#crisisteamfail and boundary violation

#crisisteamfail and boundary violation
Thanks to @eliinlowri and @sectioned_ for tweeting this picture

Thanks to @eliinlowri and @sectioned_ for tweeting this picture

Recent conversations on Twitter using the hashtag #crisisteamfail drill to the very heart of issues of agency (of individuals) and control (of institutions) which I have been researching on social networking sites over the last few years – the extent to which relationships between people accessing and providing mental health services and the mainstream media are being re-shaped and disrupted online.

With one eye on the #crisisteamfail hashtag I also happened to be reading a short article by Michael Slade entitled Breaking down Boundaries* which seemed very pertinent. In the article he considers three different types of relationships formed between nurses and people they support:

  • Detached – led by a nursing agenda with expert knowledge passed from nurse to patient
  • Partnerships – collaboration with a recognition of shared expertise
  • Real – personal relationships in which nurses relate to people accessing their service simply as people and where they (people) are in control of decisions.

Whilst Slade argues that neither one type of relationship is better than another, he also acknowledges that real relationships are often cited by people living with mental health difficulties as very important.

He suggests that real relationships can be a challenge to the mental health system because they disrupt ‘traditional ideas about professional behaviour, and the kinds of boundaries that lie between nurses and clients’. Slade goes on to argue that: ‘it should be accepted that behaviours that have traditionally been regarded as boundary violations may become acceptable’ and he cites examples of nurses sharing personal information about themselves or giving tokens as ways in which real relationships are nurtured.

I’m quite taken with this notion of boundary violation and how it manifests on social networking sites. Twitter is awash with small and persistent violations to the boundary of a traditional detached professional relationship. Conversations between people accessing mental health services and professionals shift the boundaries from formality through to informality, professional to personal, and between lighthearted banter to profound dialogue. People accessing services have conversations with each other about mental health and mental health services, part private but also public. These often include shared experience of poor services which challenge professionals and mental health services. The way in which professionals and institutions respond to them is varied – I think it can be a mix of Slade’s three paradigms – detached (ignoring or denying) partnerships (listening and learning) or real (getting involved in the conversation as a person showing empathy).

The #crisisteamfail hashtag is a example of a conversation between people accessing mental health services about experiences of poor care. The posts were stark to read and it was striking how similar themes emerged again and again (being told to take a bath came up more than a few times) and which @MentalHealthCop has eloquently blogged about.  I dipped in and out of the conversation and tweeted that people working in mental health services might want to check out the hashtag – conversations like this offer valuable learning for professionals who may otherwise only see things from their side of the professional/patient fence.

I was surprised when I noticed a professional tweet in anger (their words) about the criticisms they were reading, commenting that services are underfunded and under pressure. It made me wince. Yes of course those things are true but this isn’t about you, it’s about people sharing with peers what it feels like to be failed by their crisis team. A professional interrupting the flow of conversation jarred. It felt uncomfortable. It felt like the detached professional speaking. @Sectioned_ has blogged about professional defensiveness in a post entitled but we’re not all like that  and I think it should be required reading for anyone joining Twitter who works in mental health.

When professionals behave in detached ways on Twitter they are likely to be ignored or challenged. In the clinic or the ward those behaviours may be tolerated, accepted or even expected, but the etiquette is different on Twitter; professionals do not hold the power in the same way. In my research interviews, Ipeople who access services and mental health professionals have both told me their conversations on Twitter have increased empathy towards each other – seeing behind the label, name badge or a diagnosis. But to develop empathy requires a commitment to real relationships which are built on a shared humanity where we relate to each other as people rather than as patient and professional.

I’d love to hear from people accessing and working in mental health services about whether the ideas in this post resonate with your experience.

*Slade, Mike (10/01/2011). “Breaking down boundaries: Mike Slade discusses the different ways nurses and clients relate to each other”. Mental health practice (1465-8720), 15 (2), p. 9.

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  1. I complete agree – as someone who has extensively used mental health services and also works in one I know it is hard work to be on both sides, but the vast majority of people criticising are doing so because they want their experience validated and also because they want to help make positive changes – defensive responses just put people off trying to support change. I also run an underfunded service but ultimately that is not the problem or responsibility of the person using it – it is mine as the person running it – feedback can be harsh and feel personal but what matters is what we do with it

    • Thank you for your feedback and your comments. Love your last point – what we do with feedback is what counts!

  2. This is insightful and important writing. As a mental health ‘service user,’ I can relate to all of this and know that when the boundaries are blurred and a ‘real’ relationship is allowed a little light the effect is profound and highly beneficial. This type of relationship requires trust on both sides, which I think is difficult, for the individuals concerned but if it can be found then progress is rapidly made. ‘Shared humanity’ and an understanding that in many ways we are all on the spectrum and could become ill at any time allows this real sharing to occur. Thank you for this article it has clarified for me many thoughts that have occurred whilst receiving treatment over the past 12 months and it has helped me to understand better my own thought processes and feelings and also shed more light on those that must inevitably occur with the service providers. My thanks again, Michael.

    • Thank you very much for your comments and insights Michael – really appreciate them 🙂



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