102 – Difficult Conversations & BPD ft Keir Harding


A while ago I asked the audience what topics they would like episodes on and there was a big swell of support for an episode on how to have conversations with people about difficult topics. On top of that, there was a lot of people recommending that I get this gentleman in to have that conversation with.

Keir is a bloke that has been on my radar for a VERY long time. I’ve followed his work and his projects for years through Twitter so meeting and connecting was well overdue for us. We discussed the complexities of the healthcare system and how that often fall short when working with people who are diagnosed with Borderline Personality Disorder. We also have an important discussion about suicidal ideation and self harm and where Occupational Therapy might actually fit when working with people experiencing these.

It’s super important that OT’s learn to become comfortable with these kind of conversations no matter what field they are working in.

Keirs links:

Look after yourself, look after others and always keep Occupied


Automatic Transcription

102 Difficult Conversations & BPD ft Keir Harding

00:00:01 – 00:05:02

So very accidentally so I my parents got divorced when I was doing my a-levels which is what you do before you go to UNI. Okay, so I didn’t have a brilliant time doing those exams before you leave. So I finished my levels without any offers for University. So I had to go through our clearing system of trying to find a place to do something so awful and I had it in my head but I was going to be a physiotherapist and I had this idea about traveling the world with Rugby teams and doing lots of massage and that kind of thing and you know started going through clearing couldn’t get these courses. And so someone said, well, what do you think about doing occupational therapy? And I went yeah, let’s do that and they’re right. Well think about you for this course, then we’ll think about you for the occupational therapy course will give you a call back and then because this was like a million years ago. I had to walk down the library to look up what occupational therapy was dead. Click through a couple of Brooks for yeah. Yeah, that’ll that’ll do about that might be okay might be able to switch to physiotherapy while I’m doing it and I am in London on an occupational therapy course, I think I was a terrible student for a big long time. And then I did my mental health placement on the second year. And yeah, I think the song is about being part of a touring rugby team went out the window then and I just thought I want to work in Psychiatry. This is where I want to be. What was what was the the placement was impatient or Yes, it was an inpatient. Psychiatric hospital I tell you one of the things that really struck me but and and it just kind of like really showed me that this place was very different to buy it experienced Soldier. So I was walking through the reception and there was this really bad smell and we looked around and if there was that and we looked over and there was this woman squatting on the floor defecating off. I was like look look what that woman’s doing and they said yeah, she’s visiting a guy on ward nine so the visitors coming in and doing this and I’m not going to get these expect other places in my life. I see that on a regular time. You never see anything like that interesting me write a couple of years ago. I was at this celebration of old T’s patients on Princess. Anne said to me. Oh, what was what was some of your memorable experiences and working in mental health and I felt oh do I tell that story or not and I did Serenading the royalty. So that’s that that’s clearly about the royal family want to hear stories about public expression. That’s what they want. I’m sure it’ll stand out as a highlight from a trip post. You’ll remember it hopefully cuz I can see she loves till I hit the punch line which might have been politeness a lot but they were a couple of people from the Royal College of Occupational Therapy looking at me as violence.

00:05:05 – 00:10:11

Yeah, if I just dropped my trousers in the room it was what is this man doing? He got a good story out of it. Yes. Yes, but it’s like I’m surprised impatient didn’t scare you away from mental health month, but I quite like the idea of getting people off the boards and it was my first experience of kind of doing things with people who were I kind of thought I probably couldn’t articulate it very well at the time but they were just kind of like outside of my reality and I felt that was quite fascinating that something had happened that they they were not connecting to the emails in the same way that I was so yeah talking to people who would repeat back everything you said talking to people who had ways of understanding things that sounded like some kind of spy novel and just I don’t know cuz she got to ask them about their lives in so much detail. You became a part of town. Narrative which seemed so much better than the see somebody and fix them up that kind of fell in the physical settings, but that really touched on the wage and the the stories was something I always cuz I work in a couple of different inpatient units over my career and the the stories you were here always fascinated me and home for me. The interest was more around sort of how that story developed cuz for a lot of them I could sort of work out like where the store or you had like, there’s some basis in reality to some of it and it was sometimes like a misinterpretation of an event or something that someone had said to them and then it’s sort of that got skewed and she could kind of almost tracked back to what actually happened to how they got from that to you know, whatever the the big tail that you were being told was and Thursday. Out of an OS just fascinated me and I think it really kind of cemented. I felt like a lot of people and it’s well-documented in history mental health treatment history that for a long time people in mental health were sort of treated almost as long as people they were you know to unroll with lock them away or we essentially treat them like farm animals and some cases and even just making that simple and a lot of home maybe still look at that, but that’s another story but I think that making for me making that link between like okay like these stories that are sometimes super her labret and out there and like you said something like a spy novel can sort of be interpreted into reality as I see it in a lot of cases is if you’re willing to spend the time and get to know the person and sort of explore it with them and that to me sort of went. I feel like these did that dip people know not not dead. Like in death of that, but it’s like they’re not it almost I guess gave me hope that the work that I was doing was actually going to offer help these people cuz there’s a lot of I’ve heard all you hear all sorts of things from other professions on boards and stuff like that where you know, you are such and such as hopeless has been here for months and months and he’s never going to get better or that kind of thing. And I think in the I always found working in a ward it was very much. I was kind of difficult for me in the first world that I worked that cuz I was a new grad because you kind of in this little bubble where you only ever see what happens on the war and I never cuz I was in new grad. I hadn’t committed any other places. You never see like the progress from the war you only ever see people at their very worst kind of thing. So I found in that role initially thought some of those sort of I guess perpetuating stigmas that other people were sort of taught other staff were saying on the ward. I almost started to I guess believe some of them like, you know, such-and-such is a hopeless case or back on it. So and I think yeah making that link between some of those sort of stories Andrea and my reality with my version of reality really so I think it was so high opening thing for me. Yeah a couple of weird things. I used to find working on an inpatient unit was dead. My Style Network people tended to be on inpatient units a lot longer, whereas now I think people kind of go in short admission and names again and I always remember some of my old colleagues say in do they get them off the board so quickly they they never leave them long enough so that they’re able to access OT and I always used to think.

00:10:11 – 00:15:30

Just getting there. What are you talking about? You know, freshener you where people have got to be a certain level of Wellness for you to get involved and I always thought quite annoyed that people didn’t see that that Acuity off when somebody came in but that was a reason to walk away as opposed to a reason to get in there when they’re functioning was absolutely through the floor. So yeah, I got off of frustration with my colleagues when they’re going to I had the same thing and in the one of the impatient years that I worked at because there was multiple OTS but on the second one, I was the only one so I just did Ed. Myself, but yeah, I had the same thing in that it was like, you know such as just come in. We’ll wait a few days until he starts getting a bit better before, you know OT goes in season. I’m like just yeah just need to talk to the dude like yes. Building Rapport, like start the process. It’s not going to hurt and if anything it’s going to make your life easier and his life easier. You probably get him out of here quicker. It felt like a quest to make our input a relevant to the board if we would only start to work with people when they were on the cusp of leaving it kind of sent this big message that we weren’t required wage. But the population there and people have the attitude. We just got the wrong patience. If you have any patients would be doing some good work and like oh such a nonsense off. Yeah. That’s that’s that even just that is interesting. I never thought of it like that, but I think that’s that correlates well with my experience as well on terms of like people were often, uh, almost like picking and choosing who who they would see based on diagnosis based on level of organization. Sometimes like if there were in a depending on how far they were from the the clinicians reality. I guess you could say, yeah. Yeah people We’re often put it in and it’s not uncommon for award to be like to for a too hard basket to be discussed on award unfortunately, but yeah, I always found that some of the some of the clients. I had the most success and the most personal enjoyment with were the ones that were passed by other people as too hard, you know to acute. Mm. Yeah actually work with and there’s some of the ones that I had the the biggest breakthroughs with and like the most personal where you call warm and fuzzies cuz I actually feel like I made a difference to this person. Yeah, but even like I used to say when I used to have students I’m like, even if you on the day they get here you just go and introduce yourself and not a chat. If you do nothing. Other than that then like that’s more than they probably going to get there in a strange Place. Some of them have never been there before. It’s not the most I can probably speak for all wage. Units they’re not the most stimulating of environments and they usually not very nice or comfortable. They usually freezing cold. For some reason. I don’t know why it doesn’t matter what off our country country a little Tropical Greenery over here. I don’t know why because it’s hot outside. So they just dump the air-con and it just that everyone I’ve ever been down here is freezing. So I don’t know how people sleep at night so cold. Yeah, they’re just not very inviting environments. But if you can be a happy face be a friendly ER, you know, introduce yourself actually show genuine interest in a person if you do nothing. Other than that when they first arrived you’ve already made more steps in any other profession on that Ward, I think and I think you know if we were going to put it in our own terminology, I think that is you’re addressing the social environment around him a little bit you are being a friendly place. So that will be perfect person but you didn’t have to be you know, in a sense that is a bit of an intervention and you know, we can write that off as just chatting to 70 but it’s not it’s it’s it’s worth the effort. That’s another one of the biggest Revelations I’ve ever had in my career is I am part of the environment for that person. It’s like a lot of questions. I found even talking with a lot of a team specifically like see themselves as having an impact on that person’s environment or like almost like an external force on that person on their environment on their occupations God, but without ever really looking at like they’ll talk about Therapeutic use of self but I don’t know how many people actually consider that in doing that you are the person’s environment and by changing like if you go in there, it’s just nothing else different other than you’re in a shity mood that’s going to have an impact on that person’s social environment and it’s going to have an impact on that person and I do Wonder off in a queue coming back to I guess have it working with the difficult people.

00:15:30 – 00:20:34

I wonder how often that I guess labeling of someone as a difficult person is mainly just them reacting to you, you know, cuz I’ve seen it a lot in other caring professions where if they’re in a shity mood then the whole Ward tends to sort of carry that mood whether they mean to or not. It’s sort of transference and Thursday. We use always used to say on the on the last board that I worked on that your mood is kind of contagious within that little cuz it’s such a little enclosed bubble on the ward. Yeah, whatever you bring into the ward is contagious and that metaphorically speaking but probably nowadays. I guess I can’t really say that nowadays Lobby carries a very different meaning but speaking around food when I’m saying that rather than bacteria and viruses but thinking about how those influences in the social environment do kind of reverberate off each other off. Remember, I think it was like the first acute inpatient unit that I was employed on I’m a rag I got admitted and the leader of this kind of pointy came out and he said, oh he’s got personality disorder and I didn’t know what that meant at the time and I was like, oh, what’s that just means that you can’t do anything to help them and because I didn’t know any different I kind of like, oh, right. Okay, that’s a shame and you know the idea about we can’t help those people. They’re just walk and seek and they just manipulative because I think we’re not trained particularly well in our undergraduate training to understand why people might act a certain way then we pick up there was kind of really stigmatising attitudes from people who also went trains to understand things in a different way and that just carries on you know, and we get this toxic idea of people Who you know don’t deserve to be on the boards people who are the source of their own Misfortune. And unless we do something to combat that that just carries on and off and I think that’s a big part in those people who you know, we end up thinking are we can’t help them because there’s often cuz people have told us that and it’s often because people have gone into trying to help them with the idea that they can be helped which generally doesn’t help sounds like I had a very similar experience the very first time I again, I never heard of a personality disorder. I was in a case management team and we got a new referral and it was someone with borderline and the general consensus was the can’t give that person to it a new grad because that diagnosis is too hard. It has to go to a super experienced clinician who I date in hindsight anything did any better than anyone else but dead That was my first thing so I’m like any time I saw that diagnosis on a sheet now. I’m like, okay that’s going to go to you know, such-and-such the senior clinician cuz it’s too hard for, you know us mirror new grads or ask me about no base level clinicians kind of thing. And I think that even just that kind of set the tone of that’s to harm. Well, there’s nothing I can do that’s that’s something for us and there’s no extra training to go from a base level service to a senior therapist here. It’s just like it’s a pay pay rise. It’s about it since you’ve spent off a bit longer pretty much just means you’ve been there for a while but so I don’t know what they were going to do that I couldn’t do and I’d but I’d never actually fought that at the same time. It was just this is the Lions done. So okay. This is the way it must be and I think that’s going to be cemented in in some team. Yeah, I think about idea the dog. God because borderline personality disorder is diagnosed quite badly in my experience. You’ve got wonder when you see it written in some of these notes does it mean that something given them a very thorough assessment and they have checked off what they meet certain criteria or not, or does it mean that people have actually found them hard to work with so decided they’ve got borderline personality disorder and you know life is a lot of my experiences the people that other people find hard to help other people find anxiety-provoking they get that label put upon them and that’s that’s how it comes about rather than as a process of thorough assessment and understand how I would spend probably that died like to be PD diagnosis more than any diagnosis has its own I guess stigmatized language that tends to regularly get used with it and just you saying that made me think like I would often hear, you know, it’ll be a a client.

00:20:34 – 00:25:10

That’s got a job. Something like bipolar, but because the clinician has found it difficult. They’ve also then got unofficially borderline traits, which was something that was so common when I was working clinically on like everyone that was difficult had borderline traits and I’m like, I don’t know what that means. Like, what is that’s not a diagnosis. Like what is that just means that you don’t know what to do with them or they don’t like maybe yeah that potentially engage if I went to the conditions like for a person that’s got worried. It was always thought you mentioned some of them before to that sort of gave me flashbacks was attention-seeking the fact that a lot of the people that I worked with on the war didn’t I believe that the acute unit isn’t the right place for someone with borderline because it’s just feeding into their you know what they want kind of thing. And I feel really I don’t know. I still seeing a Kerry somewhat I guess kind of guilt in a way because I didn’t know any better at the time to actually go. No, that’s actually true. That’s not how this diagnosis works. If that is the correct diagnosis that you’ve been you know that you’ve given them anyway, cuz I also agree I think it’s something that is it’s almost like the what seems to be almost like the like The Back-up diagnosis when they can’t sort of pinpoint another one. So the light bulb back online as opposed to actually going through the clinical process and formally diagnosing it with you know, it’s ticking all the boxes. Yes. Okay. This is borderline personality disorder, whatever type depending on what manual they’re using I guess I mean even then I don’t think it’s a very useful way of describing people or them making but yes boss. About level UPS often doesn’t happen. I find it’s similar to in Psalm case. I think it just getting better. But I find it similar to autism into in a lot of ways where it’s kind of like we’ve exhausted all these options. So it must be this one as opposed to actually testing for this one. But you know, a lot of people kind of say are people with BPD of actually got autism they’ve actually got disassociative identity so that and I think we’ve got this correction of diagnosis that people find it really hard to think about and you know, is it this way is it about or is it I’m this quest to get the right label. I think we put a lot of effort into it so very little rewards. Whereas I think that’s you know, what are they doing? And can we understand why they’re doing that and if we can understand that then we can start making some decisions about men developed. Whereas like is interesting. Is it dead? You know, we can pull our hair out from the label something because I think it gives us some feeling of control and knowledge when in reality. It does very little to be able to help that person or people formulate wage. We’re off and that’s it and I can see like I have talked to people where they’re like, you know, the best thing ever was when I got my diagnosis and that I knew what was going on and I’m like, oh that’s cool. Well, yeah, obviously everyone’s different but then there’s other people that love the people that I’ve worked with just going through that because that process of actually getting a diagnosis sometimes can take years like it can take you know, multiple admissions where they’ll collect historical data across those Admissions and then compare that to previous Admissions and like it can take a long time to get a formal diagnosis month and that process can be traumatizing to people actually the process of getting a diagnosis can be can be causing trauma to dead. The individuals and the thing that I’ve I mean, I’ve said it for years and while I was still working clinically to every student. I think I’ve ever had like I can as an o t off because I’m not I don’t view o t as a medical model profession. I can completely do my job without knowing what the diagnosis is. Anyway, like I don’t need the label to do occupational therapy. Yeah. I need to get to know the person I need to know what they want to do with their lives and I need to know some of the things that might be stopping them from doing that and that’s a pretty good place to place.

00:25:10 – 00:30:27

Well, yeah, particularly if the diagnosis is one that is associated with not being able to help people be an undeserving with care. You know, I think in that way diagnosis can be incredibly unhelpful. I think it’s it. There’s a lot of uh, pretty much just building on what you just said, then like there’s a lot of stigma. I thought you’d call it that comes along with these diagnosis that quite often it’s better. If you don’t know before you go into it cuz it stops you going in there with any preconceived ideas. Yes, I always get blowback when I say that but yes, okay the safety things that you need to know, but you can no safety safety things got nothing to do with diagnosis. Like there’s no reason why you can’t get off safety and over without getting. Oh, they’ve got this diagnosis and blah blah blah might they’re very different things where I do feel even on why do I find I find health staff to be the biggest perpetuate as of stigma of any population because I think in a lot of ways that kind of desensitized to it a bit so they just it just comes out. Am I suppose again is what people are taught is once that staff culture breeds. And unless there’s a voice articulating a different way of thinking about it. Then people don’t know and like you say, you know, maybe stuff perpetuate stigma more than anything else. I think the general public they don’t know anything about you know this area of work so they are happy to think. Well, I don’t know anything. Yeah, whereas, you know, somebody on the wards will think no it’s my job to know there so I know about these people and what they need and what they don’t and there is something about the lack of knowledge that a defense against that is to have some confidence about it. Which again I think we would be a much better off being a bit more humble and curious and we’re walking alongside people so often wondered cuz I don’t like obviously I’m working in the University now and I’m obviously overseeing or I can look over all the course material and I’m like, I can’t see anywhere. Within that sort, of course material that those kind of ideas would be picked up particularly with the mental health stuff cuz that’s my wheelhouse but I teach so I know that I’ve I’ve actively trying to make sure that there’s none of that kind of stigmatizing language or anything like that. I teach my students specifically about stigma and how it develops and you know, social constructionism and that kind of thing often. So hoping that they are very aware of it when they go out and then I still see that these workplaces some workplaces. It’s still there and I’m like we’ll obviously I’m sure other courses aren’t you know are actively trying to do the same thing that I’m trying to do or we’re trying to do in that we’re not trying to teach our students. I guess these bad habits on these bad ideas. So I wonder where this come from. Yeah. And I think it can move some stuff group. See you’ve never had the training initially. So they’ve just moved on the job, you know, so I live enter to talk to Suicidal Thoughts by talking to suicidal people on the phone and think that’s a terrible way to learn more me. I’m a person I was talking to but I think that’s what happens is we learned to work with a very complex difficulties by just being in front of them article and that’s that’s not ideal. And I think if you I can I can appreciate that not every higher education syllabus can kind of think right this diagnosis on this presentation, but I think when I was at University, I was prepared for people who’ve woods they they really want their lives to be different. They would be grateful for my advice than they would go off and do what I suggested and wage. A big part of me wanting to do OT was to be helpful, you know, and I I am a good person because I do helpful friends. And then if I’m working with people who you know, they’ve lived through a life of them so they don’t trust me and you know rather than being grateful for what I’m offering. They’re quite annoyed that I’m being rather flippant in mind suggesting the mid furious at the end and then I’m leaving work at the end of the day thinking or actually I’m not a good person because you know that person seems worse than when I started and yeah, I think that’s a brilliant recipe for being really annoyed and having really powerful feelings against the people we’re working with whereas if you can understand the people in a different way if you can think of bounced off of what is it about this person’s life that would mean that they wouldn’t trust in what is it about this person’s life that would mean but they don’t see their capacity for solving problems and then Thursday.

00:30:27 – 00:35:04

Changes, but I think if you can understand one, then we can be a lot more imperfect and helpful. Whereas I think what we often time to do is think when I wouldn’t have to like that so they’re bad in some way for Patiently they do. Yeah. I do wonder how often I guess intervention plans are often like but here’s what I would do as as it there was not Jose. He’s like any therapist even just friendly advice that I hear like nurses and social workers and stuff giving clients on on Wards, but I think it’s it’s important to be aware that That you know, what you would do is shaped by, you know, your experiences and you’re potentially lack of trauma and your full Social Circles and your environment. They’re going to go. Sides here. But and what you’re recommending based on that isn’t back to fit with that lesson who’s coming to you with that or more history who doesn’t trust you who doesn’t want to be there who doesn’t even know what you do and you’re not presenting it in a way that they even care about whatever you suggest. They probably just going to tell you the shove it and then you’re going to go well, they’re difficult to work with them all because you didn’t spend much time to actually get to know them and what they’re bringing to the table essentially soul exercise that I often do when I’m training wage. Is to try and get people to think about a baby’s needs and then a toddler’s needs and people will always talk about all they need to learn right and wrong. They need to learn their place in society. And that makes a lot of sense. Yeah, but so many people I work with haven’t had that socialization, you know, so when I’ve worked with people who was who went crying to their mum to say that the kids were home with me they mum said, well, you need to go and beat them up and I’ve worked with people whose father would dangle them out of the window as a punishment for Steph and you’ve just got to accept that these people again, we have really different ideas about themselves other people in the world’s then we’re going to have an unless we can appreciate that and get into that mindset. Then we’re always just going to be judging but they’re thinking about things wrong but you know, right and wrong and they’re choosing to do this actually may be the way that right and wrong was explained to them was very different to what we picked up dead. I remember working with a guy who has diagnosed with schizophrenia, but he’d been he was only I think he’s about twenty-five and he but he been in the hospital system since he was sixteen and because of that and decide his early diagnosis at sort of 16, I think at the time I didn’t know him when he was diagnosed. I think it was might have been drug induced but I’m not sure but he development why is he kind of stopped at sixteen? So at twenty-five when I was working with it, you know, the the complaints that I got when I when he got referred over to my team to me were he doesn’t want to work. He just wants to spend all this money on video games. He wants to smoke Wade. He wants like I’m like, he’s a sixteen-year-old. Like we’re expecting this sixteen-year-old to all of a suddenly magically be a twenty-five-year-old without any of the things the experiences that we would have gone through between 16 and 25 V that turned us from an adolescent. That’s solely focused on our own needs and pleasure and you know, having fun and having friends and doing whatever it is we want and no responsibilities. Into a young adult who you know, sometimes at that age most a lot of people would have qualifications and be starting careers and that kind of stuff and we’re expecting him to do that with none of the actual training was saying what that experiences are there training. That’s what how we get to that stage and I’ve always hung under that cuz for some reason his case it was like so obvious to me that faith is what was happening and I’ve always looked at anyone who’s been in the system cuz I’ve always found if once you get into a mental health system, if you’re in it for a long time can cause quite often, you know with Admissions and then you’ve got a period of time after admission.

00:35:04 – 00:40:06

We still trying to readjust those periods. Take away from life experiences that you might normally have a game. Which can yeah stunt your I don’t know I guess progression, you know, whatever you’re meant to be doing it and expect an age. In your Society. So I think that kind of stuff just even the fact that they’re in the system whether it’s a cute or whether your case managing them or whether you’re on a crisis team and seeing people anytime that there in the system it needs to be noted that this is a time that is being taken away from time that they would be normally having experiences that help people grow. So not only are they having a diagnosis which is taking them away from that. They’re also losing the time that would normally be going towards helping them develop into whatever they’re off stage of life is whatever age they’re at and I think that’s often forgotten. It’s often like if we you know sort of teach them to manage the diagnosis and you know that takes two years two years later. They’ll just be two years more developed does look like that then need to sort of Taylor we’re doing and Taylor our mindset like as soon as I clicked that this kid guy wage. Sort of behaving like a sixteen-year-old. I started working with him like a sixteen-year-old and we made so much progress because I started I was more aware of his level. I was more able to go. These are the kinds of things like I get it I vaguely but I remember being sixteen. I know the kinds of things are 16 year old boy wants to do and it’s usually not much he wants to sleep in to lunch time. He wants to you know, eat junk food for dinner and he wants to like he’s just learning to take control of his life. He’s learning that he has control of his life and he hasn’t quite found out how to manage that control in a healthy way and most twenty five year olds. Most and guarantee. There’s still some out there that don’t buy most twenty five yards a past that and then moving on to the next stage. So yeah, I always found that a fascinating working with anyone. Faith f thing is to sort of see well, where are they just because there are you know, chronologically and age doesn’t mean that the the behaviors of the coping mechanisms of the skills that suck at that age would normally have that this person is actually going to have I’m actually difference isn’t it is that we can look at people and kind of thing, right? This is what they should be doing. And this is double X Y and Z men if their goals are totally different to that page then you know, they’re not going to be part of our kids one and then we can think about it like you did and kind of think right. Well, why is that while we can think the sabotage in their care plan? Deliberately? I’m such a bad person and you know, if we can keep that Curiosity about why does this make sense? Then we can come up with some good reasons and do something with found wire to be the biggest question. It’s always my favorite question cuz I I don’t know even as a kid I always wanted to know why things worked or how they worked and I pull things apart to work out what was going on. I think that I guess it colder the skill set that skill-set sort of carried over into my professional life and that’s always interest me, especially when I got older and I sort of got an interest in I guess psychology side of things. I want to know why people do things. Why do they make the decisions that they make? Why did you react when this happened? Cuz that’s not how I would react that’s different. That’s why why is that different like that? Sort of stuff always fascinated me and I think we need to keep that we need to keep our skin. Why does something makes sense? Because I think it always does you know, I don’t think we do work with people who act totally runs and lie, and I think we become our most dangerous as practitioners when we start asking right and we start just judging their just do it because they are just doing this and as soon as we say that we’ve just stopped thinking about people just don’t care. Yes, cuz I think I mean a lot of people talk about, you know, being a lifelong profession and we’re always learning and I think a lot of people interpret that is CPD off and professional development and that kind of stuff whereas to me. I’m like it’s like individual clients. Like if I meet a new client, I’m learning off that person. I’m learning about that person. I’m learning how they react to learning how they think I’m letting you know what their families like what the hopes and dreams and what they’ve been up to with their life that kind of stuff like that to me is where the learning is because the moment. And I got all yet. I’ve had a person like this before this is what we did then like that’s to me that’s when the learning stops and you just phoning it in so I’ve always that’s that’s one thing.

00:40:06 – 00:45:01

I’ve always really know one thing but one thing I have always been very conscious of is that lifelong learning sort of Monica that gets thrown around with OT so often dead Is to not just think about that in terms of formal courses and yeah textbook stuff. You might usually consider when you when you hear that song that it’s it can be just down to the individual clients and I think in a lot of ways that’s more important than all of that sort of formal courses and learning and that kind of stuff. Thank you, very and I think I think there’s a failure to kind of like having a template of you know, I have some familiarity with this at the moment, but then I can recognize where things diverting from what might fit my template for being able to do that. You know, and I think that’s critical reasoning to some extent but yeah, just thinking schizophrenia. I know what to do with that. That’s not very helpful. Having said that though. I think that’s part of the reason that some people can have get that sense of you know, the they don’t quite belong on this what was cuz I think if you go onto your average psychiatric ward, somebody is acutely psychotic somebody who’s manic then the war thing, right we no longer do with this person. We’ve are very clear about what our role is here when you work with somebody who you know is hurting themselves if you work with somebody who is suicidal it’s wage. Not as obvious what the role is for the team there and again, I think that that not knowing wanting to be helpful and not knowing available that can lead to people being a bit unpopular may actually make us feel a bit. Useless. Yeah. I think that I mean that’s another population of the population but that’s another instance where I’ve heard people talk about having trouble or finding it very difficult to work with people who are acutely suicidal or thinking about self-harm or actively self-harming because I don’t I think that’s one area where It’s not made clear. What oh T’s role is with that in those situations cuz we often and I think because of the a lot of it is especially in like Fair crisis team. A lot of that is due to I guess the urgency of the situation. It’s like well, I don’t have time to you know, sit down and watch occupationally what’s missing from this person’s life and What needs aren’t being met and that kind of thing and honestly, that’s not what they need in that that you know. Of that phone call or. Visit or wherever you are. So I do think that a big that is one area where I think Some extra training might be useful 440 T’s and that might come down to OT courses actually talking about what his what oties can offer home or eat or coyotes offer anything unique in sort of those situations. Do you? What do you think do you think? Oh TVs are sort of equipped or suited not working with people who are suicidal or self-harming are some of your works with people who are suicide and self-harm. Yes. Yes. They are loaded question. Yeah, I I tell you what though, right if we if we got a new client tomorrow and we looked at how they were functioning. We wouldn’t hesitate to look at the things they do and how they get by with them and what the function of the different occupations were and there’s nothing to stop us do we met with self-harm and and suicidality, you know, so for some reason Send you know trigger warning coming, you know, some reason cut in your arms open is useful. It is better in that moment, but not doing it and we can say well that’s banned and you shouldn’t do it or we can understand what’s going on. So I in some way I don’t think we need any more training to do that. I think we just need the inclination to do that and perhaps some encouragement that that area of work. That’s something that we should probably be more interested in men so many other professions and equally as you know, that sometimes life doesn’t feel worth living. So people act as if that is true when they go and do something that might end life or is actively seeking life and the King, you know, let’s be able to adjust and that and particularly let’s be unable to understand why they’re still alive cuz something is happening that is serving a function. That means that they’re still around and again we can kind of go.

00:45:01 – 00:50:03

Well, you know, yep. They they go over those four times and they not dead yet. They’re bad and again, you know can we understand that what’s going on there? You know something really important is happening there that is keeping them alive. Let’s meet you off, but at the moment I don’t think we’re curious enough because that’s one thing I’ve talked about with students and I will actually put a trigger warning on this cuz I know some people uncomfortable with these kinds of conversations, but someone who really genuinely wants to end their life and they’ve exhausted every other Avenue for support and help there is nothing you will do that will change their mind like but the thing is with the number of people that you work with there are a lot of people that still have even just the tiniest sliver of Hope or the the tiniest protective factor. That might be wrong. Just even though they might be attempting at times. There’s something that is stopping them from making it doing something. That is so final that it can’t be undone and there’s a little tiny things that getting to know that person and sort of getting into their narrative and finding those little things and then building on those little things you can literally save someone Life by spending the time and being compassionate and showing that you genuinely care is is a big thing that I always found is dead. I don’t know why but clinicians seem to think that we can bulshit our way through situations and their clinician bullshit is easier to see through the normal bullshit because usually you don’t know the person very well. So it’s even more obvious. Whereas if you genuinely show that you care whether you’ve met that person or not, you can be on a a crisis team and you’ve never met that person before that dog. Mean, you can’t genuinely have concern and care for that person’s well-being and I think finding that or or showing that portraying that to that person is is a big step for a big First Step At least and then try to find those little protective factors. So like you said like they’ve attempted, you know, suicide four times. They’re they’re bad people. I’m like, yeah, but I’m like this something this they’ve dumped something. They’ve got some strength. That’s meant that they’ve survived four times like whether it’s a really supportive support network or dead, you know, they’ve got kids that are they last minute they sort of changed their mind and they can’t go through with it. So they bring the ambulance or whatever. The reason is. There’s something there. It’s not that they’ve failed 4 times. It’s the fact that they’ve survived and and pushed through 4 times like that’s like you like you described before like that’s a good thing, but that’s something that you should log. Right and build on and find out what it is so that you can highlight that to the person and bills on it. It’s it’s the probably the most strength based practice area that way God in health, but I think there’s anything else we can do other than be strengths-based to be successful when working with that population. And humans generally want to stay alive to know equipped a fairly powerful Instinct for that. So, you know, let’s celebrate when Matt instinctive kicking in rather than you know, laying people off but you know, I think we can be really curious about when people are suicidal and I think you hear a lot of people complain that they tell somebody that I feel suicidal and the First Response page if you tried distracting yourself from that. Yeah, I think you know, like my house is on fire. Have you tried distracting yourself? You know, we want to understand what’s going on because you know, it’s not something you know, something is happening in this person’s life that meaningless checking is is a viable alternative. It feels like it’s a useful thing so we can understand what it is in that moment. That means that life’s not worth living and maybe we can do some problem solving around that or maybe we can just validate that actually yeah, it is absolutely awful and then we can have a look at and is it going to be like this forever? You know, can we have some hope that this unbearable situation might change at some point. Can you hang on while we try and do excel buyers said that will change this unbearable thing? I don’t know if I was taught back way of articulating Suicidal Thoughts when I when I was training, I don’t think I was but you know, we we turn out of curiosity we can break this stuff down and you know, and if we don’t I don’t know who else does it, you know that this is an occupation this taking these tablets off drinking and laying down in bed is something that people are doing to serve a function.

00:50:03 – 00:55:06

We need to be able to understand understand better. I think cuz I’ve had these discussions of students office super violent. So nothing new grads that I’ve super vised and clinicians. I’ve supervised around trying to find these strengths when people are in that sort of acute suicidal phase wage. And if you if there’s nothing else that you can find the fact that they’ve talking to you is a big thing like the fact that they’re if they say especially your birth Most health services will have some sort of emergency crisis line where people can ring the fact that they made that like they picked up that phone and dialed the number and they’ve talked to someone because they’re feeling suicidal or sometimes. They attempted something that the fact that they’ve made that phone call means that there’s something there that’s telling them they want to stick around home like sat alone. If you can’t find anything else build on that. Yeah, cuz I think if we see suicidality as a spectrum like you said if somebody really wants to kill themselves, then you wouldn’t need to do anything about it because you wouldn’t know what you know, something is one hundred percent on my end of the spectrum. They just do it. Whereas everything else I think is an invitation for a different outcome. But we can and endings and like I said before like that, it sounds very drastic when I say like you won’t stop them, but the number of people that you’re well that’s cool. But the number of people that you will work with over your career, the number of people that hit that point where there’s nothing you could possibly have done. You don’t know they’re not going to tell you and they just suicide these infinitely smaller percentage than the total number of people that you may talk to about their suicidal thoughts or their place ends or you know, how they’re doing or have that attempted or that kind of thing like, it’s not I’m not trying to make it sound drastic. Like there’s nothing we can do cuz I’m just saying that if someone really wants to wage they will but that is by far and away the minority of people when it comes to the like it’s the total number of people you will have interactions with who are experiencing some song Suicidal Thoughts suicidal ideation that kind of thing. So there’s that give up. Hope there’s there’s tons of them believe it or not. That is actually highlighting that there’s a lot of birth. For you to be able to help people and not only don’t give up. Hope hold that hope for somebody else cuz they might not be able to see it. Whereas you might be able to without actually validating talk about previous experiences of helping people in similar situations before knowing people have gone through similar things and come over the other size, you know, and I think you’ve got a delicate in kind of heard you say that yeah, but you know, we’ve got a lot of experience that we can use would be I think I think one thing that is kind of unique about OT General Health is There’s very few that have actually experienced anything like the people that we actually work with like this very few eighties that have got to that point where they want to take a nice life and they need to bring for support like this. There would be very few. Oh T’s that have ever had to do that for themselves. So there’s very few eighties that sort of have that lived experience of what these people might be going through. So bear that in mind when you are like it’s okay to talk about like like you said before about you know, I’ve worked with people who have you know, described similar things to you and you know, here’s what they sort of Pride. Here’s what they talked about is that but I would be constantly trying to also offer flip that back to like is that similar to you. Do you relate to that not just try not to make it so that it’s here’s me here’s what I’ve done in the past and here’s what you should do cuz it works for someone else. So I’d be using them to more highlight examples of you kind of want to try and get the other person thinking so it’s like here’s what I’ve sort of heard of before, you know, is that something that you know, you have access to your mom. Is she around can you talk to her or you know, do you have any other close family use them as examples to kind of I guess you are high life because you don’t have that lived experience. You kind of highlighting vicarious experience through other people that you’ve worked with or that you’ve talked to Etc, but you’re using that mm. Make the other person still trying to think about their own environment and that kind of thing. You don’t have to highlight. I guess the process of what we’re doing as opposed to what like a prescriptive language is what you do to feel here’s what you do to fix your situation kind of thing, you know.

00:55:11 – 01:00:02

definitely Sorry. Let’s say the Chrome kind of self-harm. The suicidality, comes the rings with people in hospital. And again, I think this is where the environments really important wage. I see a lot of people who in the community they they sell firm in a way that is kind of relatively controlled so they might cut in a particular way or they might overdose and then go to the emergency room and seek help and what I offer to find is that when those people end up on a psychiatric ward off what becomes part of their care plan that is never going to discussed and agreed but he’s enforced as most people are going to stop self-harming there. We’re going to watch and we are going to take away whatever preference you deem to self-harm and then we can congratulate ourselves on keeping people safe while watching as they do whatever they can to get that same relief and say whatever like some Thomas do it and they still need to get it. So they you know, they start ripping Coke cans open to cut themselves with they start ligature in and you know medical news leaking where was for me. It just says there’s something in my environment that suddenly made their behavior considerably more lethal and what organizations often get stuck in is the idea will be can’t let them ain’t now we can have to keep them in this place where their way of acting is considerably more lethal to themselves until they stop doing it as opposed to when they were outside and were able to keep themselves safe a lot more. So a lot of my work at the moment is trying to get people I live environments like that kind of go to our mental health tribunals off and just argue that we can’t keep people in these places that are so dangerous to them, even though it feels weird to be a bit less restrictive. Just look at home. Restriction is interacting on this person that we’re supposed to be helping I think in those are the situations when I’ve worked with people similar to that home. I think the the natural reaction is on, you know, they’re cutting themselves take-away shop things or we’re we’re keeping I think I think a lot of the you know, a lot of that I think the intention is always good and the intention is to try and keep people safe, but you’re right. I I feel like the the lack of understanding about the reasons why that behavior is happening would come full circle back to why again, but why their behaviors happening is actually worsening it in a situation in that situation and I feel like That is hopefully before that but if if that’s the first Contact you’ve got with people is when they first hit the war two things start escalating Thursday and then don’t wait as i t as an OT your understanding of person occupation environment just even just those three concepts is off the perfect for trying to understand why people do the things that they do and what’s triggering certain behaviors. So what string self-harm behaviors Obviously if the behavior is happening outside and then brought in the hospital and it escalates then there’s something that it’s sort of carried through it’s not obviously not the home environment specifically that’s causing that behavior. You might need to explore. I always find out you to be kind of like being a bit of a detective and you can you get all these little Clues and you start the piecing it together, but do it with the person so obviously the behaviour if it’s something that’s been happening at home. Then there’s something about that home environment that is also happening to a larger scale if it’s escalating in the hospital environment and that gives you some Clues to start actually having a look at well what’s going on, you know, yeah the separated from their social networking with but they’re locked away in here. So they’re even further they feel like they’re further separated. It could be something like that, but they’re the kinds of things that you can start looking at. Based on the clues that you get you can be your own little Sherlock Holmes have a say and you only get those Clues if you’re interested in you’re curious and we can talk to people about this stuff. And yeah, and I think sometimes with the idea that the OT work starts when this stuff is out the way and you know, I would always say that this turns our work.

01:00:02 – 01:05:06

This is the stuff that we shouldn’t get any faith estimate. Yeah. That’s and I think it’s important to like this kind of stuff isn’t yes. Okay. It happens a lot more regularly on a mental health board, but this kind of stuff happens in every practice area. It doesn’t matter if you’re working in. Geriatrics adult physical doesn’t matter where you are you can they come across people who are exiting behaviors who are have mental health issues who, you know are suicidal are self-harming, whatever it is. You’re going to come across people. People who have mental health issues don’t always just end up in mental health boards. They’re probably like Iraq and 1% Maybe would ever hit a mental health ward of people who’ve experienced some sort of mental health difficulties. And obviously, I’m not leaning back that up. That’s just my assumption, but I’m highlighting that it’s a very small percentage. We have to have a lot more people going through a general hospital than there are going through a Health Board and the chances of you coming across someone who’s experiencing a mental health difficulty having as we talked about before this podcast, we had changed all this month and half ago, but I ended up in a hospital for a little thing and I had to reschedule it but that and again that was my first experience in a hospital touch wood, but I could see I just actually being there the impact on someone’s mental health the fact that I couldn’t even get a night’s sleep because someone’s waking you up every 2 hours to take your blood pressure the fact that the food is horrendous the FAQ. There are some words where you can’t actually leave cuz the doors are locked like you need eat. Yeah, even though like I wasn’t trapped I could last but the fact that I don’t have that option. I don’t have that freedom. It’s out of my control is very different to what I’m used to at home here where I can do whatever I want and go wherever I want whenever I want just being on award will have an impact on someone’s Journal Health. Like like I said, I was my first experience ever being admitted to a hospital and you may come across someone who it’s their first experience ever being they may have a car accident. They’ve been admitted to your physical rehab or wage. They’re going to experience some mental health symptoms where a major minor depending on their development. They’re coping skills their previous experiences. That’s one of our everything but they’re going to experience something whether it’s due to the accident itself or just the fact that their their health care is traumatizing. I don’t know how much I have to say that name. Something that I think we often forget and we’re too busy trying to treat what’s going on outside when we’re realizing that or not realizing cuz we’re not looking for it. The fact that they’re they’re in front of us wherever we are whatever Ward whatever team we’re working in whatever clinical setting were in the fact that they’re in front of us is going to have an impact. No one comes to see us when they’re young and healthy and they just want to say thank you tell me what right this is my experience of kind of feeling powerless and helpless in healthcare and and it’s something that I use to try and really in a small way to people who were detained right, but when I’ve got a son and a daughter, right and my daughter had broken her leg was in hospital in traction and just at that time, my son was being born in the same hospital for a couple of words apart and we’ve agreed with my daughter’s consultant job. That shouldn’t come up with us. You can come and recuperate home. So my wife’s absolutely exhausted from giving birth, but she’s ready to go. None of us have slapped pages and we’re ready to go and we’re like right with we’re taking my daughter right now. And is your weapon seen it before kind of came along them whence I know she’s got a fracture in her legs. She can’t go home and I was like, no we should treat it with a consultant. You know, this is all this is all part of the plan with we’re doing this like yeah. Yeah, they they cannot come up and I’ll tell you what we’ll cuz it’s all agreed to adjust your discharge against medical advice will you know will be all right to the power bills will be sorted and she’s like, yeah. Yeah. Well, we’ll get an ambulance so we won’t get about eight hours programme and something a month kept saying well if the physios have no we’re not going to take care of the consultant said that we can do this is all agreed and and this count on for about eighteen hours long. I’ll eventually the nurse that if you take your chance on we’re going to call children services on you and I wanted to explode and it it was one night of being in hospice and the toxic in the next day. When do you want to go home? And you still here? Yeah. I’ll see you go, but that night I wanted to explode and I think if I had had a little tiny bit less control.

01:05:06 – 01:10:00

I’d have been show in and swearing and or tearing the place down and I think you know if I had a label on me, somebody would have been saying inappropriate feelings and anger from man-to-man over there. Yeah, but I think there is something very neurotic of power that we can have in most environments that would definitely exacerbate our emotional reactions. And I just think if people who are trapped in environments that they don’t want to be in and so many decisions I mean before birth And you know, I had one tiny taste of that and I hated it but to live without day-to-day I think must be absolutely excruciating. I think that that locus of control thing is is massive in you know, what should be in all Healthcare but particularly in mental health and that’s one of the reasons why I always made a very conscious effort of every decision didn’t block. I may have made suggestions, but the final decision was never mind doesn’t matter what it was whether it was yeah, you know, do you want to play 9-ball or 8 ball on the pool table? Like whatever it was. It was their decision. Like I’m just a support and the analogy I used to use with people to try and explain I guess what I was going to do with them is, you know, you’re driving. I’m just the 50s kind of thing. So I think putting this is like deliberately even if it’s simple little stuff and you already know or you think you know, what they’re going to say is the answer like give birth. Person the option even the fact that you know, they might whatever the situation is. It might not really be an option give it to them the fact that they just bought have the power have the option there. Like I said when I was in e d I think I was in e d for I I must have been longer than that. It was probably twelve hours. And because Edie emergency is a locked Ward and yeah, I could have gone out but just the fact that I couldn’t get up and go off when if I felt like it like it was out of my control. I had to rely on someone else just to go and get a drink from the vending machine kind of thing that put pressure on me like that gave you like. Oh, that’s kind of anxiety-provoking in a way even though it was only minor, but then you get a few of those little minor things and it builds up and it turns what should be a fairly smooth thing into a negative experience. I would I would assume that on 99.9% a days you would consider yourself quite a calm logical person. And just that control being taken away and I guess the blase attitude that some people guess I don’t even think they would view it as well as I just think they don’t think about it. Not only am I might example there is like we think that you are a dangerous man who is going to hurt your children. Your punch a wall maybe but I do not welcome interpretation of me. Yeah, like and then we do it two people that we work with. It’s the same situation with where their environment including us in it is having an impact in it’s not always a positive one and unless we’re consciously looking stuff like wage that can happen. They are not even realizing that something’s wrong or that something’s having a negative impact on someone. One of the biggest ones that I get worried about is like I say, you know people self harmed in a way that was safer in the community. They do it the more dangerous way in hospital and then our response in hospital is to get people who have been sexually abused get three people to hold them down take their clothes off and inject them and we keep doing that until they recover. You know, what is that about just make it doesn’t make any sense. it it’s the same that we see it’s the same with like like behave like outbursts of behavior, especially like I used to see a lot of sensory stuff where you know, like you said earlier like a key towards aren’t necessarily the most stimulating environment. So people will find way like if they have a sensory need people will make it happen. Like people are very resourceful and sometimes those ways that they make them happen are quite maladaptive and then they end up locked in the Intensive side of the ward because they’re breaking things or they’re disrupting the peace or whatever they’re doing isolated even more and with even more limited resources, and I’m like that’s not actually going to fix it.

01:10:00 – 01:15:37

We actually need to give these people more things to do. Yeah life I can remember one, dude. Years and years ago and I was working with him and he he must have just had this sort of he just needed heavy work and they’ve ended up. I can’t remember why we ended up in the lock side of the ward and he was pulling that like concrete picnic tables and he was just strong young dude. He was ripping the tops off him and throwing them against the metal fence and the concrete was shattering and he thought that was hilarious. So he kept doing it to all of them and and their thing was like, okay, we’ll put him in seclusion. Like he’s always coming to this lot area which is lowest emulation. It’s causing more damage will put him in an even smaller room with less to do and we’ll see what happens like that can no one else see what’s happened. Yeah. And in the end, what I ended up doing is cuz the hospital that ward has a gym so I took him to the gym and he worked out here, you know. Yep. Therefore Health curling weights and trying to show off to all the all the nurses and that was it. He was good. He was calm he settled down. He just needed some input and we kept wage as a service kept like trying to put him into a less and less stimulating environment and he was getting less and less and he’s getting more and more agitated and then we were wondering why and obviously it was his fault in quotation marks because he was misbehaving. I’m like, no, it’s our fault because we are not servicing him the way he needs to be But I mean, it’s interesting what we’ve just keep doing more of what we’re doing will more and more away until we hit that magic spot and that thing off and nobody else see this is something I find happens a lot and I always kind of wondered if I’m just being incredibly arrogant when that’s happening, but I don’t think we do get stuck into these little organizational cycles of well, we will restrict and if that doesn’t work, we will keep restricted and then we might send to a more restrictive environment but home of the ones that really sticks with me at the moment is submitting who who used to sell term in private in their bedroom. They let you know that was their place where they would do it and every time they sell homes the unit would stop them going on relief and I was like, they’ve never heard themselves outside of a hospital, you know, it feels like the only reason we would stop and go home. Is it for them to sell term or we don’t want that so we can lock in their bedroom as opposed to kind of stop you in Korean only. Let’s keep them in the self home environment longer and not let them get out of it. That makes it yeah. Yeah and it’s just really put the environmental adoptions. We will keep from there. We will be more restrictive and you know, we’ll put ourselves on the book that we are doing something while kind of actively not looking at how much worse things are getting. So with with high mileage. Like most acute Wards, there’s the otsr usually vastly outnumbered by other professions. Like I said, there’s been War throughout work around the only OT and there’s been more thrilled work with us a couple. What do you think in my experience all wars have the same problem? I’ve not found on board that has somehow found some magic way to avoid all of them. In conversation with other people including yourself today. It sounds like towards a pretty similar around the world. Do you think that some something that OG clinicians can do to I guess trying to break the cycle. Like what do you think we can do to try and break that cycle even though we’re outnumbered and you know where we may not have the biggest impact on the whole workplace culture. What do you think we can do about some do you have to worked on the boards for a long time? I suppose wage, you know is occupational thinking a big part of our organizations and I don’t think it is. So the moment it would be almost Harrison in the UK make sure a occupational therapist in the board manager and there’s a couple of Marines but but I think we do that more. You know, why couldn’t white biker we lead wage. On my environment. I think monkeys are generally often a bit separate from the Wallace. They might have their own base. So they will be a nursing team and the Palm o t that comes in and out and again can we be integrated into those jeans a bit more? Can we do we have to be a separate some profession that comes on and does stuff or can we be in the numbers in the same way that the nurses are and that means that we would do some stuff that isn’t our typical role but it would also mean that we’re having a bigger impact and and again she might be changing the way the staff understand and think about people we might not be running a craft group, but we might be bringing a bit of different thinking into that team cuz you suck talked about earlier you have in becoming a part of their environment and hopefully takes their environment as well.

01:15:38 – 01:20:02

Yeah, cuz I think we I think our role should be change it challenging stigma perhaps more than other professions because it is the is the wage social environment around people. So if everybody is looking at somebody and thinking, you know that person there is splitting the team they they’re split in and and you know God that’s a seventeen-year-old girl who’s lived through abuse for years to know they they don’t have the power to pull highly functioning teams apart and something that’s going on with us off of that trying to send the other that of your team’s really not that highly functioning if that’s happening. Well, yeah, but but so much better to be able to blame the one person for IT and kind of look like well, I’m like falling down ourselves. But yeah, I think we could have OTS working within our organizations a lot differently. I think some people would object to log. Traditional mode see that’s that’s not what we normally do. Well, let’s do it. Let’s let’s do it. You know, there’s a couple of pioneers out there who are running boards and leading services and let’s get behind them because that one that’s what show was that we can do that work. I think I think in my career, I’ve been really lucky in that. I think it’ll probably more than half. The teams of ever worked on have actually been run by OTS. So kind of been lucky I think that’s fairly rare for a lot of people but none of the impacts are towards the inpatient Wards of always been run by the unit manager and you’re right. I think it would be even that simple change. I think it would be a massive organizational change and a massive cultural change. I don’t know how you do it on a very sort of long-existing Ward, but I think having a it’s even any any other profession run a war cuz I think predominantly they tend to be dead. Then to run towards and that’s one of those things where I think it’s just this is how it’s always been. So this is how it is, but even put a social worker in that point of no T in their put a song anyone in there. I think it would be a very interesting thing to see how the ward culture it’s self changed and I think it would be for the better off it would yeah, we’d always talk about diversity but I think adding more influence from some of the more I guess what you’d say minority professions on an inpatient Ward or even within many mental health teams would be very interesting especially for an OT. I could see that having a huge benefit. One of them was thinking before too is one of the biggest benefits I made or I found when I was working clinically was like you said quite often just the layout of wards is OTP You know, they’ll have a little office somewhere or they may not even like one of the wards office wasn’t even on the water was you know in the building but sort of out of the water down the hallway, so we went accessible to works out. We want accessible to the the patients the clients. So one of the biggest changes I made I made a lot of changes all at once but one of the biggest ones I’ve made was I pretty much realized. Well, I’m not actually typing something. I don’t need to be in my office. So any spare time I would often just sit in the dining room or in the TV room with the page that were on the war then you know, yeah, if I was talking to them, even if I had nothing else to do which was rare just have a conversation with them and just be with them. I just trying to normalize the or Trying to minimize the sort of us and them that just naturally happens on a ward like that anyway. Yeah. And you can share a coffee then have a coffee have a chat. Obviously, I believe him alone if they want to have their own space, but sometimes there was no one there and sometimes they’d see you sitting in there and come and sit with you and have a chat they’d instigate which again that tells you something about people like everything that you observe can tell you something about the people that you’re observing.

01:20:03 – 01:25:03

I think let’s do we amount makes you part of the staff team as opposed to you being in a different environment or somebody who they have to refer back to, you know, you just become part of the way that that Ward works and and again, you know in a very simple way that means you’re doing more input with those pages and groups and stuff, but I think probably the more the more important stuff is that your influence in that culture in a way that wouldn’t happen. If the OT just came on for Dolby a special things. Yeah. I think one of the important things in be curious to see your opinion on this cuz I’ve long had the opinion that an acute unit may not be the best. Environment for a new grad and I say that purely because in my experience with them they do have these very long hot and cultures on the workplace. Which tend to form you guys come in whenever someone graduates their main thing is like how they want to impress and they just want to do a good job and then do whatever anyone tells them because that’s nice is and they tend to be shaped by the culture as opposed to coming in with their own individual identity that they’re confident enough in to maintain and make changes themselves off. I’ll be Keen. Do you have any thoughts about whether or not it’s it’s sort of a suitable environment for a new grad or Wild thinking of printed on the spot. I think I suppose it depends cuz I think it’s it’s not so much award environment need the idea of kind of having the kind of closed institution where people can’t think I think that’s where things become quite toxic and you know, potentially Ward environments have got that to a greater extent than Community Services, but I think Community Services can be entrenched in the way that they’ve read about things as well. You know, I like certainly worked in Community Mental Health Team, but would say we don’t work with that client group that you work with Kia and I’ve always kind of amazed that they think that anime is that they feel confident need to say it. So yeah, I don’t know if it is just about that physical environment and if it’s a bit more about the cultures that can develop dead. Yeah, I’m very conscious as well. A lot of people first mental health placements are on the keyboard. So I mean that’s that’s where people go a lot of their time and yeah, could you take that away with the benefits taking that away with it being Replacements left? I think that’s probably a bit different over here cuz I reckon the majority of our mental health placements our community wage over here in the districts that I’ve worked in any way they have been. Yeah, I think I maybe that’s part of my experiences. I went on the placement on a inpatient unit. So everybody off and on like like I said, my very first job was an inpatient unit. So I’m the epitome of what I’m saying. Probably shouldn’t happen, but and I wouldn’t change it. I learned a lot in that team that seemed to slightly different to a pure impatient, but I think it takes a unique new grad to flourish in that Environment Straight Out of uni and wage. From my experience like I was talking about before I kind of got interested in that bubble of not really seeing the progress that people make outside at only seeing the worst or people win their their worst home and I didn’t really until I left that job and I went into Community case management after that and then all of a sudden it was like, oh there’s this whole other side to mental health care that I hadn’t seen up until that yeah sort of thing. So yeah, it’s interesting. There’s a few people. I’ve got a few people’s opinions on that and some of them are like getting a dog in in some like you or like I can kind of see how it could work, but I can see how sometimes it might not but yeah, it’s it’s an interesting thing. My my first ever job was in a special security hospital. So like people who were regarded as quite dangerous and I thought it was little it’s kind of like a lawn Hill in the middle of nowhere and Other people they’re just like they they weren’t going anywhere very quickly and let’s just fine. But my my experience of the work there was of a very closed institution. We’re off there was a lot of judgement towards the people who had been admitted there and some of them had done some horrific things. But you know, it was a huge us and then culture it was a huge culture of chrome trouble.

01:25:03 – 01:30:04

I’m probably leaning that way more than therapy. And again, you know, somebody is an in-patient environment, but that’s a place that even though he was a really awful OT service there. It wouldn’t take much to kind of really get into that mindset of us them control restraints keep them in their place. And you know, I think if I’d stayed in a long time that that would have seeped into me quite a lot and again, I don’t know if I as in patient in general or that kind of closed off separate Institute wage Foster’s a particular way of thinking yeah. Yeah. It seems I think a lot of the community services here are seemed to work fairly well together so they’re not home. So I load as I can see them being in in other services and maybe that has an impact whereas the impatience of is very solid collected. That’s it even has got a lot to us as well off swipe card to get in but even the fact that like where I worked my last job there’s two are here. It’s a secure unit and there’s a car park between them and that’s it and you never saw anyone from the other unit like that was it? Yeah, they worked in that unit. You worked in that unit. That was it. I didn’t even know who the OT was in, you know like home. So I had times it is a very silent service. So you’re right. It could very well be more to do with how isolated the team is where and then dead. The I guess the culture that that creates within any team, not just the the inpatient aspect of it. Yeah, that’s interesting. So what’s so you say you’re doing other work now? What are you doing now? So I left the NHS in April and I worked my own company and you know, I just kept seeing young people. He was oxygen kind of self-harm and and deeper currently suicidal and they would be sent to private hospitals that were very bad for young men’s. Nobody told that they were going to be very useful and I find that very difficult to watch particularly because I’d come from a team that never sent people to private hospitals off. So I was seeing people who I know if they lived in another part of the country. They just need support in the community know they were going to lose years of their life. So I want you to turn off an alternative to that. So yeah Beam Beam helps people who pay for those private hospitals to have a different option. So wage. We support people in the community. Yeah, this is supporting them to get out like to discharge from those profiles. So it depends at what point we get involved. So we have helped people who are in private hospitals to Thursday. We have helped people who are on a keep units where they are thinking of placements to approach hospitals. We’ve we’ve given them another option. So they take the mass and touch people. That’s awesome. That’s really good. Is that is that a common? So I don’t know in Australia in my experience. There’s not a whole lot of private mental health stuff going on. There’s a few. Yeah, but there’s it’s by Far and Away mostly Public Health within Mental Health Services. Is it common over in the UK for privates Mental Health Service to be offered or are you breaking new ground or how what you see in like over this? Definitely support? Seems accommodation is is a thing so people could would move into houses with support workers in there. It’s to help the kind of private home service in the community. That isn’t just you know, a bit of 121 feral horse is it’s fairly new I think with like to think of ourselves as being quite often, but you know in a way, you know, I I did and must have degree in person and sort of it was funded by the Health Service in Britain. And what I wanted to do was then taken back into the NHS and help them to stop sending people to private hospitals. And but the typically I find is that all the jobs where you could do that they were only for psychologists psychotherapists and you know these jobs you would get in there, you know, so my my dissertation was on how much he was stopped using Private Hospital placement dead. And the place I would working would have meetings about how to stop this happening and I couldn’t be invited along now.

01:30:04 – 01:35:01

That’s like my dissertation house or yeah, so it was really frustrating interesting that and you know, it costs a million pounds a year to send for people to a private hospital and again, you know because nobody’s got any optimism, but that’s going to make any difference. It just felt such a waste of taxpayers money in a country. It’s like two and a half million Australian that’s massive. Yeah, and we will not get we will not get good Community Services while you’re spending that much money on what is basically locking people up off the old the old a solemn model. Yeah, and you know, it’s one of the few Publications I have ever made so I managed to get something in the landscape last year’s. Say that we send people to private hospitals not because we think it will make them better. But because we are worried that they will die on our perch. So if we expose Enterprise in hospitals that he can be dangerous there they can hold the risk of it and we can feel all right, and you know, it just kind of goes against what I feel as a human being that we should be doing stuff based on our interests and organizations interests rather than the interests of the people that we’re working with like the moving the cops around of responsibility like who’s going to be cuz I’m just going to shoot around, so that’s kind of that’s kind of what I do in beam and then I’m really interested in kind of mental health tribunals as well. So if you get detained in this country, you are able to appeal wage attention and I saw myself I was in experts to kind of go along and say, you know, this this restriction is generally making this person worse, and they are probably better off not home. Spill so I’m quite enjoying that and then we do a lot of training and round what gets described as personality disorder, but working with people who are recurrently suicidal and self-harming off. So it’s in some ways. It’s quite scary to be working for yourself. And in other ways, this is exactly what I want to be doing. This is it’s a very much took some parts of the of the NHS work. We don’t the crippling bureaucracy and hierarchy that was crushing the yeah. Yeah. There’s a lot of our civil areas between the NHS and the whole system over here by the sense of even just like team structure and a lot of the models are often quite similar like the the models of practice of golf and comb unless I The the comment about bureaucracy definitely resonates. It’s one of the biggest I didn’t even realize it sort of how bad it was until I left and I was like, oh man, that was that’s so the whole world doesn’t operate like that who knew? Yeah and you’ve also started a podcast off. Yes. So me and Holly Barragan so Holly is a lived experience practitioner that I work with Allah and we’re going to be talking to people who have some level of influence or have something important to say around the work of personalities cylinder. So we’re talking to I know you’ve got International audience. So this name is might not mean that much. So we’re talking to Norman lamb who was an empty over here. Joel Paris is a very influential psychiatrist. In the world personality disorder talk to Nicholas thought who’s she’s an actress and she’s a campaigner. He’s one of the few people in the public eye to talk about I have this song BPG diagnosis suggests. Yeah, it’s quite nice just to talk to people that I find quite interesting. I’m interested in and the about having a podcast. Yeah. So the people who are interested in a plot school, but yeah, it’s in some ways. It’s more for me anything else and what what’s it called? Whatever you guys name? Yeah, so it’s called it’s called the wrong kind of mass, which is how often people refer to personality disorder. It’s you know, you your needs are not high enough to access this level of care, but actually off too complex for us. So you can’t access that level of care. So we we got people on Twitter to vote for what the name should be. So yeah the wrong kind of meds which you should be able to get from most places accept wage. At the moment. I thought it’ll be ah reckon by the time this episode comes out. They’ll be able to get it pretty much anywhere and I’ll I’ll throw links in the show notes if anyone is Keen to check that one out.

01:35:01 – 01:37:12

I’m definitely Keen to have a listen cuz it sounds super interesting and I love that lived experience. I’ve had a few people on occupied with long periods of various diagnosis. I just always find that the really valuable learning material is lying directly of people same as I said earlier about learning off individuals that you work with. I always yes, that’s the bit of the job that I love the most I tell you what Holi wrote a really good piece on occupational therapy groups that need to be the pounds off. So I’ll Whip that over to you and you can consider here as a guest for some sounds good sounds awesome. Yeah. Thanks for calling minimum wage. I know I know. I know it took a while. We’ve like followed each other on social media for however many years. I tell you what right? You took a long trying to follow me on Twitter some extent but I was thinking what have I done? What why do you wouldn’t hear you? What’s going on? So yeah, I was I was always exam social media are used the least. That’s probably because I used I thought I swear I fall excited to see your stuff all the time unless it was like, yeah well off with someone else that I follow that just retweeted your stuff so much that I just assumed that I’ve ology but yeah, it’s it’s been a long time coming and this is the second time lucky cuz we didn’t get to do it last time like a month or so ago. Yeah, super super glad that we we got to hang out and have a chat and yeah, it’s definitely excellent. Yeah. I have enjoyed it. We must do it again.