It is too hard a knot for me to untie!'
Twelfth Night - act II sc ii
I am not just a collection of interconnecting muscles, nerves, blood vessels and bone. On its own my body is a miracle of complex engineering, but within this body there are many complex chemical and electrical interactions and reactions all with different functions - perhaps I could see these as the fuel and lubricant which ensures the machinery keeps working effectively - there are hormones which determine my readiness for creating children, my moods, my appetite. Then there is the product of my mind, my thoughts, the core of who I am. This is indefinable in purely physical or chemical terms, although some argue that even the most complex of human interactions are just the result of biochemistry, I tend towards believing that there is something intangible, the essence of who I am, which I call the Human Spirit, or soul, so there is a spiritual side to consider.
When I consider all three aspects of who I am I recognise that there is no part of me that does not impact on the others. So when I fall over in the street, which I did recently, it is not just my hand which is hurt. That, it has to be said was the first part of me to connect with the shock of hitting the ground. In short succession, physical pain, was followed by a wave of grief - I wanted to cry. Then I caught sight of the shocked faces looking out of the bus window as it passed. Grief was replaced by embarrassment and then shame. Then my personality came to the fore as a kind passerby offered some help and I waved her away and too quickly got to my feet. The blood in my circulatory system was unable to keep up with what I, as me, wanted to do, so I nearly collapsed again, the physical working in opposition to my spirit. You get the idea - if anyone had asked me what part of me was hurting I could answer, honestly; my hand, my shoulder, my ribs, my knees, my pride, my sense of independence, my self confidence, my conscience (guilt for refusing a helping hand). Had I been taken for medical treatment only those parts of me which were evidently hurt would have been treated.
Too often we experience health services which treat only one aspect of our person. So we treat the 'flu, but neglect the emotional impact of feeling drained physically. The plaster cast, sets the bones and supports physical healing, but the emotional cost of a physical trauma is neglected until it becomes unavoidable.
I have been thinking about this silo approach to well being recently in regard to mental health and disability. Too often services and benefits tend to separate physical disability from mental illness or emotional challenges. This is why so many disability assessments have been running into difficulties and result in so many appeals which are overturned nearly 70% of the time. The reality is that 'seen' difficulties are the most easily identified and therefore treated or managed. It does not require a hard pressed NHS service to take time to investigate or have to spend time on treatment when presented with bruises or broken bones. When presented with emotional or mental distress, time is required as well as to change the approach from 'What is wrong with you?' to 'What is causing so much distress?'. The first question allows the professional to decide how to fix the problem, the second question opens up the need for a more long term intervention. Often Mental Health interventions are time limited when mental health issues require time and relationship, something that a six week hourly intervention cannot offer.
The thing is if you can help me to manage my emotional and mental responses to the physical pain or trauma I have experienced it is more likely that the physical therapies and interventions are likely to help me recover from or manage my physical challenges. Equally if you can help me address the physical causes of my exhaustion then I am more likely to be able to manage feelings of depression and anxiety.
I have been reflecting on my own recovery in these terms and recognising that persevering with looking after my physical health will help me to continue to manage my mental health. It is common sense, it also makes financial sense when applied to a resource-and-time-poor NHS. Yet I have to piece my recovery plan together from different silo'd teams under my own initiative. I am effectively the wellness hub for my own recovery.
When I worked within criminal justice I was privileged to be part of an multi-disciplinary team made up of police, nhs, probation and charities staff each working with individuals to address the complex factors which were stopping them from reforming and ending their offending careers. As long as an individual undertook to manage their own offending behaviour, our team would provide a range of support to help them with housing, employment, substance misuse, education etc. It was effective and when the people we were targeting were responsible for 80% of local car, thefts and burglaries was arguably an excellent investment. Even with the costs involved it was still cheaper than prison for most of the people we worked with.
What do I learn from this when applied to health? Well first there was a concept of 'end to end management' from the point of arrest to the point of end of sentence. Our team picked people up and worked with them through court, into prison, out of prison and to the end of licence or community sentence. If they re-offended they came back to the same team to begin again.
What if health and social care teams in hospitals and the community were integrated and worked in the same place? What if every person who has undergone significant surgery, or who is managing a significant physical disability has access to evidence based mental health well being practices as part of their recovery? What if mental health was seen as part and parcel of recovery from significant physical illness? What if we stopped separating off mental health units from the rest of the hospital except for those requiring the most intensive mental health support? What if we actually practised our interventions on both physical and mental health as if there were parity of esteem? What then?
