One of the main areas of concern that dominated my mental health career was the forming of ‘necessary boundaries’, designed to protect both worker and client/service user. But protect from what? We, as colleagues, tried to create a system where workers and clients could meet as equals, working creatively, together, the client and the worker both acknowledging their strengths and vulnerabilities, which was a struggle but I think we got the balance right.
Much of the most interesting work happens, in my opinion, at the edges or limits of such boundaries. That ‘we’re not that different after all’ moment of realisation which is only too human a response to distress and anti individualist. Care and support systems aim to protect, or safeguard, ‘patients’, to choose one of may labels, from, at worst, exploitation (and I have seen such exploitation in action) and at best unburdening of the worker’s own problems on to the ‘client’. They also exist to protect the worker from harm and over involvement (but I could go on at length about how we train ourselves to deal with distress and trauma and how that impacts on our very being) . Two key legislative acts are at play here, the Safeguarding of Children and Vulnerable Adults Act and the Health and Safety at Work Act, which no one would argue against as they offer key safeguards on both sides of the client-worker divide.
Recent constructs of ‘professionalism’ however, and the added pressure on efficiency and value for money, are problematic and have led to the erecting of a ‘great big beautiful‘ wall of resistance. The soft, permeable and malleable boundaries, which hug whatever shape interaction of the human landscape might present, has been replaced by a solid, fixed and impenetrable wall. With ‘us’ on one side and ‘them’ on the other (I’m not even going to assume which side is which). One example of this ‘professionalism’ was the recent (in the past 5 years) re-introduction of uniforms to psychiatric wards, the clinical re-furbishing of many spaces to resemble prisons rather than places of hope and recovery, in an attempt to manage risk after a spate of on ward suicides leading to an external inquiry. The suicide rates, as far as I’m aware have remained the same since the changes, highlighting a paradoxical management of risk by removing all ligature points and means of escape, creating a more clinical and un-therapeutic environment and thus leading to greater devision and distress, when spending more time meeting the ‘patients’ as equals might have had a better impact. The Milgram and Stanford Experiments come to mind when exploring the ‘us and them’ relationships and how they are influenced by the clinical environment. The concept of Malignant Social Psychology, (Kitwood, 1997) goes some way to recognising the cause and effect of care settings on both worker and client behaviour and is recognised as an important tool in challenging the ‘us and them’ dichotomy. As health becomes a profit driven commodity, and with an ongoing late capitalist assault on the NHS and disability rights, the danger of reverting back to asylums and ghettoizing of those in distress is not just a fear but a very scary reality.
The Mad Love Project goes some way to addressing this by supporting those, caught up in current psychiatric systems and processes, on both sides of the divide. It offers a utopian view of a new kind of therapeutic space. But perhaps what is needed is a whole re-thinking of our approach to mental health. One which acknowledges similarities and vulnerabilities on both sides. One which removes clinical barriers, rather than creating and reinforcing them. One that has humanity, not profit and efficiency at its heart.
Many years ago a good friend, who was an artist and user of psychiatric care, said to me ‘I don’t need any more fucking workers, I need artists, you know what I mean don’t you?’, I replied, ‘yes’, thinking I understood but it would take me another couple of years before I even began to understand what she meant. The first time I worked with an individual as an artist, rather than as a support worker, I was struck by the marked difference in my own feelings and actions. It felt like a more humane and equal relationship, learning as much from them as they did from me. I was able to give advice and pass on some simple technical skills, but it was their creativity led the sessions. Artists too need supporting and need to be able to offer their therapeutic skills in a safe and supportive environment. Perhaps, though, artists are indeed better equipped to work at the cliff edge of the fluid boundaries and are not afraid to cross when needed, step back when required and generally be more human in their response to personhood, space and the need to work in collaboration.
Our saviour is coming and he has the power to heal us all, – Digital collage, 2017
Insanity — a perfectly rational adjustment to an insane world. RD Lang.