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Mental Health & Professional Boundaries

Juliet, a registered nurse in on of my classes shared the following incident with the group. She works in a CAHMS (Children and Adolescent Mental Health Services) unit outside London.

One day, Juliet said; I'm on shift. As you know; you don't see some of these things coming. But we end up in a restraint. I am one of the "arm persons" in a snipper position. At some point, my eyes meet with Olivia's eyes. Olivia is the 15 year old patient being restrained.

I look away. Gentle but painful tears start flowing from the corners of my eyes. "Juliet, what's wrong with you?" Olivia asked me. I turn and explain to her that I have a daughter who is 15 years old, as I you going through this, I see you as my daughter as well.

Olivia raises her voice so that everyone involved in the restraint could hear "Everybody, leave me alone, I'm calm". Indeed she was! Her body language communicated that she is indeed calm, so everyone releases their holds and the restraint is instantly over.

During the debrief, Olivia was asked why and how she could get back to her baseline so quickly. "Because Juliet was crying." Juliet and Olivia have built a good relationship before now, and it mattered to Olivia that Juliet was happy.

Juliet added that, from that day; whenever she is on shift, there has never been an incident and/or restraint with Olivia. All hell broke loose in the class.

"You'll appear vulnerable. You shouldn't be crying at work. You should have professional boundaries...."

As a trainer, of course you let the emotions flow out of people first. Otherwise, everything you say would likely go in one ear and out the other or not go in at all. When they were ready, I brought the class back together for a micro teach on professional boundaries.

Professional Boundaries and your work

Sandy Bryson's working definition is so simple you'll someone to help you misunderstand it :-)

Professional Boundaries are the framework within which the worker-client relationship occur.

As a healthcare professional, you have a duty of care towards your patient(s). This framework (professional boundaries) within which you deliver care helps you more than you might think. It helps you inter alia

  • Establish what is okay and what is not

  • Bring focus to yourself and your well-being

  • Helps you operate from a place of empathy and compassion

Establishing what's okay and what isn't

We go to work to serve, we go to work to help and some people interrupted me midway and said "Kunle we go to work to get paid". Everybody starts laughing:-) However, some staff member aren't aware of their options when assaulted or threatened with assaults.

Most people need to be reminded that Section 3 Criminal Law Act 1967 allows the use of reasonable force in the circumstances to prevent crime. As you know, in the UK an assault conviction may result in incarceration and in a criminal record. i.e. an assault is a crime.

Necessity, proportionality and reasonability.

Common Law, says one (Health care professionals) may use force to protect themselves or others. Human Rights Act 1998 requires that the use of force must always be necessary, proportionate to the threat/danger and the force must be reasonable.

The physical skills taught in PMVA courses have been risk assessed and approved by the GSA to equip healthcare professionals should they need to protect themselves and others from danger, harm and assaults. Get informed and get equipped, it helps you serve better.

Bring Focus to yourself and your wellbeing

You can't give what you don't have. As healthcare professionals, whose primary job is to support our patients within a framework of professional boundaries; our task is even more challenging when we, ourselves are personally challenged with the myriad of things life throws at us from time to time. For some of us, even every day life is challenging.

Window of Tolerance

Clinical Professor in psychiatry Dan Siegel developed the concept of the Window of Tolerance, which is likened to being in our baseline behaviour (a state of behaviour which is steady in form and frequency), in which we are able to function and thrive in everyday life.

When we operate within this window, we're able to relate well to ourselves and others; when we move outside this window, we'll be leaving our baseline behaviour behind. Factors like coping skills, childhood experiences and our environment influence our window of tolerance.

Good News for you and your window of tolerance

Windows of tolerance come in different sizes. Hence it varies from person to person,

The size of your window of tolerance can change from day to day. Regardless of where you are, you can widen your window of tolerance. Making you less likely to experience frustration, anger and hopelessness, but positions you to be your best self more often.

When your window of tolerance is wide, you'll be in a safe and secure place. You'll be able to communicate with your patients (and people around you); what's okay and what's not. You're able to set your boundaries because you've focused on yourself and your wellbeing.

You can operate from a place of empathy and compassion

Once in an SEMH setting, I had worked with a child for some time who was then leaving for another school. On his last day of school, as his Mum led him into the car, my eyes started to get wet and teary. I left the scene and went to the field.

On the field and alone, I allowed the rivers to flow from my eyes without hinderance. John, one of our teachers who had observed what was going on in the car park came to me on the field. "John, what's wrong with me? Why am I so emotional?"

John proceeded to share his experience about when his first set of students were graduating and how emotional it was for him as well. Paraphrasing John in a nutshell, "Kunle, nothing is wrong with you, you're just human".

The Truth about compassion and empathy

American research professor Brené Brown describes compassion as a deeply held belief that we are inextricably connected to each other by something rooted in love and goodness. If you're compassionate; your mindset when you deal with people is "we're family".

Professor Brené Brown explains further that empathy is the skillset you use to bring compassion alive and communicate your deep love for people. Sad but true, one could be compassionate and not have the skillset to "use it" for the benefit of those around.

You're now asking "Kunle, how did we get here from Professional Boundaries?" I'm glad you asked :-)

You remember Juliet who was crying earlier? She had her professional boundaries set. Yes, she was emotional. Yes she cried. But, crying doesn't mean she had crossed her professional boundary, it means she was compassionate, and she had empathy.

One quote from Professor Brown (she says it's from Travis) that resonates with me

If you have done your work and set boundaries, you can tread that water for ever...

In Conclusion

After all is said and done; professional boundaries do not stop you from doing your work with compassion and empathy. If a few tears show up along the way; so be it. Just be sure you do the work ahead; set the boundaries first.

This is Kunle, yours truly reminding you to "keep your flag flying".

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