Here is the challenge for health boards and social work departments. How to make it safe for patients and carers to raise concerns and complaints in psychiatric settings without fear of retaliation. Being “in for it” the next time of having to access mental health services.
Psychiatric services will only improve for ALL patients if the raising of concerns and complaints are welcomed as a way of improving conditions for staff and patients alike.
In psychiatric settings compulsory treatment is allowed if a person is deemed to be “without capacity”. However the line between capacity and incapacity is not well defined. A patient who refuses medication may well have the capacity to do so but by being “non-compliant” is seen as having no capacity.
Psychiatric wards may be understaffed and under-resourced which means the nursing staff don’t have the time to care for individual patients who are resistant to being medicated and yet have capacity. Those of us who don’t like the drugs and find them toxic to our wellbeing. It may be “easier” to force the issue and the drugs into the patient.
Some patients may not have an issue with being forcibly medicated, after the event. Others may feel strongly that their agency was taken away and they had no choice. However to speak out about it at the time may be risky if they have to return for further treatment. And so they keep their concerns to themselves. Internalise it.
Here are some ways in which I think the pathway to complaining can be made straighter:
- putting Experts by Experience (EbE) at the heart of the process
- safeguards in place which are safe
- confidentiality scrupulously adhered to
- management ensuring regular training of staff in responding to complaints, involving EbE who may be service users, psychiatric survivors, carers or family members with a range of views
- de-personalising the procedure, taking away any “blame” aspect
- training of managers in how to write letters of response to complaints which are neutral and blameless
I believe that the meaningful involvement of EbE, in staff training programmes and debriefing sessions, is paramount in bringing about cultural change in psychiatric settings where people are not free to speak out without fear of retribution. A range of experiences, from those who welcomed compulsory treatment to those who resisted with all their might.
We need ALL voices represented at the table so as to improve psychiatric services at the roots. Working at ways to include rather than having to exclude. Because this demonstrates the limitations of the process and the system. A deficiency in leadership and management.
I want to see an end to scapegoating. Tags like “treatment resistant” or “non-compliant” or “troublemaker”. If the drugs don’t work then the drugs don’t work. If a person is non-conformist in real life then they are more than likely to be “non-compliant” in the psychiatric system. It stands to reason.
Let’s do away with the blame culture and bring in a paradigm shift where people are at the centre. First do no harm. Next do some good. Collectively, together, level playing fields and straight paths.