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Working in mental health is not like fixing broken legs Working in mental health is not like fixing broken legs
(about 3 hours later)
It is an often quoted metaphor: mental health problems should be seen like a broken leg (ie not shameful, not the fault of the suffer who is in need of well-wishing and support). While this analogy can help challenge stigma (and that definitely needs to happen) and address the need for mental and physical health to be seen as equal, it can be damaging when thinking about structuring services to meet the needs of people experiencing mental distress.It is an often quoted metaphor: mental health problems should be seen like a broken leg (ie not shameful, not the fault of the suffer who is in need of well-wishing and support). While this analogy can help challenge stigma (and that definitely needs to happen) and address the need for mental and physical health to be seen as equal, it can be damaging when thinking about structuring services to meet the needs of people experiencing mental distress.
Related: I love working in mental health – but I can’t do a good job on a shoestring
You have a broken leg? You get to hospital. People may offer to take you. You accept these kind offers. You comply with treatment. You attend follow-up appointments which come by letter, which you a) open, b) understand, c) make a note of and, importantly, d) agree with the need for.You have a broken leg? You get to hospital. People may offer to take you. You accept these kind offers. You comply with treatment. You attend follow-up appointments which come by letter, which you a) open, b) understand, c) make a note of and, importantly, d) agree with the need for.
People in charge of money understand this. You can budget for x number of operations that cost £y. A similar model may work for people who are struggling to live their life despite the presence of mild to moderate anxiety or depression. Or people who choose to attend therapy privately.People in charge of money understand this. You can budget for x number of operations that cost £y. A similar model may work for people who are struggling to live their life despite the presence of mild to moderate anxiety or depression. Or people who choose to attend therapy privately.
But the young woman I saw this morning believes my colleagues and I (and most other people) to be part of a network linked to the Illuminati who want to torture and rape her. Rape is something she has experienced in her childhood and she is petrified of it happening again. She doesn’t agree with our opinion that she needs support from us (who would want to meet with rapists?). She doesn’t meet the threshold for detention under legal frameworks that allow us to assess or treat her against her will, for her own safety. She copes with the fear by using street drugs, which she sometimes funds through sex work.But the young woman I saw this morning believes my colleagues and I (and most other people) to be part of a network linked to the Illuminati who want to torture and rape her. Rape is something she has experienced in her childhood and she is petrified of it happening again. She doesn’t agree with our opinion that she needs support from us (who would want to meet with rapists?). She doesn’t meet the threshold for detention under legal frameworks that allow us to assess or treat her against her will, for her own safety. She copes with the fear by using street drugs, which she sometimes funds through sex work.
Today I hope to see a gentleman who is traumatised by his experiences of warfare and still hears the screams of children he saw die. Other voices tell him he is a bad man for not saving them. To cope with the distress he chews khat. He often sleeps all day. Having lost his wife and child, he struggles to find the motivation to do much and can’t imagine how talking with someone could help him. He doesn’t open his post.Today I hope to see a gentleman who is traumatised by his experiences of warfare and still hears the screams of children he saw die. Other voices tell him he is a bad man for not saving them. To cope with the distress he chews khat. He often sleeps all day. Having lost his wife and child, he struggles to find the motivation to do much and can’t imagine how talking with someone could help him. He doesn’t open his post.
I love my job. I love the changes that I see in people’s lives. I love being the first person in a long time that someone can trust, by showing them that I will work to earn it. To do this we need to work very differently to a service fixing broken legs.I love my job. I love the changes that I see in people’s lives. I love being the first person in a long time that someone can trust, by showing them that I will work to earn it. To do this we need to work very differently to a service fixing broken legs.
As money becomes tighter, services that show favourable data on how many legs (or arms, ears or eyes) they fix or how many anxious people they help to return to work are seen favourably. This is very understandable. But it doesn’t mean that people who can’t be supported through such a rigid structure will disappear. Evidence from different models or services show that investing in high quality interventions for people experiencing psychosis can have very favourable long-term outcomes, including economic ones. But money up front is needed for longer term gain.As money becomes tighter, services that show favourable data on how many legs (or arms, ears or eyes) they fix or how many anxious people they help to return to work are seen favourably. This is very understandable. But it doesn’t mean that people who can’t be supported through such a rigid structure will disappear. Evidence from different models or services show that investing in high quality interventions for people experiencing psychosis can have very favourable long-term outcomes, including economic ones. But money up front is needed for longer term gain.
Related: Political attitudes to mental health are harming patients and staff
Judging the services that support people, such as those described above, through a broken-leg lens means we get reduced funding. So community mental-health clinicians can’t spend time finding and gaining the trust of the woman who thinks we are part of the Illuminati. We can’t visit the war veteran to help him feel safe. But we can offer him a fixed-time appointment at our office. Maybe we’ll just send him a letter.Judging the services that support people, such as those described above, through a broken-leg lens means we get reduced funding. So community mental-health clinicians can’t spend time finding and gaining the trust of the woman who thinks we are part of the Illuminati. We can’t visit the war veteran to help him feel safe. But we can offer him a fixed-time appointment at our office. Maybe we’ll just send him a letter.
These vulnerable people’s needs won’t go away. Forcing them to access other over-stretched services which aren’t designed to meet their needs won’t help them.These vulnerable people’s needs won’t go away. Forcing them to access other over-stretched services which aren’t designed to meet their needs won’t help them.
We might as well just give the person with a broken leg a plaster, and hope that this cures them and they never return. Or that they don’t fall, while hobbling around, and break another bone. Or don’t have to turn to substances to dull the pain. Or that they don’t kill themselves.We might as well just give the person with a broken leg a plaster, and hope that this cures them and they never return. Or that they don’t fall, while hobbling around, and break another bone. Or don’t have to turn to substances to dull the pain. Or that they don’t kill themselves.