nursingforsocialjustice

None of this is permanent, not me, not you, not the words on this screen. None of this. That doesn’t mean that our decisions and actions do not matter. You matter. On the contrary, these relationships that we have are what makes any of this matter. The impermanence of it all is kind of unsettling, but also an opportunity. Are you a glass half-full or glass half-empty kind of person? Are you a thinking inside of the box or outside of box person? Maybe you are the kind of person who wants to take the box apart and make it a bridge.

More and more I wonder, why don’t we take a deeper look at what we actually do; what we actually did for each patient, what was helpful, what was not helpful and what could change to better support someone? I question this model where you bring someone into a hospital for an indefinite period of time, and then hope that something changed inside of them such that the context of their life that they are returning to won’t seem as awful. And sometimes it doesn’t really matter what the external factors are, the circumstances of their life, because it seems like the process of bringing someone into an inpatient unit involves individualization and isolation, from one’s community, from their life, from what they know.

I work (sometimes) on an inpatient mental health unit. When I do inpatient work I find I am more and more doubtful that the strategy that we are going with, the concentration of resources (human, financial, emotional) at the highest level of care, hospital-based, a centralized level of care concentrated in larger urban centres, is the best way to move forward with goals of equity and access. Some deep metacognition is happening right now in my big beautiful brain. I’m inviting you to come on a journey with me, a delightful thought experiment that may cause discomfort, to aggressively probe the question: why are privileged voices in healthcare circled back to and their position solidified with a rhetoric of innovation and change?

In Canada, a century ago (or so) the hospital system began. There was stuff happening, within the post-World War I era, that contributed to this. Sometimes I think that after years of research and going down a path that hasn’t led us to success, we keep going because we are already so far down the road surely it’s more costly to go back and start again than to just keep going and hoping somewhere down the road there will be a fork that allows us to get to our destination. Why aren’t substance use and mental health services organized in a way that allows providing support to people in communities to keep people in their communities instead of centralizing resources and bringing someone into a hospital?

The bigger the step I take away from first care, the longer the break I have, the more I read critical theory, the more I learn about nursing models, the more profound the gap between what is and what should be feels. I feel more and more pain when I listen to the talk about patients not being grateful for the services that were forced upon them and the practices that are inherently controlling and coercive.

Similarly, this pressure to create innovation in mental health care is kind of like renovating a house on quicksand; the foundation was never solid but we just keep building hoping that it will settle eventually. Just because something is different or even seems novel doesn’t mean it’s effective.

Maybe instead of asking how nursing fits into a medical psychiatric space we can start asking, how can nursing create a non-medical, non-psychiatric, wellness-driven space for people in distress?

Peace,

Michelle D.