National report

On Wednesday 16 July I represented Leeds Community Healthcare NHS Trust at the National Confidential Inquiry into suicide and homicide by people with mental illness. The event took place at the Manchester Conference Centre and was opened by Niall Boyce, editor of The Lancet Psychiatry.

The first speaker was Stephen Habgood from Papyrus This was the sharing of the story of Stephens' son's death. It was titled ' All the Kings Horses'. When this gentleman spoke there was a total silence in the room as we heard the pain and loss suicide brings. Words from me to describe this story would be a very poor thing. The power of it struck me like lightning. What I can say it is that it was so right to start this event with these powerful and heart touching words. It set the centre and heart of what we were about to hear. I would like to use this space to thank Mr Habgood for his words and sharing. 

The second speaker was Professor Dame Sue Bailey, Consultant Child and Adolescent Forensic Psychiatrist at Greater Manchester West NHS Foundation Trust. This was an impacting speech. Professor Bailey drew from the Francis and Berwick reports to share her thoughts.  What I found so valuable were sentences which really struck and resonated with me. These statements don't need my commentary so I will record them as I scribbled them down. These are my summaries

          - one death - a ripple effect of thousands 
          - the need to listen to parents and families
          - the need for continual learning - all teach, all learn
          - prefix quality with safety. The two go together. If we get safety right quality will follow
         -  the need for intelligent kindness in healthcare
         -  quoting Bill Gates - 'It's fine to celebrate success but it is more important to heed the lessons of failure.'- the duty of candour

These may seem like truisms and obvious value statements. If however we all really lived and sourced them in our practice and services a real transformation could occur. 

The last speaker was Professor Louis Appleby, National Director for Health and Criminal Justice and Professor of Psychiatry at the University of Manchester.  Professor Appleby is Director of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. He presented the findings of the report. The findings can be found here. The presentation ended with recommendations. These included: 

       * suicide three days after hospital discharge should be regarded as a 'never event'
       * care planning needs to be careful and effective including for those who self-discharge 
       * adverse situations / events that precede admission should be addressed before discharge
       * the benefits of reducing length of stay in in patient stay should be balanced with risks and should not be an aim in itself
       * in intimate partner homicides, mental health services should play a full role in multi- agency work and case reviews. 
       * Crisis Resolution and Home Treatment might not be suitable for patients with too high risk or who do not have good family and other service support
       * economic factors should be recognised with patient suicides and support offered with housing, debt and employment.
       
There is here a real challenge for our mental health services and other care services. I would suggest it is even a bigger call than that. Three months ago I received a call at work that a friend of mine hadn't shown up at work. A visit by the police and his father to his flat the next day found him there. He had taken his life. This was someone who had a job he liked, lots of friends, a great career future and who did a lot of good to others. I and others still have no real answers as to why our friend took his life. He never had any contact with mental health services and as far as we know showed no signs to any of us of mental illness. The answer to this is bigger than any service. I think it lies in how we create cities, conversations and cultures where people can talk about their feelings and thoughts and where we can support people to find hope in the darkness they may be encountering. This report raises vital questions and recommendations for all us to work with.

John Walsh, York Street Practice

What can we see?

I was invited to meet the members of the Executive Coaching Register at the NHS Leadership Academy. These are top coaches from around the UK who work with the academy to support and coach NHS colleagues. The executive coaches' are experienced in working with the most senior leaders in the public and private sector and will support healthcare staff in developing into the high quality leaders the NHS needs (http://www.leadershipacademy.nhs.uk/support/executive-coaching-register/) Over dinner, it was a real privilege to meet such inspirational people as Julie Hickton and Neslyn Watson-Druee. I was invited to this event by Yvonne Coghill who is the Senior Programme Lead for Inclusion and Coaching at the NHS Leadership Academy. As a grateful beneficiary of coaching (via LCH's Liz Whitworth), it was great to meet and talk with these good people.  

I was sat most of the evening next to Elaine Patterson. Elaine is an executive coach and has just finished her Masters on the theme of reflection and leadership. Her research question was 'What are leaders experiences of reflection?'. Elaine's website describes her practice as specialising 'in enabling leaders and practitioners to become all of 'who they are' because 'who you are' directly shapes 'how you work', your impact on others, your results and your reputation.' Speaking to Elaine was one of those conversations where new mental vistas open up and one saw the value and vitality of reflective practice much more clearly than ever before. We had a long conversation full of insights and ideas from Elaine. The following are some of the things that really struck me:

(1) Reflection is not an added extra. I don't think anyone thinks reflection is a bad thing. Many of us may regard it as a luxury - some of us maybe as not the best use of our time. Elaine's argument is that reflection should be and always is at the heart of good practice. Reflection is the act of creation. It is in reflection that we see ourselves and our work and the possibility of new options and practice arise. Habitual ways of thinking and acting get challenged and new insights emerge.  Through reflection we create the possibility of bringing something new into the world. Elaine quotes Einstein as saying, ''problems cannot be solved from the same level of thinking which created them; they cannot be changed without changing our thinking (http://www.elainepattersonexecutivecoaching.com/real-work-leaders/)

(2) Leadership is always connected to reflection. Who we are is how we lead. There is circular reality here. Good leaders are born from reflection. Great reflection is generated by good leaders. Not so much chicken and egg as how leadership and reflection both nurture and develop each other. I asked Elaine what the opposite of good reflective practice was? Her answer was 'that leaders stumble'. I thought this was a very interesting and important answer. Leaders, staff and mangers stumble because we don't reflect. Reflection gives us focus and vision. Without it we can only stumble. 

(3) Reflection is a constant practice and more. Reflection should be a daily practice. This leads to it being a being more and more a state of consciousness / a way of work life. My guess is some of the best reflectors do their reflection anywhere - on a bus, train or walking to the office. Of course, the need of conducive space and the use of exercises such as journaling can be of great assistance. I once heard the analogy of firing an arrow applied to meditation. The idea is that we withdraw, retreat in a sense. Yet it is precisely this withdrawal that gives the arrow it's power and energy. Similarly reflection is that retreat and withdrawal that gives our work practice energy and power. If we don't use these moments we either won't reflect at all or end up in negative reflection by just letting worries and problems dance around our minds.

(4) If we want good leadership, better staff morale and more innovative practice reflection will be a great key to this. I asked Elaine if the Mid Staffs tragedy would have happened if all the staff had been involved in reflective conversations and practice. Her answer was 'No, I believe not'. If we can create reflective culture and consciousness we can start to build the best services for all including staff. Elaine’s research also uncovered that costs of not reflecting. These were identified as poor decision-making and losses in understanding, creativity, relationship, energy and productivity.

Elaine's website is here - http://www.elainepattersonexecutivecoaching.com/ - and plans to publish her full research findings in the autumn. I hope colleagues will hear the message this all points to - we lead as we are. Reflection can be a great friend in the process of us being the best people we can be and creating the best cultures and outcomes for our services.

 

John Walsh, York Street Practice