There are myths presented at a Tees, Esk and Wear training session for a mixed group of staff. We have tried to provide some insight into the reality behind the myths.
MYTH: A common dynamic with complex clients is that they often find it difficult to accept or feel helped by care yet at the same time desperately seek it and demand more and more.
REALITY: So-called ‘complex’ clients are often clients who correctly identify poor quality care and speak up about it. They are not helped by poor care and rightly refuse to accept it. A common scenario is a client repeatedly mistreated by crisis team staff who then refuses to have further contact. Instead, the client demands adequate care becoming increasingly desperate as concerns about care standards are not addressed. Meanwhile the client is labelled ‘complex’ and seeking a reasonable standard of care is framed as pathological.
MYTH: Relationship patterns of childhood are repeated in relationship with the people trying to care for them
REALITY: Even the most mature person will apply previous relationship learning to new relationships. This applies to MH professionals and clients. Many MH professionals have their own problems and may be replaying dynamics where they were carers for parents or relatives. Clients who don’t provide staff with admiration, comfort reassurance and a sense of control can experience hostile and retaliatory reactions. This is why clients with an attitude of ‘doctor knows best’ tend to be so popular with health professionals.
MYTH: Staff can find themselves in a rescuing position, giving more and more – but are still accused of not caring enough.
REALITY: MH services are underfunded and under resourced. People with severe illnesses that should have intense community support are considered to receive a lot of support if they see a key worker for 1 hour a week – that’s 1/168 hours. Most clients have even less input. Rather than owning this many staff accuse patients of being overly demanding and perceive them as taking up their time. When staff position themselves as victims doing all they can to rescue and care for an accusatory client they really are losing the plot and failing to see the situation objectively: they feel overworked and patients are rightly identifying insufficient services.
MYTH: Well-intention ideal caring/rescue generates unrealistic expectations, becomes unsustainable (both personally and financially) and inevitably leads to failure
REALITY: Ideal caring is a fiction in current MH services and austerity UK. There is no possibility that staff will be providing this. Describing optimal care as ‘rescue’ is demeaning towards clients and insulting to those staff who are kind and deliver high standards. Research shows that good quality care is the type of care most likely to result in positive outcomes. Ineffective care from poorly trained staff with weak personal attributes who believe they are providing good care but lack the self-awareness to identify their personal, and training, needs and subsequently feel overwhelmed, burnt-out and then seek to blame clients, never helped anyone.
MYTH: Some staff can feel caught in a dilemma – whether to be “abused” or reject the client.
REALITY: Some staff are caught in a situation where they lack skills and personal insight and their managers and Trust leadership provide poor role models, support and supervision. Some staff, due to their inability to recognise their own skills gaps perceive clients accurate identification of care failings as personal criticism. Lacking any self-awareness and not open to accept the clients feedback about the standard of care they deliver, they experience the feedback as abusive. Blaming someone else rather than accepting one’s own failings is not restricted to psychiatric nurses but due to MH professionals role and power it is particularly harmful.
MYTH: Attempts to help are apparently sabotaged by the client leaving workers feeling worthless, neglected or victimised
REALITY: Workers impose tick box solutions on clients that are totally unsuitable. They will also claim they’ve involved a client when they may have not listened well to a client at all. When a worker imposes an inappropriate solution on a client it isn’t likely to work. Anger and resentment by NHS professionals toward patients who don’t respond gratefully to ineffective advice and solutions imposed on them is inappropriate. It is also important workers don’t respond with dramatic accusations of ‘sabotage’ when an intervention is ineffective – maybe the clients needs and barriers have not been addressed, or have been discounted.
MYTH: Splitting and interdisciplinary conflict, failure to support each other within the ‘team’. Stress. Burn-out.
REALITY: The concept of splitting was originally about how the most vulnerable patients could be caught up in the dynamics of weak, fractious teams. Overtime, and unsurprisingly given the problematic staff in such teams, splitting has come to be a phenomena blamed on the patient. In family therapy dynamics like this where dysfunctional parents blame the child would be called ‘scapegoating’.
MYTH: Use of language such as ‘it’s just behaviour’ or ‘it’s manipulative’ (experienced as blaming or abusive)
REALITY: Use of language like this by NHS professionals toward the patients they have a duty of care toward IS abusive. Such beliefs about patients are the result of ignorance, prejudice and stigma.
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