11 May 2021
Article from April 2021 edition of INPractice
He's an author, a registered nurse, manager of an international journal, a president, adjunct lecturer, and private business proprietor.
He's also a Mental Health Liaison Nurse Consultant in the ED of the Flinders Medical Centre, winner of the 2020 ANMF (SA Branch) Emerging Leader Award, and also an international figure in the field of Solution Focused Brief Therapy (SFBT).
For David Hains, SFBT isn't about analysing a problem or a person's past, it's about having a forward-focus that aims to build solutions rather than solve problems, by exploring a person's strengths, personal resources and future hopes, rather than dissecting and confronting them with their weaknesses. He strongly believes that this approach fits well with the core tenets of nursing.
"In psychiatry and the medical model in general, whether that be in mental health or whatever other area, the first thing that we are told to do is to analyse what the problems are," Mr Hains says.
"So we analyse how these things impact and prevent you from doing all the things you need to do, and we analyse and assess the problem in as much detail as possible. We then give the problem a name, what we know as diagnosis, and then they go about telling us what to do about it.
“The thing is, if you’re working in orthopaedics or oncology, that might be a really good approach. For example, if I’ve got cancer or I find a lump I’ll go to the doctor or the oncologist and say ‘tell me what it is and get rid of it for me’. It works really, really well in that sense. It works the same for my car, when it’s broken I will take it to the mechanic and ask him to diagnose the problem and fix it for me.
“But when it comes to mental health I don’t think that approach works very well because we’re doing an assessment to work out someone’s deficits and inabilities in a way that’s disempowering and somewhat humiliating. We are putting the person in the situation of being a victim, that they’re suffering from a disorder, and they need someone to fix it for them. Most mental health problems should not be approached like this.
“Whereas I think the Solution Focused approach simplifies things to such an extent that a person can tell us where they want to go to and they can actually work out how to get there with very little intervention from us. That’s in very stark contrast to a psychiatry model which will analyse the problem and then try and fix the problem often in a way the patient or client doesn’t want to fix, for example by prescribing a medication that has significant side effects and very little evidence base.”
Mr Hains’ current position as a Mental Health Nurse Consultant in the Flinders ED entails assessments, crisis intervention, counselling and therapy and teaching emergency mental health care to nurses and doctors.
His interest in SFBT began back in 2006 and he immediately knew that this would be a perfect fit in the emergency department. Within a few of years he established the South Australian SFBT Community of Practice, hosting free training events and workshops.
He also travelled to Canada as a recipient of the 2016 South Australian Premier’s Nursing Scholarship. “It (SFBT) started in the USA and quickly spread around the world. I was fortunate enough to go to Canada to see the SFBT approach in action, and also went to the North American SFBTA conference to meet some of the world leaders in the approach. It was an amazing experience,” Mr Hains said.
In 2016 Mr Hains also established a private training business, Left Turn Solutions, the mantra being ‘when things aren’t going right - turn left’. “There is a common saying in SFBT ‘If it’s working, keep doing it, but if it’s not working then do something different’.” Through his business he teaches solution-focused techniques to individuals, small businesses, large corporations, anyone who wants to find a better way of doing something. He has also trained most of the staff from Southern Mental Health in the approach. In 2021 as a result of the COVID lockdown he also established “The Possibilities Lab” to conduct online training in partnership with Emma Burns, a psychologist with the New Zealand Police Force.
Mr Hains said SFBT had proven to be an effective intervention in a wide range of clinical, social, educational and corporate settings, virtually any situation where people want to improve something in their lives but don’t know how to go about doing it. SFBT does not analyse problems but rather goes straight to looking for, and then moving towards, a solution.
“The ‘problem’ has already caused you to waste a lot of time and energy, so we don’t intend to waste any more by doing long and complicated assessments of something that you already know is a problem,”
he says.
Not long after he established Left Turn Solutions, Mr Hains was made an Associate of the Brief Therapy Institute of Sydney.
“David is a leader in teaching and promoting SFBT in South Australia. He has built a Solution-Focused community of practice of over 100 clinicians in just over one year and has been recognised by his professional peers for his Solution-Focused work in frontline, acute mental health work,” said Michael Durrant, director of the Brief Therapy Institute of Sydney.
“I am proud to endorse David as a colleague and welcome him as an Associate of the Brief Therapy Institute of Sydney.”
Since then, Mr Hains has hosted international conferences for the Australasian Solution Focused Association (ASFA) in Adelaide and New Zealand, becoming President of the ASFA in 2018 and receiving the Mental Health Achievement Award from the Australian College of Mental Health Nurses that same year.
As President he also re-established the only international peer-reviewed SFBT journal - The Journal of Solution Focused Practices - and worked as co-editor on a new multi-contributor textbook on mental health for paramedic students, Mental Health and Mental Illness in Paramedic Practice (due for release in late 2021).
“The journal had been dormant for a few years, so to revive it I appointed a new editor from the USA and we now publish the journal through the University of Nevada Las Vegas. We’ve taken it from a paper-based journal to a fully online, fully open access journal,” Mr Hains said.
“It’s available now to everybody in the world online for free. It’s been a phenomenal success. We’ve now established an international committee which I chair, with representatives from organisations from 10 different countries who are financially supporting the journal. Now that it’s online people from all around the world are accessing it.” A mental health teacher to medical professionals and students, Mr Hains describes emergency mental health as “just about anything that lands in the melting pot of the emergency department”.
“For an ED nurse it could be simply finding a person in distress. That distress could be anything from ‘My dog died and I’m distressed’ to having some chronic illness, trauma, pain, a manic episode or a suicide attempt,” he says.
“I don’t want to belittle ‘the dog died’ because it’s not about the dog dying, it’s about the 27 other things that happened before the dog died, and then the dog died which took them over the edge.
“However, that doesn’t mean we should assume the person has a mental illness. Our job should be to examine the meaning behind the presentation, and this is usually best examined through the person’s eyes rather than through the eyes of the psychiatry/medical model.”
Mr Hains believes our mental health service should be focused on person-centred care, “putting the person in the role of the expert, looking at the problem through their eyes, finding out what they want, and then working with them to find out how they might go about getting it. It’s very much about empowering the person and putting the focus on that person”.
“Quite often the person will come up with thoughts and ideas which I would have never thought of if I looked through a medical lens, but because it’s their thoughts and their ideas it is more likely to work for them,” he says.
“I’ve got teenagers. If I tell my teenagers to do something because I’m the expert and I know best, they’re going to want to do something else. My clients are the same.
“Often we’ll tell them to do something because as the ‘expert’ we know best. But with a solution-focused approach the clinician does not take on the role of expert and doesn’t tell them what to do, it gets the person to come up with answers that are meaningful to them. It’s so much more likely to succeed if they come up with what they want to do and the direction in life that they want to go in.
“If I go to my kids and tell them all the things they’re doing wrong, how do you think they’re going to feel at the end of that conversation?
“They’re going to feel belittled, they’re going to feel like they’re useless, they going to feel like I’m telling them off. Despite my best intentions and despite the fact I was a kid once and I’ve got experience, I might be trying to teach them all the mistakes that I’ve made but by the end of that conversation all I’ve done is I’ve told them 20 things not to do. Effectively I’ve told them off and they are going to feel useless.
“But if I turn it around and I look at the 20 things they’re doing right, they still might be doing lots of things wrong but if I focus on the 20 things that they’re actually doing right, they’re going to walk out of that conversation feeling better, feeling empowered, feeling stronger and then they can start looking at some of the other things they want to improve.
“So, if I talk to my client about the 20 things they’re doing wrong, they’re going to feel disempowered, like they’re useless, like they can’t do anything, like life is not worth living.
“If I turn that on its head and I look at all the things they’re doing right, it has a flow-on effect where they can see that they can use these strengths they’ve already got to get them through the problems that they’ve got. So, it’s a very empowering way with kids, with anybody really, to approach it from that direction".
The COVID pandemic has brought the issue of mental health and its alarming prevalence to the forefront as more and more Australians struggle with unprecedented social and financial stresses.
However, Mr Hains says the mental health ‘epidemic’ was here long before COVID, largely a product of the disconnect that exists in contemporary society.
“I’ve worked in an ED for quite a number of years and the workload here has gone through the roof in terms of the number of patients who come through the door and the amount of work that we have to do,” he says.
“I would attribute much of the increasing workload to the way that our society works now … I’d blame the lack of connection within our community,” Mr Hains adds.
“The family unit is not as strong, our neighbourhood is not as strong, we don’t know our neighbours up the street, we don’t mix together, whether it’s the church group or the sporting group or social club, or whatever it is. We’re not connected as much as we used to be.”
Over the years David has been appreciative of the support provided by the ANMF during some tough times.
“We’ve had a lot of assistance from the ANMF in relation to staffing levels and workloads in the ED and the mental health area. But in addition to this the ANMF has personally supported me through some quite stressful workplace issues,” he says.
“The ANMF has been a great resource and support to me so that I can focus on the job at hand – being a nurse, and helping to bring my patients back to health”.
For more information:
leftturnsolutions.com.au/solutionfocused.org.au/
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here to read the April 2021 edition of INPractice.