In all our sanctuaries we sit at risk

Mental Health Witness – malpractice in mental health consultation


Health and Social Services in the UK often run open meetings for people who use mental health services. Such meetings are seen as opportunities to give people information on new policy developments, as well as letting them “have their say.”

By definition, an open meeting means anyone might come, in whatever state they are in. An invitation to an open meeting is an open invitation.

But, somehow, the whole consultation ethos seems riddled with forgettings on the part of the organisers of events of this kind.

Many of the recent developments and policies are very complicated and difficult to understand. In recent years, and especially under the Coalition Government, they have also been coming brutally thick and fast, frightening, bewildering and deeply distressing for people dependent on a stable care system for their sustenance, for their ability to take part in community life, for their peace of mind.

And every manager in charge of this or that strand of rapid-fire innovation is required to “consult with the users” on it. So of course they comply, often using open meetings.

The first forgetting, very common, is how many other meetings are being organised , often at around the same time, called by other managers, each running a different  project, each instructed to be “passionately keen for users to have their say”, but forgetting that an uncoordinated scatter of momentous consultations can be merely disturbing for people already in a fragile state, without telling them anything that can be usefully taken in.

But now a couple of questions :

Is an open meeting, with any number of people round you, the best place and way for taking in a complex piece of information, with possibly worrying implications ?

Is your average over-worked, middle- or even senior- manager also a born teacher and communicator, experienced and expert at speaking confidently in a public setting, and able to put over in crystal clear terms complex new realities to people in all sorts of difficult mental states, sitting there listening to you while also dealing with the side-effects of all sorts of psychiatric medication ?

The answer to both those questions is absolutely no. I can personally testify to the fact that it is very common that people come out of these meetings a great deal more confused and anxious than when they went in.

Let us progress now towards a few more questions :

On paper, the “open meeting” looks to be a welcoming and inclusive idea, a level playing field where all of us can gather together as equals. Attendance there is surely a “right.” But, to repeat, we are talking here about people with mental health problems and an “open meeting” is an invitation to anyone, in any kind of mental state, to attend. It is not kind or inclusive or “level” to ignore that fact. It means that individuals might come into the room behaving in a way that’s difficult for others to tolerate ; or unclear what the meeting is for, but wanting mainly support and comfort ; or simply finding that a room full of strangers is difficult to cope with. Some people are not iron-clads, able to plough on, whatever the conditions ; some people are not meeting-junkies, scampering avidly from boardroom to boardroom.

Are there appropriate resources of skill and experience carefully set up to help such people on these occasions ?  Is sufficient support available to ensure that everyone leaves the event in a reasonable state ? Do the organisers check on how people are, as they leave ?

Again, the answer to all these questions, in the vast majority of cases, is no. Instead, the organisers count how many people came, and if those numbers were large, they congratulate themselves and go home glowing, knowing that their seniors will be pleased. They do not consider how individuals might actually be feeling as they head back to their flats and bed-sits, often so isolated and sparse.

I believe that the open meeting set up for the purpose of consulting with users of the mental health services is usually a mistake, and worse than that, a mistake which can reasonably be termed as wanton and irresponsible, putting numbers and the ticking of boxes before people’s mental welfare. I believe it is set up in denial of the fact and reality that people with mental health problems experience mental health problems.

The aim of consultation with users of mental health services is of course to maximise a service’s sensitivity to, empathy with, and appropriateness for, the people who use it. There is a great deal of bitter irony in the fact that the means and methodology so often used for consulting is the precise opposite of the end it seeks –in other words,  insensitive, un-empathic and inappropriate.  

Consultation with mental health service users has been a requirement for nearly twenty years now. With that in mind, I shall finish this piece with three more questions relevant to the subject, followed by my own answers to those questions, followed by three thoughts. 

In all these years of practice in consulting, what has been learned about how to do it well ? How much harm has been done, by people who did not mean harm but have boxes to tick and funders to     impress ? How can the malpractice described above still be operating ?

I would answer : virtually nothing has been learned on how to do it well ; a great deal of harm has been done, much of it serious ; too many employees of the care services seem willing and able to separate themselves off from their own skills and knowledge of what is right, in order to conform to what seems to win approval.

And here are my thoughts : consultation is about listening. Listening is a skill, a quietness, an act of caring and creativity, a true and open being with. As a function of command-style management, driven and harried, user consultation is a dangerous nonsense.