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.
11. Begin with a disclaimer:
2. Ensure that everybody is clear on the purpose of this discussion by clarifying the topic or theme:
3. Clearly explain how this issue or situation makes you feel:
4. Why does this topic or issue matter?
5. What are the implications if things don’t change?
6. What is your part in the issue?
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:
8. Now, clearly propose what you would like to happen next:
9. Finally, note down who will take responsibility for these outcomes.
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:
Top Tips for Difficult Conversations from South Tees Hospital NHS Foundation Trust:
The Confident Conversations Toolkit by NHS Kent, Surrey and Sussex Leadership Collaborative:
Leading across London Leadership Toolkit:
Encouraging the art of conversation on mental health wards, with an additional section (from page 32) on challenging conversations: