nursingforsocialjustice

In recent months I have been struggling with the direction that is being taken in inpatient psychiatry, particularly the places in which I have practiced (and currently practice). It seems that care is getting more and more prison-like, more regimented and structured, where the emphasis of ‘good care’ is risk-aversion and control rather than therapeutic interaction and individualized care. It seems more and more like the overarching paradigm has somehow shifted farther away from seeing patients accessing inpatient mental health services (not even those who are experiencing acute mental health symptoms…because I see this happening in rehabilitation focused centres are well) as human beings needing help, sharply turning towards being afraid that patients are somehow going to harm us. The fear culture is pervasive. And the response unfortunately seems to be designing and building more controlled, prison-like inpatient units mostly focused on keeping staff safe. And I don’t get it. And I don’t like it because it sometimes makes me feel defeated, like the uphill climb is even steeper 10 years after I first started practicing. I do not know if this is because I am just more aware 10 years later or if we are somehow standing still.

There seems to be such a mismatch with some of the places that I have practiced and the progress and change that is happening in mental health inpatient programs in other developed nations. I don’t understand how some things that I experience here fit with the Trauma Informed Practice Best Practice documents that have been published and the Recovery based literature and guidelines. It is heartbreaking for me when I go to some of the places I work and I see the care that is being given, and see the new policies that are developed, and hear the language that staff use to talk about patients. I don’t understand where the disconnect is. And I don’t understand why there is so little reflection on practice and the impact that practice setting, and personal values, and worldview and personal biases can have on care. I can speculate, and I do speculate about this all the time. It is concerning to me. The blatant disregard for evidenced based practices is also alarming to me. I do not understand how there can be such a mismatch and disconnect.

It breaks my heart that coercion in mental health just a run of the mill accepted practice, as if its part of the competencies of mental health clinicians to be skilled in using force and threats to make someone do something that they do not want to do…even though the treatments that are being provided are helpful? Are they help and are they good if you view the foundation of care as requiring treat and force in order for the patient to take it? Really think about that. And then think about some of these things that we also thought were good and helpful:

Eugenics

http://historyofmadness.ca/?option=com_content&view=article&id=52&Itemid=42

http://www.huffingtonpost.ca/2016/01/08/aboriginal-women-saskatoon-sterilization_n_8939830.html

Click to access cjnsv18no1_pg1-18.pdf

I think we actually have to try and start taking the emphasis off of using coercion and start relying more on the strategies that are used to help people make different decisions with respect to other areas of health. And I think we also have to be real about how far we actually have not, in fact, moved from paternalistic and one size fits all care built on the values and beliefs of a position of our own perspective, because even if we are only thinking, “they just need to to what I say” or, “if they just followed the plan that we made for the,m, they wouldn’t be back here” (or something similar) in our heads or saying it behind closed doors with our colleagues, the fallout is the same and we never got any closer to actually being person and family centered, we just go better at not admitting it public or to our patients and their families.

Peace,

Michelle D.