Let’s eat dirt by Euan Mcleod

Do you remember growing up and playing in the mud, jumping in puddles, playing in the middens, wellies and the ring of no confidence (for more on this see Billy Connolly et al) 

Nowadays there is growing evidence that the desire to prevent our kids from being exposed to all kinds of bugs and germs is having a negative effect on them being able to develop resilience later in life, that the overriding desire to protect them from anything that may cause them harm is in fact causing them harm

 

This has burgeoned into an array of various chemicals cleaners and devices some of which kill 99.9% of all known germs and keep you safe, (never mind the ones we don’t yet know about),  but not all bugs are bad and similarly not all feelings and emotions are bad for us as well or something we need protected from. 

We have as a society in the pursuit of risk free safe living, developed health and safety into a burdensome machine, aimed at reducing and mitigating against the litigation potential and the costs as well as the reputational damage that can bring. The quite laudable idea that we should try and prevent things hurting us has become an exercise in producing paper trails and avoiding blame and guilt and less about “real” discussion about harm and risk

 

Witness the industry and thinking that has led us to losing some of our critical thinking ability and one might say common sense in how we respond to telling people about potential dangers just in case they sue us because we didn’t tell them. Where has personal accountability gone? 

Did we not learn as children for example that water in a kettle may be hot, or that snow and ice may be slippy, that knives may be sharp.

In mental health care we are often confronted by people experiencing acute levels of distress and our natural desire as humans and members of the caring profession is to try and take that away from them. To make things better and keep them free from harm 

 

We place people under restrictions, observe them with a view to preventing them taking a course of action which may be detrimental , we act in their best interest, but we are in a complex area of managing risk for the organisation versus risk for the individual , whose rights and responsibilities are arguably foremost in the provision of our service.

 

I recently completed training in the risk assessment tool which is used across services in Dumfries and Galloway, The training helped us to see that we all view risk differently and that having a tool does not make it a simple one size fits all approach but allows us to gather information about a complex subject that is ultimately about the individual and how we help them by managing risk.

 

Managing risk is not about just making sure the organisation and the staff are protected but ultimately about ensuring that the individual receives care and treatment that helps them towards recovery 

 

Managing risk makes all of this sound like something technical process driven THING, something outside of us but its value is in helping us to see risk as something which is part of us, part of life and in living life we sometimes take risks because it’s worth it in the end. that’s where the risk assessment process can helps us to have those difficult conversations, to be able to be brave and honest, not foolhardy, succinct in our thinking, with our rationale laid bare to be observed and clear to all  and to place the person in need front and centre of those risk plans.

 

The Scottish Patient Safety Programme is designed and focussed on prevention of harm in healthcare settings, could this translate into a focus on preventing harm at all costs and thus creating circumstances and situations which create longer term harm

Are there times when we potentially cause more harm by not allowing people to be exposed to the very things that will strengthen them and make them more able to cope with the stress and strain of life, mental ill health and help build resilience-which involves a willingness to turn negative emotions involved in disruptive life events into something strengthening and empowering. In this sense the negative emotions like the dirt we were exposed to as children rather than being removed or cleaned away or sterilised has a value in being allowed to remain and be used to build up resilience and thus recovery

The Scottish recovery network define recovery as “being able to live a meaningful and satisfying life, as defined by each person, in the presence or absence of symptoms

 

 

Resilience is becoming a key issue in our approach to mental health care and treatment, for example in England and Wales the government have allocated circa £15bn of resource to tackle the problem. that might mean we are seeing an acknowledgment that our modern lives are damaging our mental health and that an over reliance on medication and getting therapy hasn’t worked and has simply led to over use of mental health resource and a failure to rely on  ourselves as healers                                                                    

I am not suggesting we somehow stop caring, or throw caution to the wind and do not take seriously the very real dangers/risks of helping people “on the edge” but perhaps we are in the business of a more nuanced approach to risk, resilience and helping people lead mentally healthier lives, and eating some therapeutic dirt might be worth the risk to support people towards hope and recovery

Ewan McLeod is a Mental Health Staff Nurse at Mid Park Hospital Dumfries

Imagine a world………… by Laura Lennox

 

Elaine has dysarthria (motor speech disorder):

 “I hate using the phone simply because I am so self-conscious of my speech.  And if they say “Pardon?” to me, it makes me more flustered because I automatically assume it’s my speech that’s the issue.  I would never think it could be that a noise distracted them at their end.  And the more flustered I get when trying to talk, the worse my speech becomes”.

 

“I love that some companies now have the ‘chat online’ service.  I will use that instead of the phone even though it takes longer”.

 

“The other day I saw some valuable looking equipment seemingly dumped under a bridge.  When I got home I went on to the Police Facebook page to message them, but they didn’t have messaging as an option.  I googled a contact email for them but to no avail. In the end I was forced to phone but it really is a last option for me”.

 

“I hate phoning for appointments, taxi’s, takeaways- all the things other people do without thinking about it – it’s a big issue for me and I often work myself up in to a state.  I try to remember the sound advice from my speech and language therapist to speak slowly and clearly but the minute I hear “Pardon?” I break out in a cold sweat

Last year I decided to get back into studying and registered for a three-year MSc in Advancing Healthcare Practice through the Open University.  I was asked to look at a small-scale innovation in a healthcare setting that could lead to a significant impact.  Straight away I knew what I was going to look at.  Listening to people’s stories time and time over – THE DREADED TELEPHONE!!

 

  

 

William and Bob both had throat cancer.

 

William:

“Speaking for myself, contact through email is the only way for me to go. I cannot carry a conversation by telephone due to the amount of Mucous and or phlegm talking generates.  I can listen on the phone to any conversation but can only give a limited response to any questions”. 

 

Bob:

“I do not answer the phone as usually the valve needs cleaned for me to speak clearly.  If I need to make a phone call I need to clean the valve first and tend to just phone immediate family due to other people possibly not understanding me.  It’s embarrassing answering the phone and not being able to speak.  An email is so much easier to correspond with. No embarrassment.”

 

Typically, the main or only method for contacting any public service is by telephone.  In the 21^st century we have so many more ways of communicating:

 

A Scottish Executive report published on communication support needs (Law et al, 2007) estimates there are between 1% and 2% of the population in Scotland who have complex communication needs.  Complex meaning to the degree that they cannot communicate effectively using speech, whether temporarily or permanently.  This is likely an underestimate given that the study is based only on people who were accessing speech and language therapy services.

 

If we consider the findings of this Scottish Executive report, having telephone contact as the only method of access within an organisation may be perceived as an inequality.

 

(International Communication Project, 2016)

The Scottish Government (2011) recognises the requirement for public organisations to become more inclusive of people with communication support needs and has set guidance for public authorities on Principles of Inclusive Communication.  The legislative driver for this stemming from the Equality Act (2010) and the United Nations Convention on the Rights of Disabled People (2009), Articles 9 and 21, which set out a person’s right to have access to information and communication in different forms.

 

Individuals and the wider community benefit from all people being more independent and participating in public life.

Lorraine has Aphonia (loss of voice):

 “I have difficulty with communication as my voice is a whisper and everyday there is a hurdle I have to try and jump.  One of these is appointments with NHS either hospital appointments or Dr Surgery appointments. I have lost appointments at the hospital as I can’t phone to cancel and rearrange. Also, when they send you a letter saying to phone up to arrange an appointment, I have to rely on other people to do this for me which is very hard as they work during the hours you have to phone, or they forget it’s also not very private. If you wanted to keep it private I can’t even have a phone consultation. I find it upsetting and frustrating that I have lost a lot of my independence having to rely on other people to make phone calls and appointments for me. There is a simple way to help people like me to give us part of our independence back and the answer is email. Most of us use it these days and I would have my privacy too. All they need to do is have on my records responds by email only, how hard is that? I don’t like to be one of those statistics that don’t turn up for appointments or when you don’t phone to make your appointment and think you do not need one. And that is just a small part of what I have to go through on a daily basis”.

 

Putting knowledge into action is what counts.  We could all work towards becoming more inclusive to people with complex communication needs by adding alternative options for contacting our services and departments.  It could be as simple as adding an email address to start with.

 

Now imagine if every service and department within health and social care did this then it would indeed be a giant leap towards a more inclusive communication world.

 

If you have an interest in Inclusive Communication and want more information or to become involved in any future projects, please contact:

Laura Lennox is a Speech and Language Therapist & Allied Health Professional for NHS Dumfries and Galloway