The Big MAC event
The Big MAC event brings together lived experience experts and NHS professionals from various fields to discuss NHS service management, operational and strategic matters, and major developments in services and trust.
Overview of the Event
The challenges of working within the NHS
A consultant psychiatrist facilitated this part of the talk. There were discussions about the following:
Moral Injury and how NHS clinicians are working in an under-resourced system and then being abandoned to inevitable failure.
We talked about how systems are designed to exclude client and give any possible reason to keep people out. We talked about how services may not accept client based on the following:
postcode,
diagnosis,
complexity,
comorbidity.
Too much need or not enough need.
Too high Risk or for not being risky enough, lack of motivation,
A client's readiness for change
The language used in psychiatry (applicable to other professions, too) adds to the exclusion culture within NHS.
Professionals hear traumatic event from client they are working with, and this in-turn influences professional perceptions and beliefs of the world, leading to self-protection behaviours I.e., exclusion criteria.
How in only the pandemic has this been brought to light, and efforts have started to have been made towards supporting staff.
The use of terms such as "low risk" so we do not have to deal with it immediately, or they don't meet the criterion to access a service they need as the case is not "Complex enough."
How we continue to behave as if the risk is both predictable and quantifiable, using risk categorizations (low, medium, and high) even though this system is not evidence based.
The tendency to stray from objectivity into judgement in psychiatric notes. For example, using terms like 'manipulative' and 'behavioural' infer that a patient is doing something consciously and deliberately.
P.S. For more detailed information on the topics above, type the article "Magical Thinking and moral injury: exclusion culture in Psychiatry" into Google
The Impact of Moral Injury and Magical Thinking on Clinical Practice
Another consultant psychiatrist facilitated this part of the talk. There was a discussion about the following:
Exclusion in mental health is a long-standing concept, but it's just changed over the years and how excessively risk-averse and under-resourced system may drain its clinicians of compassion, losing sight of the human being behind each 'protected' bed and rejected referral.
In psychiatry, when professionals are distressed, clients are more likely to be looked at like scientific objects, which can lower the professional's ability to care for and be compassionate to clients.
How service could exclude via magical thinking (thinking that if we refer clients to another service that can offer more support, they will get help there). However, we need to realize they will sit on another year or months-long waiting list for this support.
Importance of organizations and services being able to support professionals even when in a distressing environment so that professionals can provide care not based on their superego.
The impact on Service user experiences of the NHS
A Service user facilitated this part of the talk. There was a discussion about the following:
Their diagnosis of borderline personality disorder (BPD) and the treatment they received in the NHS (known as MBT therapy), and how to benefit from the skills they were taught in this therapy.
They further discussed their experience with NHS services and barriers to obtaining support. These are listed below:
The impact of having the diagnosis and how, because BPD is still stigmatized, how professionals treat them differently because of their diagnosis
How medication is not always the answer to mental health conditions.
The assessment process can be challenging and make clients feel as though they must be assessed to see if they are good enough for services, and how professionals should always think of ways to reduce the power dynamic in the assessment phase.
How some people or clinicians see the behaviour but not the pain behind the behaviour.
Potential Solutions: What can we do next?
Realism and honesty should be embedded in the training rather than teaching perfect medicine in an imperfect world. The client will have more trust in us if we are open about the scarcity of resources and restrictions on referrals; if we acknowledge that we cannot provide all we would like to.
Being uncomfortable and having adequate Staffing support.
Meaningful training and service development should be truly involve service users throughout and how a fundamental problem is focusing on beds, breaches, and targets instead of the human story behind each number.
Organizations hierarchical changes.
Lastly, As the reader, what are your views:
Whilst reading this article, do any reflections or viewpoints come to your mind?
Do you agree or disagree with some of the points made?
Comment your views below.