The Strengths Revolution with Steve Morgan | Strengths | Resources | Taking Risks

Kirt discusses his early introduction to the nursing profession growing up in Trinidad, before making the move to Guy's Hospital in London. He reflects on a few important influences in those formative professional years before he developed his specialist interest in acute mental health care and the provision of crisis response and resolution teams. He initiated the South Camden Crisis Team in 2001 and managed it through to 2011, and is in a good position to reflect on the qualities of a good team as well as its individual practitioners. Kirt identifies the support and development of new workers as one of many rewards of team management, as well as his rare combination of bringing gestalt psychotherapeutic skills and experience into the arena of short-term crisis working.

How often do we stop and reflect on our values and principles? Not often enough, despite the fact they influence who we are, what we think, what we decide, and how we present to the world around us. It can often take a sudden message or event that sharply challenges our values that triggers that very reflection on our personal standpoint. One such message recently encountered in the UK Observer Sunday newspaper was an article examining the gulf between the wealth and focus of private equity firms increasingly owning and running social care services for our most vulnerable people in society. The senior personnel and owners/shareholders are on astronomic salaries and dividends, and by contrast, many of the workers are forced to provide the work for less than a minimum wage. If we examine the NHS Constitution we can be forgiven if we ask the question 'what price are we now placing on compassion and care?' Meanwhile, the politicians of all persuasions seem equally complicit in the neglect of fundamental values-based practice, more concerned not to offend the powerful in their pursuit of value-for-money (aka greed and inequality). Our most vulnerable and needy in society should never become pawns in the game of profit, but the slow creeping takeover by private equity of the ownership of social care is making care and compassion commodities to be exploited.

In this second part of the interview Wanda Rusiecki talks about the work she does as a case manager with specific service users, 'getting on the healthy side' and supporting people to exercise more control over their own lives. She recognises the real reasons behind the cynacism and mistrust that some people come with, and how the focus on the conversation and humble listening helps to create a different experience of services for many people. The issue of 'time' is discussed; it is the service user's time, so we need to ask how they want to make best use of it, rather than succumbing only to systems needs that serve more bureaucratic requirements. Helping people to search for satisfaction also brings greater satisfaction in the work for practitioners.

Wanda Rusiecki also reflects on working alongside the criminal justice system through court order treatment, the importance of integrating mental and physical health care to be truly holistic, and the role for peer services employing service users to tap into their experience and talents.

Wanda Rusiecki has been working in 'intensive case management' services in New York State for 25 years, supporting some of the most vulnerable people experiencing mental health problems within the state system. Wanda describes her experiences working intensively with small caseloads of people with very complex problems, who require a stronger degree of linking and co-ordinating of services as well as more creative ways of engaging trusting working relationships. Wanda's reflections pick up on her value base that emerged from childhood as a theme for connecting with those who present as different. She identifies the importance of 'strengths' in her own approach of developing the conversation and listening more through 'looking for the healthy side of people'. Wanda identifies the characteristics of what makes for a good case manager and what has sustained her to stay in this line of work for the long-term, as well as the challenges that the 'system' presents when trying to deliver best practice. The true meaning of 'recovery' is identified through eliciting each individual to tell their own story and identifiy their own priorities.

How do we go about making decisions? The answer partly depends on the situations or circumstances we are in... situational decision-making is an assessment of the situation followed by a quick mental simulation of the likely outcome of our chosen course of action. It is based in experience, responds to pressures on available time, and helps us manage ambiguous detail. It is a partly intuitively based approach to decision-making. Alternatively, analytical decision-making is a more structured approach applied to research, clinical and other work situations where masses of abstract data need processing, or a range of different people come together to make a decision, and there is a greater requirement to objectively justify the decision. Ultimately it is not so much about finding the right or wrong decision, but more about our 'confidence' in the decisions we have made. Confidence will be underpinned by a focus on the strengths that can be identified and productively applied as a crucial component in our decision-making approach. An absence of identified strengths can still offer confidence, but in these circumstances it will be confidence in making the more risk averse decisions.

Positive risk-taking and risk decision-making are challenges that can be achieved with greater confidence if the right conditions are in place. For practitioners within health and social care services, and others beyond these services, a number of factors can influence your degree of confidence in your decision-making. Being genuinely person-centred, as we are always dealing with an individual with their unique combination of strengths alongside the problems and the risks. Good team-working, and support and supervision, can greatly influence the quality of decisions influenced through the culture of the team or service. The issue of 'culture' should also extend to the wider organisation, through the understanding of positive risk-taking and processes of decision-making, and supporting people's decisions irrespective of outcome if they have followed reasonable guidelines of good practice. Accessing appropriate tools to guide and influence decision-making, as well as prioritising the time needed for some of those more complex and challenging decisions.

Risk-taking is part of a healthy way of living, and we make decisions every day. However, just occasionally we are confronted with potential life-changing decisions, such as changing a job, moving our home, expressing feelings for others, ,arriage, children, divorce, and end of life choices. How can we face some of these major decisions and make them with greater degrees of confidence? This episode offers a number of common sense tips to help us develop that confidence. Being reflective, checking things out with trusted friends, being aware of consequences, being open to learning not just seeing things as simple as success or failure.

Sue Jugon describes her interest and influence on developing a unique assertive outreach team within a rural locality of Northamptonshire in England over 10 years. She explains how this type of service connected with her fundamental values and principles for working with some of the most vulnerable people. She questions what services are actually doing to engage with people needing appropriate services, and the importance of identifying the staff members who she felt would work in different ways and form a genuine 'team approach'. 'Funky Mental Health' is a description of Sue's vision for the different type of service needed, and she identifies the need for 'skilled misfits' if you are truly going to deliver something out of the ordinary.

An interview with Sue Jugon exploring the influences on her practice as a mental health nurse, team and service manager. Looking at the early influences of growing up in a farming background, and coming into nursing from initial experiences within learning disability services. A strong emphasis emerges about taking opportunities to have a go at things, without being constrained by the possibilities of failure. Sue is a person for whom working with the most vulnerable people is a life-long passion, and her career path has never deviated from the values and principles that remain focused on the needs of the most vulnerable. She also talks about her own continuing aspirations, and a natural talent for exploring the playing of different musical instruments. Above all else, it is the love of her children that keeps her focused on who she is, and continues to bring out the best of a dedicated person.

Are we risk takers or are we generally more conservative in our risk decision making, more risk averse? There is no blanket answer to this question for any of us, as there are different situations and circumstances that influence us in different ways. Health and Social Care service practitioners may become more risk averse in particular situations, and some will be more risk averse depending on their own experiences. When is it ok to be risk averse? When it is the clearly reasoned decision based on careful consideration of the information available to us. Risk decisions will be part of everyday experiences within health and social care services across all sectors e.g. mental health, learning disability or older persons services. The same principles apply to all of us in our personal lives, when we are confronted with situations that require a difficult decision.