NHS mental health service sometimes repeat patterns of trauma that are present in society and often in the histories of the people we are meant to help. 1/9 When people are coerced into receiving treatment (or ending treatment), that repeats coercive control. 2/9

Mental Health Professionals: struggling with the idea that we have power?
That's probably because we work in systems where we feel utterly powerless lots of the time.
But power is relative + dynamic + we'd best wake up to it.
It'll be painful for each of us in different ways.... We want to see ourselves as useful, helpful, caring. We could've done this in other ways e.g. a befriender. But we chose professions that conferred 'expertise'. There's probably something that drew each of us to that (the avoidance of the other bad, shameful or vulnerable place?)

So, I started to work on this in the background a bit, over a year ago. I had hoped I could get something off the ground in my workplace but that doesn't seem viable (yet). Thinking of continuing it outside (/alongside) my work role. Wondering how to do this practically.

https://twitter.com/HartleySamantha/status/1291357760848900098

I wanted to get something backed and funded going so it could be co produced. Without a structure or resource, I’m not sure how to do that well or fairly. I have drafted some stuff already so could just ‘put it out there’ and see what comes back but that seems a bit uncertain.

I am on the edge of burnout. I think it’s important I’m honest about this yet wanted to take some steps before I shared publicly. I am emotionally exhausted, full up + empty, noticing my red flags (suicidal thoughts - I’m not suicidal, I am safe; this is a sign for me to listen). Many others are too. Those and I who are resilient, persevering, compassionate, determined, innovative. I got a first class degree while depressed and experiencing ED, I did a PhD while working full time. I have worked in complex care for six years. This is new.

So much pain is caused by our human difficulty with holding in mind two truths; working with dialectics. Synthesising apparent contradictions can be healing and yet it’s hard. I am right and yet you’re not wrong. I am responsible and yet it’s not my fault. You need help and yet we cannot help you. I have empathy for your position yet will challenge your action. We are where we are and yet must move. There is good evidence and yet it is equivocal.

It has been so valuable to write this piece for @AsylumMagUK. The call-out from @HSpandler came at a time I was navigating my own position on this and writing it helped me explore and develop that
(a journey very much ongoing...) That, on submission + publication, I felt a surge of anxiety in how it would be received is testament to some of the themes I have discussed, IMO. There is pain in connecting with the current landscape, in services + our roles in that, and yet it's so vital for healing + growth.

Great to meet @chelsea_arnold_ , @neilthomas3182 and the team in my first international Zoom trip to Aus. Reminiscing on my research journey from assistant, to trial manager, to PhD to ClinPsyD to Clinical Academic was surprisingly enjoyable and moving for me. How I started doing a review for my supervisor @gillianhaddock at @OfficialUoM that turned into an accidental PhD registration and 10,000 record systematic synthesis 😱onlinelibrary.wiley.com/doi/abs/10.111…

Technique based or manualised mental health services, narrow policy driven service change and focus on content over process will never bring us meaningful, sustainable change. Techniques are offered in a relational context, service change occurs in cultures embodied, perpetuated or shifted by individuals. Any content is subverted or supported by the process by which it is implemented in the structure it occupies.

I love my job. But the day I feel comfortable doing it is the day I need to stop or radically change. The system is not helpful, in fact harmful for so many. It’s not enough to work in line with my values in my little space in the system. I have to keep using that to disrupt and heal the harm in the whole system. I need to do more and better and for longer yet I feel this is the position I need to keep coming back to.

As clinicians and researchers I think we all too easily forget that questionnaire scores are not equivalent to the construct they seek to measure. Someone isn't "less or more anxious"; their self-reported anxiety via *that tool* has decreased/ increased. The ratings are provided by someone interpreting their own internal world based on their current perspective, communicating that in a relational and social context, which is then interpreted by another person/s, via more layers of their mutual and separate context/s.

A while ago, I started to notice that I felt defensive when people challenged the idea/practice of psychological #formulation. I think because I see the benefits, believe in the underpinning values + probably because it's such a core part of my professional identity. And yet..... ....I reflected that if I stoically defended a process, rather than being open to its refinement, evolution and adaptation, in the face of valuable feedback (especially from those who use services) then I would be perpetuating the harms of MH services past and present....

I'd like to write something accessible for MH staff on iatrogenic harm- the forms this takes (both intentional + un...), why it happens, how it impacts, how to challenge + change. Already had inspiration + input from @g_shielding @MyNewMummyLife @beth_1day @DrEm_79 @AlexBThomson Wondering about whether something exists already? What form it might take (leaflet/ zine/ brief book?), how to involve others in the design and contents (and how to fund this/ use my other funds for this) and how to get started. Ideas?

Our #qualitative study exploring the experiences of people involved in #participation and #involvement for the design and delivery of #CAMHS has just been submitted for publication, but we didn't want to wait to share some key findings and resources with you! Following a #research and service development meeting to design a new staff-based intervention for inpatient #CAMHS (Follow @StudyTric and me for updates in due course), we asked those present to tell us about their experiences of being involved.

[Thread- please read in full as points are hard to articulate in isolation]….I can’t comment on the full protocol as it’s now not available. These are some thoughts that came up for me when reading the extracts, reflecting on their implications + my experiences in practice [1/9]

https://twitter.com/MyNewMummyLife/status/1280242485739098114

This area of working is very important to me - working with young people is my job and I couldn’t help but think of individuals and staff I’ve worked with and what’s been helpful and not, and what they might make of this and the impact of different ways of working. [2/9]

It’s exhausting, demoralising and often infuriating reading some of the Twitter exchanges between different MH disciplines and ‘factions’, and I don’t even do it that often. Surely there is a better way....? Clinically, I have found the phrase ‘step away from the battle while holding the line’ helpful to support people to retain boundaries while not escalating situations.

You are making dinner for your family. Your neighbour comes banging on your door. You don’t talk often. She is shouting at the top of her lungs and waving her arms. You feel intimidated and inconvenienced. She tells you her house is on fire and is begging you to come and help - bring buckets of water and help children who are in their bedrooms. Her house is over the hill, you can’t see the flames or smoke. Your house has never been on fire and you have confidence in the fabric of the buildings; they were constructed by your great grandfather, after all.

Aside from the lack of logic in some of the reasoning (driving to check vision with child in the car?, going back to work when just visited wife you think has corona?), I think you've kind of missed the point anyway.... (1/7) The point isn't whether you can reasonably justify it to yourself or others, whether you can appease or at least hide from your own conscience. The point is whether you followed the guidelines and advice. (2/7)