Unsafe Spaces report highlighted in Therapy Today

Last month we published our report, Unsafe Spaces: Why the lack of regulation in counselling and psychotherapy is endangering vulnerable people. The report is highlighted in this month’s edition of the BACP’s magazine Therapy Today (click here and go to page 5).

As a slight correction to the Therapy Today article, although it correctly states that the report calls for “counsellor” and “psychotherapist” to be made protected titles, we didn’t call for the title “coach” to be protected (though we did recommend consideration be given to protecting other titles, such as “psychoanalyst”).

The Unsafe Spaces report was also previously mentioned in the Mail on Sunday.

Our report found that one in four counsellors or psychotherapists struck off by the BACP or UKCP for misconduct continued to practice after being removed from the register. These included individuals struck off for very serious misconduct, including sexual abuse of clients. We believe this evidence shows the pressing need for regulation of these professions in the UK rather than the voluntary registration systems we have now.

What’s in a Word? Patients, Clients, Service Users…

Part of my job is to mentor student nurses. This week I had a look at the recently-revised competency portfolio that the students have to bring on placement. This is a hefty document about the size of the Yellow Pages, which lists all the skills students have to learn with me, and which I need to sign off to say they’ve learned. It’s very detailed and long, with a dizzying array of competencies in it. I’d challenge anyone who thinks a nursing degree is an easy option to read through it and then say so. However, there was one thing that struck me about the competencies.

They didn’t make a single use of the word “patient”.

Don’t get me wrong, it isn’t that the competencies weren’t aware that nurses work with people, but they were constantly referred to as “service users” and “clients”. The word “patient” was conspicuous by its absence. Apparently nurses don’t have patients.

There seems to be a view out there in mental health that “service user” and “client” are good and “patient” is bad. I don’t buy it. I’m not saying there aren’t people who don’t like being called patients, but I’ve also come across people with mental health problems who loathe being called service users or clients. Besides, anyone who’s ever been to the dentist is technically a patient.

The wording on the student competencies is particularly ironic because I work in Wales. Recently the Welsh Assembly Goverment passed the Mental Health Measure, a very progressive piece of legislation that enshrines certain rights for people receiving a mental health service into Welsh law. It gives, for example, the right to have a care and treatment plan that’s formed collaboratively between patients and staff, and a right for people who’ve been in secondary care to self-refer back to services. It’s a very good piece of law aimed at putting the person using the service at its centre. Even so, the term used in Mental Health Measure documentation is “relevant patient” not client or service user.

I suspect there isn’t a “right” or “wrong” answer when it comes to whether one should use patient, client or service user. It all depends not only on what those words mean, but also what people take them to mean. For example, when we talk about “health” some people would take that to mean a fairly narrow, medical model of diagnosis and treatment. However, if you go by the World Health Organisation’s definition of health

Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

….then that’s a much broader concept.

It’s also worth pointing out that the meanings of words can be changed, often due to a conscious effort by those to whom they apply. A good example of this comes from the recent #mentalpatient furore that erupted on Twitter and into the mainstream news. The Asda website was discovered to have a “mental patient” fancy dress costume (which Asda has since removed and apologised for) on its online store.

 

The response of various Twitter users was to post pictures of themselves in their own “mental patient costumes.”

As well as patient, client and service user, the term “expert by lived experience” has also been bandied about in mental health debates. I recently asked Twitter users what they thought of this particular wording, and got a high number of responses which I’ve Storified here. The answers varied wildly. Some loved it, some hated it, and quite a few people gave nuanced answers somewhere in between.

I’m not sure that I have an opinion as to which is the “right” wording to use (and as I’ve said, I’m convinced there even is a right answer). I’d hope that whatever wording is used, people are treated with dignity, respect and in a collaborative way that upholds their rights and wishes.

 

 

 

Prejudice or Privilege? Some Difficulties with Privilege-Checking

A couple of weeks ago there was a fairly spirited exchange between the former MP Louise Mensch and the feminist writer Laurie Penny over the phrase “check your privilege”, which started out as a feminist term on Livejournal, and has turned into something of a Twitter trope. It’s mostly (though not exclusively) used in online feminist debate. Louise Mensch isn’t a fan of it.

And that is what the modern feminist movement has become. Full of intersectionality, debates about middle-class privilege, hand-wringing over a good education (this is again “privilege” and not well-deserved success), and otherwise intelligent women backing out of debates and sitting around frenziedly checking their privilege.

It does nothing. It accomplishes nothing. It changes nothing.

Laurie Penny defended the term.

Telling someone to “check their privilege” isn’t the same as censoring or silencing, but to people who aren’t often introduced to the concept that they might be wrong, it can sometimes feel that way. When someone asks you to check your privilege, it doesn’t mean you should stop talking – it means you should start listening, and sometimes that involves giving the other person in the room a chance to speak. That’s what often upsets people most about the whole idea. It’s about who gets to speak, and who has to listen, and social media is changing those rules.

I’ve been pondering this for a while, and I’m going to give a list of what I think are some of the problems with privilege-checking. Some have suggested that the only people who have an issue with being asked to check their privilege are those who are privileged themselves. Given that I’m white, male, straight, cisgender, middle-class and able-bodied, quite possibly I may be guilty as charged here.

But here’s something I’ve noticed about the often-virulent arguments between feminists on social media (anyone who says, “If feminism ruled the world, there’d be no war” doesn’t have a Twitter account). These are debates where I’m at best an ally and at worst merely an outside observer, but when I’ve criticised some of the discourse, I seem to get an easier ride than when those on the inside say the same thing. Why are those involved expending so much energy to hurl vitriol at other feminists like Louise Mensch, Caitlin Moran and Helen Lewis? Why aren’t they flaming me?

I suspect that might be one to file under, “Be careful what you wish for”.

Anyway, here’s what I think are some of the problems with saying, “check your privilege.”

1. Not all privileges and oppressions are immediately apparent.

When someone says “check your privilege”, it suggests that they know what privileges the other person has. Trouble is, there are plenty of hidden oppressions and privileges. A history of mental health problems and/or childhood abuse, for example. I recently spoke to a woman with an anxiety disorder who got Twitterstormed by various feminists who (wrongly) interpreted a comment by her as transphobic. Getting bombarded with abusive messages telling her to check her privilege for several hours prompted a mental health relapse.

Even apparently straightforward privileges/oppressions might not be especially visible, especially if all you know about someone is from their social media profile. I spoke to a woman who’d been accused of showing her “white privilege”. When she pointed out that she’s actually mixed-race, she got the retort that since she could pass for white, she still has white privilege.

2. It’s patronising and dismissive.

I’ve actually seen some suggestions that Stephen Fry, when talking about his mental health problems, is doing so from a “privileged” perspective. Admittedly that was said before he disclosed his recent suicide attempt, but even so, do we really want to tell people with a mental illness to check their privilege? Sounds a little too close to, “Chin up, you could be starving in Africa.”

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3. Privileges and oppressions don’t necessarily affect prejudices in straightforward, linear ways.

This point leads me onto the question whether we should really be talking about prejudice rather than privilege. There seems to be an assumption in “check your privilege” that more privileged = more prejudiced and more oppressed = less prejudices. Okay, there’s plenty of examples where that’s true, but by no means always. George Orwell was educated at Eton, and went on to become one of the sharpest observers of injustice and the abuse of power in English literary history. Or there’s Joe Strummer, the son of a diplomat.

Sadly it can also be the case that some people subject to various oppressions can internalise the oppressor’s logic, and even applying it to their fellow oppressed. There isn’t a shortage of people on benefits who will tell you that there’s too many benefit scroungers in this country – though they’d frequently be mortified if someone suggested that they might be seen in the same way by others. Likewise, a while back I had a conversation with a Nigerian-born woman, and was surprised to discover that her views on immigration were well to the right of mine. She simply didn’t view herself as that sort of immigrant.

4. Privilege isn’t the only thing that affects prejudice.

Don’t get me wrong, I’m not saying privilege doesn’t affect prejudice. It can affect it a lot. But it’s not the only thing – what about your life experiences, the people you’ve met, your cultural background, the books (and blogs and Twitter feeds) that you’ve read? this is why I think it’s better to have a wider discussion about prejudice (of which privilege can be a part) rather than talking simply about privilege.

5. It talks at people rather than with people.

Laurie Penny insists that “check your privilege” is an invitation to listen rather than telling someone to shut up. That’s fine in principle, but having seen it used in various Twitter flame-wars, it’s clear that all too often it does get used as a shorthand for, “You are male/white/straight/cis/able-bodied therefore argument invalid.”

And even if it is used as an invitation to listen, is the other person also listening? I actually agree with Penny that social media is changing the way people communicate, but for slightly different reasons. Social media changes the old world of books and newspapers from one in which ideas are presented to the public, into one in which those ideas are co-created by people talking and listening with each other rather than at each other.

I’ve actually found blogs and Twitter to be powerful tools in challenging and reshaping my prejudices. I can hear about the lives of prisoners through @PrisonerBen or sex workers such as @itsjustahobby or @pastachips – two groups that tend to be talked about or to rather than with. Just recently I’ve been reading about the experience of having a gender identity that doesn’t fit into a binary male/female divide from @halfabear and @jaspergregory – a group that’s barely written about at all. But these people didn’t change my thinking through, “I’m going to tell you about your life and what you think”, which is what “check your privilege” does. They did so by saying, “I’d like to invite you to hear about my life and my thoughts.”

Ultimately, I don’t think people’s views are changed by simply tweeting “check your privilege” at each other, and in that sense it fails in its purpose. It doesn’t get the recipient to think differently. If anything, it’s the obsolete old media thinking of talking at people rather than with them. I think views are changed through civil constructive discourse where people tell each other about their own lives rather than presuming to tell someone else about theirs.

The Philpott Case – A Lesson from History

I’m idly flicking through a copy of The Burning of Bridget Cleary by Angela Bourke. It tells the tale of what’s sometimes referred to as “the last witch-burning in Ireland”.

In 1895 Bridget Cleary, a 25 year old woman from County Tipperary, Ireland, was burned alive by her husband. It was a bizarre and grotesque tragedy in which her assailant used an unusual defence. He claimed that his wife had been abducted by the fairies, and he had only killed her changeling rather than Cleary herself.

The case provoked huge media interest, and that interest turned into politicised comment. To give a flavour of how this was reported in some quarters, here’s a quote from the Clonmel Nationalist around the time of the trial.

We found yesterday that the dreadful occurrence has been utilized editorially by the Tory-Unionist Dublin Evening Mail for purposes of political capital and as a suitable occasion to pour forth slander, odium and abuse on Irish people generally; to stir up racial and religious passion and prejudice, and if possible to damage the cause of Home Rule.

As you might gather, right-wing newspaper barons used this unusual and shocking event to slander an entire people, dismiss them all as unreasoning savages, and to advance a political agenda against them.

Thank goodness we live in 2013, not 1895. This is a much more responsible media era.

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Should health professionals be anonymous or non-anonymous online?

This is a topic I’ve been thinking about for quite some time. Today, the General Medical Council announced that doctors should identify themselves on social media. To the best of my knowledge my own regulator, the Nursing and Midwifery Council, has not yet issued a similar rule. However, I wonder if this is an indicator of what other professions are also likely to do.

Professionals blog and tweet under pseudonyms for all kinds of reasons, and by no means all of these reasons are ominous. Ermintrude2 and Dr Grumble not only use their platforms appropriately and ethically; they also write extremely well and passionately. Some people just feel more comfortable under a pseudonym, and feel more able to speak frankly.

I’ve been Zarathustra on various blogs, and more recently on Twitter, over the years. I’ve grown quite fond of and attached to my online alter ego. Look at Zarathustra’s awesome moustache! I can’t actually grow a moustache in real life. Despite being a grown man any attempts turn into something resembling teenage bumfluff. I ask you, who wouldn’t want a tache like Zarathustra’s?

Over the years I’ve noticed attitudes to social media and healthcare steadily evolving. At first it was something of a free-for-all. I remember the anarchic days of NHS Blog Doctor, Dr Rant and Militant Medical Nurse. A lot of those early blogs were expletive-fuelled swearathons, with people yelling all kinds of earthy insults at NHS managers, at politicians and frequently each other. The language was of a variety that would have a fishwife telling people to tone it down a bit.

A lot of those blogs simply aren’t there any more. In some cases, I suspect it’s because people got into trouble. Some people found out the hard way that internet anonymity can be seriously overrated, especially in the long run. As behaviour on social media started to find its way into disciplinary hearings and fitness-for-practice investigations, the professional guidance became more detailed and suddenly everyone became incredibly anxious about social media. It became a demonic creature, waving a P45 in one hand and a letter from the NMC in the other.

That anxiety is still around, but I’ve also noticed a more mature set of thinking around social media starting to emerge. The Royal College of GPs’ Social Media Highway Code, and Victoria Betton and Victoria Tomlinson’s Social Media in Mental Health Practice give good examples of this new maturity. What these publications say is, remember your responsibilities to behave ethically, but also maintain a sense of playfulness to explore this evolving medium, and work out how it can be used as a force for good.

And there’s no doubt that social media can be a force for good. Last night I joined in the #mhnursechat on Twitter, which was on the subject of borderline personality disorder. This is a difficult topic, often laden with mutual suspicion on both sides. Patients with this condition are often regarded as “difficult” or “attention-seeking”. Professionals are accused of dismissing the suffering of people with BPD, and using it as a label to stigmatise and exclude rather than provide support.

The chat was joined not only by mental health nurses but also by a number of people with BPD. For an hour everybody talked openly, equally and respectfully. We talked about what the diagnosis means to people, what helps and what doesn’t help. The feedback from participants at the end spoke for itself.

“brilliant to be able to collaborate with mutual respect for each other, a wonderful experience”

“It was such a nice change to be included instead of being ignored and spoken over so to speak”

“brilliant to see and I am glad that patients welcomed in #mhnursechat not just professionals”

“What a brilliant & informative chat. Thank you all so much for joining in”

It reminded me of some comments by One in Four editor Mark Brown.

Social media, by its nature, puts together people who would never have met.  It creates strong public voices which didn’t get there through traditional routes.  It creates stories that appear from odd angles and at unexpected times.  It makes public issues of things that might once have remained behind closed doors.  It doesn’t let things stay where policy makers have traditionally put them.

It also creates a situation for mental health where it is less ‘them and us’ and more ‘just us’.    There is something hugely satisfying in seeing someone who offline would be seen as a ‘patient’ discussing online with someone who would be seen as an ‘expert’ and both learning from that experience.

Returning to the question of whether to blog and tweet anonymously or non-anonymously, there is the matter of accountability in all this. Ironically my recent Twitter run-in with Dr Christian Jessen has galvanised my thinking on this matter. I’ve been criticised for “calling out” Dr Jessen on his online statements. Personally I don’t think I’ve done anything wrong in that regard. I think he behaved disgracefully in an extremely public manner, and that I’m entitled to criticise that behaviour. But should I be hiding behind an anonymous ID to do so? If I’m confident in what I’m saying, shouldn’t I be willing to put my name to it, and if necessary defend it?

As well as being accountable, there’s also the matter of taking credit for what you’ve done well. There are pitfalls in social media, and if I’m honest with myself I think it’s fair to say I’ve made some mistakes along the way. But there’s also things I’m proud of, such as exposing the shocking lack of regulation in the psychotherapy industry. I’m also proud of helping create and maintain the regular This Week in Mentalists round-ups, in which bloggers take it in turns to tell us about their favourite online mental health writing. I’m proud of the #TwentalHealthAwards that I started this year.

So, I guess what I’m trying to say is this.

Hello. My name’s Philip Doré . Pleased to meet you.

The trouble with Dr Jessen

In the last couple of weeks the Royal College of General Practitioners published their Social Media Highway Code. As a professional with a longstanding interest in how social media can be used constructively in mental health, I’ve often been disappointed that most guidance being issued tends to focus only on the negatives and risks of this new form of communication. The Highway Code is a welcome antidote to that: it acknowledges the risks and and the need to behave online in a professional way. However, it also recognises that social media has rewards and opportunities. I highly recommend it not only to doctors but to all health professionals.

Which makes it unfortunate that today I got caught up in the absolutely atrocious online behaviour of a doctor. A TV doctor, no less.

I don’t actually watch the TV show Supersize vs Superskinny, hosted by Dr Christian Jessen. I work with children and adolescents with eating disorders, and watching a show about it feels a little like taking my work home with me. I know that some people with eating disorders have complained of experiencing triggers from the show.

Ilona Burton is a journalist who writes for the Independent about eating disorders. She writes passionaately and well about the subject, not least because she’s in recovery from an eating disorder herself. In 2012 she was nominated for the Mark Hanson Award for Digital Media in the Mind Media Awards. She also holds strong views about the content of Supersize vs Superskinny, which she regards as socially irresponsible.

Early today, an increasingly heated debate was building between Dr Jessen and Ilona.

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Dr Jessen then started retweeting Ilona to his 222,000 followers. The result was that Ilona started receiving tweets from Dr Jessen’s fans, some of them abusive. Ilona was clearly distressed by this, which really didn’t seem to concern Dr Jessen. For that reason I threw my own tuppence into the ring.

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I also tweeted him a link to the RCGP Social Media Highway Code, and suggested he pay attention to Section 7, “Treat Others with Consideration, Politeness and Respect.” He didn’t reply directly, but responded by retweeting me.

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The result was that I too started getting a large volume of tweets, which quickly turned into a Twitterstorm. As with the content being aimed at Ilona, some of the tweets I received were also hostile or downright abusive. It went on and on, lasting for several hours. This wasn’t helped by Dr Jessen retweeting more of my responses.

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Okay, maybe that last tweet by me was a little tetchy, but getting several hours of online abuse does that to me.

I’m a fairly opinionated tweeter, so I’m no stranger to getting hostile messages. I’ve had some nasty stuff thrown my way by supporters of UKIP, and also by people who object to the work of child protections services. I can honestly say that today was the worst and most intense level of trolling I’ve ever been subjected to.

I don’t feel I need any sympathy for that. I’m big enough and ugly enough to handle it. However, I’m saddened that it happened at the instigation of a fellow healthcare professional. I’m even more saddened that the brunt of it was also caught by someone who has lived experience of one of the very conditions that Dr Jessen talks about in his show.

Dr Jessen seems rather unrepentant about all this.

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What does the Social Media Highway Code say?

You have a right to express your views openly–but not to do so in a way that causes offence to others or infringes on their own rights….

When part of an online group, don’t be tempted into joining others in making derogatory comments or ‘ganging up’ on another individual – this behaviour could be regarded as ‘cyber-bullying’. Be wary of the power of the mob…

HEALTH WARNING: making derogatory,threatening or defamatory comments about others could have a harmful effect on your career. ‘I was just blowing off steam’ may be an honest explanation, but is not likely to be accepted as a valid justification by professional bodies or employers.

I hope Dr Jessen takes up my suggestion of reading the Highway Code.

Meanwhile, Ilona has posted her own thoughts on the matter in a vlog.

Does God Need A Make-Over?

There has been much in the media of recent about the rather fraught view of religion by other parts of society. On this occasion, I’m thinking in particular of the Church of England’s (and to be fair, most other Christian denominations) response to gay marriage and of course the well-publicised vote on whether women should be allowed to become Bishops in the Church of England.

I find it an interesting discussion for a number of reasons not least because I am a Christian and an Independent Social Worker so find myself asking whether the two can co-exist without being at loggerheads for much of the time.  On the one hand, they appear to be best friends; after all principles such as compassion, self-less giving, openness and honesty and shared between the two.  Prior to being a welfare state wasn’t welfare provided by family and caring neighbours? On the other hand they appear to be poles apart and the (media’s interpretation of) views of Christians have become the very definition of inequality and discrimination: Being reported as an outdated, irrelevant religion whose demise is imminent.

All this has led to the media and bloggers alike asking whether God has become irrelevant or in Katy Campbell’s blog questioning whether God requires a bit of PR to continue in contemporary society.

I think a part of the problem is that people are confusing religion with the Christian’s view of God.  For a Christian, God created everything in the beginning, has always and will always co-exists as Father, Son (Jesus) and Holy Spirit.  Whilst Christians identify that individuals can have a relationship with God who is perfect, religion is largely man-made and often where the problems exist. The problems don’t necessarily lie in the fact that people believe in God or any other god for that matter.

Does God need a make-over? If you ask a Christian they would say that to suggest that he does would be to acknowledge that he isn’t actually God so in itself is an absurd question.  Does the Christian church need a make-over to bring it in line with contemporary society and more in line with Biblical principles?

Another issue is the Bible which is of course the Christians’ book of choice. A Christian will tell you that it is one of the means through which someone gets to know God. It has itself been under scrutiny of recent particularly when discussions about gay marriage have been raised.  The reason being that the Bible sets out a clear framework for marriage; Christians believe that it is an institution ordained by God and a union between a man and women. That is why most Christians will be against gay marriage. Not because they are homophobic but because it is contrary to the foundation of their faith.

So, perhaps the issue isn’t that God requires a make-over or that the foundations of the Christian faith should somehow be remodeled because to suggest such a thing is surely questioning whether any religion is valid.