Expectation Management

I was watching Hannibal this evening and one of the characters said of mental health services that “it’s less about finding solutions and more about expectation management.”

I have talked about expectation management with a very good friend of mine and here are some of the things we discussed.

For people working in mental health services, there is often an expectation that people with a mental illness will do less well than our peers.  The general advice given, whether outright or by suggestion, is that we should lower our expectations.  Things that may be seen as a given for others: going to university, getting a job well-suited to their needs and skill-set, having successful relationships, are not seen as givens for people with mental health problems.  Instead, there is constant concern expressed that these things might be “too stressful” for us, that we might be setting ourselves up to fail, that trying to achieve our aims might actually be detrimental to our health.

As an adolescent on a psychiatric unit, I was repeatedly discouraged from going back to school.  It was explicitly stated that doing so would impact upon my recovery, probably negatively.  Faced with a bright, academically driven person with a desire to complete more than three GCSEs, the staff there didn’t know what to do.  In the unit, it was compulsory to attempt three GCSEs: Maths, Science and English, because it is the law.  One girl was allowed to do Art in addition to these because she was good.  Excellent, actually.  In general, though, we were taught to set our expectations lower and try less hard than our former classmates.  We were taught that we should be happy with whatever we did, because we weren’t expected to do anything at all.

I understand that pushing us too hard, expecting the high results our schools expected from us, would have been damaging to our recoveries.  Faced with serious mental health problems, we had enough on our plates without stressing over A*s.  But that doesn’t mean we couldn’t achieve them.  It doesn’t mean we didn’t deserve the same opportunities.  One teacher passed me along a Classics book while I was in hospital.  I’ll never forget that.  It was a small sign that someone still believed in me.

As adults, we are told to take jobs we can handle, or courses we can manage, without any real attempt to understand what those jobs or courses might be.  A friend of mine, academically gifted, has had it suggested that work in retail might be better suited to him than university life.  This is ridiculous.  Taking a job ill-suited to him would surely be more detrimental to his mental health than starting a course that he will find fulfilling- challenging, yes, but well-suited to him all the same.  I have friends with mental health problems who are students, nurses, therapists.  In choosing to do the things they really feel they should be doing, they are able to live what I assume are happier lives than they would if they spent their whole lives trying hard not to try too hard.

Jobs, university, life… all of these things are difficult, and stressful, particularly so if you have mental health problems to contend with on top of them.  But that doesn’t mean we should be discouraged from trying.  It doesn’t mean we need to set our sights lower.  A realistic outlook need not be a pessimistic one.  It should be less about managing expectations, and more about supporting us in achieving what we want from our lives.


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