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The path to a mental health strategy – blocked by breakdown in basic good practice

V – so, we were hearing last time that a big, round table meeting had decided to set up a Mental Health Action Group.  You didn’t think that was much of a step forward because a similar group already existed.  But at least you’d agreed to brief the joint chairs in advance of the new group meeting.  So what’s happened since then?

A – the Action Group met last week (two months after the round table meeting – it takes a long time to find a slot in people’s diaries).

V – and how was the meeting?

A – I couldn’t say ‘as expected’, because I didn’t know how it would go, but it wasn’t unexpected.  It was as such a meeting might typically go.

V – which was how?

A – a limited agenda and general, unfocussed discussion.  To be fair, it did consider the role of the group and try to produce some actions for it, but pretty limited.  Mainly ‘shooting from the hip’ rather than based on a decent amount of thought.

V – so what was actually discussed?

A – it considered the role of the group and how it relates to the previous group, the one it’s replaced.  They felt the previous group should continue to meet quarterly, as a place to generate ideas and have wider consultation.  I said a bit about the current state of the draft strategy.  There was also some discussion about what should be in the action plan.

V – that all sounds quite relevant; pretty reasonable for a first discussion.  Do you think they shouldn’t have been discussing those things?

A – No, it’s just that it was very unstructured.  Someone would raise something new and discussion would follow on that for a short time until someone else raised another issue.  It seemed a random collection of topics rather than choosing what needed to be discussed and having a rounded examination of it.

V – isn’t that often how meetings go – following issues as and when they’re raised?

A – yes, but it’s not a good way to manage meetings.  The risk is that you don’t spend enough time on the most important things.

M – surely the things people raise are what they think’s important.

A – to some extent, but what’s on their mind may not be what they would consider most important if they’d reflected on it.

M – right, yes.  So you need more contemplation.  How about half an hour before each meeting all holding hands and chanting ‘Ommmmm’?

A – ha, ha, very funny.  The main problem, though, was we weren’t clear what we were doing.  The chair said, early on in the meeting, that the group was to produce an action plan in the coming weeks or months.  But then people started raising possible projects and initiatives as if we were proposing and choosing actions there and then.

M – I thought you said that was what the group was supposed to be doing?

A – Ultimately – but based on the evidence and some consideration, which we didn’t have to hand in that meeting.  What we should have been doing was deciding the process for doing that.

M – perfect.  The only thing better than sitting around talking – sitting around talking about sitting around talking.

A – no, that process could have been delegating to groups or individuals, but the legwork is probably not best done in a big group like that.

But talking of getting on and doing things, it turned out that one of the participants had been getting on doing things in his particular service area, using his own budget.  He’s intending to recruit one person with lived experience who would deliver some Mental Health First Aid training and do a few other things.

M – oh no, someone actually doing something!  You must be so offended by that.  Presumably it’s not strategic or consultative enough?

A – I’m happy with action.  But maybe it would be more effective if you consult with others, and bear in mind the big, long term picture.

M – But isn’t that sort of peer involvement in your strategy?

A – in ‘the’, not ‘my’ strategy, yes.  It’s just that working together and with a considered, coherent and evidence based plan, perhaps more could be achieved.  Maybe employing more people, working in other areas, perhaps more effectively.

V – OK, so things are happening, but you’re not happy with that.  And you’re not happy with the meeting.  So what went wrong?  Was it just badly chaired?

A – no, the chair did a reasonable job.  She did regularly pull the discussion back on track and given that this was a varied group of stakeholders outside her direct control, I think she successfully kept everyone on board.

V – so, what should have happened?

A – a clearer agenda which set out what we were trying to achieve, a focussed discussion on one issue at a time and a chance to have thought about the issue in advance – I think all of that might have helped.

V – and why didn’t that happen?

A – I don’t know.  I suppose the chair wasn’t that familiar with the subject.  She was expecting the participants, who had been working on this for a while, to come up with the ideas.

M – hang on a minute.  Didn’t you say last time that you’d agreed to do a briefing on the work done so far?

A – yes.  I’m afraid I didn’t follow through on that.

M – did you at least send round a copy of the draft strategy?

A – well, no, though I have sent it round since.  In retrospect perhaps I should have.  It actually covers a lot of the things discussed at the meeting.

V – so why didn’t you do that?

A – I don’t know.  I didn’t feel confident enough to send it to everyone.  I did send it to one of the joint chairs but I thought the other, a senior local authority manager would be too busy to read it.  Also, I was nervous about treading on their toes.  Also, while we’re in mea culpa mode, I should probably have spoken up more at the meeting and given my views.

V – I think there might be some issues here of your personal performance that are better discussed in private, in our one-to-one sessions.  But I think the conclusion we seem to be coming to is that this wasn’t terrible, it wasn’t out of the ordinary, but it could have been an awful lot better.  And the things that would need to change to make it better are fairly simple.  They are known and understood.

A – yes.  It’s not just about coming up with shiny new innovations.  It’s also about how to manage in a messy, imperfect world.  When the people who recognise those imperfections may be the ones making the mistakes.

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