TRANSFORMING MY EXPERIENCE

By Mickey Skidmore, AMHSW, ACSW, MACSW

For the past several months I have shared a series of editorial essays highlighting a range of concerns, dysfunction, and disorganisation that is the “train wreck” (Skidmore, 2020) of the inpatient mental health service at Liverpool Hospital. I have recently become aware that I am begin to exhibit indications of repetition in these essays. Thus, it is my intention that this will be my final contribution on these themes brining a closure to my efforts to shine a light on the Liverpool Mental Health Services.

Over the past several months, I received correspondence in reaction to these essays. As I have consistently done throughout this series, I will not reveal any identifying details (to protect them), but will share a few responses as I bring closure to this effort:

I too was the victim of a severe and persistent bully in my previous role in SWSLHD in 2019.  I was not the first victim, nor was I the last.  Management and the Executive are aware of the issues with this staff member, however have consistently turned a blind eye to it and not addressed the problem, causing a multitude of highly skilled clinicians to leave the service in droves.  Quite a few of the issues you talk about at Liverpool Hospital are systemic ingrained practices across the district.  The victims have been the ones frozen out for speaking up and it seems far easier for the powers that be to let hard working, talented staff leave on masse than to do what needs to be done to address the problems.

The impact this has had on our mental health as well as others who have left as a result is significant.  We both feel we need to do something more to speak up/speak out, but we are both at a loss as to where to start.  Is it even worth it?

I hear your frustration. I am a whistleblower from child protection. I wrote a 10,000 page report outlining the issues, I organised a television part to raise awareness, joined Whistleblowers Aust, the IAWB but still no change- The Heads of the union are powerful political creatures & were part of the systemic problem, management don’t manage & the legal system want tangible physical injuries to make a case (hanging yourself at home doesn’t count as a consequence of workplace trauma). I resigned with a diagnosis of PTSD. 

It is ironic that the service placed such an emphasis on the gimmicky marketing message to “transform your experience”. After just short of a decade, I can say that during my tenure with the Liverpool mental health services that the leadership has absolutely and definitely transformed my experience by essentially contributing to a form of a professional moral injury (Litz, Lebowitz, Leslie, Gray, & Nash, 2016). 

In my experience in the inpatient MHU service of Liverpool hospital (8 years), I have experience the opposite of collaboration. There was a pervasive culture and deep-rooted organisational structures that disrespected, devalued, degraded, and demoralised the role and profession of Social Work at nearly every turn. So much so, that it became an ethical dilemma for me to consider taking on Social Work field placement students (in an established teaching hospital). Perhaps even worse than the glaring ignorance of what the Social Work profession entails is the complete disinterest in learning or wanting to better understand the contributions these professionals could offer to address many of these issues. (Skidmore, 2020).

There remains significant systemic and organisational gaps (which I believe may be intentional) so as to avoid addressing a range of dysfunction. In my view, there is pervasive and systematic fraud (Skidmore, 2020); massive pretending (Skidmore, 2020) and looking the other way (including a complicit Mental Health Tribunal that routinely allows for the detaining of substance abuse patients under the Mental Health Act); and an HR department designed to ensure the status quo and give cover for poor executive management and leadership.

The patient population is so heterogeneous that it is nearly impossible to develop consistently appropriate or adequate clinical programming beyond psychiatric medication. The refusal to establish and abide by clear admission, discharge and exclusion criteria further contribute to this dynamic, and results in the wards of the psychiatric service being the doormats of the hospital — and even other hospitals who refuse repatriation of their own patients.

The short-sighted insistence of the executive leadership for the psychiatric service to increasingly do the job of external stakeholders (whether that be to ADHC in the past; financial trustees or NDIS currently) is maddening, and interferes with and detracts from its intended mission — providing mental health services to their catchment area. Moreover, there is a convoluted aspect to this that only serves to reinforce the reality of alarming numbers of “patients” residing at Liverpool hospital for years at a time.

What stands out as the most significant aspect that has adversely transformed my experience is the pervasive and consistently routine manner in which the service does not live up to their own CORE standards or follow many of their own policies, principles or guidelines as an organisation. Not because they fall short, but because they engage in “the-exception-becomes-the-rule mentality.”

Despite extensive clinical post-master’s experience and perhaps being the most highly credentialed Social Worker in Liverpool Hospital, observations made in my role at Liverpool Hospital were openly dismissed and even weaponised against me, including the  coalescing of talking points to (mis)-interpret my direct and straight-forward communication style as being curt, short, abrupt, rude and/or culturally offensive — as no-one was successful in adequately debating my attempted contributions based on the merits of clinical acumen or basic logic.

My efforts to empower and clarify the Social Work role in the in-patient psychiatric service and the patients we served ultimately resulted in my being blacklisted (Skidmore 2021). In short, I have been targeted for doing precisely what Social Workers are trained to do — to observe (obvious) system dysfunction and advocate for and seek to improve and enhance the service.

The leadership of Liverpool’s mental health service has consistently made it clear over the years that they were never genuinely interested in the skill set or leadership that I offered. Yet, the service’s decision to consistently look the other way does not detract from the validity of my views or observations. Moreover, such a consistent choice contributes to targeting staff who voice positions contrary to leadership; dividing and reinforcing a bullying dynamic from the top down. It is in fact the opposite of empowerment, it is the steady and persistent erosion of morals and decency in the workplace environment.

The collective, long-term effects of working within such a toxic culture contributes to a devastating impact on its workforce that encompasses a perfect storm which underscores declining morale; burn out; compassion fatigue; and increasingly in professional moral injury. Despite alleging to be a proponent of trauma-infomed practice, the leadership ignores the basic principal of such practice and self-care — which is to recognise traumatised and unsafe systems. This is yet another tangible example of how leadership and management look the other way or do not adhere to their own policies and procedures.

The recent reporting of the Royal Commission into Victoria’s Mental Health System concluded that the current system “is not fit for purpose.” Throughout this expose, I have avoided drawing conclusions that would generalise to broader or other health systems or services. However, other’s who have responded to my observations have; and following the Royal Commissions report, would it be shocking to anyone if some or indeed many of these findings might also parallel the psychiatric service of Liverpool Hospital?

Without question the inpatient psychiatric service of Liverpool hospital has transformed my experience. It has also transformed the experience of countless other professionals as well. One can only speculate on the untold number of unnecessary professional casualties resulting from such practices. Perhaps the only thing worse is the potential impact this has had — and continues to have on the patients who rely on such services.

REFERENCES

  1. Skidmore, M. “Train Wreck”, August 2020.

2.   Litz, Bret T., Lebowitz, Leslie., Gray, Matt J., Nash, William P.  Adaptive Disclosure

      Copyright 2016 The Guilford Press, New York, London

       www.guildord.com

3.   Skidmore, M. “Professional Racism”, November 2019.

4.   Skidmore, M. “Fraud”, September 2020.

5.   Skidmore, M. “Pretending”, October 2020.

6.   Skidmore, M. “Blacklisted”, Feb 2021.

7.   Report of the Royal Commission into Victoria’s Mental Health System