At school in the 1980s I signed up for community service working at a neighbouring hospital school with children with intellectual disabilities. On one occasion I saw a teacher there push a 14 year old boy into a store room and kick and hit him, explaining that it was the ‘only language he understands’. This brutality shocked me, all the more because this teacher was someone who I had seen at other times being caring and effective. Much more recently, I heard a long-term user of mental health services describe their life having been utterly changed by a radical model of mental health practice, where people with personal experience of mental health challenges join forces with clinically trained staff to deliver mental health courses for students in the Sussex Recovery College. I have never before seen such high levels of public and staff engagement and commitment as in this project, which is driven by solidarity and a desire for collective benefit across all members of a community of care.
I believe that if we are to take care of our future health and happiness each of us will need to play our part, and that one essential ingredient will be for each of us to turn towards care giving relationships and away from acting with brutality. Both sets of behaviours are part of our evolutionary heritage, with brutality often born in response to fear for our immediate survival and care giving born of our mammalian need for bonding and closeness.
Capitalist economic ideology has emphasised competition and ‘dog-eat-dog’ elements of our fundamental nature, suggesting that these elements have driven evolutionary advantage and will therefore drive economic advantage, and by implication a health and happiness advantage. What this overlooks is that another aspect of our nature, the need for closeness and bonding, is fundamentally undermined by a competitive emphasis in our relationships. Without effective bonding with care givers infant mammals fail to thrive, become asocial and destructive. We see similar effects amongst adults where connection with others is weak or depersonalised.
I have worked in the National Health Service and its partner institutions for 25 years. I have seen great, caring practice, some change that has led to dramatic improvements, and surprisingly little brutality. However, I believe right now we face a challenge like never before in operating at our best. Financial pressures, coupled with the active promotion of competition are creating an environment in which the humans operating the health and care system are, I believe, more afraid than we have ever been. Afraid that we will no longer be wanted, that we cannot achieve what is being asked, and that we cannot cope with the demands and pressures with the resources we have. Essentially, we are afraid for our own health and happiness. This is a highly challenging state in which to offer effective care to others.
If we are to safeguard our ability to care effectively, we will need to join with one another, to form communities in which we work together for collective health and wellbeing. Services will need to join with one another and with patients, staff at all levels will need to join with one another, and we will need to recognise the impossibility of one component of this community (the services) creating a one-way transaction that gives health and happiness to another component (the patients). This impossibility is true in both physical and mental health care. A hospital can fix a heart problem but only a community can develop a culture of healthy lifestyle that reduces heart disease. A mental health service can offer sanctuary and therapy at times of crisis or stuckness but only a community can develop a culture of support, renewal and growth.
We are all part of community and we all have the possibility of action today to create and nurture bonds and connections in which both we and others can thrive. It will require great courage to overcome the fear that drives disintegration and the urge to destroy our competitors, and determination to prioritise nurturing relationships that can support our own health and wellbeing as part of communities of care. I believe this courage and determination to care is part of our very nature as humans if we reach within ourselves to find it.
by Adrian Whittington, Director of Education and Training and Consultant Clinical Psychologist, Sussex Partnership NHS Foundation Trust