Thursday, 8 January 2015

Do Staff need to be Taught Compassion?

Sometimes I need time for blog posts to 'percolate'. The reasons vary, from me recognising that I need to consider the possible impact of what I am putting out there on others, to needing time to formulate my thoughts and feelings on a subject. I wanted to write about compassion in Mental Health settings since an incident before Christmas, but hesitated because my initial response was purely an emotional response to the distress of a friend. Before putting my thoughts in the public domain I needed to allow time and perspective before putting my thoughts down in black and white.


My friend is a diagnosed Schizophrenic who battles against his labels and the medicalisation of him as a person, who is more than his often disputed diagnosis. A few weeks before Christmas he suffered a major 'meltdown' - in his words. The first I knew of it was when he phoned me from the ward and asked me to visit him. This article could deal with the ongoing battles he has with his mental health team regarding his view of his auditory and other hallucinations or of his need for ongoing medication, but more than that I needed to highlight the lack of compassion he told me about on his admission to the PICU.

Over a period of some time he had been struggling with the increasing belief that he was a psychopath and therefore a major threat to those around him. He was terrified because he was convinced by these beliefs. Instead of understanding how terrifying these beliefs must be to him and the fears that they created in him about the threat he posed to those around him, some staff started to tease him, laughing about him being a 'serial killer' and even using the term 'path' when talking to him. 'Alright, path', 'harmed anyone recently, path?'.

It is a single individual incident involving one person that I know. What has concerned me most is the basic lack of human understanding and compassion for an individual clearly in distress and need. By definition, to be admitted to inpatient care in this day and age, indicates that by all clinical standards, this person is in urgent need of help. In the world outside I would expect the usual level of ignorance about mental health in general and Schizophrenia in particular, but inside a specialist Mental Health unit, surely even a modicum of professional pride and self respect dictates a better response than taunting a mentally ill man?

I try to be balanced in my consideration of such troubling incidents. I have tried to find reasons for members of staff responding in this way:

1) Stress and pressure - under-staffing, ongoing constant change and cutbacks, bring a weariness and cynicism, probably unthinkable in the early days of most of these staffs' careers?
2) Lack of adequate training about the symptoms and perceptions of Mentally Ill people who are in crisis?

Unfortunately, neither of these reasons adequately provides any acceptable rationale for the appalling lack of empathy and understanding displayed. I know in my twitter feed I can be political in my responses to the current state of the NHS, but I do believe that there is an ideological and moral battle going on for all of our public services. When patients, services users and others in need, stop being people and become units and target statistics, then the raison d'etre of our social care and health services is under severe threat.

If a person ceases to be a person, but becomes an obstacle to completing paperwork, or sitting in an office 'getting through a shift', it stands to reason that it is only a small step to not being able to see why you should 'waste' any human compassion on 'them'. And there it is: 'Them' and 'us'. There has been a rhetoric in public life which has separated us into 'camps' of rival 'tribes' of the 'deserving' and 'undeserving'. We are not in this together - or at least that has been the effect of much of the discussion in public around Benefits and other cuts to services. So the ironic comment that 'my job would be ok if it weren't for the people I work with.', ends up being a default which in turn
informs our actions towards 'those' people.

What most of the political rhetoric forgets is that for most staff in public services; NHS, Education, Criminal Justice, they did not enter a 'career path' or to seek 'progression', but most felt a vocation. Vocation cannot be conjured up, nor can its root motive, compassion, be taught or trained. I may attend any number of Mental Health Awareness training events, with input from service user perspectives, but if I fail to see the people I work with as worthy of compassion, then there is no magic bullet which will allow me to tick this off in my professional development portfolio.

Pity cries and walks away, it looks down on those in need. Compassion enters into the experience of the person in need and seeks to understand its causes and, in time, the actions which can be taken together to meet that need.

Don't get me wrong, compassion in public services costs those for whom it is the primary motivation. I would argue that the heart of compassion in many staff is why the NHS is the envy of the world. Day in and day out, committed, compassionate staff come along side the vulnerable and most hurting people in our society. This kind of response to need cannot be trained or imitated. You know it when you see it. I know when staff working with me are seeking to understand the roots of my distress. I know when staff are motivated by more than a pay packet or are just going through the motions. I know when someone, despite the limits of the system, sticks with me until, together, we find a way through to recovery.


I have been on both sides of public service and I know that when I meet staff who recognise our shared humanity, then there is a strong foundation on which therapy and medication can be built. Rather than mock the beliefs of someone in the throes of psychosis, humanity asks, 'What would I want someone to do if it was me?' Relationship depends on trust, therapeutic relationships begin with a compassionate assessment of another human being and their needs - some of them shared by all people, even me. If you view the people you work with as 'them' rather than 'us', maybe it's time for a change of career, or a holiday?