‘Working from the inside out, rather than from the outside in.’ By Pat Gilmerton @dynamic_wheel #AHPCFS2022 @NESnmahp

Do AHP’s have a blind spot?

I wonder what patients, clients, and communities would say? Is there part of us as AHPs that we are unaware of?

Over the last few years, similar questions have arisen in my clinical practice.

Working in vocational rehabilitation within the Keep Well Service, NHS Forth Valley, has allowed a deeper appreciation of the systemic barriers that arise from an employment and welfare system that lacks flexibility and is endemic with unintended hurdles, especially if you have a lived experience of a complex mental health condition.

Despite credible, evidence-based employability programmes such as the Individual Placement and Support Model endeavouring to support people (Burns et al., 2007), the data continues to send a message that society is leaving sections of our population behind. For example, recent figures state that disabled people have an employment rate close to a third lower than people who are not disabled (Office of National Statistics Briefing Paper, May 2021).

Witnessing the individual’s effort in trying to overcome these broader system barriers is both inspirational and humbling. However, what is concerning, for those of us that work in Vocational Rehabilitation, is that we have observed persistent challenges for many years with little evidence of any improvement. These challenges relate to:

· People who experience complex mental health conditions being caught up in employment training cycles, without ever realising their work potential through paid job attainment.

· People with valuable lived assets that are cast aside as the job market has no jobs for their skill.

· Piecemeal focus from Mental Health Services on vocational rehabilitation – despite the fact that supporting people into paid employment produces significant savings for services (Burns et al., 2007).

Yet, like many of my AHP colleagues, I have often felt powerless facing these challenges driven by complex, ever-changing factors. This situation can lead to feelings of being stuck and frustration. Then, in turn, it feeds an internal dialogue that tends to blame others and the system, questioning what power I really have to change things. This pattern resulted in a disconnection from my own personal agency.

My blind spot was that I was listening and continuously downloading this internal narrative.

To embrace this insightful space and make a shift out of this cycle, I used the learning I gained from a MOOC style course called U.Lab. This experience led me to question myself on what part I was contributing to keeping this inequitable system going, and in turn, asked three powerful questions from U.Lab:

1. What frustrates you or is a challenge in your work or non-work life?

2. What is emerging in you that wants to be born is the most vital energy source and embodies your love?

3. What is holding you back? What inner resistance stops you from exploring the situation more deeply?

                                                                                                                  (ULab: http://www.presencing.org)

The U.LAB learning became the catalyst that brought me to spend the last ten months, supported through an AHP Fellowship, co-developing a social enterprise called Dynamic Wheel with people with lived experience of mental health issues or other multiple hardships.

This experience has come with its own challenges, dare we say it, COVID, yet, what remains absolutely consistent from the early discussions about Dynamic Wheel is the starting message that every person will be seen through the lens of what the person has, their asset, their lived experience.

Taking an asset approach is not new. However, we see several organisations operating from the third horizon who have chosen to work with people from the ‘inside out, rather than from the outside in’ as their raison d’être. For example, Resilience Learning Partnership in Clackmannanshire and Unlock Employment in Govan are both contributing to this new pattern. Both organisations thrive under leadership from lived experience and profoundly impact on people who experience multiple disadvantages.

In joining this collective response, Dynamic Wheel has set down some ambitious plans over the coming years, from developing a learning platform, a micro-business incubator and an events programme. During COVID restrictions we have developed DW walks, self-organised peer support zoom sessions, and ran a peer support training programme.

Like all organisations, achieving what it wants to achieve is challenging and at times daunting. However, I also realise that we are tackling unemployment and social inequalities, which most social commentators classify as ‘wicked’ problems. Nevertheless, since opening up my heart, mind and will, and uncovering my blind spot, I now know that my single contribution towards a collective response is evidently the only way forward in dealing with ‘wicked’ problems. (Grint 2008).

My blind spot was leaving it to others to sort out. I now understand that wicked problems require a collective response from everyone. We are all leaders, including people with a lived experience. Without their contribution, we will never witness an impact on these types of challenges. Nonetheless, until I went below my surface, as an AHP, I would have never fully realised this perspective.

I invite the reader to take some time out, reflect and go deeper inside.

‘Who looks outside, dreams; who looks inside, awakes.’ Carl Jung.”

Acknowledgements: I would like to thank the following for your generous time and support: DW Members; NES AHP Fellowship; Louise Leiper, AHP Team Leader; Joanne O Suilleabhain, Principal Public Health Officer, Keep Well; Keep Well Team, NHS Forth Valley; Eileen Sharp, AHP Practice Education Lead, NHS Forth Valley; AHP Mental Health Care Group NHS Forth Valley.

Author: Pat Gilmartin, NES AHP Careers Fellow,

Occupational Therapist, Vocational Rehabilitation, Cognitive Behavioural Psychotherapist,

Keep Well Service, NHS Forth Valley.

Contact Dynamic Wheel: https://twitter.com/dynamic_wheel


  1. Three Horizons, International Futures Forum: https://www.internationalfuturesforum.com/
  2. https://www.edx.org/course/ulab-leading-from-the-emerging-future
  3. Burns, T., Catty, J., Becker, T., Drake, R., Fioritti, A., Knapp, M., Lauber, C., Rossler, W., Tomov, T., Van Busschbach, J., White, S. & Wiersma, D. (2007) The effectiveness of supported employment for people with severe mental illness: a randomised controlled trial, The Lancet, 370, 1146-1152
  4. Office of National Statistics Briefing Paper-Disables People in Employment, Number 7540, 24 May 2021
  5. Grint K. (2008) Clinical Leader, Volume I Number II, December 2008, ISSN 1757-3424, BAMM Publications http://leadershipforchange.org.uk/wp-content/uploads/Keith-Grint-Wicked-Problems-handout.pdf

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