MHA Week 2022 – Seeing the Whole Person – A Blog and intro video by Together CEO Linda Bryant on Social Justice and Inclusion

Our theme for Mental Health Awareness Week is ‘Seeing the Whole Person’. We want to use the week to celebrate the ways in which we work alongside people who have difficult and traumatic experiences which has led to or exacerbated their lived experience of mental distress – the impact of being homeless, dependent on drugs and alcohol, poverty, being on the receiving end of abuse.

Our model of working alongside people with mental distress is firmly rooted in the principles and ethos of service user leadership. Empowering people to lead their own care and support and amplifying the voice of lived experience is at the heart of anything we do to address social injustice and exclusion. But we can only do that by working with the person in a way that considers every aspect of an individual’s experience – the mental, physical and social factors that are critical on the journey towards better health and wellbeing for all.

When I was thinking about what we mean by the Whole Person, I found myself looking back to over 140 years ago when our charity first started, as I’m a great believer in what history can teach us. Together in its original form was very much set up with the aim of addressing the terrible discrimination, prejudice and marginalisation people living in that time experienced. Our founder, the Reverend Henry Hawkins, was a chaplain in the era of the asylums and spent the majority of his life’s work in Colney Hatch Asylum. In 1879 he formed what he called ‘The After-Care Association for Poor and Friendless Female Convalescents on Leaving Asylums for the Insane’.

Not necessarily a catchy title but it leaves no doubt around the intention. The Association was his response to the experiences of women. Specifically, they were the most disadvantaged and stigmatised group at that time, regarded as inferior, less intelligent and less able than men. It is of course deeply disappointing and unacceptable that we continue to see misogyny in all areas of life to this day, public or private.

But Henry was well placed to see people, often women, leaving with no hope and no structure and witnessed them returning to the asylum after a short and unsuccessful time back in the community. He galvanised volunteers from the community to offer their homes, employment and ‘meaningful occupation’ as he called it, to break the perpetual cycle of recovery and then relapse.

This was all happening at the time of the Industrial Revolution and psychiatry was in its infancy. There wasn’t the reliance on the ‘medical’ model that has developed over subsequent decades and in modern day terms, we could actually argue that a ‘social care’ model was leading the way in supporting these women to have a fair crack at being members of their communities.

Our charity looks different to those times now, and we now also work with men, but our core purpose is pretty much the same.

Asking people what they want and need and supporting them to lead their own care and support is important in the mental health social sector in giving people purpose and meaning. I find it amazing that what the Reverend Hawkins was striving for over 100 years ago was also meaning, purpose and hope for people in society of their time.

From considering our history I want to focus on the importance of providing services that see and respond to the Whole Person. This is not an original idea and is, of course the basis of personalisation. I do believe though, that we must be much more explicit in thinking that the only way we achieve social justice and inclusion is if we work alongside every aspect of every person.

So far you know that I run a national charity. But just by looking at my picture with this blog or my introduction video you can’t be certain that I am a woman by birth. You could have a stab at my age (and would, of course, put me younger than I am) but you cannot tell that I am a lesbian. You also can’t tell that I am in the depths of menopause that impacts my memory, concentration and emotional wellbeing at times. But you wouldn’t know these things about me unless you spent time with me and enquired about my life story compassionately and empathically. Why would you expect me to tell you otherwise? And so logically, you wouldn’t know how you could best help me both practically and emotionally.

When we talk about seeing the whole person as a way to address social injustice and inclusion through the provision of mental health social care, we are talking about something that it is deeply personal. Often that requires a deeply practical response to what matters most for people and it is transactional. That’s because we need to enquire and ask the questions to identify what people want and need but it can only be transformative for the person through building relationships. That means spending time with people, earning their trust, building that human to human connection that we are all programmed to do. We are social creatures. But unless we build that precious thing call time into services and contracts, that transformation cannot and will not happen for people in a way that they know and need.

But there are people who we also just don’t see, let alone see the whole person, who are often systematically excluded from receiving care and support and that’s why focussing on social justice and inclusion is critical. Examples include people in the criminal justice system, people who are homeless, women who are isolated due to domestic abuse and violence. While we do have an opportunity to join up our support networks through the new Integrated Care Systems, it was puzzling it took an amendment to the Mental Health Act to ensure that mental health is properly represented for the purposes of governance and oversight.

I believe the power and empowerment that mental health social care brings to people’s lives is something vital to be celebrated and I can provide an example that is personal to me. Many years ago when I was a Forensic Mental Health Practitioner in Together’s criminal justice service in London it was my job  to assess, liaise with other agencies, write reports, present reports to court and follow up. So the role could feel very transactional all the way through a process that perhaps would take an hour, and then I would start again with the next person.

My eternal frustration and worry, which I often took home with me, was the limits that existed to providing compassionate and responsive continuity of care and support for the person once I had left the cell area of the court. Very often the person who I had spent that short amount of time with had never really spoken about their experiences. They’d never had the chance to explain what was troubling them and what had meant they had become involved with the criminal justice system. They were, and to a certain extent still are, the invisible, the marginalised, the excluded and the undefinable in our categorisation of who gets and who doesn’t.

And yet it was also the perfect opportunity for me to work to support a person and make a positive impact on the chaos of a ‘non-traditional’ route into care and support and perhaps to make a difference in their lives. Each report I wrote felt like a call for action. The inevitable question for me though, was why would someone trust me after having only spent an hour with them, to know what might help them?

There was then a simple change in the operating model as part of NHS England’s Liaison & Diversion programme with support workers coming in to help the person attend appointments, engage with a plethora of agencies and sort out things like benefits and housing. They would sit and have a coffee, re-connect with their informal support networks and build the relationship. It became very evident that unless people’s social care needs, however you want to define them, were being addressed, their ability to focus on their own mental and emotional wellbeing was completely and utterly compromised.

Relationships have the capacity to heal us, care for us, support us, and to be a vessel of refuge and sanctuary. The key message here is the critical importance of providing the care and support in a space that is appropriate to them and focused on what they know and need.

But if we are to transform our care and support for people experiencing mental distress it needs to be based on fairness and equity of opportunity. Within that I am purposefully using the word equity not equality very deliberately. That is in recognition that each person has a unique set of circumstances that bring daily challenges. Therefore there is a need to allocate the exact resources and opportunities to reach an equal outcome for those individuals, whether in healthcare, employment, housing or any other area.

In terms of thinking of the future, something that is a big priority for me, my senior leadership team and our board of trustees is our mental health social care workforce. If we are to open the doors of access and opportunity for everyone, particularly those in greatest need, we need staff and volunteers to do that. And if we go on the premise that care and support needs to be relational, we need a skilled and resilient workforce with staff who are a constant force for good advocating for change in a person’s life. With that we return to the power of the human relationship.

I loved being a forensic assertive outreach worker over 25 years ago when I worked for a charity. It was one of my best jobs ever. We had to work in pairs to manage risky situations but in doing so we modelled the power of positive relationships. I knew that for some of the people we were working alongside we were keeping them out of trouble and safe while holding the hope for them. We met them at what were really dark times for them and looked to maintain the potential for their opportunity to be part of their community again. The project was well resourced and funded and we could think and act creatively. I was well supported, trained and it ultimately led me on a vocational path in mental health and social care.

So what would I like you to take from this blog? Unless the models of care and support that are available to people feature a workforce that is valued, respected and appropriately paid who are allowed the capacity and time to deliver relationship focussed services, we will not be able to see and respond to the Whole Person. We need to inspire and attract people to see a fulfilling career path in social care. It is only through that human to human relationship that we can achieve inclusion and social justice for the many people in our society who have already faced and continue to be impacted by adversities in life.