A Holding Space but in A Different Place

 

I first came across Wicked when I read the novel, in the early 2000s. I enjoyed the book’s story and themes, questioning whether are people born evil, made evil or just painted as evil. Isn’t it so easy just to have a villain? We saw the original London West End production of the musical, back in 2006. And last month we saw the first film, in the two film version of it. I enjoyed the film as much as the book and musical, though they are all different, and found myself swept along with the story, but I wasn’t the only one.

During a press junket with Cynthia Erivo and Ariana Grande, journalist Tracy E Gilchrist asked this question:

“I’ve seen this week people are taking the lyrics of ‘Defying Gravity’ and really holding space with that and feeling power in that”.

This produced a very emotional response in Erivo and Grande. “That’s really powerful,” said Cynthia Erivo, who played the lead role, Elphaba, in the film. “That’s what I wanted.” Ariana Grande gripped her co-star’s hand as she spoke.

Gilchrist later said, for her, “holding space” was “being physically, emotionally and mentally present with someone or something.” This has all gone onto to be a meme on social media.

Defying Gravity is a very powerful song. It’s sung by Elphaba, the Green Witch of the West, at the end of act one of the musical, and the end of the film, Wicked Part One. Elphaba is fighting back against ignorance and intolerance. She literally flies above it all. It says, no matter how much you try to push me down, I’ll raise above it. It is a great end of act one/part one song and Cynthia Erivo performs it perfectly.

But for me, my “holding space” moment happened earlier in the film, when Elphaba sang “I’m Not That Girl,” performed heartbreakingly well by Cynthia Erivo.

This song comes after the handsome but rather shallow Prince Fiyero (Played with wonderful style by Jonathan Bailey) aids Elphaba in an act of rebellion. As they part ways, Elphaba realises she’s in love with Fiyero, but he loves Glinda (the perfectly blonde Ariana Grande). “I’m Not That Girl” is a painful song of unrequited love, Elphaba knows she isn’t the “girl” for Fiyero, and never will be, but she still loves him.

Sitting in the cinema, hearing Cynthia Erivo singing that song, and I was swept back to being sixteen again. I was hopelessly, secretly and stupidly in love with a straight man who couldn’t see what was happening. To him, I was just a friend. I would never be his “girl” and I left with emotions I had no experience how to cope with. Back then I saw no way out of it.

It’s over forty years ago that I was sixteen, I’ve been with my husband for twenty-six years, yet that song drew me right back to that horrible and painful time of my life. That is the power of a well written song, capturing a specific emotion.

As I sat there, in the cinema, watching Cynthia Erivo’s singing of “I’m Not That Girl,” I was taken right back to being sixteen, to those hopeless emotions. It caught me off guard, I hadn’t expected those emotions and for a moment I remembered that pain.

It was a surprise to have my “holding space” moment, watching Wicked. I’d seen the stage musical, in which I saw “I’m Not That Girl” performed by Idina Menzel. But in the cinema, with the framing and close-ups of Cynthia Erivo’s singing, it heightened the emotions. It certainly dragged up those memories for me.

But that is the power of great songs, to draw us into the emotions and story of a song. Don’t we all have one song or another that is special for us, a song that will take us back to a certain time, a song that can remind us of something good or bad that happened to us, a song that always reminds us of a certain person. This is the power of combining the right music and lyrics, to invoke emotions and/or memories in others. It’s a skill I don’t have.

I wish I could write songs, and I have tried in the past, but they were really awful. So instead I’ll carry on writing fiction about screwed-up people and writing essays from my life. If I can create a “holding space” for someone with my writing, that would be worth it all.

 

Drew

Good Mental Health Day, Just Not Today

In October, the British government announced plans to help people with mental health problemsto get back into work.

This would see “employment advisers” visiting people in hospital, who have been admitted with mental health problems, and giving them CV and interview advice. It was piloted at hospitals in Leicester and at the Maudsley Hospital in Camberwell, London, with “dramatic results”, though the results haven’t been published yet.

This isn’t a hundred percent altruistic, it is also an attempt to reduce the disability benefits bill, which is projected to increase by a third in the next four to five years, according to the Institute for Fiscal Studies. A jump to £63bn by 2028-29, from £48bn for 2023-24.

"There is clear evidence we are really struggling with health problems," said Work and Pensions Secretary LizKendall. She wants employers to “think different” about employees with mental health problems, offering flexibility to support and retain people.

Now this scheme is not perfect. Why are they only offering this advice and support to people in hospital, why not to people in the community? Why aren’t they working with employers to offer people, with long term mental health problems, work experience to gain skills that make them attractive to employers? And there are so many other things too. But this is a start at supporting people and is better than nothing, which is what the previous government offered, they just wanted people to repeatedly prove how ill they were.

Then, the other week, one of my relatives posted a link to this story, on Facebook, with the caption: “What absolute numpty thought this through? They get a job coach visit, why don’t they just say “get over it” because that always works doesn’t it?”

Underneath people had added to the following comments:

“I actually cringed watching this report.”

“Who would employ someone who could be ill numerous days a month? How can a business run if you don't know how many staff are going to be there?”

An ‘Oh how stupid’ emoji.

“This is what you get when you vote Labour in.” To which my relative replied, “Luckily, I didn’t.”

 

I wanted to scream at the post, “How can you say that? How can you be so prejudiced?”

But employment is so important to how we identify ourselves, to our self-worth. How often do we get asked “And what do you do?” How much of our identity is made up from our job/profession? Mark Tausig argued that work is the central activity whereby most adults define their identity. I retired recently and I find it is strange to no longer belong to a profession, which had been so important in my life. Robert Drake and Michael Wallach argue that unemployment worsens mental health, while employment can improve it. They said that being employed gives us self-reliance, we are valued by others, we gain the respect of others, we have an income and employment helps us to gain community integration. We can see this in our own lives.

But in the UK only 15% of people with serious mental health problems are employed. That is an extremely large number of people who haven’t got the security and value of having a job. Why aren’t we concerned about this?

The evidence shows the benefit of employment. Hoare & Machin, in their study, found that participants who found employment, had greater social contact, more structured time and therefore saw significant improvements in their mental health. Another study found that the work environment improved people’s mental health. That those with mental health problems saw an improvement in their symptoms, plus improvements in their leisure and finances from being employed. And another study found that if people with mental health problems are able to find work, then it reduces the burden on society as a whole. Those people being able to support themselves, partially or fully.

Saying all this, we can’t just give someone with mental health problems a job, then expect them to get on with it and their health get better. People will need support. Secker & Membrey identify that specific adjustments maybe required, such as flexible working hours, flexible work schedules and job tasks, especially in relation to the medication a person is taking, allowing the person to regain their stamina and confidence. Modini & Joyce found that the literature, on mental health in the workplace, focused on the negative impacts of work on mental health. But they also found that the evidence is that work can help improve a person’s mental health. Evans & Repper argue, and rightly, that mental health services and staff should also be involved in supporting people back into work, it should be a vital role because of the benefits work brings to people and communities. Drake & Wallach make the same argument, that part of treatment should emphasise the importance of work and support people into employment.

But supporting people will bare positive fruits. Castle, Crosse, and Harvey conducted a study were they provided only 20 hours of support to people in gaining employment, but their study found that 21% of those people found jobs and 43% went onto volunteering or studying. How much more could be achieved if those people had an employment coach, even for one day a week?

My own experience bears this out, too. In my early twenties, in the late 1980s and early 1990s, I suffered from severe depression. It was so bad that I was hospitalised with it, twice, and I spent a long time taking medication for it. This was a very difficult time for me. I couldn’t tell many people I was ill, the stigma of mental illness was very high, and one of the few people I trusted to tell didn’t “believe” I was ill. I was also studying for my nursing qualification at the same time. This actually helped my mental health. I had the structure of my work placements, having to be there at a certain time. Also my studies gave me structure too, having to be at lectures at certain times, having to work on assignments with specific deadlines. My mental health was poor but that structure kept me together and kept me functioning. The only person I told at college was my personal tutor, because I was afraid if others knew I would be kicked off my course, and she supported me and kept quiet about my illness.

When I qualified, I found it difficult to find my first job. As soon as prospective employers found out I had depression, they withdrew their job offers. The Occupational Health Department of the hospital I trained at told me that if they had known I had depression they would have had my training stopped. They said I was “unfit” to work as a nurse. I am so glad my personal tutor protected me from this. But all this rejection took a toll on me, my mental health deteriorated.  I was being denied employment through no fault of my own. I had already proved I could safely work while having depression. It was so hopeless. I eventually found a job but I had to lie on my application. I didn’t tick the section that asked if I’d ever had any mental illness.

During this awful time, I would have loved to have access to an employment adviser who could have helped me through this. Instead I navigated it all on my own.

So why are we only just now looking at supporting people back into work, and in such a limited way? Since 2010, we have had the Equality Act, which makes it unlawful to discriminate against people with protected characteristics, including disability, and that includes mental health problems. But laws don’t change attitudes, not straight away. Frijters, Johnston & Shields found that having a mental health problem reduces your chance of getting employment by 30%.

I had hoped that attitudes to mental illness had changed since I had depression. It seems now that every Z-list celebrity is having their “struggles” with mental health problems. But my relative’s post on Facebook has made me question this. Do people still believe that mental illness is just someone faking it, using it as a way to avoid working? That a mental health problem automatically makes you unemployable?

In 2011, David Cameron’s government coined the political slogan, “strivers v shirkers”. This labelled people in work as “strivers” and those receiving benefits as “shirkers”. This simplistic ignorance appalled me back then, but have we come no further? Now I doubt we have.

Drew

Violence is Never the Answer, But What Is the Answer to It?

 

England has been in the grip of far-right riots, in the previous week, following the horrible murders of three young girls. These riots were stoked by racist lies, mostly online, but fizzled out when confronted by large and peaceful counter protests. So many people were threatened and injured in these riots, so many people have had their businesses and livelihoods destroyed, and many NHS staff were also the victims of these riots.

Two Filipino nurses were attacked in Sunderland. They were sharing a taxi to work. GP Practices and other healthcare clinics closed early, during the riots, to enable staff to get home safely. NHS staff have received threatening messages, clinics have closed early because staff feared being trapped in themby rioters, staff were afraid to use public transport and were not going onhome visits. So many NHS staff were affected by these riots, directly and indirectly. So many NHS staff were feeling very afraid by these riots, and afraid clinicians don’t deliver the best care, and that isn’t their fault.

The new Health Secretary Wes Streeting, in response to this, said: “I will not tolerate, under any circumstances, NHS or social care staff in any health or care setting being subjected to intimidation, harassment or racist abuse.

“We have a zero tolerance policy in the NHS and we'll take a zero tolerance approach in social care too.

“People who are abusing NHS staff can be turned away, and should be turned away, if that is the way that they are treating our staff."

But Wes Streeting wasn’t right, there is no specific NHS zero tolerance policy to violence against staff. Many NHS trusts have zero tolerance policies but NHS England does not have one. In 2018, the then Health Secretary, Matt Hancock, announced the Stronger protection from violence for NHS staff policy. This announced a “violence reduction strategy”, which included:

• NHS to work with the police and Crown Prosecution Service to get prosecutions in the “quickest and most efficient way”.

• the Care Quality Commission (CQC), as part of their inspections, to monitor the level of violence against staff in a trust.
• training for staff to deal with violence.
• prompt support for staff.

What this didn’t contain was a zero tolerance to violence against NHS staff policy.

In 2020, NHS England released Violence prevention and reduction standard, which stated that it was part of an NHS employer’s duty of care to protect staff against violence and abuse at work, but this didn’t contain a zero tolerance policy either.

The Royal College of Nursing (RCN) summarised what NHS staff are allowed to do if they are faced with a violent and/or abusive patient. The nurse (or other NHS clinician) can refuse to treat a patient who is threatening or being violent. But care cannot be automatically withdrawn from the patient, it should be delivered while the patient’s violence is “managed”. Any violent situation must be discussed with the clinician’s manager and assessed. The clinician’s employer has a duty to the clinician but also has a duty to provide care to the patient, even if they are violent to healthcare staff. But an employer cannot dismiss or discipline a clinician for refusing to treat a violent patient. The emphasis is on managing the patient’s violence and ensuring the patient still receives care.

The Nursing and Midwifery Council (NMC), the nursing regulator in Britain (Find a discussion of their duties here), on 9th August, sent an email to all professionals on their register, about the current riots. They first reminded readers that, under the NMC’s Code of Conduct, “that professionals should prioritise people and put the interests of people needing or using health and care services first.” If faced with a violent patient, a nurse “should escalate your concerns as soon as possible. Your health and safety at work is your employer’s responsibility.” The NMC’s language is clumsy but their point is clear, nurses should put the patient first. If they are faced with a violent and/or abusive patient, they should still be treated and later “escalated” for management to decide what to do. There was no mention, nor any discussion, of a zero tolerance policy.

While I worked as a nurse, I was the recipient of violence and abuse from patients and/or their relatives, far too many times, and even more times I supported colleagues who had been the victims of violence and/or abuse at work, especially racist abuse. Only one time was I supported by a manager. As a ward nurse, a patient’s relative had threatened me with a knife. He also threatened a porter. My manager called the police and had the relative arrested for his actions, she also had the patient discharged that day too because he encouraged the attacks. But this was the exception. I have watched managers bend-over backwards to accommodate abusive patients. When I worked as a District Nurse, we had a patient who had physically and racially abused so many nurses that the whole team refused to visit her. Senior management repeatedly put pressure on us to visit her and they went out of their way to arrange a plan so she would get the care she wanted. She suffered no repercussions for her behavior. Senior managers seemed to be far more afraid of violent patients complaining about not getting the care they want, then about the effect of violence and abuse against staff.

I still see that attitude in the current policy about violent patients. NHS staff have to find a way to treat abuse patients. There is still no zero tolerance to violent patients. Would this be tolerated in other professions? If a constituent was violent and abusive towards an MP, would the MP bend over backwards to meet that constituent’s demands?

There are 75,000 physical and verbal attacks on NHS staff each year yet only 2.4% of these assaults ended with the attacker being cautioned or charged bythe police, let alone found guilty by the courts. This 2.4% could be an over estimation because only half of trusts responded to this survey. How is this zero tolerance of anything?

Punch a nurse and you’ll probably get away with it, scot-free.

 

Drew