Choice and control – what does it mean?
At the opening plenary session of the 2017 TheMHS Summer Forum, Helen Glover and Ken Thompson addressed the tensions that exist in mental health services in promoting autonomy whilst providing support. This is not a new topic, but the fact is that, despite over twenty years of policy and initiatives to encourage services to adopt a more recovery orientated approach, the experience for most users of services is the opposite. This doesn’t come from a wilful desire to do harm; mental health staff are, on the whole, well intentioned people who were drawn to work in ‘the caring field’ for good, vocational reasons. But the mental health system is inherently inequitable in terms of the staff and consumer dynamic due to complex issues including capacity impairment, professional responsibility, defensive practice and, frankly, the historic drivers and disincentives that make letting go of power a scary and difficult thing to do. A real paradigm shift is needed. As we heard today, service users are all too aware of the degree to which their own self-determination facilitates their recovery but this can be undermined all too easily by staff who find it too difficult to let go of control. The clear message coming from this session is a call for authentic adoption of collaborative working that respects the expertise of those who use services as much as those who have been trained to work there. To create a real culture change, this needs to be a fundamental value in all mental health services, established through training and formally evaluated in practice. Contemporary levers such as personal budgets are one of the tools that can help this process, but people have to have the skills to use them. You know the saying ‘a bad workman blames their tools’? Well, how many failed policies can we blame for keeping things the same? If we are serious about wanting change, then it is all of our responsibility to skill up and get on with it.
