1. 1 The Search for Compassion Paul Lumsdon- Chief Nurse, Executive Director of Nursing and Quality @Paul_Lumsdon

2. The Search for Compassion 2

3. What is Compassion? Definition: “…a sensitivity to the suffering of self and others, with a deep commitment to try to relieve it.” The Dalai Lama (1995) It is not a new concept. The work which is demonstrated here is the culmination of many years of research and development. 3

4. Compassion 4

5. The Search for Compassion- Aims 5 Compassion Focussed Theory Compassion into Clinical Care Compassion into Management

6. The Search for Compassion Quality Visits Centre for Compassion Compassion Training Research and Development Serious Untoward Incidents Compassion Metrics Coaching 6

7. The local context Professor Paul Gilbert (O.B.E ) a Professor of Clinical Psychology University of Derby, an internationally renowned researcher and therapist who has worked for our trust for over 25 years. Paul is leading the way with the team at the Centre for Compassion to build on the work that has already been achieved within our Trust to benefit the people who access our services and staff 7

8. The human brain is the product of many millions of years of evolution – a process of conserving, modifying and adapting

9. Why we have complex brains and minds that are difficult to understand regulate 1. Old Brain Emotions: Anger, anxiety, sadness, joy, lust Behaviours: Fight, flight, withdraw, engage Relationships: Sex, status, attachment, tribalism 2. New Brain Imagination, fantasise, look back and forward, plan, ruminate Integration of mental abilities Self-awareness, self-identity, and self-feeling 3. Social Brain Need for affection and care Socially responsive, self-experience and motives What happens when new brain is recruited to pursue old brain passions?

10. Types of Affect Regulator Systems Incentive/resource- focused Wanting, pursuing, achieving, consuming Activating Non-wanting/ Affiliative focused Safeness-kindness Soothing Threat-focused Protection and Safety-seekingActivating/inhibiting Anger, anxiety, disgust Drive, excite, vitality Content, safe, connected 10

11. Components of Compassion WARMTH Adapted from Gilbert (2009) 11

12. Compassionate Mind – Alleviation Imagery Attention Reasoning Feeling Behaviour Sensory Care for well- being Sensitivity Sympathy Distress tolerance Empathy Non-Judgement Compassion ATTRIBUTES Warmth Warmth Warmth Warmth ALLEVIATION 12

13. The Search for Compassion Quality Visits Centre for Compassion Research and Development Serious Untoward Incidents Compassion Metrics Coaching 13 Compassion Focussed Therapy

14. Compassion Training Compassion training has been split into levels 1.1 hour basic awareness training for non leads. 2.1 day training for lead staff. 3.3 day introduction to compassion focussed therapy. 4.36 week Post Graduate Certificate with Derby University. Training has been conducted in a compassionate way with flexibility to allow staff to attend. The training content has been guided by Professor Paul Gilbert and Dr Rayner. 14

15. Compassion Pathway Training 15 Compassion awareness training delivered to a whole care pathway including: a)Acute inpatient ward b)Crisis Resolution and Home Treatment Team c)Outpatients accident and emergency liaison service d)Occupational Therapy and Recreation e)Hotel and Reception Staff f)Locality Pathfinder and Recovery Service. 95% success rate in terms of delivery. Positive feedback confirmed that it achieved the stimulation of interest, encouraging people to attend further training: ‘Well structured, enlightening and very thought provoking’ ‘feel like I want to learn more, need more information’

16. Compassion into Practice Melbourne House is a 10 bedded rehabilitation gender specific service for women with complex mental health needs. Primarily it is designed to provide a transitional step between secure and community based services. The Trust has taken a whole service approach. Two staff are undertaking the 36 week course with plans for a further two. Training delivery will include: a)Coping strategies and surviving stressful environments to all staff. b)Professor Paul Gilbert to provide monthly supervision sessions to staff. c)The compassion trained staff will provide awareness training to existing staff and as part of inductions for new staff. d)Staff will undertake regular de briefs to discuss feelings and concerns. e)Networking with Cygnet who are using a similar approach. f)All staff will have access to the psychologist at Melbourne House. g)Pre and post assessments will be undertaken to assess the benefits of this approach. 16

17. The Search for Compassion Quality Visits Centre for Compassion Compassion Training Research and Development Compassion Metrics Coaching 17 Compassion Focussed Therapy

18. Serious Untoward Incidents Traditional approach Compassionate approach What we did differently a)Reduce anxiety/ threat b)Stimulate green thinking c)Start with the team description and reflection d)Share findings with the team e)Co-produce conclusions and recommendations. Advantages Disadvantages 18

19. The Two Psychologies of Compassion Compassion can be defined in many ways: As a sensitivity to the suffering of self and others with a deep commitment to try to relieve and prevent it Two different Psychologies –To approach, understand and (how to) engage with suffering –To work to alleviate and prevent suffering - nurturing Each more complex that might at first seem

20. Types of Affect Regulator Systems Incentive/resource- focused Wanting, pursuing, achieving, consuming Activating Non-wanting/ Affiliative focused Safeness-kindness Soothing Threat-focused Protection and Safety-seeking Activating/inhibiting Anger, anxiety, disgust Drive, excite, vitality Content, safe, connected

21. Threat and Compassion Suicide investigations are, by their nature threatening and therefore will stimulate threat- based emotions and ways of processing information –mostly defensively Compassion-based investigations understand the nature of this threat, seek to contain the threat and be mutually supportive to all involved and collaborative, with attention to non-verbal communication and the intention of creating non- persecutory, open and supportive learning

22. Threat vs Compassion investigations Compassion based Desire to understand and recognise suffering in all ( staff and family) Collaborative, genuine exploration –bottom-up and shared solutions Desire to become one’s best – open to/learning from one’s mistakes Shared learning and support for improvement Emotions are regret, sorrow, sadness Compassion-based minds are open to suffering and struggle, openness to difficulties and building mutually supportive systems Threat-based Desire to fault find Top-down –fear of down rank attacks criticisms Desire to punish and condemn Backward looking –blaming and shaming Emotions are anxiety, fear anger, frustration contempt. Threat-based minds give rise to threat-based solutions –mostly avoidance of harm and threat

23. ShameGuilt Rank Mentality Attention is on damage to self and reputation (inward) Feelings are of anxiety paralysis confusion emptiness - self-directed anger Thoughts focused on negative judgments of the ‘whole self’ Behaviours focused on submissive appeasement, escape, apologetic denial, avoidant displacement, self-harm Caring mentality Attention is on hurt caused to the other (outward) Feelings are ones of sorrow sadness and remorse Thoughts focused on the other, sympathy and empathy. Focus on behaviour – what one did Behaviours focused on genuine apologies, reparation, making amends

24. The Search for Compassion Centre for Compassion Compassion Training Research and Development Serious Untoward Incidents Compassion Metrics Coaching 24 Compassion Focussed Therapy

25. Quality Visit Programme Allows teams to promote what they do well Supports them to improve Rewarding Teams are in control Teams are connected to their topic Ward to Board The visitors go to the teams Visits are facilitative with a problems solving element. Anger, anxiety, disgust Drive, excite, vitality Content, safe, connected 25

26. In the paper presented to the Trust Board in October 2010, 8 expected benefits from the quality visits were set out. The Trust is now in season 4 of the Quality Visit Programme. Each season has had a common theme. Season 1- Dignity, Season 2- Staff and Patient Safety, Season 3- Patient engagement, Season 4- The Trust Values 1. Increased Staff Morale and Staff Satisfaction 2. Improved Outcomes for Patients 3. Increase in use of innovation 4. Increased sharing of best practice and learning lessons 5. Increased patient and carer engagement 6. Increased visibility of senior management 7. Increased Board awareness of service delivery to inform decision making 8. Increased embedding of Quality as the Trust’s organising principle QUALITY VISITS All teams are visited in each season by teams of 2-4 people comprising Executive Directors, Non-Executive Directors, Heads of Service, Divisional Nurses, Trust Governors, Commissioners and the Coroner. 26

27. For each season we have sought the views of the teams: 1.What they considered to be good about the quality visits in the previous season. 2.What they would like removing from the Quality Visits for the coming season. 3.Any other suggestions for changes for the coming season. 4.What should be the common theme for the next season? Teams choose the theme and are given a free reign on how they demonstrate this in their practice. 5.Any other suggestions for the coming season. 6.Their views of what the external viewpoint in the previous season brought to the visits ( eg. Trust Governors, Non-Executive Directors, Commissioners, the Coroner). 27

28. Team results across seasons 1-3 28

29. The Search for Compassion Quality Visits Compassion Training Research and Development Serious Untoward Incidents Compassion Metrics Coaching 29 Compassion Focussed Therapy

30. 30 Structure for Compassion Research Audit Centre of Compassion Training Patient Experience Outcome Comms (Aim, Who, Where, Plan How to contact and be involved Structure Clinical Director Head Board Fellows Admin Reporting to: Clinical Cabinet Governance - Board Clinical Development External Internal Physical Identify Verbal/Read Outcomes Enablers KEYKEY KEYKEY How It Supports Trust Strategic Direction

31. Centre for Compassion Not a physical centre but a Hub. A team of people working to progress compassion and compassion focussed interventions. The service is available to all staff. It will support and help staff to participate in research into practice, practice-based evidence and evidence based practice in compassion and compassion focussed intervention. The centre structure consists of: a)Clinical Director b)Clinical academic Director Lead c)Head of the Centre d)Clinical Experts e)Service user representatives f)Research and Clinical audit representatives g)University of Derby programme leads h)Administrators 31

32. The Search for Compassion Quality Visits Centre for Compassion Compassion Training Research and Development Serious Untoward Incidents Compassion Metrics 32 Compassion Focussed Therapy

33. A combination of Co-active coaching and CFT Ingredients: 1.Co-active Coaching 2.Compassion Focused Theory 3.Jacob L Moreno Directions: 1.Blend together 2.Add a dash of Jacob L Moreno to complete the mixture. LISTENING CURIOSITY Incentive/resource-focused Wanting, pursuing, achieving, consuming Activating Affiliative focused Safeness-kindnessSoothing Threat-focused Protection and Safety-seekingActivating/inhibiting SELF- MANAGEMENT ACTION LEARNING INTUITION 33

34. The Search for Compassion Quality Visits Centre for Compassion Compassion Training Research and Development Serious Untoward Incidents Coaching 34 Compassion Focussed Therapy

35. Compassion Metrics It is critical that the compassion metrics capture the “felt sense”. Compassion metrics add extra layers to existing systems and processes. They are part of a collaborative approach, which is represented by an agreed view based on a panel decision. The compassion metrics help to close the gap between targets and perception. Compassion will be measured against the 6 attributes in the following 4 domains of the organisation: 1.Clinical Patient Outcomes 2.Management and Leadership Outcomes 3.Environment outcomes 4.Staff relationship outcomes. 35

36. Compassion Circle 3 variations AttributesSelf CompassionCompassion to others Compassion from others 1. Sensitivity I notice when I am distressed I would notice that the person was distressed The person noticed when I was distressed 2. Sympathy I have a sense of wishing to help myself when I am distressed I would feel moved to help the person I felt that the person was genuinely moved and wished to care for me. 3. Non-judgmental I accept, rather than judge myself, when I am distressed. I would accept the person in their distress The person accepted rather than judged me. 4. Empathy I am able to makes sense of my feelings The person’s feelings would make sense to me I felt that the person understood my feelings. 5. Distress Tolerance I am able to tolerate my distress. I would be able to tolerate being with the person The person was able to tolerate my distress. 6. Well-being I actively invest in my own well-being The person’s well-being would be important to me. The person was clearly concerned about my well- being. Ref: Professor Paul Gilbert, The Compassionate Mind. 36

37. Compassion Metrics 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 1. Sensitivity 2. Sympathy 3. Non-judgmental4. Empathy 5. Distress Tolerance 6. Well-being 37

38. The Search for Compassion Quality Visits Centre for Compassion Compassion Training Serious Untoward Incidents Compassion Metrics Coaching 38 Compassion Focussed Therapy

39. Research and Development- Useful links. The Centre for Research and Development: The Centre for Compassion: The Trust Values: The links for all the above can be found on Twitter: @Paul_Lumsdon The Centre for Research & Development Ashbourne Centre Kingsway Site Derby DE22 3LZ. 39

40. Next Steps Grow the model, train the whole Trust. Dynamic DVD resource created to improve the flexibility of learning. Compassion in everything we do- Care Quality Commission visit. Further Develop research into clinical application, management application and environmental application. Networking and working with partners in other organisations. 40