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PROactive Management of Integrated

Services & Environments


Person-centeredness, spirituality, and the slow steady march to thoroughly humane mental healthcare

John Nicholson, Senior Chaplain, CPFT, November 2014

I love my son. I love him with a depth of feeling beyond measure. I love my son so much that I would do anything to protect him and keep him safe. If I ever had to hand my son into the care of someone else, somewhere else, away from all that is home and familiar and I came to call to see how he is and how you are caring for him, I would want to feel, see and know from how you talk about him and treat him – but especially in how you talk about him – that you know him well enough to have discovered what makes him the person he is - the person he is, uniquely.

In a recent mental health training session for CRUSE volunteers one of our peer workers was talking about recovery and his own journey. Concluding by asking for questions, one of the group repeatedly asked him for his diagnosis, but he very gently explained each time that “we don’t go there.”  It felt  like the story of his long and challenging walk to ‘here’ was being threatened with  being pulled down by a reductionist attempt to nail him to the mast of a diagnosis. However, he stressed the point that we look forward and beyond to a better time ahead, in recovery; a place where a deeper understanding of a person’s own emotional, psychological, physical, relational and spiritual needs and gifts shape the story, their journey.

So, where does any of this take us regarding the PROMISE project, and the fundamental contradiction between care and control that lies at the heart of mental health services?

It leads me to want to help build the momentum for change – to be part of that movement that is pushing us to a tipping point, as it were, beyond which we are noticeably and quite naturally, unquestionably more humane in what we say and do and in how we do it as people who care.

On the road to that tipping point we have markers. Here are some that come to my mind:

  1. Recovery language comes first. I noticed that Jimmy’s night shelter now calls homeless people staying with them, guests. A simple but effective and thoughtful change in language. It’s just one word, but it says so much and helps create the change we seek.
  2. Caregiving is creative. Creative caring is fuelled by an attentive curiosity to know more deeply what makes the person tick. In the Chaplaincy leaflet we say “Chaplains do what they do because for many people in our care living well depends on the very same things in life that we all need to be clearer about: Who am I? Where am I going? What is this experience showing me about myself? Can I even go on? What do I believe in and hope for? These are human, spiritual questions, and the answers depend on you. Chaplaincy can help you with that.” These are questions we can all have in mind in our task of getting to know the patient in our care.
  3. The patient is not in the way, the patient is the way.
  4. Kindness never fails: it saves lives.
  5. Being kind is challenging. The circumstances we work in require self-management, greater awareness of being present on the job when you are on the job, and great support from your team and the organisation. I think more opportunities need to be found for mindfulness practice, good and strong supervision and support, and an openness by all involved regarding  the cost of caring. SCHWARTZ Rounds are recommended so that wisdom, experience, and feelings are safely but openly expressed and tensions held. The safer people feel in their role, the more they will be able to look with curiosity at their own attitudes and prejudices and more open to the emotional experience of their patients.
  6. Let the patient be your guide. A snapshot of what matters to someone in our care should be instantly available, visible and absorbed by us. Here are three simple questions that can help that might be put to someone: What gives your life meaning?” “What gives you hope?” “How can we help you to feel connected to these things whilst you are with us? [Appendix 2 in Keeping the faith, from the Mental Health Foundation download from www.mentalhealth.org.uk ]