Questions we need to ask

Dr Sarah Ashworth on the latest care abuse scandal.

Like many others I was shocked and saddened to watch the Panorama documentary exposing the abuse of individuals within the field I have worked in for the last ten years. It is a shame to think that despite the widespread attention the Winterbourne View abuse scandal received, it appears the subsequent reaction was insufficient to prevent this situation from occurring again. In 2011, responses included vilification of the perpetrators, criticism of organisational ‘culture’, and calls for governmental action. Recently, I have observed similar reactions from both professionals and the public, and therefore am not hopeful for a different outcome.

As a psychologist, what I believe is essential, is the professional curiosity and compassion we apply when working clinically, asking the questions ‘why?’ and ‘how?’. I appreciate the automatic emotional reaction to criticise, express disbelief, and distance ourselves from colleagues who act this way. Believing ‘we would never act that way’, saying ‘there must be something other about them’, fearing that ‘if we are observed trying to understand their actions, we may be in danger of excusing them’, may be self-preservative; an attempt to protect our own professional and personal identities.

Whilst understandable, these reactions are not constructive. I believe it is our role to try to explore, understand, and explain human behaviour. Furthermore, the specialist skillset held by forensic psychologists regarding risk assessment and management has direct utility when faced with the most abhorrent behaviours such as these. Asking questions designed to provoke consideration of the factors involved is the starting point to developing a formulation which may inform future work aimed atprevention. This piece aims to ask some of those questions.

Is it something about the individual within the role that increases the likelihood of resorting to such behaviours? Are people with harmful intent seeking out positions of relative power and isolated access to vulnerable individuals? If this is the case, focus needs to be drawn to recruitment processes. Use of evidence-based advertising, shortlisting and interviewing techniques may increase the effective recruitment of appropriate staff. The introduction of aptitude and attitude assessments may screen for negative or potentially harmful characteristics.

Is it that individuals with similar backgrounds and experiences to those we care for are drawn to the caring profession; for example, adverse childhood experiences, relationship instability, trauma, and exposure to violence? Often those facing the most direct contact with our client group receive the least training and support. If so, would the profession benefit from more attention being paid to the mental wellbeing of those we rely on to care for possibly the most challenging and complex individuals?

Are healthcare jobs seen as an ‘easy option’ with high application success rates, low qualification requirements and low experience expectations, drawing in apathetic individuals, who prioritise money over healthcare provision? Does this lead to a culture of inaction, the bystander effect we are all aware of, so that when one person oversteps the mark, there is no repercussion, no action, and by lack of a response such behaviour is sanctioned?

Or is the environment to blame, creating this faceless ‘culture’ the media refers to. Drawing upon my experience within healthcare I think there are several proximal factors which may benefit from consideration. Those working in secure environments are often exposed to violence perpetrated against them; they experience normalisation and expectation of workplace violence and subsequently experience high threat perceptions and high levels of arousal.

Is the behaviour we’re seeing an unacceptable and abusive extension of the ‘gallows humour’, with which those working within challenging environments may be familiar? A slow and steady overstepping of boundaries; difficult to perceive and even more difficult to backtrack from? Is it this, combined with the barrier to physical contact having been broken down due to the use of physical restraint?

Do employees lose sight of the outside world through working within an isolated, insular and depersonalising environment where, in the interests of relational security, they are actively discouraged from bringing their personal lives into work? Employees lack reminders of their outside lives such as the photos and keepsakes that many office-based staff are accustomed to.

Or, as is so often the case within risk assessment, is it that a constellation of factors, proximal and distal, individual and environmental, were involved in the creation of the perfect storm?

Yes, asking these questions is difficult, yes they are uncomfortable, but I believe it is our responsibility to ask and possibly even to answer these questions: to use our professional skills and experience to try to understand and explain these behaviours, in order not to excuse, but to prevent.

Dr Sarah Ashworth
Forensic Psychologist
Nottingham

Picture by Tim Sanders

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