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So Who Cares Anyway E32 The Power of Stories · SoWhoCaresAnyway

• 0:05
  Hi, I'm Ruth Germaine, and this is, so Who Cares? Anyway, a podcast shaped by my deep curiosity about who cares, what do they care about, what do they do, and why does it matter? My aspiration is to build a community that listens with intention and explores care from every angle from the North Yorkshire malls.
• 0:25
  So behind clinical doors, each episode invites people to share their stories, their ideas, and talk about what matters to them.
• 0:34
  Together we reimagine what care could be and how we might shape health and wellbeing through the assets, values, and the lived wisdom of our communities.
• 0:44
  And why does it matter? Because for too long, health and care have been treated as things to be delivered, often depleting systems and the people around them.
• 0:54
  And it's time to rewrite the narrative to center everyone as a contributor, not just a recipient, to offer joy, hope, and meaningful belonging.
• 1:04
  To invite each of us to shape the future of health and wellbeing with courage, with creativity, and with care.
• 1:12
  So who cares.
• 1:13
  Anyway, hi, it's Ruth.
• 1:17
  And before we start, I just want to ask what the scariest moment of your life became the reason that drove you to change the system? If you wanna find out, then I'm listening to this episode with Tracy Robinson.
• 1:29
  She's an occupational therapist, a coach.
• 1:31
  And importantly, a survivor of postpartum psychosis.
• 1:36
  I think Tracy is absolutely incredible.
• 1:38
  We talk about vulnerability, power, and the stories that shift culture.
• 1:43
  This one's about reclaiming your story and helping others to do the same.
• 1:47
  Enjoy.
• 1:51
  Hi, and welcome to the next episode of So Who Cares.
• 1:53
  Anyway, and today I'm really delighted to have Tracy Robinson join me.
• 1:57
  And the reason why I'm so delighted is Tracy, we've known each other for quite a few years now, haven't we? On and off.
• 2:03
  But particularly when I was in that ICB role going through what a lot of people in the ICBs are going through now, um, that's the integrated care boards.
• 2:11
  I was got to the point where I knew my role was being made redundant and I would probably be leaving and Tracy just sent out an email saying if there's anybody who wants some support, I've done my coaching course, um, or I've done a coaching course and I'm prepared to support people.
• 2:27
  So I got in touch with Tracy, who really helped me.
• 2:29
  Um, at that time.
• 2:31
  And Tracy, you've now left the ICB yourself, haven't you? Yes, that's right.
• 2:36
  Yeah.
• 2:37
  Yeah.
• 2:37
  And you've set up your own, um, entity, a bit like myself, uh, called Mother Nature Coaching, um, and you're an occupational therapist as well.
• 2:45
  So I dunno that you practice on the frontline now, but you are still a registered occupational therapist and you've just come to talk to me a little bit about not so much your business, but the work that you do and why you are particularly passionate about that.
• 2:56
  But I wonder if you just wanna start off by giving a bit more of an introduction about yourself please.
• 3:00
  Sure.
• 3:00
  Thanks Ruth.
• 3:01
  And you have to say it's been such a pleasure seeing your progress and your development and the podcast.
• 3:06
  Thank you.
• 3:06
  And everything else you've been doing since I was supporting you when you were going through that redundancy.
• 3:12
  Yeah.
• 3:12
  So, um, so, um, as you said, I'm an occupational therapist by background, um, is over you, well over 30 years since I qualified now.
• 3:22
  And I chose to go into mental health right at the start of my career as an occupational therapist.
• 3:27
  I worked in forensic mental health services, then adult mental health services, and I was a a manager and a professional lead.
• 3:36
  I did that for 10 years and really I had quite a life changing experience really after I've been qualified for 10 years and I'd been managing and kind of running different mental health services.
• 3:48
  I had my first baby and I developed postpartum psychosis out of the blue.
• 3:53
  So it was an illness that even though I'd worked in mental health for a lot of years, I'd never heard of, I didn't have any insight into the fact that I was unwell.
• 4:03
  So my use of is really difficult using services and using services I worked in and, um, being on the receiving end of services.
• 4:13
  Really sort of made me reflect a lot on things that weren't right in services about how they weren't client centered.
• 4:20
  How I didn't feel listened to how, um, kind of people like my needs didn't really feel understood.
• 4:28
  And when I went back to work after that, when I'd recovered, um, and was back at work, I, my, my career ended up going in a different direction due to what I'd learned and.
• 4:39
  Kind of how I felt at that time about what wasn't right with services.
• 4:43
  So I did a lot of work, um, um, in project management roles and program management roles, and in the end on national policy in leadership roles around improving and transforming services.
• 4:57
  Um, I worked at NHS England on the National Perinatal Mental Health Program and there was money to spend, um, to develop new services across the country.
• 5:06
  And, uh, my final job in the NHS was in maternity services transformation.
• 5:12
  But I think fundamentally for me, what drove my passion to do that work, um, alongside my professional skills was my personal experience.
• 5:22
  And, um, just having that kind of.
• 5:26
  I guess really kind of deep understanding of what services needed to look like to serve people and how vulnerable I felt beyond the receiving end of services, and to notice that power differential between professionals and people using services.
• 5:43
  Thank you Tracy, and you, what you've given there.
• 5:45
  You've really given your, your drive and your, your driving passion and where that came from.
• 5:50
  And it's obviously something that's really quite personal.
• 5:53
  Um, and I have to admit, I don't know, I have heard of postpartum psychosis 'cause my daughter works in psychology, but, um.
• 6:01
  On the other hand, I wouldn't have known anything about it if it wasn't for her.
• 6:04
  And also if it wasn't for you mentioning it as well to me over these last sort of year or two that we've sort of, um, done, sort of worked quite closely supporting each other, haven't we? And you've mentioned it a few times, but I think it is something that isn't completely understood and lots of people have heard of sort of baby blues and these, you know, sort of things like this, or there's depression afterwards.
• 6:23
  But something like this is quite a bit different.
• 6:27
  We also spoke about there is that vulnerability.
• 6:29
  And I know this is sort of for personal stories, Tracy, so I don't want you to just feel that you've got to share more than, than you want to.
• 6:37
  But I wonder if you can just talk about that vulnerability and what that was and what that felt like for us and sort of give a bit more explanation behind that please.
• 6:46
  Absolutely.
• 6:46
  And um, you know, I'm really happy to talk about my experiences to ways, you know, raise awareness and.
• 6:54
  Kind of, um, help people understand.
• 6:56
  So I think for me, um, until that time in my life when I had that experience, I'd always like been successful, be able to kind of control my outcomes in life by having clear plans, by, you know, studying hard, by developing hard by.
• 7:16
  You know, kind of, I, I guess, um, you know, planning everything, knowing what to do, very much feeling in control, but to, um, I think kind of, I started to feel that loss of control when kind of my, my birth experience wasn't what I expected, um, and was more traumatic than I'd expected or being prepared for.
• 7:37
  And then, um.
• 7:39
  I, I think kind of like losing control of your mind and not being able to trust your own thinking feels like the ultimate vulnerability.
• 7:49
  And, um, you know, like my, my first contact with services at that time was that I was almost sectioned.
• 7:57
  So basically a mental health act team turned out on my, turned up on my doorstep to assess me.
• 8:03
  So, um, and I remember that, like that ultimate vulnerability.
• 8:07
  I still have real kind of.
• 8:09
  Really clear memories at the moment when I gained insight into what was happening because of the nature of that illness, I didn't realize I was unwell.
• 8:18
  I believed my own delusions and I was confused by the kind of visual hallucinations I had, but I didn't realize it necessarily kind of indicated illness.
• 8:30
  But as a team of professionals sat there asking me.
• 8:34
  Questions.
• 8:34
  And you know, I'd, I had a diploma in forensic mental health care.
• 8:38
  I knew all about the Mental Health Act and knew what was going on.
• 8:42
  And suddenly that came to me really clearly despite my psychosis.
• 8:46
  And I remember just feeling I.
• 8:48
  I terrified that I'd lost control of my life and had no choices and, you know, might be sections.
• 8:55
  And I remember looking at our back fence and thinking, oh, could I run to that? Could I make it over the fence and run away from this? That sounds absolutely.
• 9:06
  Just so scary.
• 9:07
  Tracy just listening to you.
• 9:09
  Um, and people of course, can't you see your face? But I can see how, you know, this is some type many years ago that we're talking about, isn't it? I can't remember.
• 9:17
  The other bit of children I think are in their twenties, aren't they? So this is quite a long time ago, but I can see from your face that you, you absolutely remember this.
• 9:25
  And what's interesting is how you were saying that because you already knew about the Mental Health Act and that it was that, that.
• 9:32
  Suddenly clicked with you.
• 9:33
  Oh, I know what's going on here now.
• 9:35
  And that was the bit where you gained insight.
• 9:37
  So I wonder if we, you know, I'm sort of thinking about, there'd be people on this podcast who are still thinking, they've talked about postpartum psychosis.
• 9:44
  Ruthie said, said that she didn't really know much about it.
• 9:47
  So I wonder if we should go back a step, talk about the postpartum psychosis, and then perhaps talk about after that what, what it was that.
• 9:56
  Happened that worked well for you, but what it was that you also thought, because you said, you said at the beginning, this drove you to think about actually, how can I make things better? What was it that was happening that you thought, this isn't quite right, or this could be better, or maybe we could do something else.
• 10:12
  So let's start with Post Pass and Caris and we can come on to that bit in a moment, if that's okay.
• 10:16
  Please.
• 10:17
  I say at the time I hadn't heard of it and it took me a long time, actually quite a few months before.
• 10:24
  I got clarity that that was the diagnosis.
• 10:27
  And I think that's really important at the time is I also wasn't given hope of recovery.
• 10:32
  So when I was first done, well, no one clearly said to me, this is the, you know, this is the illness you've got, you know, like many women make a full recovery.
• 10:42
  So, um.
• 10:44
  So I've, I've found out, you know, a lot about postpartum psychosis since, and I'm, I'm a trustee now of a national charity action on postpartum psychosis, which wasn't around really when I was unwell.
• 10:56
  'cause as you said, it was 21 years ago.
• 10:59
  But now does a lot of work on peer support, raising of awareness, uh, challenge and stigma.
• 11:05
  So postpartum psychosis is a rare but very severe mental illness.
• 11:09
  That can happen to women after giving birth normally within the first few weeks or months.
• 11:16
  Um, the symptoms are very severe of hallucinations, delusions, um, often affect a lack of sleep, severe anxiety, and really in that situation, a woman is just not herself and it is a medical emergency and requires an emergency response.
• 11:34
  Um, it, it happens to, um.
• 11:36
  The kind of incidence is about one to two in a thousand women that give birth.
• 11:42
  So it's relatively rare, but also sort of not uncommon when you consider how many births there are in total.
• 11:49
  Um, and so some women would.
• 11:52
  Be known to be at risk of it because of their previous history of bipolar disorder or family history.
• 11:58
  Um, so those women are at more risk, but in some cases, like mine, it just happens out of the blue with no previous history.
• 12:05
  Um, and there's still so much more research is needed about the causes, um, of postpartum psychosis.
• 12:14
  Um, I think sort of one another thing about it is if, um, you've had postpartum psychosis once after one birth, you know, your chances of getting it again, having another baby are around kind of 50 50.
• 12:28
  So, um, so basically that incidents, if, if, you know, then you obviously become at no risk.
• 12:33
  So the, having that experience also really impacted my decisions about having another child.
• 12:40
  And the reason.
• 12:42
  I did.
• 12:43
  The only reason I was brave enough to have another child is because by that point I knew I could access a specialist perinatal mental health service.
• 12:51
  But yeah, I think, um, I sort of, I've worked, you know, over the years in all of my policy and program work and the different work I've done, I've worked with quite a few, um, uh, specialists, perinatal psychiatrists, and I've heard a couple of them say now that have been in that for years, when I've asked, why did you choose to work in this? I said, because really it's the most severe.
• 13:14
  Mental illness presentation, a psychiatrist will ever see.
• 13:18
  But there's also really good hope of recovery and many women recover.
• 13:22
  Well, thank you.
• 13:23
  And I think that gives us quite a good de sort of idea about what it is.
• 13:27
  Um, and definitely that symptoms that people are hallucinating not quite often don't understand what's going on.
• 13:33
  I'm not having insight.
• 13:35
  Yeah.
• 13:35
  Um, and.
• 13:37
  Hearing voices, those sort of things.
• 13:39
  You talked about it being a medical emergency, so that sounds quite scary, really.
• 13:44
  And it must have been, you know, it sounds like it was scary.
• 13:49
  This might sound an obvious question, but why is it a medical emergency if we don't deal with this quickly and the response isn't quick, what might happen? I think, um, you know that it is an illness of a high level of risk if it's not responded to appropriately.
• 14:03
  And sadly, you know, maternal suicide is still the leading cause of death between six months to a year after birth.
• 14:11
  And some of you know, some of those suicides are associated with postpartum psychosis and there's also a risk of harm.
• 14:19
  To the baby and the quicker it's treated, obviously the better recovery is.
• 14:23
  But those are the most extreme risks.
• 14:26
  And I always, um, you know, call myself a survivor of postpartum psychosis.
• 14:31
  And it's not a term everybody likes, I think, across the community of people with lived experience, there's different terminology, but to me, I am a survivor of it because sadly, I, you know, know so, so many stories and have met kind of families where.
• 14:48
  The women didn't survive.
• 14:50
  Thank you.
• 14:51
  And I mean, they do sort of sound obvious, you know, that obviously the, what that risk is that you know, but they are, you know, it's just worth making that explicit that I think a lot of people don't think about maternal suicides.
• 15:02
  We all sort of see these pictures of lovely babies and hopefully we won't get the baby blues or depression or whatever people want to call it.
• 15:08
  But actually, you know, there is that risk and people.
• 15:12
  That happens and it's really quite sad.
• 15:14
  And of course that risk of harm to baby.
• 15:16
  And if that's something as well that if people, um, if somebody has postpartum psychosis and they do harm their baby in some way, well what an awful thing for them to then have to live with when they do recover.
• 15:29
  So absolutely, I can see why that is important.
• 15:33
  Um, but I just want to make it explicit as well.
• 15:36
  So what I wanted to go on and ask you then, Tracy, was about, um, you spoke about how when you had your second baby, you had access.
• 15:44
  Somebody.
• 15:46
  So I wonder if you can talk about how that was, how that made a difference for you, because obviously during that pregnancy you would've been concerned about the fact that you might go on to get postpartum psychosis because you knew that risk had increase.
• 15:58
  And obviously some people that might be their first baby because perhaps there is that sort of thing where they know or something's happened in their family or somewhere else.
• 16:06
  So people have that.
• 16:09
  But did, how did that support or make a difference to you knowing that that was there? And did you access it? Did you do anything pre hand? That's what I'm wondering as well.
• 16:17
  Yeah, yeah, absolutely.
• 16:19
  So what had happened, um, with my first episode of my first baby when I was unwell was, um, specialist perinatal psychiatrists and, and the teams around them, the multidisciplinary teams existed in very few parts of the country at that time.
• 16:35
  And in Kemp, where we are, they only exist.
• 16:37
  Did, they only covered kind of two localities.
• 16:41
  Um, so it was that kind of postcode lottery that we hear about.
• 16:46
  And, and so because of where I lived, I didn't like have immediate access to a perinatal psychiatrist, so I didn't, um.
• 16:54
  The general psychiatrist that assessed and treated me the first time didn't, wasn't an expert in understanding the kind of intricacies of being unwell at that time, of the, of caring, of caring for the baby of, um, medication, considerations of breastfeeding, et cetera.
• 17:12
  Um.
• 17:13
  And I was just, you know, given a kind of a general mental health diagnosis, but because I was a staff member of the mental health Trust, you know, I've been treated in the mental health trust where I was a, a reasonably senior staff member at the time.
• 17:26
  And when it was time to go back to work, I wasn't recovered well enough to go.
• 17:30
  They, um, enabled me to have an appointment with a perinatal psychiatrist and a team that covered a different part of the county from where I lived.
• 17:38
  And that was what made such a difference to me, like being given an.
• 17:42
  Correct information about, um, the condition, somebody understanding that particular perinatal mental health aspect.
• 17:50
  So the services had expanded by the time I was due to have a second baby, and I knew that I could get, um.
• 17:58
  Well, those, so one of the things those services offer is preconception support to kind of talk you through the risks and how to prevent things.
• 18:06
  But they also offer kind of preventative care during pregnancy.
• 18:11
  So that time around, yes, I did have regular appointments with a perinatal psychiatrist to check how I was and also plan for what we'd be doing afterwards when the baby was born, to try and prevent it happen again, because.
• 18:23
  I guess kind of knowledge was powered by that point.
• 18:25
  Have it happened before? I knew I was at risk and I could also, um, work out some of the factors that had caused me to become.
• 18:33
  I'm well, and one of them was lack of sleep in the hospital.
• 18:37
  So, um, the second time around, um, I had, yeah, I developed a preventative care plan, which was shared with maternity services.
• 18:45
  So when I was, um, in hospital that time I was given more support.
• 18:50
  I was given a separate room so that I could, um, get sleep.
• 18:53
  I was given support with breastfeed and 'cause these are all fact.
• 18:57
  That had led me to become unwell before, and I stayed in hospital for longer and I also started taking preventative medication immediately after the baby was born.
• 19:09
  So it made a huge difference, I guess, to, it was still a really, really scary time.
• 19:16
  But having access to that specialist support, someone that would listen, that would understand my needs, understand what would be important to me, yeah.
• 19:26
  It just made such a difference that second time around.
• 19:29
  Thank you.
• 19:29
  And you, what you are really talking about, what's coming straight into my mind is that do with approach, that somebody was there to support you and find out what you were concerned about, what mattered to you, and help you.
• 19:41
  Through that.
• 19:41
  It sounds like there was that going on, would you say? Yeah, absolutely.
• 19:45
  'cause I think one of my things, like the first time around was I felt a care plan.
• 19:51
  It was a care plan was written for me, given to me.
• 19:54
  I didn't feel involved in my care.
• 19:56
  I didn't feel it was client centered.
• 19:58
  But working with the perinatal psychiatrist this next time I felt I was.
• 20:03
  Given all the information, I could make informed choices.
• 20:06
  We sort of, um, collaboratively in partnership develop the preventative care plan.
• 20:12
  Um, you know, they, they might have, you know, they sort of, their top recommendation was probably that I don't try to breastfeed because that meant I could be open to a wider range of medications.
• 20:23
  But being able to breastfeed was really important to me.
• 20:26
  So therefore, knowing that was important to me.
• 20:30
  We, you know, we agreed a medication I could take that it would be safe to breastfeed on.
• 20:35
  So it's just those things like that being given informed choice and it's kind of those kind of principles that really.
• 20:43
  Drove my leadership in healthcare and all the years after that, um, delivering projects, you know, which I worked on sort of the recovery approach in mental health, on personalized care planning and personalized budgets.
• 20:56
  'cause I really understood the importance of putting the control back in, you know, back in the place of the patient or the service user, but the health professional working alongside to, you know, give all the information that was needed to make an informed choice.
• 21:12
  That sort of takes me on quite nicely, Tracy, because you've spoken here about what happened to you and two scenarios.
• 21:18
  I mean, we could say the first scenario, actually, nobody could have predicted it, but maybe things could have been done better.
• 21:24
  The second scenario sounds like you got pretty much all the support that you needed, but you still felt that thing to go on and to drive change yourself.
• 21:35
  So I wonder if you want to talk a little bit, uh, which is what I was asking earlier on a bit about what was it that.
• 21:41
  Didn't happen, perhaps in the first time that you think, or maybe in the second time as well, that you think actually this needs to happen.
• 21:47
  Where you were thinking there was gaps and how did you, how did that shape your journey? So what have you done when you were working in these project management roles that has made that difference or to try and make a difference to women, perhaps with postpartum psychosis? But as you also talked about, you know, it's not just that level of severe mental illness, there's other levels of mental illness that women might have after having a baby as well.
• 22:11
  I think fundamentally one of the things that didn't happen or didn't land with me, you was feeling hope of recovery.
• 22:18
  And one of the things, um, that I've, you know, really passionate about since then, and it's been important across many of the projects I led, is about the value of peer support.
• 22:29
  So, something I know that would've happened been made such a difference for me is to been able to speak to another women that had had that type of illness and recovered.
• 22:39
  So I could see in front of me proof that somebody that, you know, had been in that situation, had been that I'm well.
• 22:46
  Had, you know, was able to recover and go back to a normal life and go back to work and you know, bring up their family, et cetera.
• 22:55
  So that was like one aspect was the peer support and the hope of recovery just wasn't there.
• 23:01
  And I mean, it actually took me 10 years to meet another woman that had recovered from postpartum psychosis.
• 23:07
  And that was when I attended the peer support training myself for action on postpartum psychosis.
• 23:14
  So that's one aspect.
• 23:15
  Um, Ms.
• 23:16
  Phil is so important and is overlooked and underfunded and not respected enough in healthcare is including peer support in multidisciplinary teams.
• 23:27
  I mean, my main expertise is mental health.
• 23:30
  So, you know, I've met, you know, a lot of people now that work as peer supporters in mental health.
• 23:35
  On one of the projects I did was developing the peer support strategy for the mental health trust.
• 23:41
  So that's.
• 23:42
  I think one of the big things, I think the other thing that wasn't there for me and you know, that's I, the second time I did get un well as well, just not with the psychosis.
• 23:52
  I accessed a lot of services the second time as well.
• 23:56
  And something again, a kind of a nuance that's hard to see if, unless you're on the receiving end of it, is that kind of power imbalance between the professional and the person using services about the person.
• 24:10
  Feeling truly listened to about what their needs are and about, um, what matters to them.
• 24:16
  I think it's that question, what matters to you? What's happened to you, rather than those question is what's wrong with you? And, you know, how can we fit you into our system or the way we are set up for you to get better? There was an example, actually this was the, um, after my.
• 24:34
  Second baby when, um, because that time, although I didn't get a psychotic, I did get the severe depression, which often comes at a later phase in that illness.
• 24:43
  And I was, um, under the mental health crisis team as an alternative to admission that second time around.
• 24:50
  And I remember really distinctly sort of something that happened that they were visiting me three times a day, then twice a day, then it was a little less often, and I was on the road to recovery and, um.
• 25:01
  Obviously had an older child as well as a baby at that time.
• 25:04
  My husband was a teacher, so he, you know, he had a week's holiday booked in the summer just for a cottage, um, in the uk and we weren't going too far, but that was really important to us as a family and I felt it would really help my recovery to take a break, you know, and to like have that time with family.
• 25:22
  So he had this holiday booked and I was under the crisis team and they contacted me to say that, um.
• 25:28
  My CPA meeting, my care program approach, like multidisciplinary meeting had been scheduled for a particular day.
• 25:36
  And I said, well, I, you know, I won't be available on that day because I'm going, um, you know, I'm going on holiday the next day and I really need time to pack and get sorted out so that time doesn't suit me.
• 25:48
  And the response was.
• 25:50
  Well, if you're well enough to go on holiday, we just discharge.
• 25:53
  We just need to discharge you if you can't come a job.
• 25:57
  Oh, I just thought it was just so non-client centered.
• 26:01
  It was so not appreciating or recognizing the important that that particular holiday had as a role in my recovery.
• 26:10
  And I thought, how many times? How many times do we do that, you know, in care? Do services do that? Um, like have to fit things in with kind of their assumptions or eligibility rather than somebody's recovery journey or what's important to them? It's a really impactful story actually.
• 26:28
  'cause the natural thing is think, well, you know, you are, you're coming along and this is the NHS, you're getting your service, um, you're being supportive.
• 26:35
  But actually there's so much more to unpack when somebody can't make an appointment or doesn't attend an appointment.
• 26:41
  And often they're the people that need supporting most and they're not, not coming for any other reason other than it doesn't work for them.
• 26:48
  There's something else that's more important to them, um, and that they think will support that.
• 26:54
  So, yeah, thank you for sharing that, Tracy.
• 26:57
  And then what else? I think you were gonna go on and say there's a couple of other things.
• 27:00
  'cause we've got fear, um, feeling, hope of recovery, the power imbalance between professional and the person.
• 27:08
  Was there something else that you were going to add to that I've interrupted you? Maybe for me as well, is that whole thing about the importance to listening to stories.
• 27:17
  Because over the years I've ended up, um, telling my story and lots of places and the media, um, supported by a PP as the charity.
• 27:26
  I told my story as a staff member as well to challenge stigma about, you know, staff members could, you know, there's not such a gap between a patient.
• 27:37
  And a staff member, you know, there can be one and the same person.
• 27:40
  And I think so many times when I told the story with honesty and vulnerability, it just had so much impact to make people stop and think about that power difference, um, and stop and sort of think about actually how it feels to be on the receiving end of that, how powerless you feel.
• 28:02
  Um, you know, as a patient receiving care.
• 28:04
  Yeah.
• 28:05
  And, um, I think, you know, I've spoken to this before, before, probably one of the words I don't like is patient because actually is somebody receiving care.
• 28:14
  And what you're talking about here is actually reducing that power imbalance.
• 28:18
  And that means somebody who is presenting to be supported, to be cared for as a person and an equal partner.
• 28:25
  In that power dynamic and um, I won't go into it too much now, but I think there is a certain amount of, um, because we have.
• 28:34
  Hierarchies within our own systems, you know, being a nurse and I dunno how you feel as an occupational therapist.
• 28:42
  I always felt, particularly going back to my early career when the doctor came on or the consultant came on on the ward rounds back in the eighties, you know, I was privileged if I was allowed to make the coffee for them.
• 28:52
  Um, I didn't actually feel like I was privileged at the time, I have to say.
• 28:55
  But the ward system, you know, told me it was a privilege that I was gonna be making coffee for the consultant that day.
• 29:00
  So that power dynamic is there within.
• 29:03
  Our organization, it's really important that we, we remove that power dynamic because the minute I'm not as powerful as perhaps somebody else who comes in to see the person I'm caring for, then actually where, where do they fit? So the person being cared for.
• 29:17
  So it's very much something, it sort of goes back to my first podcast actually, um, about that, you know, um.
• 29:24
  Do people know who you are? Do people know what you do? And how do you make sure that you get that respect and recognition that you need professionally? And sometimes we don't because we think, oh, actually they're the more important person in this, or they're able to do this, or perhaps they might even think that themselves, and I wouldn't.
• 29:42
  Begin to suggest that every, you know, medical doctor actually thinks that because, don't think they do, especially now.
• 29:48
  But of course that was the case and that power dynamic exists and can affect the way that, um, people are sin.
• 29:54
  But I think it works all the way through and that, you know, as a professional and as a nurse, I'm sure the situations where people have said thought to themselves, oh, she's the nurse, so she's more important, so I must listen to her.
• 30:05
  But it is about evening that out and stories can really help with that.
• 30:10
  I sort of very much felt that in healthcare, and that's one of the things I think.
• 30:15
  That drove me to train as a coach that I love about coaching because coaching is so much about an equal partnership, about really actively listening to the client about that, them being in charge of their own story about being guided and supported through questions and reflection to make their own decisions, take their own actions.
• 30:38
  Yeah, receipt.
• 30:38
  Being in receipt of coaching, which I was before I trained as a coach, I, I just found that so empowering because I felt it, it was opposite to not just what I'd experienced as a patient receiving services, but what I'd experienced in the dynamics of healthcare.
• 30:54
  Over all the years I've worked in it, it just felt so refreshing to be in a genuinely equal partnership.
• 31:02
  Yeah.
• 31:03
  And I know that you've gone on in your, one of the areas that you're actually doing your coaching.
• 31:07
  It's called Mother Nature Coaching, isn't it? And it is for women that have perhaps had mental health or issues, um, after they've had, after childbirth, whether that be postpartum, psycho, um, psychosis or, um, other mental health issues.
• 31:21
  And I think particularly sort of supporting them back to work, um, is what you're looking at.
• 31:26
  Yeah.
• 31:27
  Yeah, that's right.
• 31:28
  So as you said at the start, I chose to, um, leave them.
• 31:33
  The ICB, the NHS kind of leadership roles I had there, um, you know, just over a year ago now in order to set up, um, my own kind of practice as a coach in order to deliver things, I guess in a way where I was in control of the structures and, um, kind of what I focused on and wasn't working and some of those constraints of the health service.
• 31:57
  And, um, you know, after sort of initially I, I worked with a lot of, I'm really, really interesting coach of women to support and empower them.
• 32:06
  But when I, um, started to think, who do I really want to coach and who could get most benefit from this? Where's there a gap in the provision, particularly in perinatal mental health, which.
• 32:17
  Most passionate about because of both personal and professional experiences.
• 32:20
  I really saw that gap in particular about when women return to work.
• 32:26
  That um, because that was a whole nother part of my experience, which we haven't discussed, is that going back to work and going back to work in the health service, after having those experiences of being on the receiving end of services after.
• 32:40
  Losing not just my professional confidence really, but my whole self identity and trusting myself.
• 32:46
  It was so tough going back to work and trusting myself again.
• 32:51
  Reconnecting with my professional confidence, feeling socially confident at work.
• 32:56
  And over the summer this year I did a lot of um, kind of research conversations with women who had had a perinatal mental health problem and gone back to work.
• 33:05
  And I found that was a very kind of common similar experience.
• 33:09
  And in particular, you know, there are many professional women who in the same way as I had, had always been successful being in control of their career, thought they're gonna go for maternity leave, have a baby come back, and everything would feel the same.
• 33:23
  You know, even for women that don't get unwell, that transition into motherhood is such a major, you know, is such a big transition in life and really sort of changes you as a person and much more.
• 33:34
  So obviously if you start to have mental health experiences that you hadn't had before and you suddenly got anxiety or low mood or you know, post-traumatic stress disorder from the birth or obsessive compulsive disorder, there's just so much to work through at that time.
• 33:50
  So I thought, yeah, that's the group I can really help here.
• 33:53
  That's where I can use, combine my professional and my personal expertise.
• 33:58
  And it very much, um, yeah, is in line with occupational therapy as well.
• 34:02
  Although what I'm offering is coaching my OT skills come into it as well because.
• 34:08
  Yeah, that translates so much into women's roles and occupations and returning to work.
• 34:14
  So yeah, so I now support women who feel lost returning to work after struggling with anxiety or depression or any other mental health disorder during their maternity leave, and to help them reconnect to their professional confidence.
• 34:28
  I use nature in my coaching because over recent years.
• 34:33
  I sort of start to realize myself how much being connected to nature, being in nature really helps you connect to your confidence, to your true inner intuition, to to regulate all those difficult emotions that cause us to feel so anxious and amongst the many distractions we face in modern life.
• 34:53
  So I've gone on to do further training in nature-based coaching on top of my, um.
• 34:58
  You know, general transformative coach training, and that's now I, I bring nature into my coaching in any way possible.
• 35:06
  Whether it's working with a client who chooses to be outside and to walk outside during the coaching, whether it's using nature metaphors within the coaching process.
• 35:17
  Or whether it's, you know, sort of very much like nature focused questions and observations within the coaching process.
• 35:25
  Again, that feels so natural and empowering compared to kind of some of the systems I've.
• 35:31
  Receive, been on the receiving end of and spent a lot more working in than being on the receiving end of.
• 35:37
  So much of it feels unnatural and disconnected from our kind of inner true selves.
• 35:43
  Yeah, and of course we know that.
• 35:45
  I mean, I'm just thinking back to James Metcalf's episode, which was about the natural health service, which is quite a big movement actually, that being outside, there's so much evidence now, and I know other people on the podcast have spoken about this, that actually being outside in nature.
• 36:00
  Makes a huge difference to our health and wellbeing, um, and the way that that works within us as well.
• 36:06
  So yeah, I think that's a really important thing and that what you are doing, your work and when I, you know, I've been following that as well and seeing what you're doing.
• 36:13
  It's just amazing, Tracy, and really is driven by what you think.
• 36:18
  Um, or what happened to you and to your own experiences.
• 36:21
  I'm gonna step back as well 'cause I feel like we've missed out some of that work that you've done in the ICB.
• 36:26
  So I know you've stepped out now, but I'll just recap on those three things that you gave me earlier on.
• 36:31
  And I'm sorry if I interrupted and perhaps sort of lost it, but I think you probably, they came through, you talked about feeling hope.
• 36:37
  They need to feel hope of recovery.
• 36:39
  And particularly around that peer support about addressing that power imbalance and say, asking people what matters to you and what happened to you rather than what's wrong with you.
• 36:48
  And then actually that active listening and supporting people to make their own decisions, um, and being an equal, it sort of comes into that.
• 36:56
  Power bit, but actually that active listening takes it that little bit deeper, doesn't it? So I wonder what it is that if you, there's perhaps, 'cause I know that you worked within the, um, ICB, that leadership roles for many years, and maybe there's one story.
• 37:09
  I know we chatted before we started today, didn't we? And you've, um, already linked in with Jewel Phillips around that Hugh Shoes project, um, who was on a couple of episodes ago.
• 37:20
  But I wonder if there's something that you've particularly done in that role where you want to sort of share the story of that leadership role and how it made a difference in practice and what it was that you or perhaps a team of you were doing to try and do drive the changes based on everything that you'd experienced.
• 37:39
  I mean, I think, um.
• 37:41
  Actually my kind of my best ever role, I think in the, um, NHS was actually the three and a half years I spent working for NHS England on the National Perinatal Mental Health Program, where um, there was funding to, I mentioned the importance of the specialist services and there was funding.
• 38:00
  To set up specialist services across the whole country.
• 38:04
  Um, and, you know, across the few years we did that and part of, um, the implementation was to make sure that the teams were set up in a way that had full multidisciplinary team, including peer support, um, and set up, you know, with evidence-based practice and a lot of, um, choice and control really for the people using services.
• 38:26
  Yeah, and what actually happens.
• 38:28
  So for somebody listening, you know, I might not know what, you know, a lot of people will be from medical background or clinical background know an MDT, but describe what actually those teams done, and it sounds fascinating and what they were doing that was perhaps different or wasn't there before as well.
• 38:45
  So those teams.
• 38:47
  Specifically to work with women during pregnancy or, initially it was the first year after, but now it's two years.
• 38:55
  So they were set up to provide that kind of specialist type of care that I didn't have the first time.
• 39:01
  So they're able to, um, support women who are already in mental health services, who we know might risk relapse when they have a baby.
• 39:08
  So they offer that preventative care.
• 39:12
  Um, and also for women who become unwell after having a baby, they offer, um, the, the specialist care and support, um, you know, in the way that I was like, supported in a much more specialist way after delivery.
• 39:28
  Sorry, this isn't No, no, it's fine.
• 39:29
  So what you're talking about there is that really, you spoke earlier on about that postcode lottery.
• 39:34
  I sort of put you on the spot there, so it's fine Tracy, but you spoke No, no, no, it's fine.
• 39:38
  You, you spoke about that postcode lottery earlier on, and what this really was, was a national role to try and address that, to make sure that the first time round that your post closed lottery was, that there wasn't that support for you.
• 39:51
  So even though you, it hadn't been identified pre-birth, that you might be somebody at risk, um.
• 39:57
  It still took a while.
• 39:58
  It sounds like the things to kick in, you got to that crisis point before anything really happened for you.
• 40:04
  Um, the second time the postcode lottery had changed and there was a team there to support you, plus it was known that you were at risk, so you had all the support that you needed.
• 40:14
  Um.
• 40:15
  We can't change the fact of the first one of not knowing, but perhaps there could be support in place.
• 40:19
  And it sounds like what you did, and the reason why you probably think this is your best role ever was because you were working at that national level to say this is what needs to happen.
• 40:28
  You understood the package that you needed.
• 40:30
  We've spoken about that.
• 40:31
  I think I've mentioned it a couple of times.
• 40:33
  You understood the package.
• 40:34
  You understand that it needed to be a multidisciplinary team, so a mixture of all different professions that could offer different things, including peer support.
• 40:42
  And actually you went out and helped to roll that out.
• 40:44
  Nationally across the country so that that postcode lottery either disappeared or maybe it isn't in some areas that sometimes, 'cause we know services sometimes change, but was absolutely reduced and everybody knew what it was that they needed to be aiming for.
• 41:00
  Would that be a fair reflection? Yeah, yeah, absolutely.
• 41:03
  And I think go stepping back, like for the few years before that was a funded project, um, at NHS England funded by the government.
• 41:15
  It showed the, the power of kind of, um, storytelling and developing empathy and people realizing why things important is, that's such a strong example in that policy program because.
• 41:28
  Um, the, those, there's the small number of clinicians that were delivering that specialist service across the country and were passionate to make sure it was accessible to everybody.
• 41:37
  Got together with some women that had due services.
• 41:41
  Um, the stor, um, they told the stories, their campaign, they had these stories presented in Parliament and there was, um.
• 41:50
  Yeah, there was like strong research evidence as well done alongside about the economic impact.
• 41:56
  So that develop of development of specialist perinatal mental health services is again, a really strong evidence of the power of hearing service, user stories, working in partnership with the specialist clinicians, working in partnership with researchers who could prove the economic benefit so that all of those.
• 42:17
  Those stories and the evidence together became so powerful that a package was funding was nationally agreed because there was, it developed a shared understanding by policy back 'cause of why these services were important, of what the risks were of not having these services and why they needed to be prioritized.
• 42:35
  So there, so there is such clear targets on that program about o you know, over a number of years just breaking down that.
• 42:43
  That postcode lottery, ensuring that services of the same type of an equal standard were funded in every part of the country, where in England, as we were covering at the time.
• 42:56
  And also there was addition as well as those community teams.
• 42:59
  There was funding put in to ma and baby units, which specialist inpatient units, where a woman can be admitted with her baby when she's unwell, so they can be treated together.
• 43:10
  She can be supported to bond with her baby because.
• 43:13
  There can be such poor outcomes for families when mom and baby are separated.
• 43:18
  So there was a specialist inpatient mother and baby unit alongside the community teams.
• 43:23
  And I think the part of that project I loved the most was when we'd funded the projects, we'd supported the professionals and the commissioners in each locality to set up their service.
• 43:34
  And then we got to visit all the new services that had been funded across the country, you know.
• 43:39
  The kind of, um, team from NHS England to hear how it was going to share the learning we had from having visited all the teams to hear about the good practice, to help them with things that still weren't going well.
• 43:52
  But the most amazing part of that was always we, you know, we always like had families that had used that service come to those visits and tell us about their experience.
• 44:04
  And that was always the most powerful thing that was so.
• 44:07
  Rewarding, I guess, to hear those families, to hear those moms and dads and sometimes grandparents, et cetera, talk about the difference the service has made to them, particularly those that might have had a baby when the service wasn't there and then they had another baby when the service was, and they could tell us what the difference was.
• 44:28
  And it's that power of kind of storytelling, that power of really hearing about and understanding the impact.
• 44:35
  I think it.
• 44:36
  Drove our resilience to keep that program going.
• 44:39
  Make sure it was delivered because you know that that was what it was there for, for, for those women and those families.
• 44:46
  And to hear the difference it made just emphasize the importance of the work and you know, for anyone who can't sit or people can't see you 'cause we're not recording video.
• 44:56
  But actually the passion there really came through.
• 45:00
  And what you were talking about is.
• 45:03
  Yeah, the power of storytelling, but you were telling that at.
• 45:06
  You know, we talk about that all the time and say, you know, we should get people in and learn from their stories, you know, and I've seen that happen at sort of various learning events.
• 45:14
  Probably not enough, but it is happening more and more now through different channels and conferences and events.
• 45:21
  But you took talking about people coming to share their stories at Parliament.
• 45:24
  Tree level to really say, look, this is me.
• 45:26
  This is what I need.
• 45:27
  This is what's happened.
• 45:28
  This is what didn't happen.
• 45:30
  This is what could happen or has happened that made the difference.
• 45:33
  And those stories influenced Nat National change.
• 45:37
  Um.
• 45:38
  People were learning.
• 45:39
  So to me, this comes back to my passion, which I, you know, one of the pieces of work I've done in the past, and I did talk on a podcast on my own on it, one of the ones I did around that place-based learning, which is about learning not just from within our workplace, but actually learning across the, across our whole place, which is absolutely what we need now, isn't it? Because we are the government's talking about the.
• 46:00
  10 year plan and having neighborhood development.
• 46:03
  Well actually to do neighborhood development, you need to do exactly what you were doing back then.
• 46:07
  You need to say, help have somebody help those teams to say, right, what's the issue that's going on? And it might be a big issue, you know, a sort of broader issue.
• 46:16
  It might be something like this sort of very particular.
• 46:19
  Is, this is around maternity mental health and saying, right, who do we bring in to find out what's going on? How do we work together with people? How do we learn from them? Which is those shared stories.
• 46:31
  And to me, this steps, I spoke earlier on about that do with approach that, that perhaps that team took with you in that second, um, uh, in your second, after your second pre pregnancy, after the birth of your second child, you, um.
• 46:46
  They took a do with approach, but what you're doing here is that much broader do with approach of actually how do we develop this service with and for people, not because we think the service needs to happen, which obviously you did because you had that drive, but because they feel that this service needs to happen and they are able to say what happens and message to them.
• 47:07
  Yeah.
• 47:07
  It brings me on to kind of something else I've like, been passionate about, has been included in so many projects over the years, and I would have insisted it is working in co-production in true partnership with people using services at every point from the beginning of developing a service to designing it and to deliver on it.
• 47:27
  Um, and there's so many, uh, could be a whole podcast of the challenges in the area of co-production about.
• 47:35
  How people are really treated equally, how they are really listened to, how they're supported in partnership in those positions.
• 47:44
  Because you know, when you, you know, when you do like, tell a story of great vulnerability that's very personal, you know, there can, um, it can be.
• 47:55
  Traumatic obviously.
• 47:56
  So it's important for the support to be put in place, but also the level of respect and things like payment for people that are doing that because they've got a different type of expertise, but it's still really valuable expertise and it's what should be driving the development of services.
• 48:13
  And I think.
• 48:14
  It can be hard.
• 48:15
  I know like busy professionals, policy base, it'd be hard to take the time to properly listen to the full story from that person's perspective.
• 48:24
  But sometimes a, a survey, sending out a survey and people say what they would prefer from a list of options is just not as powerful and doesn't really hit the mark in the way it does to actually see it.
• 48:36
  And listen to that story from that person's perspective.
• 48:40
  I can, um, share an example.
• 48:41
  Actually, when I was working in the ICB and leading maternity transformation across Ken and Medway, we had our board meeting there, which consisted of senior people from all the four trusts in Ken Medway providing maternity services.
• 48:56
  And that was where we were, you know, deciding on the priorities to transformation and taking things forward and, um.
• 49:03
  We introduced a slot where a service user story would be told at that board.
• 49:09
  And, um, somebody came and start told their story of giving birth about one of the trusts.
• 49:15
  And there were just so many things that came from that person's perspective that people hadn't stopped and thought about, hadn't noticed.
• 49:23
  And it was little things like the way.
• 49:26
  The letters are sent, but everything in the letter feels punitive.
• 49:29
  And you feel threatened by most lines in the letter.
• 49:32
  'cause most lines are about, oh, you have your appointment being canceled if you don't phone up.
• 49:37
  And then you arrive at the department and all the notices are, oh, you know about things you mustn't do rather than things you, so she was just talking about how.
• 49:47
  Unwelcome.
• 49:47
  She felt as if she was an A hindrance and an inconvenience because all of the communication and all the notices in the department made her feel scared that if she took her foot wrong, she wouldn't receive care anymore.
• 50:00
  Yeah, a bit like my experience, I guess of a dare to book a holiday there for care is gonna be denied of me and I think like the power of her story.
• 50:11
  Of, um, just the little things and how it made her feel and the impact it had on her when she was in a vulnerable position.
• 50:17
  It just made people think about things they just hadn't noticed or hadn't thought about.
• 50:23
  And I mean, the leaders in the room were really great listeners and, you know, immediately went and, you know, to cover service users around to review the department from that perspective and take down notices that made it seem unwelcome in.
• 50:38
  But, um.
• 50:40
  But yeah, it is just those, like really properly listening to the nuances of how I, it's about how I make peop how things make people feel.
• 50:48
  I, you know, a lot of the, so many of the projects I've worked on, it's been about experience and outcomes, and of course the outcomes from a clinical measure and everything are really important.
• 50:59
  But there's also the experience.
• 51:00
  What was the experience like? Did somebody feel like they had choice and control? Did they feel welcomed? Or did they feel really scared and nervous about going to every appointment because they were worried if they were late, they'd be struck off the list, et cetera.
• 51:18
  It's just those, yeah, it's like how people feel, isn't it? How care makes people feel and whether they feel empowered in those situations.
• 51:27
  And that brings us back to that bit that you're talking about, that power imbalance.
• 51:30
  Because actually the minute you walk through the door of a hierarchical institution, which DNHS is, along with lots of other, you know, services, you are, you are put on the back foot, I suppose, aren't you? By those things.
• 51:42
  And how does that make you feel? Tracy, we are coming towards the end now and you've said some incredible things here, um, and really been really open.
• 51:51
  So I just want to thank you as well for sharing your story because you know, it is something that is personal to you and that's a, you know, a, a great thing to give.
• 52:00
  Um, but before we go, I just want to know what, what is it that you would like to.
• 52:05
  Say to people out there that are listening, what do you think is important for people to share? And you might have a, a couple of messages.
• 52:14
  Yeah.
• 52:14
  So if it's something about active listening about really taking the time to stop and listen to stories.
• 52:21
  And, uh, I just think about empathy as well to really try and put yourself in the position of that person and think how, how would I feel if I was there? Being told this are on the receiving end and services are under so much pressure, aren't they? Professionals are under so much pressure.
• 52:40
  These are the things that can easily be lost.
• 52:43
  And I suppose, um, for me, because I'd never lost, my empathy was always.
• 52:50
  Kind of quite deep and I noticed things because I actually knew, had experienced what it was like to be on the receiving end.
• 52:58
  So I think sort of empathy and truly listening and putting yourself, I, I know you've got, um, you've had another speaker who talks about whose shoes and putting yourself in the shoes of the person.
• 53:09
  I think, yeah, those things are just really important.
• 53:12
  Thank you.
• 53:13
  And for those people perhaps listening who have gone through mental health or know somebody who's had mental health issues, uh, particularly after, you know.
• 53:24
  Um, pregnancy, is there anything that you would particularly want to say to them at all? Yeah.
• 53:30
  To reach out for help.
• 53:31
  'cause there's a lot of support available.
• 53:33
  There's a lot of charities both locally and nationally to, um, to know that you can recover, to know that you're not alone.
• 53:43
  To know, you know, mental health, um, you know, perinatal mental health problems as a whole.
• 53:47
  You know, recent research shows it's one in four women, but used to be one in five across, um, our country that experience mental health issues, issues after birth.
• 53:58
  So to just, yeah, just know.
• 54:01
  It's not that unusual to know supports available and to seek support and seek out people that understand.
• 54:09
  Of course, we can put some links in the resource, in the notes, can't we? Of many of the resources you've spoken about, but also to make sure that those.
• 54:17
  Um, those places are there for people to go to and have a little look.
• 54:22
  Thank you so much, Tracy, for joining me.
• 54:24
  It's been an absolute pleasure.
• 54:26
  Um, you've been a great support to me at a time when I needed it.
• 54:31
  Um, and I know that you'll be a great support and are a great support to many other people.
• 54:35
  So thank you for everything you're doing and thank you for joining me today.
• 54:39
  Hi for me, Ray.
• 54:41
  I hope you found this episode interesting and inspiring.
• 54:44
  If today's conversation has stirred something within you, please share it together.
• 54:50
  Let's build the ripple that we need to create change.
• 54:53
  And if you haven't yet, please follow the show and leave a rating.
• 54:57
  You can also find on my link tree a link to my feedback form where you can share your questions, ideas, and reflections, and talk about what you'd like to hear on this podcast in the future and what matters to you.
• 55:10
  Together, let's shape a space into something reflective and purposeful.
• 55:16
  So for now, stay caring, stay connected, and stay curious.
• 55:22
  So I hope you found that as fascinating and amazing as I did, hearing Tracy open up and share her story with such generosity to help drive change.
• 55:33
  I mean, she drove change at a national policy level, and she's reminded us that hope matters.
• 55:38
  Peer support matters.
• 55:39
  And deep listening deeply can change everything.
• 55:44
  Thank you for listening, and until next time, bye.