Active listening in challenging times

We all know that active listening is important.

Active listening is generally good for mental health.

Mental health services - in particular - need to be good at active listening. Unfortunately, I am not sure that they always are.

One of the reasons for that occasional failing I suspect is due to the history of mental health services.

The old asylums were not good at listening. The great Victorian asylums were infused by a spirit of (mostly) benevolent paternalism. Services knew best. And because they knew best, they really didn’t need to listen to ‘inmates’ or ‘patients’ (as people receiving services were called back then). Whether as individual patients or in the collective, the old asylums were mostly run for the convenience of the doctors and nurses. Listening was generally not what the asylums focused on.

I saw this very clearly training as a psychiatric nurse at Tooting Bec psychiatric hospital in London forty years ago. Tooting Bec was a classic Victorian asylum, and nothing had changed much from care over the previous century. For example, tea was still made in big pots to which sugar was added – whether people liked sugar or not. This seemingly small act of not listening for individual preferences was symptomatic of everything in the asylum.

When the asylums closed, we had the ‘hospital in the community’ for quite a while. There was generally more listening during this period but now ‘clients’ (as people receiving services tended to be called) were to be monitored and supervised as if their home was in a hospital ward. Listening often meant listening for the signs and symptoms of problems. As a community mental health nurse in both the UK and NZ with large caseloads, listening was something I learnt to actively do by monitoring for signs that things were getting worse.

With the onset of the recovery, approach listening was more strengths-based and individuals certainly benefitted from an increasing emphasis by professionals on active listening. However, as a collective service users/tāngata whai ora still struggled to have their voices heard.

It’s strange to say, but even when mechanisms have been put in place to ensure we can hear the collective voice of tāngata whai ora and whanau, these have not been used as much as one would expect.

Currently, most DHBs and several NGOs are using Mārama Real-Time Feedback (RTF), and rich information is emerging which deserves a greater awareness than it presently receives.

As He Ara Oranga made clear, we need to be listening closely and carefully to the voices of both tāngata whai ora and whānau.

Mārama RTF has been up and running for four years now. It provides real-time feedback in seven question areas for tāngata whai ora and whānau, giving us invaluable information about what tāngata whai ora and whānau think of the mental health services they are receiving.

My only hope is that we are actively listening to what people have to say about the services and treatment they are receiving. Particularly in these challenging times, we need to actively listen to people's wants and needs and not just assume that we already know.