1. Effective Communication; Verbal and Non-Verbal “Good Communication can aid Recovery, Poor Communication can be abusive”

2. Sometimes we may speak to another in a way which has a negative effect on how they feel. We may not even be aware. This is true of conversations with our friends, partners, clients and colleagues. Even our selves in the case of harsh inner dialogue. In conversations with clients and in reflection on my own personal experience of the patient journey, there is much concern and distress arising from what is at best careless words and at worst abusive attitudes. I was delighted when I first saw Detraction codes, people were aware of this problem and had found the words to express them to mental health professionals, in a non-critical way likely to engender reflection. 2

3. 3 Empathy and trust improve relationships and communications, handling complaints and, in an age of competing service providers, customer retention.Empathy and trust improve relationships and communications, handling complaints and, in an age of competing service providers, customer retention. Empathy and trust will defuse conflict.Empathy and trust will defuse conflict. One-sided persuasion is not sustainable and is often insulting.One-sided persuasion is not sustainable and is often insulting. Part of the 'empathy process' is establishing trust and rapport.Part of the 'empathy process' is establishing trust and rapport. Creating trust and rapport helps us to have sensible 'adult' discussions Creating trust and rapport helps us to have sensible 'adult' discussions A useful focus to aim for when listening to another person is to try to understand how the other person feels, and to discover what they want to achieve.A useful focus to aim for when listening to another person is to try to understand how the other person feels, and to discover what they want to achieve. Mostly, people don't listen - they just take turns to speak - we all tend to be more interested in announcing our own views and experiences than really listening and understanding others.Mostly, people don't listen - they just take turns to speak - we all tend to be more interested in announcing our own views and experiences than really listening and understanding others. From; Businessballs.com ‘Seek first to understand, and then to be understood’ Covey

4. Detraction Codes were developed within Bradford Dementia Care. They form a part of Dementia Care Mapping (DCM). They are words and actions which damage a persons sense of value and undermine their personal identity. We thought it would be useful to examine the codes and develop awareness of them within Adult Mental Health Services. Detractions range from Mild to Extreme and sit at all points in between 4

5.  A staff member buttons a service users coat when they can do it for themselves.  Staff says to service user “ your hair is a mess today.”  Speaking about a service user in their presence without including them.  Telling service users what they should and should not wear.  Sending a service user to put on their night wear early in the evening then sending them off to bed at 9pm 5

6.  Staff gathered around service user who has fallen out of wheelchair, no one helps saying “this is a rehab ward she must learn to get up herself”  Service user is sent to her room, as care worker rudely and loudly say's" I'm tired of your shouting”  An informal service user is threatened with being detained under the Mental health act for not doing as their told.  An informal service user is told that if they do not take their tablets they will be held down and forcibly medicated. 6

7. Undermines Comfort Needs Intimidation Making a person frightened or fearful by using spoken threats or physical power. Withholding Refusing to gave asked for attention, or to meet an evident need. Outpacing Providing information and presenting choices at a rate too fast for a person to understand. Undermines Identity Needs Infantilisation Treating a person in a patronising way as if he of she were a small child. Labelling Using a label as the main way to describe or relate to a person. Disparagement Telling a person that he or she is incompetent, useless, worthless, incapable. 7

8. Undermines Attachment Needs Accusation Blaming participants for things they have not done, or have not been able to do. Treachery Using trickery or deception to distract or manipulate people in order to make them do or not do something. Invalidation Failing to acknowledge the reality of a person in a particular situation. Undermines Occupation Needs Disempowerment Not allowing people to use the abilities that they do have. Imposition Forcing people to do something, overriding their own desires or wishes, or denying them choice. Disruption Intruding in or interfering with something people are doing, or crudely breaking their ‘frame of reference’ 8

9. Objectification Treating people as if they were lumps of dead matter or objects. Undermines Inclusion Needs Stigmatisation Treating people as if they were diseased objects, aliens or outcasts. Ignoring Carrying on ( in conversation or action) in the presence of someone as if they are not there. Banishment Sending someone away, or excluding him or her; physically or psychologically. Mockery Making fun of people; teasing them and making jokes at their expense. 9

10. Should you be present when a service user is subject to this type of treatment and you do nothing then your lack of action is a form of consent. That is the message you convey. There are several frameworks which suggest alternative methods of interaction. Personal responsibility requires each of us to challenge harm to, neglect or abuse of service users. There is however another side to the DCM which is the Enhancement codes. 10

11. Supporting Comfort Needs Warmth Demonstrating genuine affection and concern for the person. Holding Proving safety, security and comfort to a person. Relaxed Pace Recognising the importance of helping create a relaxed atmosphere. Supporting Identity Needs Respect Treating people as valued members of society and recognising their experience. Acceptance Entering into a relationship based on an attitude of acceptance or positive regard for the person. Celebration Recognising, supporting and taking delight in the skills and achievements of the person. 11

12. Supporting Attachment Needs Acknowledgement Recognising, accepting and supporting people as unique and valuing them as individuals. Genuineness Being honest and open with people in a way that is sensitive to their needs and feelings. Validation Recognising and supporting the reality of the person. Sensitivity to feeling and emotion take priority. Supporting Occupation Needs Empowerment Letting go of control and assisting to discover or employ abilities and skills. Facilitation Assessing levels of support required and providing them. Enabling Recognising and encouraging a persons level of engagement within a frame of reference. 12

13. Collaboration Treating the person as a full and equal partner in what is happening, consulting and working with them. Supporting Inclusion Needs Recognition Meeting the person in his or her own uniqueness, bringing an open and unprejudiced attitude. Including Enabling and encouraging the person to be and feel included, physically and psychologically. Belonging Providing a sense of acceptance in a particular setting regardless of abilities and disabilities. Fun Accessing a free, creative way of being and using and responding to the use of fun and humour. 13

14. What these principles demand of us then is to treat those, whom we have the honour of working beside, as we would wish to be treated, as if this were your mother, your child, your beloved. “Inherent in the DCM is the scope for identifying and recognising really excellent care. If the daily life of long stay patients is to improve we have to evaluate against standards of excellence, not standards of mediocrity.” Brooker 1995 14

15.  Capabilities For Inclusive Practice – D.O.H.  Top ten tips for recovery orientated practice - Shepherd, G. (2007) Specification for a comprehensive ‘Rehabilitation and Recovery’ service in Herefordshire.  Dimensions of hope inspiring relationships – Repper and Perkins; Social inclusion and recovery; A model for mental health practice/  NIMHE guiding statement on recovery – www.nimhe.org.uk www.nimhe.org.uk  Making Recovery a Reality - Sainsbury Centre for Mental Health,  Creating and inspiring hope – CCAWI;ESC Recovery Training, Integrating recovery values and principles into everyday practice. 15

16.  –Working in partnership  –Respecting Diversity  –Practising Ethically  –Challenging Inequality  –Promoting Recovery–Identifying People’s needs and strengths  –Providing service user centred care  –Making a difference  –Promoting safety and positive risk taking  –Personal Development and learning 16

17. 1 Valuing people as human beings 2 Acceptance and understanding 3 Believing in the person’s abilities and potential 4 Attending to people’s priorities and interests 5 Accepting failures and setbacks as part of the recovery process 6 Accepting that the future is uncertain 7 Finding ways of sustaining our own hope and guarding against despair 8 Accepting that we must learn and benefit from experience 17

18. 18 Focus on people rather than services. Monitor outcomes rather than performance. Emphasise strengths rather than deficits or dysfunction. Educate people who provide services, schools, employers, the media and the public to combat stigma Foster collaboration between those who need support and those who support them as an alternative to coercion. Through enabling and supporting self-management, promote autonomy and, as a result, decrease the need for people to rely on formal service and professional supports.

19. After each interaction, the mental health professional should ask her / himself, did I… 1...actively listen to help the person to make sense of their mental health problems? 2...help the person identify and prioritise their personal goals for recovery – not professional goals? 3...demonstrate a belief in the person’s existing strengths and resources in relation to the pursuit of these goals? 4...identify examples from my own ‘lived experience’, or that of other service users, which inspires and validates their hopes? 5...pay particular attention to the importance of goals which take the person out of the ‘sick role’ and enable them actively to contribute to the lives of others? 19

20. Did I… ..identify non-mental health resources – friends, contacts, organisations – relevant to the achievement of their goals? ..encourage self-management of mental health problems (by providing information, reinforcing existing coping strategies, etc.)? ..discuss what the person wants in terms of therapeutic interventions, e.g. psychological treatments, alternative therapies, joint crisis planning, etc., respecting their wishes wherever possible? ..behave at all times so as to convey an attitude of respect for the person and a desire for an equal partnership in working together, indicating a willingness to ‘go the extra mile’? ..while accepting that the future is uncertain and setbacks will happen, continue to express support for the possibility of achieving these self defined goals – maintaining hope and positive expectations? Shepherd, G. (2007) Specification for a comprehensive ‘Rehabilitation and Recovery’ service in Herefordshire. Hereford PCT Mental Health Services. 20

21.  What is Human – Tom Kitwood  Dementia Care Mapping: Principles and Practice – Dawn Brooker and Claire Surr  Dementia Care Mapping- http://www.brad.ac.uk/health/dementia/dc m/index.php http://www.brad.ac.uk/health/dementia/dc m/index.php  Virtual Ward - www.virtualward.org.ukwww.virtualward.org.uk  Recovery and the Conspiracy of Hope – P Deegan  Recovery articles and links- www.recoveryleeds.blogspot.com www.recoveryleeds.blogspot.com 21

22. Presented By  Bev Thornton - beverley.thornton@leedspft.nhs.uk  John Thorpe – johnthorpe@nhs.net 22