Don't we all feel anxious?

OK hands up; who suffers with anxiety?

 I’m guessing most of us; I’m sure it’s part of the human psyche,  I haven’t yet met a person who didn’t get anxious about something at sometime, if you are passionate about something surely we’re going to be anxious about it? Right?

 Four years ago I really thought I had cracked my anxiety. Up until then I’d always been an anxious Annie, but my life changed overnight in 2016 and I faced one trauma after another. I just took it all in my stride believing that I was not being particularly anxious. I thought that if there were a god looking down on us that they had decided I’d suffered enough and the last thing I needed was to be anxious!!   

 What I realise now is that the grief I was feeling and the tremendous support I had from my nearest and dearest had encapsulated me in a secure bubble, for want of a better expression. That bubble enabled me to function, to get on with my life, to do what I needed to do. Of course, it didn’t stop the pain of the losses and in truth I wouldn’t have wanted it to. Those feelings are important, I see them as a rite of passage, but it did help to manage the stuff that was ready to trip me up. 

 The last couple of years I have felt my bubble under attack;  it’s not as robust as it had been. Life throws so many balls at us that we run out of steam to catch them, or enable them to bounce off us.  Very slowly the anxieties have been returning, to the extent that  now my bubble feels like a balloon that has been burst and is blowing raspberries as it shoots off into the atmosphere.

 So what do I get anxious about? Last week it was driving to London; then it was where do I park. Then it was, what if my hotel reservation gets cancelled? And on and on it goes . Non-rational thoughts preoccupy my time. It’s blimin exhausting, especially when they infiltrate my sleep, so that I’m not even giving myself time to recover....

 This morning I woke up to a feeling of dread. ‘Oh my god, I’m supposed to be delivering a training course’, was how the conversation in my head started. “No, it’s tomorrow’. ‘Are you sure, better check the diary’. And so it went on until I dragged my sorry arse out of bed. 

Of course, I KNEW the course was tomorrow, I knew that I was organised and have everything ready.

 I manage my anxiety as best I can. I don’t enable it to control me and at the moment I can find the tools to manage it. I meditate, well I call it breathing, I concentrate on each breath and focus on bringing my heart rate down. I talk myself through what is causing me the anxiety, my rational brain takes the lead and finds practical solutions to the ‘what ifs’. I remind myself that it hasn’t let me down yet...when I have time I walk; exercise is such a calmer, and those times I really just want to stay in bed, my rational brain shouts at me that I know I will feel better once the cobwebs have been blown away. Sometimes I share my ‘stuff’ with my friends, but they have a load of crap going on too, or I write a blog, not a poor me, but one to remind all of us that we can either be controlled by our anxieties, or dig  deep and find that resilience where we control them. As a society we have been fed this world view that we should be happy all the time, when of course that’s not realistic. We have lost the art of compromise, the recognition that life is not certain, that it is full of ambiguity. It is a game of tug of war but one where  brute strength will not conquer. We have to be reflective, we have to be honest and we have to seek and accept help even if it’s from the most unlikely places.

Today, it was dictating this blog on my phone, whilst I walked the dogs. It’s preparing for tomorrow when I’m facilitating our first face to face Mental Capacity workshop since lock down. It will be being kind to myself and allowing those worries to come but then let them go . At the moment I don’t need any medical intervention and I hope it remains like that, but if it doesn’t, well it will be another tool and help me navigate this hard, uncompromising world we live in. 

A View from Behind the Shield

Sinead O’Connor sang ‘it’s been seven hours and fifteen days, since you took your love away’. Well, for me it’s been 13hrs and 85 days, (or 12 weeks, or 3 months) since I took myself away; away from the world beyond my garden gate, to live in isolation as one of the two million people or so, who have been advised to shield themselves owing to the current pandemic.

To misquote Charles Dickens, "It has been the best of times, it has been the worst of times; it has been the age of wisdom, it has been the age of foolishness. It has been the epoch of belief, it has been the epoch of incredulity, it has been the season of Light, it has been the season of Darkness”

It has, above all else, been an interesting experience, and not one I would have imagined myself undertaking a few months ago. I could never have imagined not wearing shoes, using a purse, or driving a car for 3 months. These things I do not mind in the least, although I am not looking forward to the inevitable blisters that will erupt on my protesting feet when they are eventually forced to accept the confines of footwear.

But, these things also remind me of just how much I am removed from society, from the shared experience of ‘lockdown’ and social distancing experienced by those not shielding. There’s ‘distance’ and then there’s remoteness. I have no idea what it is like to visit a supermarket during lockdown; I don’t know the customs for distancing when you come cross someone on a walk, or what the hedgerows look like.. Apart from the evidence on my flat screen, I have no idea whether the world outside my garden gate even still exists. My Facebook page is full of beautiful photos friends have taken on their daily walks, so I assume some kind of life continues in the big wide world during my absence. But, images of my daily walk would be nowhere near as interesting: bedroom, bathroom, kitchen, lounge, dining room, garden; repeat, repeat, repeat.

I have not been in the same room as another human being for 12 weeks and resorted to hijacking the neighbour’s cat for 20 minutes yesterday, just to have some physical contact with another living, breathing creature. The contact was great, although his thoughts on existential anxiety were somewhat limited.

I say this, not to invoke sympathy, but to explore why the actual experience of isolation is so far removed from my expectations of it.

When all this began, I was very blasé about it. I am not, habitually, a very social person, and consequently thought it would all be a bit of a breeze. It would give me an opportunity to lounge around in my pyjamas for 3 months, eating chocolate, and to do all those really important things I have successfully put off for years. I fondly imagined cataloguing my books according to the Dewy decimal system, writing an epic novel, and finally learning to crochet. I stocked up on books to read, books to listen to, and any number of craft activities.
I was all set for a giant holiday and the opportunity to rediscover myself, and my hidden creative talents in the process.

Well, I have rediscovered myself, but not quite in the way I imagined it would be.

There have been some really positive outcomes. I can now tell the difference between a dunnock and a sparrow, recognise an orange tip butterfly at 50 paces, and have finally got round to reading ‘Three men in a Boat, (to say nothing of the dog)’ by Jerome K Jerome. I have also discovered that I enjoy making things out of felt; spoiler alert – everyone can expect hand crafted lavender bags for Christmas this year!

I have learned that there are 270 different species of bee in the UK and have taken to chasing them round the garden, trying to identify them. What difference this will make to the bees is unclear, but I have learned a lot
about their habits and become even more enamoured of them in the process.

So, there has been much that I have taken delight in, but there are things I have struggled with, some of which really surprised me.

I have tried the ‘isolation’ experiment before. A few years ago, I decided to see what it would be like to remove myself from the world for two weeks. I took a fortnight’s annual leave, stocked up on food, switched off the phone and didn’t speak to anyone, or go anywhere for the duration. It was wonderful, and I re-emerged rested, restored and re-energised. How much better then, to have a whole 3 months to do the same thing? A kind of sabbatical for the soul.

I have to say, it hasn’t been quite like that. At the outset, the government and media were focussed on the need for social distancing. At the time, and following one of our long philosophical discussions, Anna and I thought that maybe, a better term would be physical distancing as, with the plethora of social media etc available, we could all still be social; it would just be from a physical distance.

And I have taken full advantage of it, with regular Zoom / Skype meetings with friends and family, which have been great. But … I have learned it is not the same as actually being in a room with another human being. Instead, I have discovered that fundamentally, it doesn’t matter how technologically sophisticated we become; emotional connectivity, face to face, remains a core part of being human. We need each other on some kind of physical, 3 dimensional level as well as the flat, 2 dimensional images projected through a screen. Well, I do anyway, and I can’t be alone in that surely?

The Care Act’s wellbeing principles include the following:     
Physical and mental health and emotional wellbeing

The individual’s contribution to society

Domestic, family and personal relationships

It could be argued that all three of these are part of what it means to ‘belong’ to society on either a macro or micro level.  And I wonder what, for those isolated within their own homes, this belonging looks like. How does one ‘belong’ in society when you can’t physically be a part of it?

Imagine you wake up tomorrow morning and discover you have no job, you live alone and you can’t leave your house. Now imagine that you also rely on others to support your personal care, do your shopping and cook your food. Imagine this happening, not just for a few days or weeks, but month after month after month. Imagine being seen solely a recipient of society’s beneficence, not viewed as a contributor to it; being ‘vulnerable’ rather than independent and empowered.

I can’t begin to imagine half of this. I still have a job and am independent with regards to my personal care needs etc.. The only thing I don’t have to imagine anymore is living alone, being confined to my house and not having any human company. And that, without having any additional needs, has been challenging enough.

I really hope I don’t forget the reality of this experience when I finally get ‘released from captivity’ (Boris Johnson, May 2020). There is so much talk of ‘getting back to normal’, but in our haste to do so, let us not forget, or exclude from society, those for whom what I am currently experiencing is the norm. 

Some thoughts on End of Life Care

‘Do not go gentle into that good night,
Old age should burn and rave at close of day;
Rage, rage against the dying of the light.’     Dylan Thomas

The poem above, written by Dylan Thomas in 1947, was inspired by his father who was nearing the end of his life. I am reminded of it now, as we approach the first anniversary of my own father’s death. He had vascular dementia and in the last months of his life he both ‘raged’ and ‘went gently’ into that good night. And I raged and went gently with him.

I raged at the bureaucracy, the ‘labels’ attached to him, and the lack of anything resembling person-centred care. I raged at a hospital who seemed incapable of listening to my argument that maybe, just maybe, his ‘aggression’ was due in part, not to his illness, but to his frustration at being cooped up, against his will, in a hospital ward for months. I raged against the assumption that, because he had a dementia, he had no capacity to make his own decisions and, having Lasting Power of Attorney, people asked me to make them for him. ‘Have you asked HIM’, became my mantra, as we weaved a troubled path through options for the future.

But … along with all the raging there were also some wonderful times. Wonderfully gentle times, when we would sit and talk together, or just ‘be’ in companionable silence. The subjects of conversation were often apparently random and, as his ability to express himself diminished, I frequently had to play guess the topic. But we connected in a way that we hadn’t done since I was a child – solely in the ‘here and now’, no past, no future, just these precious present moments. And, as the rage leaves me, these are the memories I am left with, the gentle walk together to the final ‘goodnight’.

Once we had finally managed to negotiate his ‘release’ from hospital, dad was admitted to a local nursing home, where, (surprise surprise!), the aggression disappeared and the gentle affable man who was my father resurfaced. He died two weeks later, and I will be forever comforted by the knowledge that in those two weeks he was surrounded, not by bureaucracy, systems, and flow charts for ‘safer patient bundling’ (whatever that may be!) but by people – people who were prepared to engage with him in what was left of his life. People who invested their energy and emotion into making every day as positive as it could be. My last memory of dad is leaving him, sitting in the dining room, eating carrot cake and custard, with a big grin on his face.

At the end of life, each story is different; some people rage, others go gently, and some do both. It is a great skill to totally ‘be’ with those who are at the end of their life. We often don’t know what to say; we confuse being ‘professional’ with being remote and unemotional; we rely on systems to try and shield us from the emotional pain. Or, we are just trying to hold it all together, because we are reminded of the deaths that have impacted on our own personal lives, deaths that come racing back to us as though they happened only yesterday. Perhaps that is why it is sometimes easier to focus on the processes and tasks than the person. But at what price for the person whose final goodnight is just around the corner?

So, what do you hope to get out of the session?

This is a question we often ask at the beginning of training and have become used to the inevitable replies of:

‘I’ve come for an update’

‘Well, it’s mandatory isn’t it?’

‘My manager said I had to.’

‘Because I value the people I support, and I want to be the best I can be’ – said no-one, ever!

You can spot them a mile off. They enter with arms folded, motivation to learn dialled down to zero and that look on their face that says, ‘yeah, I know all this stuff’. Sometimes, they thaw; maybe they had just had a bad start to the day or have other things on their minds. Some we manage to win over in a kind of pincer movement, with us at the front exuding enthusiasm and energy and the other participants asking really interesting questions and sharing their experiences. When this happens it’s joyous and we love comments like, ’I thought it was going to be boring, but actually I’ve really enjoyed it and learned a lot’.

And some? Well, some remain stoically disinterested for the whole day. I honestly think if we performed cartwheels or magic tricks their expression would stay the same – the yawn may be metaphorical, (although not always) but the message is clear, none the less; ‘I don’t want to be here’ and ‘when is the next break?’

So, they spend their time staring vacantly into space, sighing loudly, having ‘whispered’ conversations with their friends, or checking their phones every few minutes for Facebook updates.

You think we exaggerate? We don’t.

Obviously, this doesn’t apply to everyone who attends our training, – we would have given up by now if it did; and, to be fair, the ‘I don’t want to be here’s’ are in the minority, even if their ‘presence’ is felt by everyone else.  

We do try and make our training as relevant and interesting as possible, whilst acknowledging that issues of abuse and neglect aren’t the jolliest of subjects. But … Safeguarding, the Mental Capacity Act, Equality and Inclusion, and Human Rights are fundamental to good practice. If people are motivated to do their job well, then they will be motivated to learn how to do their job even better. As we face those who are bored and disinterested across the training room, we ask ourselves the question, ‘What on earth is their practice like?’ - and not from a positive perspective!

Training staff isn’t cheap, so surely it makes sense to squeeze every last drop of value possible out of it including, most importantly, the transfer of the learning into practice. And people who are on their mobiles, chatting to their friends or sitting with arms folded, challenging us to ‘entertain’ them, aren’t going to be transferring anything anywhere!   

So, for those of you who arrange staff training please think about the following:

Why are staff attending training and how to you prepare them for the event?

What do they hope to learn and what do you want them to learn?

How will you evaluate their learning when they get back to the workplace?

How will you support them to put their learning into practice?

How will this benefit the people who use your service?

What will you do about those staff who resolutely refuse to learn and change their practice?

If you do think about these things and ask the questions, it may be that we get a more varied response to the question. ‘So, what do you hope to get out of the session?’

PS: To those of you who attend our training with enthusiasm, commitment and curiosity – thank you. You are the reason we do what we do.

Safeguarding Adults: A View from the Training Room

We were delighted to be asked by Research in Practice for Adults to write a strategic briefing document for Safeguarding Adults Boards on the effectiveness of Safeguarding Adults training. This blog reflects our response to writing the document and offers a small glimpse into our world as Safeguarding Adults trainers, with all its joys, frustrations and challenges!

The first challenge? Safeguarding training is ‘mandatory’ and most people are not there out of choice. Some arrive full of trepidation and anxiety, a few arrive expecting the training to be death by PowerPoint, and some, thank goodness, arrive with enquiring minds and a desire to improve their practice. Most however, have not thought about what they want to get from the session, beyond the mandatory ‘update’ – and that worries us! It worries us because by ‘update’ they are thinking solely of policies, procedures and process, not a person-focused, rights-based approach to safeguarding that meets, wherever possible, the desired outcomes of the individual concerned.

And this is the second challenge. In our experience, safeguarding is frequently driven by a fear of being blamed by other professionals for ‘getting it wrong’. There is often discussion from delegates in the training room about making a referral to ‘cover our backs’ or the ‘Spanish Inquisition’ atmosphere during safeguarding conferences. Individual culpability rather than collective responsibility seems to be perceived as the order of the day, and there is a belief that by sticking rigidly to process and timescales, any ‘blame’ will be avoided. Yes, as trainers we can, and do, give people information on policy, procedures, timescales, and how to fill in the forms – but the filling in of a form never safeguarded anyone! What safeguards people is a culture that values them and upholds their rights to make choices about how they live their lives, including the right to take risks.

The third challenge to effective safeguarding training? As trainers we find it extraordinary that some practitioners have little grasp of the legislation that should underpin their practice. They speak of their ‘duty of care to keep people safe’ as though it were a comfort blanket against the cold wind of legislative requirements, whilst conveniently forgetting that following these requirements is a fundamental part of their duty of care. If we are to safeguard adults in a person-focused way, a good understanding, and implementation of the Mental Capacity Act and the Human Rights Act is surely paramount. They are pieces of legislation that are common to all safeguarding partners and are therefore, powerful tools to utilise as a means of ensuring we work, in partnership, towards the outcomes the adult wants, as far as possible.

Perhaps the most fundamental challenge for safeguarding training however, in our opinion, is that it does not take place in a vacuum, but in established cultures that can support or hinder its transfer into practice. Safeguarding training alone, however good, will not establish an effective safeguarding culture in organisations; it is only part of the picture. Values driven recruitment, effective induction and probationary periods, quality supervision and excellent leadership, to name but a few, are probably more effective in preventing abuse and neglect, and responding effectively to concerns, than any safeguarding training.

So, how do we meet these challenges? How do we try and ensure that training is the best it can be and that learners can put their learning into practice?

Firstly, we believe that learners should know why they are attending training – and not just ‘because it’s mandatory’. They need to be aware of their legal responsibilities and accountability for safeguarding. They also need to have considered what they want to get out of the training and how they will be supported by their organisation to transfer the learning into their practice. This necessitates a three-way partnership between the learner, the organisation and the training provider, with each being clear of their roles in the learning and transfer process.

Secondly, it would be helpful for training to emphasise a rights and values-based approach to the safeguarding of adults at risk, with a genuine focus on working towards the desired outcomes of the person. However, in order to do this, we need to let go of the illusion that training on process and timescales will make everything better, and plunge headlong into the often messy and complex issues of people’s real life situations. It is, after all, their safeguarding, not our ‘back covering’. This is not to suggest that knowledge about processes and timescales isn’t important, but to quote Making Safeguarding Personal (2014:4), there needs to be ‘a shift from a process supported by conversations to a series of conversations supported by a process’. Therefore, training content, at all levels, needs to shift its focus too, in order to support practitioners to be confident in having those, sometimes very difficult, conversations with people about how they want (or don’t want) to be safeguarded.

All this is perfectly achievable. However, it cannot be accomplished in a culture where the fear of ‘blame’ drives practice, and consequently drives the content of training. Individual practitioners, managers of services, commissioners and Safeguarding Adults Boards all have a vital role, and responsibility, in supporting the necessary culture shift, away from individual blame and towards collective responsibility.

The Care Act 2014 talks about Partnerships as one of the key principles of Safeguarding. We tend to think of partnership working in terms of those directly involved with the adult at risk. We would like to see trainers routinely involved as partners in the broader Safeguarding context. We need to start having some meaningful conversations about how we can support the culture shift, because as trainers, we may want to ‘change the world’ but we know we can’t do it on our own.

A fantastic new service in Cornwall - Guest blogger Kelvin Leighton-Julian

SHOCT Kernow is a new HIV and sexual health information venture in Cornwall. Started in March this year by Kelvin Leighton-Julian, SHOCT Kernow aims to improve access to HIV and sexual health information and services to the community in Cornwall. Whilst SHOCT Kernow aims to provide this service to all, its speciality and primary focus is around the LGBTQ community, specifically gay men.

Why was SHOCT Kernow set up?

Simple, people have sex……phew, there I said it! It’s unbelievable, but true. Sex should great, it should be fun and someone should be able to be fully informed before they have it. However, people are still putting themselves, unknowingly, at risk of HIV and STIs (sexually transmitted infections). Some are doing so because they don’t have the knowledge to be able to protect themselves properly, some don’t have a true understanding of the implications that poor sexual health can have on their wellbeing or self esteem and others are embarrassed to make that first contact with a sexual health service or clinic.

Late diagnosis of HIV in people in Cornwall is well above the national average but overall positivity rates are well below the average. This means that out of those few people who are testing positive a high number are doing so late. This means that they have been living with HIV unknowingly for some time and have only presented to a clinic because they now of symptoms that relate to a low immune system. During this time they may very well have infected other people without knowing.

SHOCT Kernow wants to empower people, through learning, to think positively (excuse the pun) about their sexual health. In turn they can then protect themselves, protect others and empower others to do the same. It’s all about #PayingItForward.

It’s not just about the individuals though. Often there are opportunities for services and their staff to provide someone with information which could empower their service users but due to a lack of training it remains a missed opportunity. SHOCT Kernow wants to embody a culture of peer education within Cornwall allowing appropriate HIV and sexual health information to cascade freely down to the service user so no-one is denied access to the knowledge or service that they are entitled to.

You can find out more about SHOCT and the work it does at: https://shoctkernow.wixsite.com

FreeBird looks forward to working with Kelvin very soon - watch this space!!