Dr Chloe Beale is Consultant Liaison Psychiatrist at Homerton Hospital and has been working with James’ Place to refer men in suicidal crisis to our new online service in East London.
She has written this opinion piece about kindness being absolutely essential in a therapeutic setting.
Many people, myself included, have expressed reservations about the theme of Mental Health Awareness Week 2020, ‘Kindness’. Some see this rather vague, fluffy concept as an example of the way in which normal distress is made the focus of our ‘awareness’ at the expense of shining a light on severe mental illness, addiction, socioeconomic deprivation and other problems which lend themselves less easily to soundbites and celebrity endorsements. Important though kindness is, mental illness and suicide cannot be resolved by a cup of tea, a hug, and a reminder not to be mean to each other.
But perhaps kindness is more of a powerful concept if we reframe it and look at it on a bigger scale. Services need to be commissioned and run with kindness as their basis. Many people who have tried to access mental health care will not have found the system kind to them. Kindness is helping people access the right service instead of saying “that’s not our remit, try someone else.” It is not kind to leave people without treatment because they are ‘too complex’, ‘don’t meet criteria’, didn’t get the letter, live in the wrong postcode, or otherwise fall between the cracks. Kindness is remembering there is a human being behind each referral.
Exclusion is deeply unkind. The language we use is not always kind. Mental health providers talk about ‘gatekeeping ’ referrals and admissions as if patients were unwelcome intruders who should not breach their walls; this is institutional and systemic unkindness. We need to stop asking how we can keep people OUT and focus on inclusion and accessibility. Centuries of unkind views and decisions have led to a lot of suffering; it is not hard to see how some of us end up feeling despondent about the messy reality of mental illness being distilled into a sanitised hashtag.
As someone who is passionate about suicide prevention, I want to challenge the culture in mental health services that sometimes puts perception of risk before compassion and human instinct. When people talk about what helped them back from the brink of suicide, we hear stories of being truly listened to, with understanding and an open heart. I don’t think I’ve ever heard anyone say they were saved by a detailed risk assessment and a list of formulaic questions. We spend so much time in mental health services talking and thinking about ‘risk’ that sometimes we forget to see the person in front of us. We learn to worry about risk, about missing something, and about getting blamed when the worst happens.
This culture can erode kindness and compassion so that our assessments can become about our own fear and anxiety. Instead of asking what we can do to help, we ask “how can you reassure me?” Nobody who is suicidal should feel obliged to guarantee their safety to a professional who is supposed to be offering hope. My wish is that everyone working in mental health, and particularly with people who are suicidal, uses human instinct and kindness to reach out to people, not a checklist of questions they are compelled to ask.
Kindness really does matter in suicide prevention because the quality of the therapeutic relationship and a collaborative, individualised approach is actually protective. For those of us working to help people who are suicidal, it’s not always about what we say or do, but HOW we say and do it. Kindness, in the form of listening and empathy, can literally be a lifesaving intervention. There is nothing fluffy about that.
Dr Chloe Beale