by Kay SheldonThe experiences of people with severe mental health problems and our views on the services we receive have been overlooked for too long. My own experience of mental health problems and several periods in hospital is characterised by the lack of a meaningful voice. Having interviewed many hundreds of other service users as a Mental Health Act Commissioner, I know this is an experience shared by many.
Most involved with health and social care would readily subscribe a way of working that places the experiences and views of people receiving services at the heart of care provision and it is beholden on each stakeholder to play their role. This includes the health and social care regulator, the Care Quality Commission, of which I was appointed to the board because of my background as a service user and in service user issues.
It was with some trepidation that I took up the role. Whilst I was pleased that someone with significant experience of mental health services had been appointed to help ensure a strong user focus and voice, I wondered if it was a token gesture, to make the organisation look good. Ten months down the line, I am convinced that the organisation is serious about getting to the experiences of people receiving services and using these as an important and integral part of regulation and inspection.
Putting down a marker
The survey of people recently discharged from acute mental health care published by the CQC has put down an early marker for this way of working. Surveys are not new but this one was different. It gathered the views of the care received by over 7,000 people, asking about issues that matter to us as service users such as access to talking therapies, time with staff, activities and the provision of information and rights.
It was with astonishment and dismay that I saw the various responses by national director for mental health Professor Appleby to the survey and its findings, asserting that the results and key messages were inaccurate, invalid and headline grabbing. Appleby suggested that the role of the regulator is to provide accurate information to the patient and the public. I agree entirely. The problem is that for far too long the information has not been an accurate representation. The irony of the suggestion that the results were misrepresented is self evident. Even from a research viewpoint a response rate of 28% equates to significant and valid information. This was not about making the headlines but about providing a platform for the experiences and views of people receiving mental health services.
Inappropriate and prejudiced
I was further stunned to learn that Appleby has asserted that limited credence should be given to the views of service users who have severe mental health problems and/or have been detained under the Mental Health Act. It is difficult to think of a more inappropriate and, frankly, prejudiced view. Having spent many months detained as well as talking with hundreds of people who are detained (not to mention the extensive body of service user literature), this view is erroneous and flawed. I can categorically assert that the feedback and suggestions that come from service users (including people who are detained) are apposite, insightful and invaluable.
It also flies in the face of the plethora of national policies emphasising respect, involvement and rights.
Culture of negating views
Appleby has also suggested that the survey was frightening for patients and unfair to staff. Frankly I am not frightened by fellow service users reporting bad - or rather mixed - experiences of services. It is much more frightening to think that a culture of disregarding and negating our views is being perpetuated at a senior and national level. Giving prominence to experiences and views is not about castigating or criticising staff. For many service users it is the help and support of individual members of staff that has made the positive difference in their care.
The vast majority of staff are dedicated, caring and well-intentioned. In fact, accessing the experiences and views of staff working in services could also yield positive results. It is not about finding fault with all and sundry but establishing an inclusive and constructive approach. This may be threatening to those in the higher echelons of power but in the longer term, this way of working will yield positive results.
A challenging agenda
As the regulator, the CQC is firmly committed to accessing the experiences and views of service users like never before and, crucially, using these to both inform assessments and as drivers for improvement. It is a challenging agenda but the principles and ensuing practice will lead to higher quality of services for service users that, I believe, most staff and managers are happy to plan and deliver.
So, the CQC will continue to seek and put forward the voices of service users as a fundamental part of our regulatory model. I am gratified to be in a position with real influence to ensure that the voices of people using services (and not just mental health services) are both sought and heeded. We are working for a common aim in achieving high quality services. I would suggest that those who are not fully committed to defining this in terms of the experiences and views of service users may not be in the right job.
Kay Sheldon is a mental health service user and a commissioner with the Care Quality Commission
It was with some trepidation that I took up the role. Whilst I was pleased that someone with significant experience of mental health services had been appointed to help ensure a strong user focus and voice, I wondered if it was a token gesture, to make the organisation look good. Ten months down the line, I am convinced that the organisation is serious about getting to the experiences of people receiving services and using these as an important and integral part of regulation and inspection.
Putting down a marker
The survey of people recently discharged from acute mental health care published by the CQC has put down an early marker for this way of working. Surveys are not new but this one was different. It gathered the views of the care received by over 7,000 people, asking about issues that matter to us as service users such as access to talking therapies, time with staff, activities and the provision of information and rights.
It was with astonishment and dismay that I saw the various responses by national director for mental health Professor Appleby to the survey and its findings, asserting that the results and key messages were inaccurate, invalid and headline grabbing. Appleby suggested that the role of the regulator is to provide accurate information to the patient and the public. I agree entirely. The problem is that for far too long the information has not been an accurate representation. The irony of the suggestion that the results were misrepresented is self evident. Even from a research viewpoint a response rate of 28% equates to significant and valid information. This was not about making the headlines but about providing a platform for the experiences and views of people receiving mental health services.
Inappropriate and prejudiced
I was further stunned to learn that Appleby has asserted that limited credence should be given to the views of service users who have severe mental health problems and/or have been detained under the Mental Health Act. It is difficult to think of a more inappropriate and, frankly, prejudiced view. Having spent many months detained as well as talking with hundreds of people who are detained (not to mention the extensive body of service user literature), this view is erroneous and flawed. I can categorically assert that the feedback and suggestions that come from service users (including people who are detained) are apposite, insightful and invaluable.
It also flies in the face of the plethora of national policies emphasising respect, involvement and rights.
Culture of negating views
Appleby has also suggested that the survey was frightening for patients and unfair to staff. Frankly I am not frightened by fellow service users reporting bad - or rather mixed - experiences of services. It is much more frightening to think that a culture of disregarding and negating our views is being perpetuated at a senior and national level. Giving prominence to experiences and views is not about castigating or criticising staff. For many service users it is the help and support of individual members of staff that has made the positive difference in their care.
The vast majority of staff are dedicated, caring and well-intentioned. In fact, accessing the experiences and views of staff working in services could also yield positive results. It is not about finding fault with all and sundry but establishing an inclusive and constructive approach. This may be threatening to those in the higher echelons of power but in the longer term, this way of working will yield positive results.
A challenging agenda
As the regulator, the CQC is firmly committed to accessing the experiences and views of service users like never before and, crucially, using these to both inform assessments and as drivers for improvement. It is a challenging agenda but the principles and ensuing practice will lead to higher quality of services for service users that, I believe, most staff and managers are happy to plan and deliver.
So, the CQC will continue to seek and put forward the voices of service users as a fundamental part of our regulatory model. I am gratified to be in a position with real influence to ensure that the voices of people using services (and not just mental health services) are both sought and heeded. We are working for a common aim in achieving high quality services. I would suggest that those who are not fully committed to defining this in terms of the experiences and views of service users may not be in the right job.
Kay Sheldon is a mental health service user and a commissioner with the Care Quality Commission
Hopefully your voice will give encouragement for many more people who use Mental Health Services to find avenues through which to make their experiences count in the shaping of services.
Having watched and worked in services over nearly three decades, it has been a relief to see the small but very significant minority of service users being given valued positions of influence. Confidence and interest in exerting influence in this way, can be hard for people to find.Often it is one of those voices that may reconnect staff to their reasons for pursuing this type of work. For some, however, the 'Us and Them' perspective may be a harder nut to crack.