- Aug 12, 2008
- Southend on sea
http://www.guardian.co.uk/society/2009/mar/04/nhs-complaints-mental-healthThe NHS is failing to deal adequately with complaints about its services, according to a recent report by the Healthcare Commission, the watchdog responsible for reviewing complaints that cannot be resolved at a local NHS trust level. The report reveals that the proportion of complaints upheld rose last year by 50% - and in less than a fifth of the 9,000 cases it looked at, the watchdog sided with the trust.
Most worrying for those who believe in the importance of listening to user feedback as a means of improving services, the main issue raised by complainants was the way in which the NHS handles complaints. In other words, what bugs people most is not the issue that led them to complain, but the way in which the NHS responded when they did so. Complaints, it appears, breed complaints about complaints.
What the figures cannot show is how many people wanted to complain but failed to do so because they believed there wasn't any point. It's only a hunch, but I'd hazard a guess that users of psychiatric services are not exactly under-represented in this category. It's not that we don't moan. The psychiatric service user without at least one burgeoning grievance is a very rare being indeed. But while moaning is the province of the disempowered, a complaint requires at the very least a hope that one might be heard.
A complaint is more than a moan; it is a call to action. The action called for may range from a simple apology to compensation to a full-scale inquiry and reform of the service in question, but whatever the specifics, the complainant wants something back. And the more they have to barter with, the more likely they are to get it. Regrettably, the success of complaints has more to do with the power of the complainant than with the merits of their particular case, as anyone who has tried complaining about social security benefits, for example, can readily attest. And few positions, if indeed any, can be quite as powerless when it comes to complaining as that of the mental health patient.
A typical letter of commercial complaint comprises the following elements, the proportions of which may vary: a compliment designed to flatter the reader and impress on them the sound judgment of the complainant, along the lines of: "I've been a loyal customer for the last 10 years and have always been tremendously impressed both by your products and your exceptional standards of service"; an expression of shock at being let down, culminating in "I was therefore extremely disappointed..."; empathy with the predicament of those responsible for the failure, such as "Naturally, I understand that a car is a complicated piece of equipment..."; or a request for some form of restitution and a threat of forever withdrawing custom if this is not forthcoming.
With this model in mind, it's not hard to see why psychiatric service users may struggle to get their complaints taken seriously. The fact that they have mental health problems automatically calls into question the soundness of their judgment why else are they barred from jury service? And the longevity and loyalty of their custom, far from aiding their cause, is likely to be held against them. Any shock or anger at the way they have been treated is easily dismissed as a symptom of their condition, and a threat of withdrawing custom can always be answered with a section.
The complaints of psychiatric patients are, in short, so instantly dismissible that they are seldom worth making at all. Time and again, it proves too tempting for recipients of service users complaints to exploit the credibility gap, rather than confronting the awkward process of self-examination.
There are, of course, complaints procedures for mental health services, like anything else, but unless we are prepared to address the stigma that lies at the heart of the problem, these are likely to constitute little more than box-ticking cosmetics. Which is a shame, as the genuine feedback of service users, both positive and negative, might be seen as something well worth bartering for.