Thursday, 24 January 2013

management and leadership in psychiatric situations

Is it me?  Should I not be expecting good management and leadership in psychiatric situations?  As in it's only for business settings and the real world of normal people.  Where there is accountability, evaluation and customer feedback.  Where people vote with their feet and go somewhere else for the service.

But maybe this is the issue after all.  For in psychiatry we don't have the choice of setting or doctor or treatment.  You have to take what you're given, swallow the drugs if detained or be forcibly injected if non-compliant.  It's the name of the game in terms of crisis management psychiatrically speaking.  Unless you have money to pay for The Priory or suchlike.

Even after 40yrs of engagement with the psychiatric system it's interesting that there are surprises to be found.  For why should psychiatric system management and clinical decision making be any different to any other setting?  It should make sense, both financially and personnel wise.  So that people are consulted and the best use of money is made.  As a good manager I really don't like having to witness stuff like this.

Scotland is where I was born and brought up, and have lived here for 60yrs, so think that I can speak with some authority on its culture.  My early years up to when I got married at 19 were spent in Perth.  Then a few years in Aberdeen at university.  Living most of the next 15yrs in the Lanark area with brief spells in the Crieff and Arbroath areas.  And now in the Cupar area since 1990.  A mixture of city, town, village and farm settings.  

Working as a shepherdess, youth worker, lecturer, advocate, shop manager, volunteer co-ordinator.  Driving tractors, milking cows, selling sheep at market.  Running my own business, warden and cook for elderly, setting up church groups, writing news articles, managing websites.  Developing numerous community projects in different areas, working in schools, colleges and universities.  Above all being a mother and grandmother.

What has got clearer over the years is the different cultures in the Scottish areas, even if only 20mls or so apart.  I'm thinking it goes back to our heritage and history, of clans and settlers.  And a weaving of people through the generations, a rich tapestry which makes life interesting if challenging but never dull.  For me the latter is the most important as I really don't like being bored.  Never did.

John Knox House on the Royal Mile Edinburgh
Therefore in psychiatric system management the recognition of Scottish culture has to be considered.  It makes no sense to think only of logistics and saving money.  There are people involved, the patients, staff and family/carers.  Cultural considerations of language, background, upbringing, history and meaning.  The reasons for people choosing to live and work in a certain area.  And if it's working well then why fiddle with it?

Trying to fit a square peg in a round hole isn't a good idea.  No matter if the high heid yins think it to be so.  For Scotland is a grassroots country and we're not keen on folk telling us what to do.  Think of John Knox and the covenanters.  Or the present day plans for political independence.  We really don't want to be following orders that don't make sense.  It stands to reason.


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