Thread by @MentalHealthMum

Someone here said that some patients just don't want to engage. OP's bio says they're a consultant #psychiatrist. I hope not but this sort of arrogant statement is rife among MHPs (mental health professionals) and absolutely boils my piss.

Let's break it down.
🧵1

#MentalHealth

Firstly, I'm talking as a parent regarding inpatient treatment but this transfers to other settings.

My child was first referred to CAMHS in 2019 and has had 4 inpatient admissions. They've probably been in contact with 100 - 200 MHPs.

🧵2

#MentalHealth

My child has been variously described as 'hard to reach', 'not engaging' and unable to communicate their needs.

(Yes, yes, they are #autistic - something these MHPs denied in favour of emotional dysregulation etc but that's a story for another time)

🧵3

#MentalHealth

So, here's what happens.

Your MHP's been home overnight, maybe socialised, exercised or just chilled, they've slept in their own bed, eaten their own choice of food that day, had easy access to their own clothes and come in to a job they chose to do...

🧵4

#MentalHealth

They will choose the time they see the child, the room they meet in, how the chairs are arranged and so on.

They will have had time to revisit notes and think about what they will discuss in the session. Above all, they can control when the session ends.

🧵5

#MentalHealth

The child hasn't slept in their own bed at home - probably hasn't slept well at all in fact because of the noise & the lights & the person watching.

They've not had the choice to socialise, nor had access to exercise or fresh air and definitely no privacy.

🧵6

#MentalHealth

They've eaten hospital food, have had to ask for their clothes & if on 1:1 have been watched by a stranger in the bathroom.

There's likely been an incident(s) on the ward overnight - alarms, the sound of headbanging, screaming, a child being restrained.

🧵7

#MentalHealth

Perhaps they had an 'incident' themselves.

Their room may have been searched and their possessions moved, broken or lost.

They may have been restrained or, worse, held down by multiple men, their pants pulled down and then forcibly injected with sedative.

🧵8

#MentalHealth

Maybe they know they have their session with e.g. #psychologist on a certain day or maybe they've been told it's happening later. They won't know exactly until this person turns up. If the child doesn't go, that's usually the session missed until next week.

🧵9

#MentalHealth

So the adult psychologist leaves the MDT (management team by another name) office, the one that's nicely segregated from the chaos of the ward, collects the child and takes them to the allocated room. They sit down, make themselves comfy and start chatting.

🧵10

#MentalHealth

The exhausted, humiliated and scared child, who's got to this place because previous experiences with professionals have not helped, is in a small room with a stranger they have no reason to trust and who will not be part of any long term treatment.

🧵11

#MentalHealth

This adult asks a question.

Child shrugs.

Another question.

'Dunno.'

And so on until the child is labelled 'hard to reach' or 'not wanting to engage' and all of the other disparaging terms that are used to place the blame on the patient.

🧵12

#MentalHealth

You don't need specialist training to recognise a) the huge power differential between the parties and b) that the child feels no way near safe enough to open up.

If your patients aren't engaging then, as my child would put it, that's a YOU problem.

🧵13

#MentalHealth

So if you find yourself writing patients off in this way, you need to take a look at whether you're in the right job.

If you're a professional who accepts these terms about patients from your colleagues, you need to start challenging them.

🧵14

#MentalHealth

As an aside, a friend asked why she'd had such a good experience with her private counsellor, who also works in the NHS. Does that counsellor act differently with private vs NHS patients?

And that's a good question, isn't it?

🧵15

#MentalHealth

NHS patients have to get far more ill and be far more persistent to get an appointment than private patients. They really want help.

So look, if they're not 'engaging' in ways you find acceptable perhaps you've got some inherent bias you need to check.

🧵16 End

#MentalHealth