Let's make our services human again

We welcome people living with complexity as a priority for care

In 2011 I travelled to Monterey California for an “Unconvention” led by Dr Christie Cline and Dr Ken Minkoff, two Psychiatrists I had heard speak in Australia at a Dual Diagnosis Conference.

When you think of white American Psychiatrists you might not think of champions of non pathologising, harm minimised, strengths based and trauma informed practice.

I certainly got a surprise.

 Hearing their passion for compassionate service systems, their stories of people leaving services with less hope than they had when they called, their vigilance to addressing all of the ways our systems do not put out the welcome mat for substance use and mental health complexity. I was inspired by them, their message resonated and integrated into my being.

Since then, I have beaten the welcome, empathy and hope drum wildly. In service design, in training and supervision, with the people we call “clients”.

“If you get welcome, empathy and hope right you get everything right”, said a service recipient when sharing this model of care.

When working with teams and organisations I am amazed to hear of the barriers to welcoming complexity: fear of complexity and risk, risk aversion that denies a treatment response, system processes that require the client to do this and that, it seems it has become harder to listen, build  relationship, count the work, KPI’s, funding requirements, 28 page assessment tools facilitated in a tick the box fashion, beau acracy, administrative burden, technology not fit for purpose, fragmented services, systemic problems.

And the outcome of that is often a narrative that blames the person seeking help: non-compliant, treatment resistant, frequent flier, not ready to do the work, I am sure you can think of many others right?

In co-design sessions, staff see the system, they see that they might hold hope, but the client has a whole lot of red tape and hoops to jump through and barriers to overcome, and don’t feel it. It is not the work with clients that burn out workers, it is the values clashes, the desire to provide care and the transactional system approaches the de-humanise.

I reminisce about the times we welcomed people with complexity as a priority of care, we were free to assess and continue to provide service in the one place, with the same worker, collaborating with the person about who they wanted involved in their care, no pressure to tick boxes, and have “throughput”. We had time to listen. It was seamless, we had capacity, support networks, relationships with multidisciplinary teams, peer support workers, groups and social connection and health promotion. Pre-contemplation had a plethora of harm reduction and humanising responses possible, ah the golden years.

The reform, consortiums with unaligned philosophical values, cultures of competitiveness and power struggles, funding changes that didn’t have the person living with complexity in mind, didn’t think about trauma and diversity, the systems broken.

People with complexity need to be seen as a priority for care, it is time to step back and get into the shoes of the person we call client, explore the service system practices from their eyes, their experience, their hopes and dreams.

The people most in need of our help don’t fit the boxes we have created.

Our left brained, colonised service system is a barrier.

Welcome people living with complexity with empathy and hope. Simple right?

What would it take to do that?