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UniversityofBath OP t1_j0govow wrote

That's an amazing image of it rolling down the hill. The pressures being passed on feels very true. I think there's also the bit about how people who have been traumatised respond to a system around them and how the trauma influences the system too. It's so complex. Important to recognise anyone could be involved in this as a dilemma though, as you say.

There was an article in The Psychologist magazine this week (the British Psychological Society mag) which summarised a book called Hospitals in Trouble by John Martin. I haven't read the book but the authors said certain quite practical aspects of ward location and culture influenced whether care became poor. The factors included ward location, personal and professional isolation of staff and lack of training opportunities. Obviously this is no excuse for abusive practice but I did think it was interesting to think about what factors could act as roadblocks to make abuse less likely.

Thank for your perspective on intervention efficiency - that's a very helpful thing for me to think about.


Own-Tax-2811 t1_j0h8xr6 wrote

By "people who have been traumatised respond to a system around them and how the trauma influences the system too" do you mean that people working in Health & Social Care have often had difficult life experiences which affect how they respond & that can also feed back into a vicious cycle?

I was wondering about a more straightforward or prosaic effect of uncaring/abusive management>systems which reward suboptimal care>having to switch off to avoid moral injury>high likelihood of being uncaring and increased likelihood of being abusive.

I worked for a while in a social care dept where the criteria for receiving social care were being revised. I was an assistant OT, trained in equipment provision only to help make tasks easier where people were struggling (not where they had stopped altogether), but would get referrals like "Due to changes Mrs X is losing her lunchtime meal prep visit, please work with her on food preparation, she hasn't done this for 5 years". I asked for supervision from a qualified OT, which was refused. Management cared mainly about throughput. I left. The only way I could have stayed and not had a breakdown would have been to disengage from caring about the people we worked with.