The elephant in the room. John Wattis University of Huddersfield Education, training and supervision for professionalism based on co-production: The elephant in the room. John Wattis University of Huddersfield

Defining terms Professionalism: Education and Training: Supervision: Different meanings in different contexts (e.g. sports) In caring professions – being registered with a professional regulator like the GMC for medics and adhering to standards with respect to knowledge, skills and performance; safety and quality; communication, partnership and teamwork; and maintaining trust/integrity Education and Training: Training relates to specific skills Education relates to developing intellectual capacity and the ability to maintain and apply it in complex situations - professionalism Competency-based education Supervision: Managerial and developmental – how much of each?

Beyond Competencies Co-production of mental health = professional competencies (knowledge & skills) + personal professional development (attitude/aptitude &motivation) + situational factors. + the other (thou-I relationship)

Competencies for professionals engaged in co-production of mental health? A. Setting the Foundation   1. Meeting Ethical Guidelines and Professional Standards 2. Establishing the working Agreement B. Co-creating the Relationship 3. Establishing Trust and Intimacy with the person 4. Presence C. Communicating Effectively  5. Active Listening  6. Powerful Questioning (to help the person explore their own needs, values, purpose and direction) 7. Direct Communication  D. Facilitating Learning and Results   8. Creating Awareness  9. Co-designing Actions 10. Joint planning and Goal Setting 11. Jointly managing Progress and Accountability  Adapted from ICF standards for professional coaches

Definitions of Coaching Coaching is partnering with clients in a thought- provoking and creative process that inspires them to maximize their personal and professional potential. (International Coach Federation) Coaching is a skilled relationship that supports people through change, promotes a balanced life, accelerates personal development and enables people to realise their potential (JPW)

Personal Professional Development Socialisation into professional role as a ‘limited expert’ Understanding professional standards and how to apply them Interactive learning (involving people who use services) Group discussions of ethical issues, complex situations etc. Role models Coaching and mentoring Compassionate motivation Resilience - the ability to sustain knowledge, skills, compassion and motivation to do the job.

Situational factors - Obstructions Fragmented patterns of working with diffusion of responsibility blocking the “thou-I” relationship Time and caseload pressures Limited sessions Insufficient recovery time and support Bad management systems and cultures Top-down ‘command and control’ Authoritarian/bullying culture Box-ticking Work-arounds (how professionals get round these obstructions)

Factors promoting co-production of mental health Team working Mutual respect and support Variety of special competencies and capabilities Extended to the people we work with Good leadership and supervision Distributed leadership Peer supervision can support co-production Support, realistic expectations and supervision beyond the team Good management systems and cultures Better ways – e.g. TPS, VMPS

NAViGO (principles based on SRV) People who use and work in services influence design & operation Design facilities on domestic scale & style Educate staff to understand their power & influence for good or bad Ensure organisational design focuses on people who use services Language is important ‘people’ not patients; avoid clinical jargon Involve people who use services in all staff education & training Make clinical and security features unobtrusive in buildings Share common space Encourage public access and interaction Support people (staff & service users) to develop valued roles & creativity Modified from Bond K (2017)

Alternative relationships Paternalistic We, the experts, act in the patient’s best interests Informative We, the experts, give the consumer/customer information to make choices Interpretive/Co-productive We put our expertise at the service of the people we work with, asking questions and using our knowledge to support them in finding the best course of action: What is your understanding of the situation and its possible outcomes? What are your fears and what are your hopes? What are the trade-offs you are willing to make and not willing to make? What is the course of action that best serves this understanding? (modified from Atul Gawande, Being Mortal, 2011.)

The elephant in the room Gus Spence veteran environmentalist said, some years ago, speaking of climate change and other environmental problems: “I used to think that with thirty years of good science we could address these problems, but I was wrong. The top environmental problems are selfishness, greed and apathy – and to deal with these we need a spiritual and cultural transformation.”

Discussion Some possible areas: What are the competencies that are needed for professionals to work to co-produce mental health? What are the personal qualities we need to develop in professionals to enable them to work in this way and how do we support them in this work (sometimes against the system)? What social, cultural, political and organisational systems need to change to facilitate co-production?