‘Keep your friends close and your critics closer’. I’m sure I’ve heard that one said. I was pitching the idea for our app, Mental Snapp, to a group of service users the other day and the idea was being picked up and tossed around like a football round the room. The experience was challenging, and certainly invigorated the idea, making it practical, smoothing off some of the edges. My personal challenge was to listen and absorb, respond to the feedback and not respond to a universal human instinct, to be defensive.
It helped me understand the service provider role, as much as I appreciate and value the feedback of service users. I have often heard service providers say that the process of coproduction is challenging, and imply that service users certainly aren’t backwards in coming forward with their views. I have not sat in their seat before. Though I wasn’t in fact posing as a service provider, I was offering an idea which presents a critical shift in the status quo, and the power balance between service user and service provider. But the service users responded to it as if I was presenting something that was in line with the status quo as they know it. After some time they also accepted that there were merits to the idea. But their initial response was one of resistance.
It is interesting, the relationship of mental health service users to the status quo. Historically, because of the power structures and imbalances that are an intrinsic part of labelling someone as insane and sectionable, the service user collective feels aligned to an outsider status. Having been judged as out of one’s mind tends to put one in a certain antagonistic relationship to authority. I appreciate the desire and the drive of service users therefore, when they are consulted for their opinions, to instinctively challenge the status quo. In fact, this is their great strength. The status quo exists, or should exist, precisely to be challenged.
However, in posing a solution, I felt myself in that instance cast into the service provider role, and I could understand something of their difficulty. It is like the difference between being the political party in opposition and the one in power. High ideals versus low pragmatism. The solution that I was proposing, that service users should have the right to contribute to their mental health record, is inspired by an ideal. But implementing it involves the kind of pragmatic solution based reasoning that colludes with big structures and the macro level of the NHS and record keeping system that service users of the NHS, whether it is mental or physical health, feel understandably suspicious of. I do believe that the real way to challenge the status quo is to get as close to it as possible, while maintaining ideals and an agenda that is of an outsider. But to represent it to those in positions of power that you offer a solution, you’ve thought of the problems that they face, and that your solution demonstrates that you care about the issues that they are facing as well as your own.
For example, today I was at the Oxleas Council of Governors meeting. There was a question posed about voluntary patients and the fact that they are often denied leave, even though this is illegal. The clinical director was suggesting that if there was significant risk to the person leaving the ward, the staff should arrange to have them assessed with a view to putting them on a section. Now I understand that this is safeguarding, both the patient and the staff. But the point I made is that there is a lot of confusion about the rights to leave of a voluntary patient and they are often overridden. The solution I posed was that there should be a leaflet given to a voluntary patient on entering the ward, explaining their rights and when and why they might be assessed for a section. And that there be staff training around this. So I saw his problem, I hope; I certainly proposed my solution. And I hope that it is one that will be mutually beneficial.
So, now that I am proposing these kind of service adjustments, have I relinquished my outsider status? I hope not. I hope that I continue to think of things from a position of challenger, and that I embrace the challenges that coproduction and the group of service users I pitched to – who I hope to work with closely in the future – pose. I also hope that Mental Snapp, our app, becomes part of the status quo. The group of service users that I was working with the other day certainly have the potential to shape it, kick it about, make it relevant to them and their real life experience. The idea could take on a life of its own. I hope that when it does it represents significant challenge to the way that service users relate to their health records and their health professionals. Finally I hope that when the concept is thoroughly absorbed into the status quo and becomes part of the mainstream, that an upstart trouble maker like me comes along and takes on the assumptions that it is based upon and subjects them to their own radical system changing challenge.