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

NHS急性精神健康住院部的服务用户的不良待遇最近在三个独立的调查中曝光。这个问题通常被掩盖：它被描述为“最后的禁忌”，研究发现，服务使用者对他们的护理提出的投诉被精神健康信托机构驳回，精神健康专业人员从事“神奇的思维”来否认消极的住院经历。病人并不总是得到良好的治疗，但这到底意味着什么并不清楚，也没有阐明造成和维持不良治疗的动力。在住院部工作时，我观察到羞耻感严重影响了工作人员与患者的互动。羞耻感被宽泛地定义为一种关于他人如何看待和评判我们的负面自我意识情绪，是心理健康病房等环境中的一个重要研究途径，这些环境充斥着权力、等级制度和耻辱感，所有这些都促进了羞耻感。羞耻感也是一个重要的研究对象，因为它将现象学与结构学联系起来，而这两者往往被精神病学所忽略，而更倾向于生物学。为了纠正患者所经历的认识上的不公正，他们的治疗将被概念化为“联合国/善良”，而不是“照顾”，这已经在精神病学或“同情”内制度化，这中心的工作人员的感受超过了患者作为工作人员行动的接受者的经验。使用文化理论方法，以前的工作经验，新的人种学和日记访谈方法，本研究将调查病人和工作人员的经验，工作人员不/善良的NHS精神健康住院治疗，在限制善良的羞耻的作用，如何不善良可以被中断和颠覆，以及如何工作人员可以维持和加强善良的做法。

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.