Though in some circles I am Dr. / Professor Barrett, with a Ph.D., there are other contexts where I hold highly stigmatized statuses. In a medical context, I am a person with psychiatric disability, and even more stigmatized, I am a person who has lyme disease...also known as a "lyme loonie."
Because of my life experience, I feel deeply about our history, the lives of people with MI, and the origins of recovery movement within psychiatric rehabilitation. I teach because I think it is important to expose providers to a different way of thinking, or a perspective they may not have considered. No approach or theoretical orientation will apply in every situation (e.g., therapeutic use of hallucinations), but as a person who has skin in this psychiatric game, I also feel strongly that some approaches are more consistent with recovery than others.
When I am symptomatic, I want someone to listen and validate my experience. I want to feel emotionally safe. I want encouragement, and to be reminded of all the things I have made it through in the past. I want to be reminded that I have the ability to figure it out, whatever "it" is. I need to know that I have value.
What I don't want: judgement, use of a skeptical or scolding tone, being told what to do, being told the obvious (e.g., you would feel better if you lost weight), being mocked and/or humiliated, being physically controlled, and being asked if I've taken my medication (!). The surest way to escalate my agitation is to tell me to "calm down," which in my estimation, is the ultimate invalidating statement. Under certain circumstances, that response may cause me to behave aggressively, or lash out in anger. What happens then? My fate as a person with mental illness is sealed. I am now labelled a problem, "out of control," and potentially, a victim of the "goon squad" or worse. (Goon squad is a group of nurses who restrain someone and administer PRN tranquilizers to chemically control a person).
For example, think of the young man at the Judge Rotenberg center being shocked remotely while prone and in a 5-point restraint.VIDEO HERE Think of Natasha McKenna, naked, strapped to a restraint chair, in a jail cell. Ten men in hazmat suits and gas masks approach her to move her to another facility, and they end up killing her. We can pat ourselves on the back about how far we've come in psychiatry, yet there are too many stories of my brothers and sisters suffering at the hands of providers. The officials responsible for Natasha's death felt so confident in the way they treated Natasha that they posted a 48 minute video of the incidents that led to her death. The official video of the incident is no longer on youtube. However, someone else posted a version...VIDEO HERE
How does this happen? What is the story these "providers" tell themselves? Why didn't anyone object at the time? What might be a better way, according to Shery Mead? Other recovery advocates? Answer these questions, feel free to post your own, and then reply to at least 2 of your classmates.
After watching these two videos, I am left with a bad feeling I cannot imagine the torcher both patients endured. Natasha McKenna was dead, and the providers had no idea. She could have been saved if the sheriffs used more of a therapeutic approach or called a mental health professional for assistance. These two scenarios happened because people with a mental illness are not considered people and get no say in their treatment. The world would rather drug these people than try to help them recover. The providers only goal is to keep them out of the public and for the young man, his providers wanted to control him. As a mental health professional, we need to pick our battles. Instead of restraining the boy about his jacket, they should have given him space and then proceded to have a conversation after. Prisoners are not therapeutic or rehabilitating people who have mental illness need to be removed from these spaces and put into rehabs so they can begin to recover. I believe nobody objected because they do not care about the patient or prisoner they are just trying to do their jobs and go home. Sherry Mead and other recovery activists would share that they think these two situations could have been prevented. More mental health facilities started focusing on recovery instead of control. Judy Chamberlin would stress the importance of clients having a say in their treatment. As stated in her video, "nothing about us without us."
ReplyDeleteVictoria,
DeleteThank you so much for your post. I think you made a great point that the teachers should not have shocked the student for not taking off his coat. They should have given him more time. I use the approach of “picking my battles” with my children as I try to avoid setting myself up for an unnecessary battle. I give them time and choices. In this case there is a parent/child relationship that is natural. What I think is great about Shery Mead approach is that she is changing up the dynamics so there is no staff/client relationship, it’s just community members. There is more sharing ideas and less directions. There is more commiserating and less advice from someone that knows the answers. I think if the client picks the battle, they are more likely to win. In many cases, staying out of institutions is a win. :).
Victoria,
DeleteI think that picking battles is such a fine line to walk on. You are absolutely right, in my opinion, when you say that patients like the boy described should be given space and time instead of restraints. Patients should be offered support, not oppression. The only place where I disagree is when you state that you feel that no one cares, they just wanted to do their job and go home. While I absolutely understand your point of view, I do see it a little differently. I feel, or maybe I just hope, that they do care but do not have the skills, resources, or belief that they can do better. Maybe they were trained to believe that this is the right way, even though we know better. Maybe I just need to believe that in order to have hope that we can change this mindset and do better moving forward.
Kaitlynn Littlefield
I enjoyed hearing both your thoughts! It is so great to be able to read others thoughts and reflect on your post. I believe patients also need to be given support instead of oppression.
DeleteThanks for your comments!
Victoria,
DeleteI really enjoyed reading your post and all of the great points you have made! You are absolutely right, the incidents in both videos could have been prevented and should never have happened. It really makes me wonder where the turning point was for these individuals in their professional settings for the abuse to rise to this point.
One of your points particularly stuck me -- the video of Natasha McKenna. If a mental health professional could have intervened, the results could have been drastically different. I am so thankful that our society is beginning (though it is slower than I would have hoped) the need for specialized trainings for frontline professionals. There has been an up and coming movement to train professionals on Mental Health First Aid and CPR as well as many (often larger) police departments are beginning to train a few of their officers to be more aware of symptoms and interactions with individuals who are living will mental illness(es).
-Ashley Williams
I am writing this week’s post with a sour feeling in my stomach. I feel great sadness for the victims and the families in this weeks blog post. I can’t even imagine how Natasha’s family must feel. I am sad for the mom who brought her son to school to be helped, and he received shock treatments as a form of “treatment.”
ReplyDeleteI think of my own professional life and have sadness as well. I once worked at an alternative high school where there were restraints used. One student refused to do his school work. The staff set out with a “let’s do this” attitude. A kind of “that will learn him” attitude. I remember being uncomfortable with the incident. I gathered with concerned staff in the in the parking lot after school to seek support. Complaints were made to the administration, but nothing was done. Those who spoke out were mocked by administration. I’m thinking I should have done more. Sometimes, people turn the other way from what is wrong. This is not right.
I think people tell the story that they can’t make a difference or that this is “normal”. This is not the “true” story as this treatment is not okay.
Shery Mead, founder of Intentional Peer Support was interviewed in a YouTube video, she shared about a 5 day workshop that is focused on Peer Support. She supports a much better way to treat people. She stated that the workshop is unique in the learning experience as there were no experts there, “we are all learning together.” She also shared that peers were “developing skills.” The idea was to have a “crisis alternative” and not viewing people as ill. My favorite statement is one that encourages us to “get out of the service mentality, challenge each other, and build conversations. That is a new way of thinking.” (YouTube video link bellow)
Howie the Harp (OISC manager) stated in last weeks video, “the people most effected by the problem are always most effective at handling it” seems like a very true statement. The people who handled Natasha were telling themselves that they were the experts and had to control or fix the person that was “ill”. They were just so wrong.
Reference:
YouTube Video can be found-
https://www.google.com/search?q=shery+mead+intentional+peer+support&ie=UTF-8&oe=UTF-8&hl=en-us&client=safari
Becky, I completely agree with you about people often feeling stuck with the way things are now, that this is "normal" when 1) It's not, and 2) Even if it was, it's irrelevant because we are obligated to work toward change.
DeleteAnd I'm so sorry to hear about your experience at the school. I can imagine feeling helpless in that kind of situation, especially after the administration openly mocked your complaints. As someone who's very new to the field, it's a situation I haven't had to face yet - what do you do when the administration, agency or institution you work for condones practices that go against your own moral code? Do you fight it? Advocate or change? Or leave, and find a position that suits your beliefs? I'm not sure I have the answers, and I'm not sure the answers are necessarily the same from situation to situation. But I'm grateful that you shared your story here!
Becky,
DeleteYour story hurt my heart, because I have seen this done, too. I worked on a long term care unit for adults, and restraints were used when patients became too "rowdy" or difficult to deal with. At the time, I was young and didn't know better. Though it wasn't my job to restrain the patients, I did often sit with them after to help calm their nerves. I was not effective, of course, because the patients never felt safe after that. How could they? Their rights were violated and their humanity was disrespected. I am grateful to have learned from this experience that I never want to take part in it again, but I am also left with anger that it happened at all. It is amazing to me, not in a positive way, how people do just fall into the status quo of their work, even when human beings are involved. We must do better than to let that happen. We have to keep questioning and changing.
Kaitlynn Littlefield
Becky, thank you sharing this story! I know that the school you worked at is non the only place that still uses restraints for various reasons. I, like you, would have bee upset by the incident and also would have sought out support. It is a tough situation to be in, knowing what is right and what is wrong, but feeling powerless to change it. It seems like you and your colleagues did what was right in filing a complaint, and it is not your fault that the school did not feel that they needed to change anything at that point. I hope that we, as a society, can work to make sure these types of situations do not happen again in the future!
DeleteBecky,
DeleteWhat an insane experience you had!! Not only to witness the overuse/abuse of restraints, but also to be ostracized by the individuals (administration) that should be leading the team. I think it is equally as worse that the administration had the "sweep under the carpet" attitude about the fellow staff members expressing their concerns. This is part of the major problems within out mental health field -- the supposed leaders being okay with abuse/neglect and shaming the ones who are ethically sound.
Wow, Dr. Barrett, I can identify with your needs/wants as a person with mental illness. I can also relate on the things you DO NOT want: "calm down," makes my blood boil, but if I'm on my spiritual game (able to pause and reconsider my reaction) I don't offer more stigmatization to my disease. However, that's not always the case. And that should be OK! We should be able to express anger without being labeled the "looney tooney!" Unfortunately, society has made this very difficult.
ReplyDeleteWhile viewing these videos, I felt a sense of numbness and very little shock. This speaks to the fact that I've seen these things so often in my own life and in other people's lives that I'm barely affected. How sad is this? I noticed in the video of McKenna's death, that the beginning shows a staff discussing what lead up to the whole situation. He says that she had been non-compliant all weekend and that they had already used multiple restraints. This is where the problem begins! We have read the research in this course which proves that a non-restrictive, therapeutic approach yields much more effective responses from patients than staff using aggression or force. This being said, McKenna was already on the defensive and ready to act in protection of her survival.
The reason that no one objects is because of the fear of being alienated and isolated in their field. This fear often overrides the rational and true thoughts of "THIS IS NOT RIGHT!" Until staff members of these facilities can begin to speak up for what is right and take action to change these approaches, this treatment will continue to happen. I have been blessed with the tools and coping skills that help me to be able to live, function and thrive in my community! What about those who aren’t so lucky?
Hi, Unknown!
Delete"We should be able to express anger without being labeled the 'looney tooney!' I completely agree with both you and Dr. Barrett. Although it is in no way the same sort of experience, I know what it is like to have my emotions invalidated by others - it can be so demoralizing! It's belittling, and it's kind of like gaslighting. I mentioned in my post that Shery Mead talked about our culture's inability to just sit with discomfort, and I think this ties into that. Anger, conflict, confusion - these are all uncomfortable feelings to both FEEL and also to witness. But instead of simply accepting them, validating them, hearing them, we do our best to medicate, silence or ignore them. It's important for us as practitioners to learn how to sit with discomfort so we can truly listen to our clients, without offering solutions or a way to dull it.
Thanks for your response Megan! I couldn't agree more about our "culture's inability to sit with discomfort." One example of this which I see often, is when someone begins to cry in a public setting (for me this is usually at a 12-step meeting). When the person begims to express their feelings and they become upset, most likely someone will grab tissues and give them to the person. Although this is gesture seems appropriate and even caring, I believe it indirectly tells the person that "I'm uncomfortable with your display of emotions in public...please use this tissues to wipe your tears - stop crying." May be a stretch, but I've spoken with others who agree. Why is it so difficult to let people feel however they want, validate them, and sit with discomfort? I know! Because we believe discomfort is BAD and WRONG and will last forever. Feelings are not facts, but they must be expressed. Also, no feeling lasts forever. That's something I have to remind myself of daily.
DeleteUnknown, I enjoyed reading your post. I could not have agreed with you more when you stated your blood boiling when someone tells you to calm down. After watching the videos I also felt numb and could not believe that one way these clients were oppressed ended in death. I also enjoyed reading how as professionals we need to learn to sit with discomfort in order to help our patients and build meaningful relationships with them.
DeleteFortunately, I have never been involved in a situation where someone's life has been in danger or that I have actively assisted in the detriment to someones care without making sure my voice was heard and making a decision.
ReplyDeleteThroughout my career, I have had situations where my ethics where challenged and where my own morals played a key role in my own self-care. I can truthfully say that I spoke up in regards to the issues I saw and that I made decisions to move on from those providers in search of a system or agency that did support the needs of their clients and listen to the staff who served them.
Personally one of the biggest issues I see is the money factor, even non-profit agencies look to gain the most finances and develop their own programs, this means needing more income for more properties, etc, someone is always winning out of the situation perhaps just with bonuses. Billing practices need to be scrutinized and agencies that settle into the status quo of the services they provide also need to be challenged. It is great that provider x- do meals on wheels, but at some point, those skills are mastered and then a new challenge has to take place. Humans need to feel challenged and successful and treated fairly when we skip those basic steps we are not doing a good job.
Listening to peers and promoting the use of peers in the recovery movement is vitally important. They have seen it, they have been there and like Dr. Barrett, they have challenged the system and done more. We can utilize these experiences not to be sickened by their experiences but to illicit change, and learn from them. It is not ok what people have gone through, and I condone none of it, I just hope that we learn something from it and we can advocate and educate effectively for the future.
-Sean K
I like your attitude! It's so easy for me to wallow in the way the mental health system has been dealt with, instead of asking myself, "what can I do?" I think the change starts initially with just small steps. As you mentioned, challenge a situation that feels off to you. Say something in the moment if possible, and if rejected, go to human resources and make a formal complaint. So often, we just accept the way things are, way below our moral standards, because of money, power and society. Also, thanks for talking about recovery with peers. In my experience, being able to socialize, vent, deconstruct, analyze and feel my emotions with others who KNOW HOW I FEEL, is hugely imperative for recovery and personal growth in and out of the communities we live in.
DeleteSean, I'm so glad you brought up the financial piece of all this. The fact that our system is designed to make money off of people who need care means that agencies, institutions and providers who should be focused on actually treating their clients or patients is instead focused on the bottom line. Which is part of the reason why certain types of people fall through the cracks and are given the bare minimum.
DeleteThe other point I think you made that reminded me of some of this week's reason was about the advocacy piece of this - it's clear from the research we've done throughout this class that public outrage is a powerful motivator of change, especially in this field. Reminds me of the exposure the Black Lives Matter movement has brought to the issue of police brutality, which has resulted in dash cams that record officer's movements.
Sean,
DeleteYou are absolutely right all around. I am grateful that you just voiced your concerns over the years and challenged the systems you needed to question. It is such a difficult thing to do, and moving on from jobs and organizations can be daunting at the time. It speaks well to your character that you have been able to do this. I was unfortunately not as brave when I was younger and did what I was asked to do. I witnessed a lot of things I wish I hadn't, but am glad to have had the experiences because they taught me TO question and stick by my beliefs. I am glad that I have only ever run into one truly unethical business in this way, although it was a large one. I am vocal about it now. I am glad I have the voice and capacity to do so.
Kaitlynn Littlefield
Sean, I enjoyed hearing your insightful thoughts. I agree that we need to start relying more on are peers for help. I also never considered the financial aspect to services. Thanks for the post!
DeleteLike you Sean, I have not been in a position where I have been in the experience of a person's life in danger. I think you bring up a good point about how finances can impact how a program runs. I also think about the training staff receive and the type of staff that are hired in some positions that involve direct care of people. Many times, these entry level positions require little previous experience and knowledge and a lot of training happens on the job. These entry level positions can also be high turn over which ends up meaning vacancies and current staff being overworked. And this all relates back to finances because needing to pay staff as little as possible to cut down on costs but also needing to maintain productivity of the program to ensure funding continues to come through. And then who suffers most from this, the clients who aren't receiving enough support and proper help.
DeleteSean,
DeleteLike many others I too think you made a good point talking about the financial battles that are played in our field of work. It is a shame that we find ourselves spending more time looking into financial matters with a fine toothed comb rather than providing the level of guidance and counseling that our clients really deserve. I also think that at times its easy to sort of get lost in the financial part of the field and be overwhelmed with numbers to the point where we forget we are even counselors. I can however, look forward to the promise of change and growth that will in hopes make the financial part of the field become second hand to the real quality work we all want to do. It seems like common sense really but I do think that people in the helping world should be much less focused on financial gain and a lot more focused on the true needs of the people sitting across from them. I to, admire your willingness to stand up for what you believe in, for someone still really new to the field like myself it gives me confidence to also stand up for better services.
-Spencer
Those videos were incredibly powerful, and very difficult for me to watch. I am sad to say that I am not surprised to see that the kinds of historical “treatments” we’ve read about in this class continue in our world today, even in our own backyard.
ReplyDeleteI think there are probably several different reasons this type of behavior is allowed to continue, despite its horrific consequences: some providers must believe that it’s simply what’s done, a necessary evil; some experts probably justify it via its financial benefits for the agency, institution or hospital; at some point, some practitioners probably become numb to this kind of abuse and lose sight of the humanity of their patients. In other cases, some staff must truly believe that it is the best kind of treatment available for their patients. Ultimately, I believe the biggest motivator for medical staff is the perceived safety risk a patient may pose who is experiencing acute symptoms of mental illness. It becomes a discussion of behavior management, rather than treatment, for the safety of everyone in the facility. They believe that aggressive language or behavior must be met with equal or greater aggression in order to force compliance, and compliance is necessary for safety purposes.
None of these reasons justify the type of abuse patients experience at the hands of their providers, like Natasha McKenna, the young man from the Judge Rotenberg Center, or any of the other individuals we’ve learned about during the course of this class. That young man wasn’t asked why he didn’t want to take his coat off – he was simply shocked 31 times when he refused to do so.
Shery Mead, a psychiatric survivor and expert on the power of peer support programs, would look at these videos and see them as the avoidable tragedies they are. Her personal stories of people experiencing crisis with people who provided them with empathy and helped them find balance within themselves without judgment flies in the face of the brutal methods used by practitioners who believe that compliance and behavior management are paramount in treatment. One of the points she made that really stuck with me is our culture’s inability to sit with discomfort. As a social work student, I totally understand it – I’m a fixer by nature! I want to help, I want to be solution-focused! But based on this reading and on the works of several other recovery experts, simply allowing that person to share their truth without offering solutions or trying to “solve the problem” can be an effective way to allow the client to find the solution within themselves. For clients, receiving validation, feeling understood and like they’re not alone are such important parts of the healing process, and sometimes receiving these things from peers bridges the gap where a provider may fall short.
I like to fix things too. When doing counseling and in school I was always reminded to slow down and focus on the problem at hand, sometimes I think to globally that I do not get going in the process. When I sit back and look, taking time to sift through the problems is so important and allowing time brings to light the small aspects that may be key to the recovery. If you are a good provider you have done your research, you have challenged yourself to work in a variety of backgrounds and disciplines and witnessed dynamic changes in peoples lives so you can talk the talk and refer to other appropriate peers, programs or services.
Delete-Sean K
Megan,
DeleteI share your beliefs on how this treatment of patients still happens today. It is so hard for me to think that the majority of providers are simply indifferent to their patients' rights, care, and well being. To me there must be more to the story, such as exhaustion, frustration, or a belief that they were taught best-practices even if they were not. But the question still remains: how do we move forward? I have also always been a fixer, but in the work I have done in my past, I had to step back from that. Giving a client a genuinely safe place to tell their story on their own terms and with no judgement can be powerful and begin a healing process on its own. Rather than the provider being the one initiating change, the client has far more power to do so if simply given the chance. We need to let them try it, or else their time with us becomes something less than what it could be.
Kaitlynn Littlefield
Megan, As you stated I was upset after watching these videos. Even after reading all the history I had more hope that patients were treated more fairly and respected. Unfortunately many patients are mistreated and disrespected. I also agree with you that many people in the mental health profession have not been trained any differently and thats why patients are still being mistreated. Thanks for your insight!
DeleteHi Megan!
DeleteThe part where you talked about not having to jump in and fix everyone's problem, but rather be a listener, really resonated with me. This can be a really hard thing to do, especially when a "to do" list immediately pops up in your head while you are talking to a client or patient. But, I really like that this idea is front and center in the recovery movement. As seen by the videos in today's blog post, it is high time that we begin to listen to people with mental illness rather than acting. Hopefully this will end up with some lives saved!
Megan, Thank you for bringing up the point the difficulty of sitting with with discomfort. I think this is an important piece of counseling that is developed over time. It is easy to say it’s okay and try to brush off the emotions. But to really sit with the sadness is a skill. I practice being quiet and it is not always easy. There is something really special about receiving comfort from a peer. I think that if professional want to recreate that type of support they could use good reflection skills such as “that is hard, you are hurt, you want to be heard...etc. Hopefully professionals won’t fall to short off from being a supportive connection.
ReplyDeleteI believe that providers, for the most part, start with the best of intentions. Perhaps I have been very fortunate in that I have seen the wonderful qualities of psychiatry more than the negative ones, but I do understand that they exist and are, at times, quite rampant. Stories like the ones provided are heartbreaking and provoke intense anger for me. These situations are never acceptable under any circumstance. Providers, whether they are psychiatrists, doctors, police officers, BHPs, or counselors, need to be aware of how their actions impact their clients. Unfortunately, stories like the ones above still exist. I believe they happen because providers get nervous, anxious, overworked, and/or frustrated. They at times become overwhelmed with the task at hand and have been trained to take care of the situation swiftly and quickly. They may even believe that they actions are for the safety and protection of not only themselves, but the client in the middle of it all. These are not acceptable reasons to me, but I do believe that they are part of the providers' narratives at times.
ReplyDeleteIt bothers me to hear of stories like these because it is clear that very few people, if any, objected in any way. I question whether it is a training flaw, a "group/mob mentality," or even an indifference issue. Every situation is different, but none of them are acceptable. There are so many better options available for providers to use when they are working with a patient who is in need of some type of intervention. Deescalation skills would be so important here. I wonder at what point providers stopped having conversations with their clients in order to find out what the root of the concern is. Taking a few minutes to actually sit down and talk, or even just observe if necessary, could do so much good for the client in question. Gaining a few more pieces to the client's puzzle could help alleviate the tension, frustration, or the need to "speed up the process" for the provider. He or she may be able to connect with the client on a deeper level and begin to understand what his or her needs are. Practicing basic human care and kindness shouldn't be an afterthought. For clients who are not in need of services currently but possibly may in the future might benefit from more appointments with a counselor, peer supports, or a mental health intensive outpatient program. Genuine consistent support may just help a client know that someone cares, that they are heard, and that their experiences are legitimate. If we as providers can connect our clients with these types of services on any level, I believe that we will make a big impact in this field.
Kaitlynn Littlefield
Thank you Kaiti,
DeleteI think we are similarly minded in that our experiences have been primarily positive but have witnessed and heard enough of the negative to make sure we are here to make a difference. I echo your sentiment that we as providers must connect clients with services on any level and that in doing so, have made sure those we connect with and touch feel that they have been heard.
-Sean K
I agree with you Kaiti that majority of providers and people working in the mental health field go into the field with the best intentions and have the typical "want to help people" motto, which is good because that's the reality of the work- helping people to live their best life. And you mentioned all the reasons why things start to change for providers- feelings of being overwhelmed, frustrated, over worked- are all real things that happen when working in the mental health field. This doesn't excuse the behavior that happened in the video at all because people working in the mental health field should have the common sense to know that was not ok. And you bring up a good point about was this a situation of lack of training/poor training or the group mentality where no one wanted to say anything and because everyone else was doing it, they were going to do it too. I'm sure there will never be a clear answer of what happened but what needs to be answered is how it will be prevented from ever happening again.
DeleteKaiti,
DeleteI too think your point about people initially getting into the field for the right reasons is valid. I dont see how anyone would go through the needed training, schooling, and work experiences needed to get into the field just to then practice for the wrong reasons. I think we all probably have that internal fire to help individuals change their lives for the better or else we would not even have thought about this line of work as an option in the first place. I really think that workload, and pressure on the job can burn people out at a very alarming pace. Those people that get burnt out though, what else are they to do when this field is all that they know? Its hard to up and leave the field and start over completely and for this reason I can see how people would become stagnant and compromise that passion they once had. I think that with more and more pressure people are given at work the quicker decisions are made and the less thought is given in the decision making process. I also think that my point here is talking more about surface level treatment and not the level of brutality that is seen in some of the videos. There is literally no excuse for abuse or harmful treatment whatsoever.. In these abusive situations I dont think we should even really have the debate over lack of education or not, abuse and neglect of other humans really isnt acceptable to me, I mean we should in this field, all have a basic understanding of morals and human rights. It is a hard topic to find a solution to thought and as a helper I try my best to see from both sides.
-Spencer
I truly believe that most treatment modalities and providers begin their treatment models with the best of intentions -- to help someone without inflicting harm. With that being said, I think that the video link above shows a treatment plan that exceeded the helpfulness of a treatment plan and went to an extremely harmful place. I do not think that one day, like at this Center, the provider made a choice to begin harming children, but rather it alternative punishments were increased/intensified over time.
ReplyDeleteI have not worked in a setting that physically restrained children; in fact, nearly all of my employment history strongly encouraged personal space and boundaries. Similar to Sherry Meads approach, support individuals while they are on their road to recovery will serve much better than trying to physically restrain and, at times, abuse them.
Hi Ashely, I like your point here. Providers don't just "turn bad" overnight. But, I am wondering - do you have any ideas of what can be done to stop the slow escalation of harmful behaviors and treatments over time? Do you think burn out and lack of proper supports plays a role?
DeleteErin,
DeleteI have thought a lot about what may cause a provider to "turn to the dark side." The only conclusion I have rationalized is what you mentioned -- burn out and lack of supports. Too often, professional within the social work field are overworked (and underpaid). Combining that with the lack of self-care and supports, could certainly result in the lack of patience or oversight between what is right and what may be easiest. I think about other countries and how their professionals are treated differently than ours and ponder if our agencies took the time to value their employees and ensure they are being cared for, if it would begin a movement of change towards overall better care of clients.
-Ashley Williams
I wonder if that is true about punishments being intensified over time because the previous methods weren't working. I think it is sad to think someone would think that is ok to do though and to justify doing it for the reason they did. I also agree that providing the child personal space and allowing them time to cool down sounds like it would be more effective.
DeleteBoth of these videos were very challenging for me to watch. I wondered especially why so many men were needed take one woman out of a prison cell, and why she was told to repeatedly "stop resisting," when she was barely able to move because of the restraints put on her, as well as the several large men that were holding her down. Further, the young man at the Rotenburg Center was put in that five star hold and then shocked after an incident that was sparked by only his refusal to take off his jacket. I can only assume that the victims of these crimes were not seen as human, or at least less human then the providers or guards that were dealing with them. I recognize that places like prisons and psych hospitals are challenging places to work. I am sure that it can b an effective defense mechanism to dehumanize the patients or the inmates. But, that dehumanizing leads to incidents like the one that we saw in these videos.
ReplyDeleteI know that both of these situations could have prevented. Violence did not need to be the answer for either of these people. I believe that Shery Mead would agree with me on this. There could have been more de-escalation tactics and better trained people that would have handled the situation better.
It is alarming to see the treatment that occurred with this people. I agree with you that it was unnecessary treatment and extreme. I also had the same thoughts about why it took so many men to restrain the woman because it did not seem necessary at all. I think these examples show an abuse of power from staff and how when given that feeling of power, poor choices can be made as a way to continue to enforce their authority over people. It definitely shows these providers are not viewing the people they work with as people but as things that they can control every day when they are at work.
DeleteErin,
DeleteYou bring up an interesting point about how challenging it can be to work in a setting like a prison or an inpatient psychiatric facility. I wonder what is going on in the worlds of those staff/professionals that perpetrated the abuse we see in those videos. How are they able to cope with the violence they are seeing every day? It makes sense that they would need to dehumanize and detach as defense of their own wellbeing. I agree with you that these folks certainly need better training, and would add that ongoing support and check-ins around general wellbeing could be beneficial, too.
I think providers can begin to convince themselves that the treatment they are providing to the patient is the best based from research they have read and trainings they have attended where other professionals with more work experience and people of higher educational status are telling them this is what they should be doing. Sometimes I think there is still a very old school way of thinking that causing bodily harm will make a person behave the way they should and in the two examples from the videos, this type of abuse was not needed in order to keep the person or others safe. There are so many reasons why no one objected- too afraid to say anything, not sure if it really was wrong treatment, inexperienced worker and being told by supervisors it is what needs to be done, power trip from having authority over someone else, the list could go on.
ReplyDeleteShery Mead has many alternative ideas on how to work with someone in crisis and also how to provide peer support to potentially prevent reoccurring symptoms from happening. She believes in building relationships on shared truths and mutual empathy and not from an assessment (like most providers do). She had many examples of how engaging a person in dialogue about their experience can be beneficial for them. She noted how changes can be supported through a peer relationship when old patterns of crisis start to happen which can help a person to recognize the patterns themselves and learn how to cope with them. Mead gave a personal example of how when she was able to talk about her own experience with a peer, she felt hope from that conversation instead of feeling shame from what she had shared. Mead discussed how important it is to be respectful of a person’s story when they are in crisis and help them to feel welcome, safe and heard. Understanding that when a person is in crisis, they are in full blown flights of fright so trying to understand their experience and how they are reacting to it can be most helpful in working with the person.
Lindsay,
DeleteI agree with your point about providers believing they are delivering the best care based on research and trainings. We do spend a lot of time in school (and, I'm sure, once we graduate) reading and thinking about research, focusing on evidence based practices. It's so important for us to be considering the actual human being in front of us, too, and what's best for them. Thanks for the reminder!
Lindsey- I love your post and points about Shery Mead and totally agree peer support could be beneficial. I think often we forget about human connection when people are in crisis because it can be scary and intense for everyone involved. I also agree it is so helpful to learn what is happening for the person in crisis rather than to just look at the unsafe behaviors and make our own judgement.
DeleteThose two videos were difficult for me to watch. It is scary that professionals that we trust to care for some of our communities’ most vulnerable folks are able to tell themselves such outrageous stories that they come to think that this behavior is acceptable, even desirable.
ReplyDeleteAfter listening to Loren Mosher speak about the Soteria Project and its reception within the psychiatric world, I have a clearer idea of the story that these professionals are telling themselves. The sort of psychosocial and humanistic approach that was demonstrated as effective at the Soteria Project does not fit in with their concept of what psychiatric treatment should be: led by neuroleptic medications. The idea that conversation and human connection can be as healing as drugs is so dissonant in their minds, that they have to just ignore it. Mosher shared that two major lit reviews about treatment of schizophrenia simply neglected to include any references about the Soteria Project in their review — they don’t think it’s even worth considering the approach. He also said that pharmaceutical companies are “aiding and abetting” this attitude, which just reinforces the story that the professionals are telling themselves. Money certainly has influence.
Shery Mead would encourage the “providers” to de-emphasize medications as a first line of defense and increase the use of human connection as a major strategy for healing. I think Shery Mead would applaud the Soteria Project, especially the fact that the staff that interact with “patients” every day are not clinical professionals. This allows for the sort of peer to peer conversation, connection, and validation that Mead proposes, rather than the sort of analysis and problem solving (with the patient centered as the problem to be solved) that can occur in conversation with a clinical professional. I think we have a lot to learn, as professionals, about these approaches and how we can integrate them into counseling more formally, while still maintaining boundaries that allow us to stay healthy and effective.
I am having a challenging time articulating my thoughts and feelings about the two videos. They were painfully challenging to watch and knowing situations similar to these occur daily. Providers most likely justify their actions by saying it is for their own safety. However, these two videos demonstrate to me when providers treat people with apathy, versus accurately de-escalating the situation, and creating empathetic rapport. Last year I saw a documentary about school restraints or solitude rooms in elementary and middle schools. It created a hostile environment and promoted fear versus education. Teachers and aids used the same justification to put an elementary student in solitude. Mead created an alternative recovery environment highlighting rapport and validation, as well as, promoted treatment with minimal medication. She created the environment the two videos horrendously lacked, empathy needs to be a critical factor in recovery. One of my professors in the program discussed working with challenging clients or clients you thought you would draw the line for. He said "Find the human in them." There needs to be more awareness and research versus President Trump declaration of creating asylums. Our push towards empathy will help end the stigma about treatment and environment for people with mental illnesses.
ReplyDeleteI have have only once in my life been at work in the human services field when another human life seemed like it was in question. The situation was not a matter of neglect or lack of fair treatment or anything like these video examples, however, it did change the way I approach the people I work with day to day. When I was job coaching one time, a lady that I had been working with had been complaining about feeling dizzy and needing to constantly take breaks from her job. For a while I questioned in my mind whether or not the lady was actually feeling ill or if she was just sick of the work she was being asked to do. Before long I noticed that something was seriously wrong and escorted the woman down to the break room of the workplace and got her some water. Before I could even really game plan for what was about to happen the women fainted and fell unconscious in the break room. It was the only time in my life that I have called 911, and I will never forget aiding her myself until the medics showed up after what seemed like an hour. The woman was taken to urgent care and I was then expected to follow through with the accident reports and standard procedures. Although this is a different situation than the videos, what I can say is that the experience changed me. Before I had started working with this woman I had been briefed that she could at times come off as dramatic and "extra" when she didnt want to do certain tasks, or didnt like the staff she was working with. I will never forget thinking at the start of this situation that she was "being dramatic" to only soon realize I was very very mistaken. Really, this situation has made me realize that regardless of any sort of pre made opinion or label of the people we work with we need to ourselves provide the highest level of care possible and always see our clients point of view over the reports that we get on them. I think this was a lesson for me to focus on getting to know the people I work with first hand rather than relying on the word of others. I think this ties into this weeks topic some.
ReplyDelete-Spencer
Sounds like that was a scary situation for you Spencer, but I am glad you had the thought to take the situation seriously and trust your gut. I also love your point about taking people at face value and for who they explain they are. I once inherited a caseload, and was told it was pretty rough. I choose not to read into it and I was glad I didn't, someone was not being objective when working with the clients and creating a negative image of them. If we take the time to understand situations and not react on others opinions we can usually make a better call. Glad you did,
DeleteSean K