I've spent the last 13 months working as a mental health technician in an acute inpatient psychiatric unit. In this role, I work with patients living with severe depression, suicidal ideation, bipolar disorder, schizophrenia, borderline personality disorder, and other unimaginably difficult diagnoses. Many of them have a dual diagnosis with an addiction, and too many of them are people my co-workers and I know from repeated stays in our unit.
This is the primary population I had in mind when I recently attended the Center for Civic Reflection’s Open-Call Facilitation Training in downtown Chicago. Each day, our patients attend programming that we call “groups” and twice a day, the patients attend an education group, led by a mental health technician such as myself. Different from therapy (which I am not qualified to provide to patients), the group is a chance to explore a variety of topics such as self-care, communication skills, relaxation methods, and other areas that might be beneficial to our patients. Months ago, I began leading groups that involved patient-led analysis of poetry or short stories, with the hope that this sort of task would instill confidence and boost self-esteem in patients sorely lacking in this area. When I found out about the civic reflection training, I realized that it would give me the tools to take this practice further and help my patients.
At the CCR training, I was fortunate enough to co-facilitate a discussion on issues surrounding leadership and trust with 3 very smart women, using the poem “The Contract” by William Ayot. We worked hard to come up with concise, insightful discussion questions and had an amazing group of participants to enhance the experience. We were given some wonderful feedback by CCR Director, Adam Davis and other great trainers, and the entire 2 days was both exhausting and energizing. On Friday, after our training ended, I got on a bus and headed home, my mind buzzing with possibilities and enthusiasm for all of the great work my fellow participants are doing in their work and lives. The next morning, I went to work and started putting my ideas into practice. I decided to play it safe and used “The Contract” with many of our original discussion questions, with some modifications based on my knowledge of the patient population, for my first civic reflection group at work.
Overall, the discussion went better than I expected. Waiting out the silence was hard, as was staying neutral, but trusting my group to step up was rewarded by insightful participation by almost everyone in the room. It was a thrill to hear people connecting ideas gleaned from the poem and prompts to the struggles and themes in their lives. A few days later, another try had a mix of positive results and setbacks, with patients listening to each other and discussing differences and diversity in their relationships, but there was also some difficulty making the objects and ideas relatable to the patients and a lack of adequate preparation on my part.
These early attempts were far from perfect and had many places for improvement, but I'm hopeful. In addition to increasing self-confidence and challenging my patients to think in a way that may be out of practice or entirely new for them, I hope this model of facilitation can give my patients a modicum of agency or control in a setting in which they generally have an almost total lack of agency (often necessary, I might add, to keep a person in an altered mental state from self-harming or hurting others). There are a lot of complicating factors to consider when planning for this particular group of people: which topics may be too emotionally-loaded for vulnerable patients or could do more harm than good? How do you navigate the involuntary status of most or all of the participants in the discussion? How do you reduce the impact of disruptive patients while keeping the discussion free and open for the majority? How do you write discussion questions that demonstrate respect and compassion for the accomplishments and painful struggles the participants have lived through? The CCR training helped me to start sorting through these questions and move toward answers as I introduce and integrate civic reflection into my work as a mental health technician.
-- Abby Griffith, mental health technician at Rockford Memorial Hospital