Sunday, August 13, 2023

Improving compassion in mental health services

Elisa Liberati et al (2023) tackle the issue of the lack of compassion in acute mental health services, exposed, for example, by undercover reporting of abuse in psychiatric inpatient services (see eg. previous post). As they say, the preconditions for compassion in mental healthcare have been severely eroded.

The reasons for this are complex. There has always been a tendency for staff to dissociate themselves from the pain and distress experienced by services users. As Liberati et al say:-

Rising demand, resource shortages, and weak organisational support are causing staff burnout and disillusionment, compromising their ability to act compassionately. … These problems are especially acute in inpatient settings, where staff are often exposed to intense negative emotions and may experience vicarious trauma.

But this lack of compassion seems to have become worse over recent years with the rise of risk management. The challenge for staff is to maintain therapeutic relationships with patients in the context of an organisational bureaucracy which has become primarily concerned about its accountability and responsibility rather than concentrating on its main task of patient care. In this context, staff may practice defensively for fear of making mistakes and being blamed by the organisation. Such tension can lead to practice becoming too risk averse, prioritising service requirements over patient needs.

Risk management in mental health is not always applied sensibly (see eg. previous post). Emotional safety can actually be reduced by too much of a focus on physical safety and organisational risk. Rigorous adherence to procedures designed more to protect the organisation rather than patients may not really reduce risk but instead infantilise people, taking away their personal responsibility and thereby emotional safety. Relationships between staff and patients need to be prioritised in practice and developed to provide therapeutic services.

Biomedical understandings of mental illness can also objectify people by reducing their psychosocial problems to brain disease. Nonetheless, even biomedical services should act humanely. If staff cannot provide good quality care, their sense of professional integrity may feel violated. It may nonetheless be difficult to challenge ways of working which conflict with their values leading to the normalising of poor practice.

The lack of compassion in mental health services needs to be taken seriously and staff supported by service organisations in their supervision and training to provide good quality care. The rights of people with mental health problems must be promoted to improve the standards of modern mental health care (see eg. previous post).

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