Despite what you might read on social media, we don’t live in the matrix. We’re not mere consciousness, isolated from the rest of the world. We have an environment around us that motivates, inhibits, sustains and harms.
As occupational therapists we are encouraged to adapt environments. If you have a physical injury, it won’t be long before an occupational therapist starts raising your chairs to make it easier for you to stand. They might get big chunky grips on your cutlery so you can continue to feed yourself. This is core occupational therapy, but do we think about social environments in the same way? To what extent do we consider the environmental factors that are not made of brick, earth and stone? To what extent do we consider the impact of people, policy and ideas?
The relationships we have with our patients are the most important and meaningful, but also the most easily influenced of our social environments. Whatever goals we have around helping people do what they want and need to do, we probably won't achieve them if we don’t have effective relationships with them.
There are many things in the environment that impact on us, and the relationships we have. The goals of services and organisations may not align with the goals of our patients or the goals of a holistic, client centred practitioner. In under resourced organisations, under the scrutiny of criticism and blame, practitioners may feel obligated to do what looks good, rather than what does good. With innate humanity and a duty of candour driving staff to flag issues that harm their patients, practitioners can face dilemmas on how much to tolerate inadequacy or strive for the ideal. These conditions will be intolerable for good, experienced staff who will start leaving or striking.
In a wider society, we hold ideas that champion individualism and pathologise legitimate responses to distress. The number of children taking antipsychotic medication in the UK has doubled, adult and young people's services are finding themselves overwhelmed by the levels of distress in society and people working fulltime need to visit food banks to feed their families. Is there something in the environment that is hurting people? Have we created a society where poverty and fear are classified as mental health issues to be resolved by medication from mental health services and input from mental health professionals?
I'll explore this in my Elizabeth Casson Memorial Lecture 2023, ‘Nothing grows in toxic environments’. I’ll share some of the experiences that shaped my thinking including where I’ve experienced attacks on meaningful relationships, felt pressure to do what’s has always been done regardless of outcome and discovered the dangers of raising concerns. I'll also consider the iniquity of labelling appropriate reactions to hellish circumstances as 'disordered'.
There are many factors that negatively influence the social environments around us and our patients. If we are a profession concerned with the environment, what can we do about it? What will we do about it? I encourage you to reflect on this and use your voice to push for change.