One aspect of my training as a Systemic Psychotherapist was the training I got and the awareness I developed about how systems operate. Systems are everywhere.
Within ourselves, there is a system of thoughts, ideas, feelings, unconscious processes, memories etc. all interacting together. In workplaces, we enter complex systems, in schools, within our families; we are all part of multiple systems. And while systems exist on a micro as well as a macro level, there are properties they all have in common, because they are systems. For example, take a family system, there are rules within that ‘system’ that may be spoken about rules or unspoken about rules. The same is true at an organisational level, take for example a school system.
Two properties of systems come to my mind when I think of the current mental health system in this country. I know many hard working, dedicated people who work within the mental health system and I know people too, like me, who felt the need to step out of the system, because the system as it is currently operating is gravely letting people down.
Systems, all sorts of systems, can constrain and can let people down and I don’t think that means in any way that people aren’t trying. We all need to try because I believe this system is for us all and looking to the principles of systemic thinking, there are things that systemic thinking can offer us in to manage the ‘system’ better. Systems theory has a lot to offer when it comes to thinking about the ‘system’ of mental health. Here are two components of systems which will hopefully illustrate my point;
1. Cybernetics
Cybernetics refers to the investigation of feedback processes in complex systems. Cybernetics addresses the question;
‘How do systems use feedback to remain stable or to adapt to new circumstances?’ (Alan Carr, Family Therapy, Concepts, Process and Practice, 2000)
So it gives a map in terms of how systems can repair, move forward, grow, heal and if applied to the ‘system’ of thoughts, feelings, memories, behaviours, habits, ideas etc. that exist within each one of us, then the cybernetics as I understand it is the magic that can happen when we step back from ourselves, learn about how time or experiences have changed us and then adapting to the changing (circumstances/ ideas/ feelings) in order to feel fully functioning or whole again.
At a family level, families can learn to look at what is happening within their own family system and then use this feedback in order to move forward in a way that best meets the needs of the people in that family. Take this idea now to a more macro or organisational level; take the example of Facebook. It is currently looking at ways to combat the spread of false news stories and it is doing this because it took feedback from its system and will use this to grow and develop.
My question: How is the mental health system utilising the process of cybernetics? How much feedback is the system getting or requesting from both people working in the system and people being served by the system? Does the fact that the mental health ‘system’ is not a commercial operation and no-one’s income is dependent on the ‘success of the system’ in the way organisations such as Facebook’s profits are dependent on its success mean cybernetics is being used less?
2. Boundaries Matter
A girl is being treated in a psychiatric hospital for anorexia. She is really, really unwell and needs to be transferred to a general hospital because the risk to her physical health is great. She moves to a general hospital and then she receives no on-going psychiatric support. This could be because her chart is now with the general hospital and she is no longer a patient of the psychiatric hospital. The boundary between the hospitals in this situation are too rigid.
A young boy is in need of psychiatric support in the middle of the night. He is brought to A&E where the family wait and wait to see a psychiatrist on call. The activity in A&E is making the young boy feel worse. He is traumatised by what he sees and he begins to believe that not even the hospital will have any answers for him. He loses hope. The boundary in this situation between the general hospital service and the mental health service is too blurred.
Systems need their boundaries to be permeable. Take it to a micro-level; no person, or family can cut themself off from everyone else and still feel good as we need to have a level of connection to function well. But healthy boundaries are good and that means being connected – but not to the point where you begin to feel as if you don’t know who you are any more, you have no clear identity, you have no time to yourself.
And whether the system is an individual system, a family system, or at a much broader level such as that of a mental health system, the same rules apply. Systems cannot continue to thrive or even survive if they try to go it alone or if they blur too much with other systems. That’s my view, and I am delighted that people who care so much about mental health are sharing a vision of what is possible.
So many excellent staff work within the mental health service. So much good work is being done but the system needs to be updated. Otherwise, people are being let down and that’s not what anyone wants. My view is that systemic thinking has a lot of offer in terms of moving things forward.
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