The luck I’ve had could make a good man turn bad; The Smiths. I visited Rotherham Railway Station last Tuesday, I’ve never been to the place my sister Alison took her life but I’ve wanted to close that bit of the circle for a while. It felt like a loose end that needed tying up. In fairness, it is one of many loose ends but the others are much less in my control. It was a warm sunny afternoon as I sat quietly on the empty station platform and visualised the steps she may have taken to find her way onto the track, into the path of a powerful oncoming train and a powerless startled driver. As I did this a feeling struck me more lucidly than ever, a feeling that those who were complicit in what happened to her in the run up to her death were directly complicit in her death. I have been reading up on the impacts of the abuse of trust by Health Professionals as well as the impact of pregnancy termination on young vulnerable women with Mental Health problems. It does not make pleasant reading and research in the field is naturally quite limited, but various people, including the Manchester Centre for Suicide Prevention have been incredibly helpful.
As I sat at the station I pictured the man who had behaved inappropriately toward my sister when she was in the care of the NHS, and I pictured the managers of the Mental Health Trust that he worked for, managers that allowed events to occur, I pictured them with their hands on her shoulders guiding her onto the tracks. That might sound melodramatic, but as I have reviewed some of the research in this area and begun to understand the impact that the breaking of professional boundaries can have on the fragile and vulnerable, it has helped me realise that what happened to Alison when she was in the care of the NHS was a recipe for her ultimate progression toward suicide. My sister had a pregnancy termination when she was under the care of the NHS, there is no record of this information being shared with the consultants treating her and no one was ever held to account for what happened. Alison was a young, deeply troubled, sexually inexperienced and devoutly religious young woman who needed professional care and expert attention. Alison’s story is a tragic story of a vulnerable mentally ill girl who was damaged by a healthcare system that was supposed to help her. When all the issues of misplaced trust, blurred boundaries and with hindsight, a seemingly inevitable tragic aftermath are put aside, mine is just another grieving family whose pain has been amplified by knowing there are people who knew the truth and suppressed it and by those who continue to deny they made mistakes. After years of pushing the Police to take action, it is only within the last few months that someone has at last been arrested in connection with these events.
Professional boundaries exist for a reason, to protect the vulnerable. As others more knowledgeable than me have said, there can be few if any medical conditions which are improved by having patients see the genitals of those tasked with their care. Can there ever be a compelling reason for crossing these professional boundaries? I remain to be convinced. Crossing them is an abuse of power and position, whatever the motivation of those involved. Such violations can have a devastating effect on individuals, those who love them and on all those around them. Boundaries can be broken by the ill-informed, the unaware, the unscrupulous and the inexperienced. The importance of effective vigilant and supportive management and effective supervision in clinical situations becomes clear in relation to those who commit acts with significant and long-lasting consequences, simply because they lack self-awareness and judgement.
When professional boundaries are broken, there is a breakdown of faith in the system and the professionals within it. Trust is lost and victims become less treatable because they have been taken advantage of. Ironically, they are then in a system that suggests the answer to their problem is more exposure to the same system that has just let them down. The original position or condition is often exacerbated, the patient becomes in need of even greater levels of help because now they are more messed-up than when they entered the system that was supposed to help them. Relationships with those around them are broken and guilt and shame can prevail, fuelled by feelings of inadequacy or inferiority at having been taken advantage of and also a belief that it was somehow their fault. Victims of the breaking of boundaries by healthcare professionals can suffer a profound loss of trust in their own judgement.
I also lost my Dad last Tuesday, not in the, “he’s old and wandered off somewhere in the shopping centre” sort of lost, but in the “permanently passed away” sort of lost. He was 81, he had cancer of the throat and dementia was starting to take its toll. To me, it seemed an unnecessarily cruel and unfair end for a man who thrived on intellectual exchange and loved his food and drink. He lived in Sri Lanka and I kept in touch with him via Skype (other suppliers are available) which proved invaluable in bridging the significant geographical gap and to some degree wider emotional gap that existed between us. I think I inherited my appreciation of real ale, good curry and questionable dress sense from him. Much more importantly I inherited a healthy disrespect for authority and for figures and institutions of authority from his actions if not his example. When a man, however likeable, casts a wife and three young children adrift in foreign climes without a penny to their name or a home of their own to go to, it’s difficult to respect the institution of fatherhood or the establishment that sat back and watched events unfold. I think I can now understand how at times like this people succumb to the urge to rewrite history, writing this post I felt the temptation strongly to wax lyrical about the man and father I wanted him to be rather than the one he was in reality. But I have resisted and I have little hesitation, and definitely no malice, in stating that he was a poor father but a generally decent intelligent man. No child should feel abandoned by their father and it is my Dad’s absence, unenforced and seemingly voluntary, not his presence, that have had a lasting impact on me and those around me. This week I have found myself mourning the loss of what might have been rather than remembering what was. I’m sure next week will be better…