Written by Christopher Munt, Founder of Authentic Voices.
When care is compromised, humanity suffers, and patients are victimised.
Back in 2022, I was invited to contribute to a pan European study of institutional violence as one of the lead authors. I was to write about the experiences of patients who had experienced violence within NHS Mental Health provision in England. To reach out to those who had suffered such violence, I approached several notable service user/patient groups. Some of these organisations didn’t respond to my approach, and others explained that the subject matter either didn’t match their organisational profile or wasn’t one of their priorities. Though saddened I wasn’t wholly shocked or surprised by this.
Over the last two decades, as a patient, manager, governor, chair, transformation facilitator, I have observed how close provider organisations and service user/patient groups have become. I’m all for different parties coming together to address the ultimate goal of improving and elevating the care experience. However, by working so closely with provider organisations, I think the patient voice has sometimes started to lose its autonomy and its representation and advocacy functions in some situations.
Creating a safe space for sharing
Despite this, we found some allies and developed a group of 24 people who had experienced violence at the hands of those employed by a variety of NHS mental health trusts in England. We met in small groups and on a one-to-one basis, depending on what worked best for them, and through our shared Lived Experience, we soon established a bond and trust. We avoided many difficulties that come with group work by co-designing a term of reference that we could all adhere to. We established that one person’s experience of violence was no less or greater in respect of impact than someone else’s, and that though the pen was in my hand, it was the cohort and their testimony guiding that same pen.
I would write a thousand words at a time, share the text to the cohort for their views and comments, weave them into the text, then we would repeat the process until we achieved our target. I felt it was important to establish and maintain a sense that this was a consensual process. That my co-authors were absolutely invested in and guiding the creation of the chapter.
Opening Pandora's Box; not an ancient myth, but a modern tragedy
Our chapter captures testimony of people whose illness and distress were made worse by the behaviours of nurses, health care assistants and senior ward staff. Inpatient provisions are not an easy place to be accommodated, and absolutely not an easy or straightforward environment to work. The reality for many is that it can feel like a tedious and extended wait in a waiting room, routinely interrupted by bizarre and worrying outbursts. I will challenge anyone who is forcibly detained, unable to exercise their liberty, and struggling with serious mental illness, not to occasionally protest, reject, become emotional, and make demands. These are natural responses to unnatural events that thankfully most of us will never have to go through.
Although every one of our co-authors talked fondly of how magnificent some staff were towards them, they also shared how you would quickly develop a clear idea of which staff you should avoid. In general, a number of us shared that incidents of violence would take place in plain sight of other patients and other staff. This was interpreted as reinforcing a view that such behaviours were tolerated, and such staff were untouchable. This led a few of us to complain about such treatment. Those that did complain told of a process where every effort was made for the complainant to withdraw the complaint or not to escalate it. The complainant would also be burdened with attempts to mitigate or underplay the violence. The chapter recognises just how challenging these environments can be for the workforce, however we are clear that though extremely challenging at times, these vulnerable people expect and deserve to be treated with dignity, care and respect.
Of course, the chapter describes these adverse conditions, and the first-person narrative humanises these experiences. As a group we shared experiences of being verbally and physically abused, how some were racially abused, been intimidated on grounds of sexuality or gender, weight, and disability. Being humiliated and treated as having little or no value were our common and shared experiences. I hope this blog has motivated you to appreciate that sometimes, in some places and at some moments, and with certain individuals and groups, apparently good people can and do inflict acts of violence, with no provocation.
Health and social care organisations should be provided with insights, like what is discussed here, that lay bare the real experiences of everyday people who engage with their services. This is the vision of Authentic Voices, a group that I recently founded. We determine that any process we commit to has to be aligned to full and active collaboration and equity in all matters. The value of meaningful engagement is in service users and carers co-managing and co-directing the entire project, not parts, and not at the whim of the commissioning organisation. This needs to be the new order of things.
If you’re interested in reading more about institutional violence, the pan-European study in which Chris’ chapter features will be published in September 2024.
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