Integral to establishing a trusting relationship is the commitment to facilitate real choice. Alan describes how in his role he was able to support the consumer’s choice for spiritual guidance. Alan is employed as a rehabilitation assistant in a secure forensic unit. Into this role he brings with him his mental health support worker qualification. In many mental health services Alan’s role would have the title of mental health support worker; however,
the DHB that employs him uses the title ‘rehabilitation assistant’. Alan spoke about an experience he had that was not only meaningful for him but also for the consumer he was working with.
We had a patient who was wishing to go to a church, to a Mormon Church and staff were saying it wouldn’t be good for him and for his mental health and I utilized the Treaty of Waitangi as the pivot to actually allow him to get the access to go to the church because of spirituality. Just because staff didn’t agree with where he wanted to go, it wasn’t right to say no, so by utilizing the Treaty of Waitangi we were able to make progress for him to go. In the end he chose not to go on the day after we had arranged everything, but the thing was it was in place for him to be able to go.
Basically the other staff didn’t agree with the type of church he was going to go and my argument was that we didn’t have the right to say no and it was the fact that the Treaty of Waitangi, that although is predominantly geared toward Māori, I was using it for a European, they couldn’t argue with it. That was the big thing. He was expressing his interest in wanting to go somewhere. That was the church he had been brought up in as a child and he wanted to go back to it. That was the leverage I used to allow him to have the option of going there.
What was important to me was that he should have the right choice of where he wished to go to for his spiritual beliefs and for the patient it was actually allowing him the ability to go if he chose to. Like I say, at the end after all the work we put into it, he changed his mind. Then about six months later he did go and he has only been twice in 18 months but the thing being it is all set up in place for it to happen again if he wishes. If I had not formed a case for him, it more than likely would not have happened.
It was annoying. The arguments that were going about were that he wasn’t mentally stable, the type of church could upset him but the thing being was that on all our outings, because I work in a Forensic Unit, everything has to be approved for leave and those types of things and even at the last minute if the mental state assessment that has been done by the Registered Nurse, they make the decision on the day before they go out, so the thing being as long as everything is working for the patient – it happens. If he is unwell then it doesn’t happen, but it doesn’t stop it happening in the future.
I am a verbose person and I get upset and I make my point. Somebody else may have easily backed down on it. But it is my own personal belief that spirituality is important to every person and it is their choice where they wish to go for that.
Alan describes a situation where he provided support for a consumer who had a desire to attend a church, in order for the consumer’s spiritual needs to be met. Alan recognised the connections that this consumer had with this religion, through knowing and therefore making the connection with the consumer’s childhood. Alan’s advocacy was based on supporting this consumer with ‘their choice’. In taking this position, Alan calls into question the right of his colleagues to deny the consumer access to a place where he could have had his spiritual needs met and also able to connect back to his childhood. In supporting the consumer’s request Alan considers a number of factors. His tries to understand why his colleagues are using the argument that the person is not mentally well enough to justify not taking them to this church. Alan interprets this as staff are really saying no just for the sake of saying no. He senses that there is more to the statement than just saying no. His highly-developed sense of fairness and desire to ‘create space’ for the consumers to exercise ‘choice’ places Alan in conflict with his colleagues. However Alan’s ethical sense of ‘rightness’ is stronger than his need to conform to the view of others. Alan’s ethical belief structure that includes where possible, supporting consumers to have ‘choice’, is being called into question.
The context that frames Alan’s approach is important to understand. The consumer that Alan refers to is subject to a court order under the Mental Health (Assessment and Treatment) Act 1993. In order to meet the requirements of the Act, certain action (such as going outside of the unit) require permission by the Minister of Health through the Ministry of Health. The application to the Minister of Health is made by the consumer’s Responsible Clinician, who is usually a psychiatrist. Stringent conditions are placed around requests to leave the unit, with additional staff being required to escort the consumer. The application has to include details such as the purpose of the leave, duration, locality, how many staff will be escorting the consumer and if there are any victims associated with the consumer’s detention in a secure unit as they are required to be notified. Alan is aware of the legal requirements; however, his principled belief is to support the consumers to exercise their choice within an environment where choice is very limited. He recognises that this outing will allow the consumer to be connected with his childhood and spiritual wellbeing and, for him, it far outweighs the legalistic paperwork and views of his colleagues.
Alan states that he used the Treaty of Waitangi18 (the Treaty) as a way to gain leverage to enable the consumer’s spiritual needs to be met. Although he does not expand on which part of the Treaty he used as a point of reference, he does suggest that his argument was built around the right of individuals to have their spiritual needs met. Kingi’s (2007) interpretation of the Treaty into the health environment suggests that the Treaty “can also be used to assist health service delivery and more focused interactions between health professionals and clients” (p.9). As recognised by Alan, the Treaty holds a special significance for Māori, in that it provides for certain rights for Māori. Alan also views that as the Treaty is about two peoples ie Māori and the Crown that the principles of the Treaty equally apply to non-Māori (including the consumer, who is European). He uses this knowledge as leverage for the consumer in order to support the consumer with their aspirations’’. For Alan’s, his short-term goal is for the clinical team to recognise the consumer’s choice and enable him to access a church of his choosing in order to have his spiritual needs met. Alan has used his knowledge and his relationship with the consumer to ensure that the consumer is heard and this request is given the consideration it deserves.
As Alan’s story unfolds, he reflects on this event; he recognises that while the processes had been put in place to enable the consumer to attend his childhood church, it was the consumer who made the choice not to attend. Alan created an environment that enabled the consumer to exercise their choice. In fronting his colleagues Alan supported the consumer’s choice, which was contrary to that of his colleagues. He then identified a legitimate way, through the principles of the Treaty of Waitangi, to enable the consumer to be able to exercise choice. It was the consumer who exercised choice, not the staff. Alan’s actions created, in a very structured and regulated environment, a way by which the consumer became the eventual decision maker.
Alan saw the positivity with the consumer exercising choice. He advised that at some time in the future the consumer did attend the church of their choice a number of times. In telling this story, Alan recognises the challenges for consumers who are in a secure, contained and structured environment. He called on a range of skills to work creatively with the consumer and the system to see a positive future.
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The Treaty of Waitangi is New Zealand’s founding document. It takes its name from the place in the Bay of Islands where it was first signed, on 6 February 1840. The Treaty is an agreement, in Māori and English, that was made between the British Crown and many of the tribes in New Zealand
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