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

最近，在三个独立的调查中，NHS急性精神健康住院病房对服务使用者的恶劣待遇被曝光。这个问题通常被隐藏起来：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的投诉被心理健康信托机构驳回，心理健康专业人员从事“神奇的思考”来否认负面的住院经历。患者并不总是得到很好的治疗，但这究竟意味着什么尚不清楚，造成和维持不良治疗的动力尚未明确。当我在住院部工作时，我观察到羞耻感极大地影响了工作人员与病人的互动。羞耻感被宽泛地定义为一种关于我们如何被他人看待和评价的消极的自我意识情绪，它是心理健康病房等环境中一个重要的研究途径，这些环境充斥着权力、等级和耻辱等现象，所有这些都助长了羞耻感。羞耻感也是一个重要的研究对象，因为它将现象与结构联系起来，而这两者往往被精神病学所忽略，而倾向于生物学。为了纠正患者所经历的认知不公正，他们的治疗将被概念化为“仁慈”而不是“关怀”，这在精神病学中已经制度化，或者“同情”，这将工作人员的感受集中在患者作为工作人员行为接受者的经验之上。本研究将采用文化理论方法、以前的工作经验、新民族志和日记访谈方法，调查NHS心理健康住院护理中患者和员工对员工善良的体验，羞耻在限制善良中的作用，如何打断和颠覆不善良，以及员工如何维持和加强善良的实践。

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.