A patient's perspective of mental health: is it because I am Black?

Joining us on the podcast, we have Michelle Joseph, who is a patient representative here at the Royal College of Psychiatrists. For Black History Month, Michelle will be sharing her experience of being a patient on a psychiatric ward, her experience of racism in the UK and how she would alter the mental health system to benefit both staff and service users.

Find out more about how the College is celebrating Black History Month.

Comment from South London and Maudsley NHS Foundation Trust

"We are always striving to improve the quality of care we provide for people who use our services both as inpatients and in our community. We are committed to working together with the people who use our services, and their carers, who remain crucial in our ambition to improve the quality of our care and the design of our services. 

"South London and Maudsley NHS Foundation Trust's Patient Advice and Liaison Service (PALS) provides advice and information about its services. PALS can also help resolve any problems people might have with services, whether they are a patient, carer or member of the public. More information about the Trust can be found at www.slam.nhs.uk."

Transcript

Ella Marchant: Hello and welcome to the Royal College of Psychiatrists' podcast with me Ella Marchant.

At the College, every October, we celebrate Black History Month. As part of this, it's crucial to recognise and celebrate the diverse past, present and future of the College by speaking to psychiatrists, mental health professionals and patients. It is very important that we speak to patients and here about the care they received.

Joining us on the podcast, we have Michelle Joseph, who is a patient representative here at the Royal College of Psychiatrists. For Black History Month, Michelle will be sharing her experience of being a patient on a psychiatric ward, her experience of racism in the UK and how she would alter the mental health system to benefit both staff and service users.

Thank you for joining me today. Do you think we could just talk about when you first became aware of having mental health needs?

Michelle Joseph: Well, I think this kind of question is one where I can look at it in the moment and then look at it retrospectively. So, my first encounter with a mental health hospital was in 1999, I didn't necessarily think there was anything wrong with me at the time. But my friends and family were concerned around my behaviour. With this concern, I was what they call, kind of triaged, as it were, because they would have three professionals, a social worker and all that kind of stuff come assess you. If you are going to be sectioned, and then these three professionals would need to agree or you can go in voluntarily. And it just so happened that I had been in a situation quite similar a couple of months previously. I got a sense that they were going to, you know, take me to hospital as it were. I decided that I was going to go in voluntarily, because I just kind of knew that that would be the best route. So, yeah, I first became aware in 1999, which was my first admission into hospital.

EM: And when friends and family would voiced concerns to you, what kinds of things what they say?

MJ: It was more a behaviour thing. The way I was talking, the way I was acting, the way I was reacting, you know, if I look back on it, literally no boundaries. In the sense of speaking at great speed, disconnected thought processes, almost like a fearless, quite full-on behaviour, in the sense of a lot of speaking, and making perfect sense to myself, but clearly, not to others.

EM: And what has your journey with mental health service has been like?

MJ: Well, to be honest, it has been mixed, my first encounter in 1999. And so, a bit of background, I lived in an area that was very close to a particular mental health hospital that was called the Maudsley. Because of just growing up in the area that was seen as the hospital that nobody would want to go to. My assessment was in that hospital, which is where, you know, assessments actually happened in those days, as opposed to being triaged in an A&E situation. So, yeah, with the stigma that was attached to the Maudsley, I requested to go to another facility. And this facility was of a private nature.

Unfortunately, it was atrocious, and I felt more like I was trying to have to protect myself, while I was there, rather than feeling like I was being taken care of. The basics of just being respectful and kind did not exist. There was only one particular nurse who was on the night shift, she was almost like an angel, and the reason why I state that is, when I went to this private hospital, I was admitted late and they didn't do checks on my health like whether I was even on medication. Or whether I had any health issues. And actually I have reactionary asthma. They gave me medication that reacted to my asthma. I truly felt that I was passing away, like I was not being able to breathe. I was struggling to breathe.

EM: Did you have access to your inhalers?

MJ: No, because I was just taken from the Maudsley to this place and was given medication to help with what was going on. And you know, things like Haloperidol, Procyclidine, and all that kind of stuff, which can react to asthma. I spent that first night in fear that I was going to drift off, and this particular nurse that was on at night, she stayed with me and reassured me and said that the medication will work its way out of my system, and we just need to just try and keep you awake until the morning and by then it should it should ease. I felt like I had to protect myself right from the beginning. It would appear that you're not allowed to have an opinion in these settings. Now, whether this is because they see that you're not of sound mind, so clearly anything that you come out with [is invalid], and also there is this control. And therefore, if you have an opinion, again, it is not considered. It can be with the most basic things, I remember one incident where I went for breakfast, and the food was cold, I hate cold food. I asked if it could be heated up. I was dismissed in not a very nice way, and just told, have what you're being given type thing.

EM: You're not a prisoner, you're meant to be being looked after?

MJ: Well, that's what we believe is the case, but it isn't necessarily the truth, and especially when you're vulnerable, like anybody who goes into these facilities, these mental health wards/facilities are vulnerable. I always use the term, it should be a safe place to fall. And that you should be kind of made to feel that even though the pressures of the world because that's what it is, you know, it's the pressures of the world that are so overwhelming, and literally breaks you and breaks your mind and fractures your mind. And so, at that time, when that happens, you should be held, in the sense of, in a safe environment. However, unfortunately, my experiences were not like that.

To be honest, the very place that I said I didn't want to go is the place I ended up in the end. I left the facility of this private place. This would have been like, six weeks afterwards, in that second six weeks in this private facility. It was awful. I mean, we were literally taking care of each other. I ended up in the very place I didn't want to be in. However, it was the best place to have been in, when places have stigma attached to them. Then you make a decision, you're thinking you're making the right decision for yourself, and you're not.

So, yeah, I ended up in the Maudsley, and there was care from the staff. It was almost it flipped. Like in the private facility, it was the patients that were taking care of each other, and the staff weren't. Whereas in the Maudsley, the nurses were taking care of the patients, the nurses were on it. And there was a particular nurse, and he was amazing. He cared about me, he cared about my wellbeing. In those days, they would have meetings of all the necessary people that was assigned to your care, and they would try to work out what would help you. Once you leave the facility, what do you need? It was so patient-centred, a really good marriage of health care. For me, it was around needing a secure home, a place I could call home, and that was achieved, and they were able to put me on a housing list, and I was able to be housed. That place truly did become my sanctuary. However, unfortunately, I was supposed to have a CPN, the community nurse, they never showed up. I was pretty much left to heal myself for the rest of the journey, which was unfortunate, because there were times I felt despairing, but knew I didn't want to end up back in a ward. I have to be honest, my faith has always been with me. I really had to draw on that.

EM: So, after you're discharged from an inpatient setting, in a ward, you're given a nurse who will visit you and check up on you? And does that happen to every single person who's discharged?

MJ: Well, I would like to think so I think that's what it was back then. I think they called them CPS, community practice nurses, was assigned to you, but my one never turned up. And so you know, that was the experience in 1999. In 2005, I was actually living in Ireland and I think again became unwell and it was a very different approach. Literally, they did assess you, and then they gave you a really heavy duty drug which I don't know what it was, but it just, it just knocked you out. I clearly slept, and as a result, when I woke up, it's like my brain had recalibrated. My thoughts were making sense again, you know, I'd reached a place and I actually thought that was quite good. Because really, it is about, you know, your brain firing and misfiring and disconnected. It is about bringing it to a place of absolute rest, as opposed to if you remain alert, because sleep goes, you don't need it.

When you are experiencing mania, from my experience, you just don't need to sleep, every bit of information that you are receiving, you're hitting off and reacting and responding. So, that process was actually, I thought, quite a good one, because it brought me back quite quickly. Then the two years that I count as really healing and given me an understanding of mental health was the fact that I ended up in the Maudsley in 2012.

Then two years later, I was there in 2014, I was going through a very traumatic situation, I'll just say I'm a divorcee now. We will leave it at that. And as a result, because obviously I'm talking about this retrospectively. In 2014, there were still staff members who knew me from 2012. This continuity of care which I would sing from the rooftops, it helped me heal in 2014, because they knew me in 2012. And as a result, in 2014, they put in measures, because there was almost a repeat of what happened in 2012. But in 2012, they didn't realise who my stressor and trigger was. Whereas in 2014, they went, something's not quite right here, and therefore safeguarded me. I was able to be in an environment that I felt so protected by. To the point that my care in 2012, obviously, it had its challenges, but as feeling cared for, and supported on a ward, it meant that in in 2014, I actually ran to the hospital, to be assessed, to be admitted, because I truly believed it was my only refuge. That goes to show that in 2012, I must have believed. So, imagine, you know, I'm not thinking straight, because my brain has disconnected again, and the one thing that I knew I had to do was get to a place of safety.

In that place of my mind, it made me feel that my place of safety would be going back to the Maudsley. And that's a testament in itself, I think, because if I hadn't had the treatment that I knew I'd had in 2012, there's no way I would have thought like that, that would have been my best environment.

In 2014: I was heard, I was taken care of, there were many things revealed, and I truly believed that they, I like the term - they had my back - when all those around me didn't. Outside, they had my back. And it was a process that led to me being able to be cared for, be protected. They have these home treatment teams who are that bridge of being out in the world, still feeling vulnerable to a certain extent. And then being in a situation where you're seeing them, they're coming to see you every day. But I also was given therapy, which revolutionised my life really, because it was at that therapy in 2014, where it was identified. So, the term chemical imbalance is used a lot when they talk about mental ill-health, but actually mine was a chemical imbalance. It was identified that I had very depleted iron stores, and that was due to a condition which I had, which was fibroids. Fibroids mean that you bleed a lot. was losing blood in a crazy way. As a result, I would be my haemoglobin would be low, my ferritin would be low. I wasn't getting enough oxygen to my brain, which was making me go into psychosis. Because one of the things that the psychiatrist said to me was: How come you remember everything that happens? And I'm like: Well doesn't everybody? She goes no, they don't. Which shows that I was in a state of being able to process but I wasn't in a state to be able to communicate. There was a visual, I can remember everything so vividly. So, that's why I remember. But it really changed my life.

As a result, it meant that one of the things that needs to be checked is to see where my ferritin stores are, my iron stores are and where my haemoglobin is. Since I've been keeping on top of that, then medical intervention. I had myomectomy first and then they came back, and then I had embolization. And that reduced the fibroids, and as a result, I was an experiencing massive blood loss. And now at the age of 51, I'm in the menopause, so there's no bleeding. As a result, my health, and my mental health has improved.

It's one of the things we talked about, you know, when having had meetings with the Royal College, I think they call it comorbidity, where they're taking into account what's happening with you physically. And all these things have to be considered, which is something that is so important, because there are many people who are experiencing what I'm experiencing, and it hasn't been picked up and it was only by having a psychiatrist. I saw this, psychiatrists for at least over a year, that is gold. It's a kind of gold treasure that I really think should be unearthed again and used because I don't believe that you can process this condition in like, seven weeks. It's just not possible. It's ridiculous to think so. Actually, you know, they talk about money, money is always the thing that people talk about. But the reality is, is that you'll be saving money, if you're able to address what it is that's in that person that's making them snap.

You ask about my journey, mental health services and I think it's important for me to speak about the last one that I had, which was in 2017 and again, I won't mention names, but it was atrocious. From what I've said previously that it can work and it does work to then revisit it three years later, and this was a totally different bar. To see how awful it can be and how awful it has become from that timeline of 2014 to 2017.

Again, I found myself in a situation like in 1999, in this private hospital, and it wasn't private it was NHS and to find myself in a situation where again, I felt fearful for my life. Not only that, the senior doctor who was supposed to be assessing your care, again, with my long history, I had a care plan in place. The care plan was put in place from 2014 of what medication I need and all that kind of stuff and this particular medical professional refused to accept that and put me on such a high dose and also not the one that I use. There's a medication called Quetiapine Excel and there's one that's called Quetiapine. Quetiapine Excel is a slow release and this doctor refused to give me the one that was mine and Quetiapine for me who has high absorbency. So, absorbs medication in quite a quick rate. I was given it and I just about, and I mean that, made it back to my room. That's how quick it worked for me and so that really concerned me.

It so happened that there was a day when a friend came in. Whose also a medical professional and it was just at the time when I was going to be going in to speak around meds and what's happening on the ward and what the plan was going forward. She was able to come in and she advocated for me and stated, that I know what I'm supposed to have, there's a care plan and place - why aren't you doing it? The medical professional agreed. And so it gave me real comfort. However, when it came to taking the meds, they had reduced it, but then they'd replaced it with another mood stabiliser, which was Sodium Valproate.

So, it's that kind of thing where it's so upsetting that you're in an environment again, which is supposed to be helping you, healing you, protecting you, and guiding you. If you're not really thinking in a way that you know, is conducive to everyday thinking, you should feel like you're being protected. Instead, I was given medication, high doses of medication that I didn't require. I was kept on the ward, and wasn't allowed to leave the ward, it was awful. And very damaging.

EM: Thank you so much for sharing that story and thank you for being so honest and also thank you for putting it into a timeline. We can understand the journey that you've been on. And the fact that you visited the same facility several times as well as very interesting. As a black woman on the receiving end of mental health services, in your opinion, do you think it's changed for the better or worse, considering that you've got experience spanning from 1999 to 2017?

MJ: You know, I can honestly say, when I initially went into any mental health facility, I never, ever thought that my the colour of my skin was attributing to how I was being treated. However, I have to saying, when you are witnessing how other people are being treated, to how you're being treated, you can't help but wonder: Is it because of the colour of my skin?

Being a patient representative for the Royal College of Psychiatrists, and the discussions that we would have been having from August 2020, to put together papers and stuff, and we're talking about equality and equity. Then hearing the statistics of how black people are treated with mental health, you almost go, surely not. Surely I wasn't treated like that, because the colour of my skin. However, is very evident to me as a black woman, that there are times when I feel I have a right to give my opinion, which is an informed opinion, and an intelligent opinion, because I know my journey, I know what works for me.

I have, alongside medical professionals, been educated, gone to meetings around mental ill health, around strategies in dealing with it, you know, around assessing my triggers, and being able to understand what I need to do to keep myself well, which does include medication. When you're in a situation where you're trying to impart that knowledge of your health-needs, to become well again, and you're not being heard.

You're being told you're being aggressive. You're told you're talking over people and not giving people an opportunity, you're even being told that you're talking too much. You go, I'm just trying to inform you about this last situation in 2017. They did home treatment team, knowing what a home treatment team is like, seeing how these people were conducting themselves as a home treatment team. They would come into my home, they would ask me questions, I would answer those questions. Then they would note down that Michelle is still experiencing mania because she's talking too much. And you're just like, how does that make sense? Then I found myself adjusting my behaviour and realising that in order for me to be heard, I'm going to have to adopt a personality that is more acceptable, and more conducive, to them hearing my voice. I think because you can't help but avoid knowing that if over the years because you have a voice and you feel you have a right for your voice to be heard, that you're being called aggressive. You're being told that you almost don't have a right to your opinion. That I suppose I still want to believe and maybe that's just me, I still want to believe it's not to do with the colour of my skin.

However, I am at times on the receiving end of behaviour that can only be reacting to me because of the colour of my skin. Because there were times I wouldn't even have opened my mouth and expressed myself and a reaction. And a defensiveness, I'm being presented with, you know, I'd be presented with a reaction of defensiveness. There are times I'm having to say to people: I don't know what this is about, but I just need to tell you and I have said this recently, my name is Michelle Joseph, I'm a really nice person, so whatever's going on with you, can you see me please? And to think that you have to say that. The only thing that they can be responding to when you haven't opened your mouth, is how you look.

EM: So, there's aggression already happening towards you?

MJ: There's a defensiveness. I have to acknowledge that as a person of colour, when I see people who who are not people of colour, how they are being treated in a softer way, then you know that? Well, it's not because I'm shouting. It's because they feel more comfortable interacting with them, than they do with me. Even though they don't know me.

EM: So in your opinion, we've already talked about this a little bit, but has the UK progressed or regressed, in terms of dealing with racism.

MJ: I think we're in a very difficult season in our world. Now, we know that things have changed quite significantly, with what happened. With George Floyd. We see many organisations trying to acknowledge or take ownership of what they are, or are not doing within their organisation. We know we've got the whole thing around Black Lives Matter, I can honestly say to you, I've always believed my life has mattered.

I am in this kind of place where I go, is this just another short-term reaction to something that should never have happened? Because this is not something new. I was growing up in the days of Stephen Lawrence. I was going to college in an area very close to where his life was taken. I was experiencing so much racism. That would have been between 1989 to 1992 when I was at drama school, and to find ourselves in 2021 having to express slogans straplines, like Black Lives Matters. You have to understand when I grew up in the 70s, there used to be in South East London, National Front rallies, in Camberwell. As a young child growing up, you had to, if you found yourself out in Camberwell Green, you needed to run pretty quick to get yourself home. Because they were coming. They were and had the right to march openly on the streets of London.

Also, I've been in a situation where when I left school, because of the way I speak, and I used to speak a bit posher, because my mom is a bit posh, bless. I had a very, like RPesque accent then. I remember calling up for a job position. I had all the O Level qualifications. I went to this establishment, they saw who walked in, I sat down, they left me waiting for 45 minutes. Then said that the post had gone. Because the person who they thought they were speaking to on the phone was not the person who presented when they walked in. The only difference can be, because I never lost the qualifications in that time, I never lost the way I spoke at that time. It was very evident it was due to the colour of my skin.

When you've grown up with that and say has it regressed? Well, it's just come out of the shadows because I believe it's always been there. Is it a beast that we're ever going to be able to slay? I hope. However, and this is how I always phrase it, I continue to see man's inhumanity to man. Which is humankind being inhuman to humankind. In my opinion, has the UK progressed or regressed in dealing with racism? I feel sometimes we're in this dance of progression, and then it fizzles out and we regress. I also believe that, as a woman, who has been born in the UK, and who has lived in England, I will, and I make a point of it. Now, I'm English. I say to my friends, how can someone be born in France and be French? How can somebody be born in Germany and be German, and I'm born in England, and I'm British, because of the colour of my skin. That makes no sense to me. The reality is, is that I was born in England, and therefore I'm English.

I just feel like there's a generation of young, black people. And I consider myself young as well still, who are not afraid to speak out against injustices, that they're on the receiving end. I always say, it just takes one. If all of these one people in their own little places, stand up, and speak out. It doesn't have to be aggressive. It doesn't have to be confrontational. I think that's the misunderstanding of communication of how we present ourselves with our attitudes with our behaviours and in communicating. I'm speaking to you, I'm talking about things that I'm passionate about. There's no aggression in me. If someone receives what I say as aggressive, then I would question what's going on for them?

EM: Absolutely. And if we could create a step-by-step process, or if you were Prime Minister tomorrow, how would you change mental health services to make them work for patients and staff?

MJ: I truly believe that we have the ability to improve mental health, which is why I believe I get so frustrated by it. I do perceive my journey in mental health, even with its moments of sadness, I do perceive my journey as a positive one, even just speaking here with yourself. Being able to communicate, not with pain anymore, but with genuine passion, because I genuinely decided, and this was after the life changing experience in 2017. I stated to people that rather than become bitter about what I had been on the receiving end of, I was going to make it better. I was going to stand up, and I was going to speak out.

It's not in any way other than to try and communicate to all those who have the power, the position and the pennies. To change it, then we need to start doing that. If I was able to speak with these people, I would say to them, and I do feel privileged, I have to say. I'm actually in the Chief Executives Task Force. I mean, my mind gets blown when I think about it. That I have been positioned where I get to speak and have conversations with Adrian James, Paul Rees, with Lade, with Raj. I feel privileged and also to hear what is happening for workers and also for patients. It gives you a real understanding that what we need to do categorically, is listen to each other and not feel like there is one against the other. It's very easy for me to feel based on my experiences, say with a CPN that didn't appear or with a nurse, a psychiatric nurse that didn't assess me in a way or with a medical doctor on a ward. It'd be so easy to tar them with the same brush. And that's not the case. Equally, that has to be the other way. Not everybody who has mental ill health should be tarred with the same brush.

You know, I truly believe in my experience that mental health is on a spectrum and there are those who have moments where the world is just too much for us. And we need to be protected, I would consider myself high-functioning, because it's being maintained by myself. Now you leave hospital, you get put into the home treatment team, and then you get signed back to your GP. That would be what I would state for the journey of someone who needs help. Also, the hospital that was in 2017, looked amazing. It was clean. I mean, it was so clean. They spent all this money on people cleaning the places and making it look really clean. While the actual nursing staff was had such a high turnover, the staff were fearful. At times in this particular ward, when a patient would as I call, kickoff, the nurses hid themselves and locked themselves in this nurse's station, and left us as patients to either run to our rooms and lock our room to make sure we were safe.

So, it is about protecting the nursing staff, it is about appreciating what they do. I do believe that this role as a nursing staff is a vocation. Because not everybody can be in that environment, and it not impact on them. It's about making sure that nursing staff have the support that they need, whatever that looks like for them. We need to listen to what that looks like what that feels like. Whether it's having groups that they're accessible to, at any point, if they're struggling. Whether it's a specific set, Team Leader, you know, that or a buddy system, whatever that looks like for that person. Those things need to be in place for them. If we don't take care of the nursing professionals, then how are they supposed to take care of us, we need to safeguard each area, because then when they are their best self, and they don't feel weary.

When it's a vocation, it's a role that you take that is more heart-lead, and head-instructed. They know what they're doing. They know what they're supposed to do within their role. However, there are times when you meet a nurse who you know, cares about you and you feel so safe. And in order for them to feel that they have the capacity to care, then those in those senior positions need to make sure that they are cared for. It is like a trickledown effect. It really is, and then as a result, as the person on the receiving end of care.

When I say that I believe that my story is a success is because in that time line between 2012 and 2014. Well, actually, let's say 2012 and 2016. Because that's when I then went into getting the psychiatric care that I needed. Talking through what had happened was, what life skills I was going to put in in place, teaching myself to be kind to myself. Because when you have this, and I can only speak for myself, you feel worthless. You feel like, you know, why? Why did this have to happen to me? And you blame yourself. You blame yourself because you have responded and reacted to friends and family members in ways that you can't take back that you have been stigmatised throughout your life. You feel like you'll never be beyond that mental health problem. Then you have to learn to accept what you have. Because until you reach that point where you accept that this is going to be your life, what are you going to do to try and make your life still worth living. It starts with accepting and loving that this doesn't have to define who you are, even if others do define you by. It doesn't have to restrict the quality of life that you can have, if the proper processes are put in place.

So, what would I do? Based on my journey, I would make sure that everybody has a safe environment on a mental health ward. That would look like staff that genuinely care, that genuinely want to be there so that they can take care of the patients who need a soft place to fall. Also that they are prepared to listen to the patient.

When I mean that there are patients who come in, like myself, who didn't need to be on that ward, as long as I was, and had to in 2017, because I had been allowed to keep my mobile phone, I was able to call pals. And it was pals that got me out of that ward, because they were keeping me there. That in itself makes, is just crazy. You'd say: Well, why would that happen? And what's very unfortunate when I called pals, pal said, You're supposed to be home, we have you down under the care of the home treatment team. And I said to them, well, I am not at home, I'm on this ward, this is the name of the ward and this is where I am. It was them who advocated for me and contacted the manager of the ward. I went from just about being sectioned to then all of a sudden, being able to leave. That needs to be addressed.

I would then say that once they feel that they're in a place, that they are ready to go into their home. If they have a home for themselves that make sure that there is a home treatment team. These home treatment team members again, need to be coming from a place that they are looking at the patient. That they're taking the needs of the patient, into what and how they are trying to care for them once they're out in their environment. Equally, there are people who are maybe having to go back into a home environment that is fractious. Again, that needs to be considered and then signed back into the care of the GP. For me, I'm very fortunate, my GP has known me since 2012. That continuity of care that I talked about, speaking about 2012 2014, this is the same continuity of care, because if there is at any point, when I feel on need to address something, I'm able to speak to my GP. He's amazing, I know that he takes time to just check in with me to just see, and this is another thing. It's so much about time.

If we were to safeguard those, and listen to what our needs are, and try to help with those needs, and I do believe at talking therapy, whether it's in a group, if they're having to say that, you know, this one-to-one can only be for seven weeks, we'll make it 28 weeks and make it of seven people because information that can be learned from hearing other people's experiences. It also gets you from out of your mind and makes you realise: Oh, that thought, you have it too? There is great learning in sharing experiences, learning strategies that people who might be at the beginning, like me in 1999. If my 2021 self could talk back to my 1999 person, then I would make I've made many different decisions choices. However, we live our lives. We can't live it retrospectively.

But I do believe that we have the resources to be able, when you think of the amount of readmissions that happen, that we actually have the resources to try and prevent where possible. These readmissions, people being discharged before they're ready. It's an automatic readmission. I left the private hospital, I was not ready, I had not healed in less than three weeks. Three days later, I was back. Because what happened in that six weeks had nothing to do with looking on how I can be best cared for. I don't believe it's reinventing the wheel. You know, I use the term it's about putting on Pirelli tyres. It's about making sure that we put better tyres, really good tyres on that wheel.

EM: Thank you so much for sharing that it was amazing and what I think everyone will respond well to is, taking care of carers so that they can care. You're talking about something very simple, which is just staff retention. You're talking about not having a high turnover of staff, which as you say, not reinventing the wheel. Service users and friends and family of service users want to know that as you've been saying throughout this podcast, there's a safe place to fall. It's very important that there's a soft blankety place.

MJ: Absolutely.

EM: A huge thank you to Michelle for her openness and honesty on the podcast.