and the biggest killer of men aged 20-49 in the UK, the new suicide prevention strategy being developed by the Scottish Government needs to be forward thinking and brave in its aims and ambitions.

To develop a truly effective and useful suicide prevention strategy, one which guides people and professionals across Scotland on how to support people who are experiencing crisis because of intrusive suicidal thoughts and ideations, the Scottish Government needs to be led by people with real lived experience of suicidal thoughts, attempts and those who have lost loved ones to suicide.

This cannot simply be a consultation. When asked to be consulted on the recently published Mental Health Strategy, some third sector organisations expressed that they felt that the Scottish Government has a culture of over consulting, but under delivering on the feedback. People feel that they have opened up and told very personal, and often quite painful, stories of their own lived experience to try and guide and influence policy and strategy but are not seeing their experiences reflected in the final outputs.

To make sure that they are doing the right thing by people they need to put lived experience at the heart of the process from the very beginning to ensure that consultation is undertaken in an appropriate, sensitive and realistic way where people feel like their voices are truly heard and being used to improve the lives of others in the future.

As someone with both lived experience of attempting to take my own life, and working at an organisation who works in partnership with our members to influence and develop Scottish Government policy and strategy, I can see both sides of the coin. I understand that the state cannot realistically meet every demand or provide the necessary changes to services and support overnight, however when I most needed support I was let down by the very system we are told to tap into and ask for help from. If there was a clear suicide prevention strategy with realistic outputs and therefore outcomes, I may have never reached the point where I felt I could no longer cope and tried to take my own life. On the other hand I may still have reached that point and if I had, again, a clear and realistic strategy could have ensured that there was a clear pathway of support on hospital discharge to support me in the time between discharge and CMHT appointment.

Instead I was discharged, still in a state of disconnectedness from the world, with no involvement of my family in the lead up to my discharge from a High Dependency Unit and no coping plan put in place to keep me going until my appointment 8 days later with a Community Psychiatric Nurse. My family, friends and I were left to muddle through that week and deal with my ongoing depression and suicidal thoughts with no professional support purely because I had seen liaison psychiatry while still in a blur, recovering from the after effects and trauma of an overdose and had lied, like so many others, about still feeling suicidal because I was terrified that I would be sectioned under the mental health act.

I was lucky to have an incredible support network who got me through that incredibly difficult period and who now actively support me to look after my mental health and identify any issues.  But what if that happens again? Would anything be different? Yes, it would be, but not necessarily because the support services are any different, but because my family and I know what needs to be different and would fight for different support.

Consultation is not co-production. I want my voice to be heard by policy makers, I want my experience of the darkest period in my life to be used for good.  But I don’t want to be involved in a tokenistic consultation where nothing really changes, because the Government are afraid of raising expectations and letting people down if they cannot meet them.

I want to be part of a strategy which is brave, forward thinking and truly strives to make a difference in people’s lives and isn’t another strategy which goes into desk drawers across Scotland. I want to be involved in the development of a strategy where the consultation is a two-way discussion which is open and honest about what is realistic, what the challenges will be and work together to find realistic solutions to overcome these.

Let’s not forget that they have done this before. In 2008 members of the ALLIANCE worked with the Scottish Government to develop and produce Gaun Yersel’ The Self Management Strategy for Scotland. Gaun Yersel’ 9 years on is still held up as an excellent example of effective co-production to produce a realistic strategy document.

I call on the Scottish Government to be brave, put aside the fear of raising expectations and let’s work together for a Scotland where death by suicide rates are reducing, not increasing and strive for a support system to be held up as an example across the globe.

‘It’s about unleashing, not controlling’

On 26th June, the Health and Social Care Academy hosted ‘Emphasising Humanity over Bureaucracy in Social Care‘; an event that explored what emphasising humanity looks like in practice, not just for those receiving care but for those providing it. 

 William Kløverød Griffiths Policy and Information Intern, Dementia Carer Voices spoke at the event about the work of Dementia Carer Project and the emerging themes from the pledges that have been gathered. In this blog William writes about the You Can Make a Difference campaign and the importance of celebrating the kindness of people with dementia, their families and carers.

President of Institute for Healthcare Improvement, Don Berwick, has been credited with saying “The heart of improvement is not in controlling, it is in unleashing.” For me this really sums up the work of Dementia Carer VoicesYou Can Make a Difference’ campaign. The work we do is about unleashing not in controlling what people do, their messages and their stories.

The campaign is about celebrating and unleashing the kindness and dedication of people with dementia, their families and carers. It is to emphasise that they are equal partners in the care they receive. To this end we collect the stories and experiences unpaid carers have in providing care to their loved ones. Dementia Carer Voices are building a range of multi medium case studies, asking people what matters to them. It is our hope that these will provide useful evidence about the lived experience of the lives of unpaid carers. In that regard, we hope to be a platform to unleash the messages of unpaid carers.

youcanmakeadiff

The project also shows the lived experiences of people with dementia, their families and carers to those who work in the health and social care system. It is a difficult and underappreciated role that health and social care staff do every single day, day in and day out, but it is essential to the health and wellbeing of millions of people. Thousands of people come into contact with NHS Scotland every day, an estimated 37,000 people living in care homes in Scotland, and many more receiving home care visits. If our campaign can unleash some compassion, care and consideration into every one of those human contacts, then we will make our health and social care system better.

So the work we do at Dementia Carer Voices is about unleashing the passion and kindness of unpaid carers. It is about those people who sit by our beds, knock on our front doors and who we speak to on the phone. It is about the people who treat us when we are unwell, about those who offer kindness when we are vulnerable and are able to make a difference in people’s lives. To all those who follow the five must dos of caring for someone, and place the person at the centre of their care.

nothingaboutmewome

When I first joined this project a little over two months ago, I took out a selection of the pledges we have received over the years. Just over 13,000 people have made a personal pledge to make a difference, giving people the opportunity to commit to, to share and celebrate the difference they and we can all make every time we meet someone. That is what this project is about, it is about unleashing the voice of people with dementia, their families and carers. These are people seldom heard, but with our project hopefully gives them the chance to express themselves and take this message to people who make policy.

Dementia is everyone’s business. It is not about buildings or organisations, it’s about the people within and the people we meet, on every occasion it’s about people and relationships. It’s about the life and love stories of families all across the county. So I truly hope the people the pledges, the life and the love stories are about unleashing what matters, who matters and about unleashing the parts we can all play in every moment, every day and every time.

If you would like to learn more about the project, or to sign up to our mailing list, please email dementiacarervoices@alliance-scotland.org.uk

@WK_Griffiths
@DementiaCarerVo

 

 

 

 

 

 

 

How can we work in ways that will enable everyone to flourish?

On Monday 26th June, the Academy will be hosting Emphasising Humanity over Bureaucracy in Social Care, an interactive event that aims to explore what emphasising humanity looks like in practice, not just for those receiving care but for the care workers too. What would human rights look like if we focused on the human rights of the system? 

Speaker Helen Sanderson poses the question of how we can work in ways that will enable everyone to flourish in this blog written ahead of the event: 

The Guardian, in November last year tells the story of Jean. Jean works for a home care agency in the north of England. She starts work at 6.30 am, and completes 23 calls in 12 hours. She drives 20 miles between appointments, and is not paid for her travel time, and earns £64.80 before tax.  Jean is on a zero hours contract. She does not know how many appointments she will have each week, and therefore how much she will be paid. Her list of appointments comes through on a Friday.

It is stressful work, she says, and she feels she has little support.

“It’s a lonely job…you are in the care on your own, you get to peoples houses and often face problems on your own. They tell you all of their worries and then you take them home. Often at night I’m tossing and turning worrying about them.” But Jean still loves her job.

Jean’s experience could explain why there is up to 40% turnover in home care. Yesterday I spoke to a manager of a large home care organisation in the south of England. She said that they lose 50% of their new recruits before their 6 month of employment.  How close is Jean’s experience to Alan’s?

 Michael Marmot, in his book ‘The Health Gap’ tells Alan’s story.

Alan was a picker in a warehouse, and Michael described in detail his daily experiences of work and ends the story with this statement.

“It was as if his employers had taken everything we know about the damaging aspects of work, concentrated them in a syringe and injected them into Alan.”

The damaging effects that he refers to are high demand with no control over the work task, high effort and little reward, social isolation at work, job insecurity and working antisocial hours.

I am not suggesting that every carer who works in home care experiences these damaging aspects, but I am sure many do, and it does resonate with Jean’s experience.  In changing home care most of the focus is on the experience of people using the service, or on making efficiencies. Both of these are important, however we must consider the experience of the staff. If we don’t not only will turnover continue to be very high, but we are also building health challenges for the future. The challenge therefore is to create a different way of delivering support for people at home, that is truly person-centred, where they have choice and control, and delivered by an engaged, happy workforce.

There is a lot of interest in happy workplaces. It almost sounds frivolous to talk about happiness in home care.  Ron Friedman, in his book ‘The Best places to Work’ talks about how meeting psychological needs are at the heart of employee engagement and wellbeing.

The psychological needs that he refers to are autonomy and relationships. It is clear that having choice and control matters to staff as well as people using services, and that having friends at work is critical to productivity and happiness. Jean has no autonomy over her work – she is told where to go and when, and for how long. She describes the work as lonely.

We care trying to build choice, control, and relationships into the DNA of Wellbeing Teams. Wellbeing Teams are small, neighbourhood, self-managed teams inspired by Buurtzorg. (link: https://www.youtube.com/watch?v=MNJ3iTw0AXw)

 For people who are supported at home

People choose what they want support with (their outcomes and priorities), how they want to be supported, when and where. We enable them to choose their team too, either through looking at the team’s one-page profiles or a 30 minute film of a team member introducing themselves. No more than four team members work with an individual, to provide consistency and to develop good relationships.

For team members

The team meets every week to share information, address any problems or issues and support teach other. Each team member has a buddy. The team shares the roles needed in a self-managed team together, and they choose the roles based on their strengths. Each person has a coach to support them to become confident in their role (for 3 – 4 months) and then the team has a coach to help them work well together. The team develops the rota/schedule together after the team meeting.

There are two Wellbeing Teams starting in Dumfries, and we will be learning from practice in how to deliver choice, control and focus on relationships.

Michael Marmot is compelling that we need a radical change in the way we think about health and society. This means not only ensuring that older people are supported well at home, but that the health and happiness of staff is critical too.

If you are interested in attending Emphasising Humanity over Bureaucracy in Social Care please email event@alliance-scotland.org.uk to register your place. 

 

 

 

 

Carers’ Week Chaos and Concerns

Lynn reflects on yet another Carers’ Week in the context of a tumultuous General Election.

When I was asked to write this blog for Carers’ Week, I was conscious of the looming General Election. I did some fine-tuning post election on three hours sleep last Friday; still trying to make sense of it all (and not doing very well!).

Here we are then – Carers’ Week. It’s my second as an “official” full time carer – someone who provides 35 hours or more of care for the princely sum of £62.70 a week.

It’s not a landmark I want to celebrate, for a number of reasons.

I miss being in full time work; I miss earning a decent wage and I miss being valued by society. As a “scrounger”, I am deemed to be a leech sucking on taxpayers’ money. That’s what many in the political world would have you believe and yet, carers are essentially a significant, poorly paid public service, which underpins our communities and our economy.

Carers’ Week should be a spur to action – to improve carers’ experience and outcomes and to improve the way we treat disabled people. However, it seems only to elicit the usual platitudes about unsung heroes (my least favourite phrase). For many, Carers’ Week serves to remind us of how little progress has been made; in many ways, we are going backwards. The services and supports we need are not always there; the right services and conditions for our loved ones are eroding fast.

This past year has seen many of my friends and fellow activists fighting local authorities over destitution level care charges and further cuts to crucial care services. I’ve watched families brought to breaking point by a deeply flawed interpretation of legislation, which was meant to transform our broken social care system.

Continued cuts to respite and community support; further benefit reductions and cuts to pupil support all combine to leave families coping with more than most can imagine.  Dealing with constantly challenging behaviour; lack of sleep; learning to use medical equipment; physical lifting and turning; washing; wiping and changing beds are a daily part of our lives – yet public services meant to make life easier often fail to work with us. The facets of good public service, outlined in the work of the Health and Social Care Academy seem quite elusive. Rather than ceding control to families to achieve good outcomes, carers feel that they have no control over their destiny.  Carers’ Week often hides the less sanitary and salutary aspects of caring.

It has also coincided with the fallout from last week’s election – an election marked by chaos and change. Those concepts are not unfamiliar to carers and yet, there is no comfort here.

The result doesn’t help appease my worries for the future. It won’t do much to secure much-needed investment for social care or other services we rely on. It’s also unlikely to shift the debate on the value of unpaid care or the pitiful level of Carers’ Allowance.

Carers are a pretty cynical bunch – we will continue to be cynical as we wind our way through another Carers Week. And we’ll be watching what happens post election – with more than a passing interest!

@Carer49

Emphasising Humanity

In this blog post Pat Tyrrell, Deputy Director of Nursing and Midwifery at NHS Highland continues our #EmphasisingHumanity theme and talks about the importance of this, not only for patients but staff working within the health and social care systems.

Our health and social care systems are full of those who care deeply about the people with whom they work – both their colleagues and the people for whom they provide care and support. Minute by minute, hour by hour, day by day, we see interactions and services which are designed to respect the rights and needs of our fellow humans. This design delivers time and time again the kind of care that supports and helps the most vulnerable in our communities meet their potential and flourish with love and compassion.

We also know that the experiences of many people, both working in the health and social care systems and those experiencing the services of these systems, is not always a fulfilling one. People are often left feeling dehumanised and devalued, on the receiving end of transactional processes which fail to recognise and respect their needs as human, sentient beings.

We cannot talk about emphasising humanity in health and social care systems without recognising that this must include everybody within that system – staff and patients are not separate entities when it comes to considering the basic needs which we all have for relationships that respect our rights and which are based on compassion and kindness.

In Reinventing Organisations, Frederic Laloux states that “Extraordinary things begin to happen when we dare to bring all of who we are to work.” He also recognises that “In a forest, there is no master tree that plans and dictates change when rain fails to fall or when the spring comes early. The whole ecosystem reacts creatively, in the moment.”

Here he recognises what we know to be important – that we respect and honour our individuality and diversity and that as individuals we interact with others in a way that enables each and everyone of us to develop and to adapt in ways that meet changing needs and contexts.

It was on many of Laloux’s principles that Jos de Blok, the founder of Buurtzorg, the Dutch community based nursing service, established his new organisation on in 2006. This was in order to address the problems which he identified within a fragmented and transactional health and social care system in Holland – a system which met neither the needs of the patients nor the staff.

‘Humanity beyond bureaucracy’ is the mantra of all the nurses who work within the self organised teams in Buurtzorg. They work in teams of no more than 12 people, where respect and dignity are at the heart of their approach towards each other and towards the communities with whom they work. 10,000 frontline staff are supported by an organisation of 45 backroom staff. And there is no hierarchy. Decisions are made and enacted by teams, based on the needs of their patients and staff.

System design is important in enabling this. I have been fortunate enough to spend time with one of these teams in Rotterdam and know only that the positive visceral and emotive which I have experienced told me that emphasising humanity in everything that we do is a core essential of success in health and social care systems.

There is an urgency to redesign our health and social care systems in Scotland. As we advance with this redesign we must recognise both the individual and the system components that enable human flourishing. We can now make unprecedented decisions which challenge existing organisational paradigms and halt the perpetuation of poor experiences. We just need to be truly human and brave.

@PatTyrrell1

 

Rediscovering Humanity – The Building Blocks of Good Public Service

Lynn Williams, unpaid carer, argues that humanity should be at the heart of every political decision driving public service reform

Caring for someone you love often plunges you into the heart of a public service maelstrom. The last few years in “Chez Williams” have brought numerous professionals into our lives – physiotherapists, OTs, a whole gaggle of different hospital consultants, specialist nurses and so many others. (I’ll leave our recent DWP/ATOS experience for another day!)

In reflecting on all that has happened to us, there has been one factor clearly evident in every good experience; professionals who have treated us both with tangible humanity.

The consultant who hunkered down on his knees to speak face to face to my husband – who saw the funny and deeply intelligent man behind the wheelchair; the specialist nurses who understand my husband’s needs and who have helped us to laugh during difficult periods which I can’t even begin to describe; the local rehab OT who took time to get to know us, to listen to my husband’s desires for his life and who worked with us and identified a service we didn’t know existed.

Humanity, compassion – and yes, the word of the moment, co-production. At the heart of those positive interactions, my husband has been treated with deep respect, with honesty and with the humanity that should form the foundation and building blocks of strong and effective public services.

This doesn’t mean that those working with us can always offer practical help or provide answers to our questions. Often, we just have to find our way through the next challenge. However, with someone at the end of the phone; with someone who has taken the time to understand our wee family, the challenges we face become more bearable.

If only that humanity was more evident in all aspects of public service; if only a desire to maximise quality of life sat squarely behind every commissioning exercise and at the heart of service and policy development.

The sad fact is that the lives of disabled people and their families are often reduced to numbers; to a unit cost in the equivalent of a factory production line. This culture is sadly too evident in the work and myriad of papers that drive the work of the still new Health and Social Care Partnerships.  “Commercialisation” of public services can effectively squeeze out humanity or compassion for our fellow citizens – the criminality of charging for help to get to the toilet, to get out into your community are perfect, if somewhat disturbing, examples of this.

Like others, we have sometimes become lost in a maze of jargon, bureaucracy and confusion, deftly described by the Christie Commission seven years ago. Families are sadly still left to fight the public services which are supposed to be helping them.

In that fight, people are left exhausted and de-humanised; that was not what was envisaged in the journey to transform health, care and other services. Unfortunately, compassion and good outcomes often happen in spite of policies like integration or self directed support.

My husband and I are incredibly grateful to the many professionals who have touched our lives. They have helped us deal with dramatic changes and some dark days. Our experience should not be the exception and therein lies the challenge.

How we “measure” the humanity of public services must be considered by the Burns review of health and care outcomes; humanity should be sought in every manager and director who wants to progress their career in public service.

Humanity should be at the heart of every political decision about the services which profoundly impact on people’s lives.

@Carer49

Humanity in Healthcare: Seeing the Person in the Patient

“Wherever the art of medicine is loved, there is also a love of humanity” – Hippocrates

In 1816 René Laennec, a 35-year-old French doctor, invented an instrument that would allow him to listen to a woman’s chest without having to place his ear against her chest, thereby preserving her modesty. “I rolled a quire of paper into a kind of cylinder and applied one end of it to the region of the heart and the other to my ear, and was not a little surprised and pleased to find that I could thereby perceive the action of the heart in a manner much more clear and distinct than I had ever been able to do by the immediate application of my ear,” he wrote in the preface to De l’Auscultation Médiate in 1819. The instrument, which he named the stethoscope, quickly became popular and in the words of medical historian, Stanley Reiser, “led to a seismic shift in how doctors evaluated illness and their relationship with the patient.” In his book Technological Medicine: The Changing World of Doctors and Patients, Reiser expresses concern that over-reliance on technology has replaced openness to the patient as a whole person. The new technology, he wrote, “made doctors more interested in the physical findings of disease than in the life of the patient.

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Rene Laennec

Humanity in healthcare rests on an awareness of patients as human beings first, patients second. Sir William Osler (1849-1919), who is often called the father of modern medicine revolutionised the teaching of medicine by bringing students out of the lecture hall for bedside clinical. One of his most famous sayings was “the good physician treats the disease; the great physician treats the patient who has the disease”. This I believe is the essence of humanity in healthcare – the ability to see beyond the biomedical model of disease to the life into which the disease has intruded.   “The foundation of healing”, believes Dr Adrienne Boissy MD, Chief Experience Officer of Cleveland Clinic Health,  “begins with reassurance that [patients] have been seen and therefore valued and appreciated for the human that they are beyond the disease”.

I vividly remember the day I was diagnosed with breast cancer twelve years ago.  The doctor who delivered the news ignored my tears, and while he spoke, didn’t make eye contact, reassure me or make any other effort to acknowledge my shock and distress. When I remarked on the doctor’s lack of empathy to a family member later that day, he asked me whether I would rather be cared for by a skilled surgeon with a poor bedside manner or a caring and compassionate surgeon with adequate but not exceptional surgical skills. Does it have to come down to a choice between compassion or competence? Can’t we have both?

Compassion and empathy should be at the core of any good therapeutic relationship, but as Dr Rita Charon, founder of the Program in Narrative Medicine at Columbia University, wrote in a 2001 paper for The Journal of the American Medical Association, “despite medicine’s recent dazzling technological progress in diagnosing and treating illnesses, physicians sometimes lack the capacities to recognize the plights of their patients, to extend empathy toward those who suffer, and to join honestly and courageously with patients in their illnesses.”  Dr Charon believes that “a medicine practiced without a genuine awareness of what patients go through may fulfil its technical goals but it is an empty medicine, or at best, half a medicine.”

Clinical empathy has been defined as the ability to stand in a patient’s shoes and to convey an understanding of the patient’s situation. It means not just recognising that the patient is suffering, but acknowledging the distress and moving to address it.  The ability to listen and empathize is central to establishing trust in the clinical encounter, and yet these skills are undervalued and often ignored in traditional medical education. In years past, clinical empathy was simply viewed as having a good bedside manner, a “nice to have” rather than a “must-have” trait in medicine, but a wave of recent scientific research has now shown positive correlations between empathy and improved patient outcomes, satisfaction and adherence. A study conducted with diabetic patients showed they had better control over their illness and fewer diabetes-related complications requiring hospitalisation if their doctor scored high on cognitive empathy. In another study, patients who rated their surgeons as highly caring during their stay in the hospital were 20 times more likely to rate their surgery outcome as positive.  And empathy is not just beneficial to patients, a 2013 study suggests that doctors with higher empathy levels—meaning that they are aware of their patients’ emotional needs and respond appropriately to their concerns—experience less stress, cynicism, and burnout than those with less empathy.

An extensive scientific literature review conducted by the Center for Compassion and Altruism Research and Education (CCARE) at Stanford University demonstrates that “when patients are treated with kindness — when there is an effort made to get to know them, empathize with them, communicate with them, listen to them and respond to their needs — it can lead to faster healing of wounds, reduced pain, reduced anxiety, reduced blood pressure, and shorter hospital stays.”  The research also shows that when doctors and nurses act compassionately, patients are more likely to be forthcoming in divulging medical information, which in turn leads to more accurate diagnoses. They are more likely to adhere to their prescribed treatments, which leads to fewer readmissions. The authors of the review conclude that “kindness shouldn’t be viewed as a warm and fuzzy afterthought, something nice to show after the “real” medicine is administered. Instead, kindness should be viewed as an indispensable part of the healing process.”

More recently, Mills and Chapman in an editorial published in the Australasian Medical Journal, go beyond kindness and empathy to a call for compassion in medicine. They draw a distinction between empathy, which relates to an awareness of another’s experience, and compassion which relates specifically to contexts of suffering and the alleviation of it. “Compassion is more than just kindness,” they write, “it involves cognition, affect, intention, and motivation; that in a context of suffering, relate to the alleviation of that suffering.”  In an article in Modern Healthcare, Julie Rosen, executive director of the Schwartz Center for Compassionate Healthcare, writes that compassion is the foundation of good medical care “recognizing the concerns, distress and suffering of patients and their families and taking action to relieve them”.

I believe compassion in medicine is based on acknowledging the difference between illness as a diagnostic entity, and illness as the way in which the disease is perceived and responded to by a person.  In limiting its focus to the physiological effects of illness, medicine often overlooks the human experience of illness and is in danger of losing sight of the person with the illness. The late neurologist, Oliver Sacks addressed this failing when he observed that “medicine has shifted its focus to getting to know and treat a disease instead of getting to know and treat the person with the disease”.  This echoes Donald Evans in his book Values in Medicine: What are we Really Doing to Patients? who writes, “the contribution of science to the development of medicine has made remarkable strides in the delivery of effective health care, but it has also tended to remove the patient’s experience of illness from centre stage.”

The practice of medicine is both a science of knowledge and the art of humanity. For too long we have trained doctors and nurses to see illness through a bio-medical lens which reduces patients to a set of symptoms without taking into account the wider emotional and social aspects of illness. Attending to how patients experience their illness within the context of their lives, rather than the narrow confines of symptoms, provides a richer perspective within which to learn how to care for the person with the illness.  Collectively we must learn to cultivate the skills that are essential for humane medical care – empathy, dignity, respect, caring, kindness, compassion, and above all, a willingness to see and understand the person behind the patient. Repeated cases of failure in health and social care have revealed a common failing – staff lost sight of the person and stopped responding to patients as people. Building a culture of compassion doesn’t involve any large capital outlay, but in reframing medicine through this human lens we will reap a greater reward in terms of meaning, context, and healing in healthcare.

Why human rights can be transformational – Lucy Mulvagh

One of the Academy’s Five Provocations, Emphasising Humanity, is described as the need “to emphasise the humanity and human rights of the people accessing and providing support and services, to create relationships that enable people to flourish.” Here, Lucy Mulvagh explains why she thinks human rights can help achieve transformational change.

 

It was love at first sight (or should that be sound?) when I first heard about human rights. I can’t really remember a time as an adult when they haven’t figured somehow or another in my life and it’s usually a subject that’s knocking around my head on most days.

I’ve got many reasons for this passion, but primarily it’s because human rights can identify and challenge the myriad power imbalances that currently exist. I firmly believe that if we were to adopt a truly rights-based approach – as widely as possible in everyday life – then many of society’s ills and injustices could be overcome.

Using rights to support decision-making – at the individual, community, regional or national level – means it’s based on fairness, transparency, equality and proportionality instead of (political) ideology, decisions around who is ‘deserving’ or ‘undeserving’, and (unwittingly or not) prejudice, bias and stigma.

I’m thinking of decision-making that can apply anywhere and at any time: how resources and budgets are allocated and disbursed; homes and public spaces are designed, built and sustained; health and social care services; income and social protection; good quality food, heating and clothing; transport; education; employment; … you name it!

I’m very sad that there is still such a great deal of suspicion and unease about human rights in some quarters. While this is due, in part, to genuine misunderstandings about rights being purely associated with lawyers, court cases and punitive action, I’m pretty sure that some is deliberate misinterpretation and misinformation by those who are challenged by the idea of greater equality in the distribution of power.

We all have human rights, simply by virtue of being human, and it’s a bit of a personal mission of mine to help raise awareness about rights and support efforts to increase our understanding about how truly revolutionary they can be – for all of us.

I welcome the growing appreciation – and name-checking – of human rights in national policy, but there’s still a long way to go to bridge the (growing) gap between rhetoric and reality and translate rights into everyday life. In the meantime much of the focus, including in health and social care, has been on concepts like ‘person centredness’, ‘compassion’ and asking people what’s important to them.

Don’t get me wrong, of course I agree we need as much compassion, kindness, listening and understanding as we can get. But I can’t help feeling that it’s a sad indictment of how we currently relate to each other – irrespective of where our interactions take place – that these could ever be seen as transformational.  Aren’t they the basic minimum that we should expect when we relate to each other?

And what happens when, say, a service says that they listen to what’s important for people, but then they either don’t, or do but then don’t actually act on what they’ve been told?  Very often this sort of practice is deplored and decried as unacceptable, and a (public) apology may be offered, but what difference does that really make to the people and institutions involved, and are we sure there are adequate concrete measures in place to ensure it never, ever, happens again?

We can’t, and indeed shouldn’t, legislate for compassion, but we can legislate for human rights and rights-based approaches – like the right to free, meaningful and active participation in decision-making – which means that when things go wrong there will be an open and honest approach to accountability, remedy and redress.

But it’s not just about the ‘stick’ of holding people or services accountable when things go wrong. Taking a human rights-based approach to decision-making means we can start with the ‘carrot’ and conceptualise and deliver support in very different ways, nip issues in the bud at a much earlier stage, and even avoid things going wrong in the first place.

I’m committed to spreading the love about human rights – who’s with me?

@lkmulvagh

 

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Try A Little Tenderness… – Dharmacarini Kuladharini

To celebrate National Acts of Kindness Day, Dharmacarini Kuladharini of the Scottish Recovery Consortium makes the case for #EmphasisingHumanity and why we all need and should encourage kindness.

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Try A Little Tenderness…

A week into the national kindness challenge, Kinder Scotland 2017, I find myself writing chalk messages of appreciation on the pavement outside the building that houses the Scottish Recovery Consortium. In the heart of the merchant city in Glasgow people stop and stare and smile.

Kindness is something we all need more of; its that connection, acceptance and loving regard that is part of what helps all humans feel well, alive and that life is worthwhile.  Bruce Alexander in his seminal work, “ The Globalisation of Addiction”, calls this experience psychosocial integration. We know our place in the world and in the hearts of our loved ones; we are part of a real community.

Dislocation is when these connections, environments and those secure places in the community are broken.  This can happen through war, economic upheaval, loss of family and nation as well as other aspects of the unrelenting march of hyper capitalism, from the mass indoctrination into self-interest and greed being the only interest worthy of attention to the loss of support services that kept you from falling off the edge.

This dislocation, he says is at the heart of the spread of addictions in the world.  We use substances and behaviours that we feel will soothe us and reconnect us quickly with a sense of well-being. As Johan Hari points out in “ chasing the scream” humans and animals take substances to alter their experience of emotional pain as well as physical pain.  This is normal.

When the dislocation grows and gets more extreme some of us will turn to more substances, more shopping, more working, more video gaming, more overeating, more gambling, some of us will get very depressed, some will commit suicide.

The chronic health problems of the 21st century are resistant to public health strategies that focus exclusively on the individual as the source of the problem. Phil Hanlon, while he was Professor of Public Health at Glasgow University, called the problems of addiction, depression and obesity ‘diseases of modernity’, products of our market driven, highly materialist, individualized form of economy. He suggest that new forms of public health action are needed to stem the tide of pain.

At the SRC, we are all about the love, the human connection, the real community and so we have joined up with U lab Scotland and Carnegie Trust and surprising bodies like Visit Scotland to promote that spirit of Kindness, that will be part of helping us all heal.  It’s not the only change we need but it’s a great contribution.

To celebrate the Kinder Scotland 2017 challenge, the SRC has made a PDF of its Scottish Recovery Workbook and is giving that away to anyone anywhere in the world that could use it to recover from addiction.  It’s a gift from people in recovery in Scotland to people suffering from addiction anywhere in the world.  Connected through kindness and our beautifully flawed humanity.

Dharmacarini Kuladharini

Chief Executive of Scottish Recovery Consortium

www.scottishrecoveryconsortium.org