By Poppy Ellis Logan @poppyellislogan
Associate Lecturer in Mental Health (Middlesex University), My Care Academy Practice Lead

We all have to face challenging conversations in our day to day lives, usually when putting forward views and opinions that may not be shared by others. Some people develop good strategies for dealing with these challenging conversations, but others may shy away from these uncomfortable confrontations.

Regarding our work with service users, it’s often hard to know how we can empower and enable service users in advance of a challenging conversation where there is a concern that they may struggle to advocate for themselves.  This can be a common challenge for many service users who can face additional barriers of scepticism from people opposed to their viewpoint, who may use their position as a mental health service user to disregard their input. This can range from personal relationships, to professional, and even public reception. An example could be if a service user’s decision to change their name or transition to another gender is dismissed by family as a ‘phase’, or, in a professional setting, if a concern raised at work is viewed by their employer as a symptom of their paranoia rather than a legitimate issue in the workplace. An individual publishing an article or giving a speech may even be seen as an unreliable source if they’re publicly known to struggle with a mental health condition.

Today’s blog aims to provide a tool to strengthen and empower anybody preparing for a challenging conversation. For the purpose of this blog, we give examples of how the tool might be used when working with service users. However, you may wish to use it in other contexts – for yourself in a personal capacity, or as a team to raise concerns or suggest new processes, or to feedback after a difficult event.

When supporting a service user to prepare for a challenging conversation, it is best if you work through this template with them in advance. It may be helpful for you to print out this blog post and add notes under each section specific to their situation. If multiple people are going to be involved in the discussion, add a side column to your plan where you should note down who will deliver this part of the discussion. For example, you can note down what topics the service user might be prepared to speak about and what topics the carer will take responsibility for explaining.

Part 1 – setting the scene and explaining the issue:

11. Begin with a disclaimer:

• Start with a disclaimer of anything you (the service user) wish to make clear primarily. For example, you may wish to explain that the purpose of the conversation is not to cast blame on anybody for any issues that are discussed.

2. Ensure that everybody is clear on the purpose of this discussion by clarifying the topic or theme:

• Note down any topics or themes that you are going to explore.
• Note down exactly what the aim of the discussion is.

3. Clearly explain how this issue or situation makes you feel:

• Explain exactly how this situation makes you feel at the moment. 
• Avoid making ‘you’ statements such as “I’m angry because you think I’m stupid”. Instead, clearly state how certain experiences influence your feelings.
  
  If this tends to be difficult for you, work with someone to write an explanation of how you often feel in the situations being discussed. Then, you can simply read this statement out during the conversation. The statement does not need to be lengthy, however for the sake of covering a variety of common experiences, here is a long example:
  
  “when nobody asks what my opinion is, I worry that other people don’t value my knowledge or ideas and that makes me feel powerless and frustrated. Experiences like these put me on edge and I get worried about saying the wrong thing. Sometimes I’m so on edge I seem like I’m ‘snapping’ at people and I end up saying nothing at all or shouting in order to get my point across which other people see as anger or aggression. When this happens I end up feeling isolated and alone and feel embarrassed if I’m reminded about what happened.” 

4. Why does this topic or issue matter?

• Apart from the fact that it might make the service user feel distressed, there may be other reasons why the other person involved in the discussion should be interested in the issue. 
• For example, if the discussion is about your wellbeing in the workplace, you could use this opportunity to explain how your wellbeing also affects your workplace productivity overall. 

5. What are the implications if things don’t change?

• At this point, it is useful to explain what will happen if things continue without any change. 
• For example, if the discussion is about your requirement for reasonable adjustments, you might explain that without these adjustments you may become unwell and unable to perform well in your role.

6. What is your part in the issue?

• Explain how you are going to help resolve the issue and anything you have done already to try and address the situation. For example, you might say that your part in the issue is that you’ve identified it, are raising it with those involved and are proposing some ways of resolving the issue.

Part 2 – what can be done to resolve the problem:

It is important to be clear before the discussion exactly what you would like to happen as a result of the discussion. At this point, you will clarify exactly what you want to happen as a result of the conversation.

7. If not previously explained in full,  list what your actions have been so far:

• List what you have already done to try and address the issue. 
• For example, you may state that you have consulted your mental health nurse for advice about managing medication side effects in the workplace. 

8. Now, clearly propose what you would like to happen next:

• List what you would like to happen next, with clear time frames and realistic responsibilities for those involved. 
• Make sure that you state what you are willing to do to further work on this issue yourself. 

9. Finally, note down who will take responsibility for these outcomes.

• Be aware in advance that you may need to make compromises and the priority is finding a realistic way to get the outcomes you need – achieving these outcomes may require input from a range of people and be a group effort rather than one person’s responsibility. 

We hope you enjoyed this blog post!

You can download the Challenging Conversations Template as a pdf to print out and use with your service users. If you find this template useful, or have any feedback about how it could be improved, please don’t hesitate to let us know by email or by contacting us on Twitter!

Further reading and resources:

A toolkit for NHS managers to assist with challenging conversations:
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Top Tips for Difficult Conversations from South Tees Hospital NHS Foundation Trust:
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The Confident Conversations Toolkit by NHS Kent, Surrey and Sussex Leadership Collaborative:
shorturl.at/sLQS9 

Leading across London Leadership Toolkit:
shorturl.at/dkHM6

Encouraging the art of conversation on mental health wards, with an additional section (from page 32) on challenging conversations:
shorturl.at/jrMOQ