Un/kindness, shame & resistance: the care of inpatients in NHS adult acute mental health units and how it might be improved

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The poor treatment of service-users in NHS acute mental-health inpatient units has recently come to light in three separate investigations. This problem is generally concealed: it has been described as the "last taboo", and research has found that complaints made by service-users about their care are dismissed by mental-health trusts, and that mental-health professionals engage in "magical thinking" to disavow negative inpatient experiences. Patients are not always well treated but what exactly this means is not clear, and the dynamics creating and sustaining poor treatment have not been articulated. Whilst working in an inpatient unit I observed that shame significantly impacted staff interactions with patients. Shame, loosely defined as a negative self-conscious emotion about how we are seen and judged by others, is an important avenue of research in environments like mental-health wards that are steeped in the phenomena of power, hierarchy and stigma, all of which facilitate shame. Shame is also a significant object of study given that it links the phenomenological with the structural, both of which are often elided by psychiatry in favour of the biological. In order to redress the epistemic injustice experienced by patients, their treatment will be conceptualised as 'un/kindness' rather than 'care', which has been institutionalised within psychiatry, or 'compassion', which centres the feelings of staff over the experience of patients as the recipients of staff actions. Using cultural theory methodology, previous work experience, new ethnography and diary-interview methodology, this research will investigate patient and staff experiences of staff un/kindness in NHS mental-health inpatient care, the role of shame in limiting kindness, how unkindness can be interrupted and subverted and how staff can sustain and enhance practices of kindness.