By Professor Sir Simon Wessely
[this blog was written by Professor Sir Simon Wessely when he was President of the Royal College of Psychiatrists. It has since been cited as the only reference for this BMJ Feature article: Medical profession turns to soft power to influence policy]
Dale Carnegie’s “How to Win Friends and Influence People” is one of the most successful books ever written. Since 1936 it has sold over 30 million copies, and is the 11st highest selling non fiction book on Amazon. It is part of a self help tradition that goes back to Samuel Smiles, although I prefer Toby Young’s “How to Lose Friends and Alienate People”. Failure is always more amusing than success.
But making friends and exerting influence is a core part of what I am supposed to do as President. And like everything that is important, no one ever tells you how to do it, although they are always on hand to let you know when you have done it badly. Indeed, much like Toby Young, I remember rather more easily how I failed to influence people than when I succeeded.
But let’s have a go. A journalist writes a bad piece on antidepressants. I immediately write an email telling him that this is ridiculous, ill informed, prejudiced and will cause great harm and distress, and I will be complaining to the editor. And then delete it. Why? What does Dale say? “Try honestly to see things from the other person’s point of view”.
You are dealing with a professional journalist. They are just reporting what someone told them, or what was in the press release. It’s a story. And as anyone who has read Nick Davies “Flat Earth News” knows, they will probably have written three other stories today, plus tweeted, blogged and so on. They are tired, and don’t have time to do a literature search, Cochrane review and lots of interviews. They are just doing their job.
So now you try again. Send another email, or even better pick up the phone. You congratulate them on a well written piece. Perhaps however because of space they over simplified a bit. Maybe they would like to return to the subject at a later date? How can you help? Would they be interested in a “comment” piece, bringing the reader up to date with some new research?
Always have a story
Now what about a politician? Two rules. First tell a story. Politicians love stories. I have given evidence on numerous occasions to select committees, commissions, ministerial round tables, consultations etc on the subject of military mental health.
Often we turn to the topic of mental health screening. They tell me of a terribly sad case of a young man recruited to the Armed Forces who comes back from deployment in a very bad way, and sometimes has done something terrible to himself or someone else.
The politician says it’s a disgrace that they weren’t screened before they deployed – because all this would never have happened. I can talk statistics, NICE criteria, evidence – I can see their eyes glaze over. But if I agree, and then ask them if they can think of another constituent, from the same sink estate, left school at the same age with no qualifications, had a father in prison and a mother on the bottle and so on, and who also joined the Army?
They usually can. How did that person do? “Really well, actually, became a Sergeant Major, I gave him a medal on the home coming parade a few months ago”.
“Well, if we had screened out your first case, we would also have screening out this chap and four more like him”.
They get that. I could have sent them our study showing this, and our new randomised controlled trial only out last week, and they wouldn’t even have opened the email. But a story they will remember for ages… (BMJ research article, IOPPN press release)
So always have a story.
And even better than you doing this, get patients and relatives to do the job for you. Give them the address of their MP. One of the virtues of our system is that even if your MP happens to be a Secretary of State or even Prime Minister, sooner or later they really will see you. It makes a difference.
And ride the wave. Mental health is fashionable. More and more people “get it”. And even those who don’t really get it, which is probably still the majority still, they know that they are supposed to, and that’s almost as good. You and I know that we deal with mental illness, but, button your lip for the duration of the meeting, and talk mental health and well being until you are out of the door with the commitment that you wanted.
Get allies. When I started in psychiatry it was fair to say that the main user group, MIND, didn’t like us and the feelings were reciprocated. A lot of careful work by my predecessors has reversed this. And now we are alongside MIND in the Mental Health Policy Group, which contains the six key influencing organisations in the field. When we hunt as a pack we are a very powerful lobby – as was the case with the Five Year Forward View and also getting a voice, not a large voice, but still a voice, in the Holy of Holies, the Treasury.
And then lobby, lobby and lobby again. Politics finally depends on people. Get to know them. It is fashionable to be cynical about politicians, but I have a shameful secret that only now as I come to end of my term I am now prepared to admit. I like most politicians. There, I have said it. Nearly all work very hard and don’t actually get that much pay for the hours.
Try, try again
Very few will reach the glittering prizes, but that doesn’t deter them. I have now dealt with 11 ministers for veterans’ health during my time working in that field, from all main parties. All but one were very good. 90%, wasn’t party political. Most really wanted to do the best they good for those who have served. And I find most politicians, once they have decided that you aren’t secretly filming or recording them, are decent people with a sense of humour and of the absurd. I did say “most”, not “all”.
But whatever their personality or party affiliation, my job is to get to know them. It is important to develop personal links. It sounds cheesy but it is. And how does one do that? If at first you don’t succeed, try, try and again. And if that still hasn’t worked, befriend the person who keeps the minister’s diary. They know what’s going on.
Lobbying works. Sometimes. We have lobbied I think successfully for changes to the Prevent programme, Mandatory Reporting on Child Abuse, sensible outcome measures (well, more sensible than they would have been if we hadn’t bothered). the way in which NHS Digital use data, persuading NHS-E to accept the findings of the Crisp Commission on beds, and many more.
And what about the longer game? When I started this role we went through a big review of our communications, which wasn’t easy. But in the end we decided that what we really wanted to be was not so much a campaigning organisation – there are organisations better placed to do this.
We want to become a trusted source of advice – to be in effect a calm, authoritative voice for mental health, one that is visible, credible, and useful. And I think we are achieving that. Here’s one example – in February 2015 we had 106 media pieces with audience reach of 30 million, Last month it was 283 media places reaching 100 million.
We’re trying to use digital more effectively too. See our short video for Members which explains what you can do to embed recommendations to improve acute adult psychiatric care in your Trust. It’s just one of many improvements we’re introducing, I hope you like it.
Finally, being a psychiatrist can be a help. After all, Dale Carnegie said that one of the best ways to exert influence was to “become genuinely interested in other people”. If we aren’t, then who is?
Professor Sir Simon Wessely