A tin of tuna (or: an alternative tale of impact)

Can a story change perceptions?

The blue plastic inhaler tells the story of a trip to A&E, and the three steps back taken by the blue gowns, when the answer to the question: “So, where are you living at the moment?” is “Well, actually, I’m homeless”.

The set of precision scales tell the story of a GP seeing more and more patients who have lost their homes; how she wants to redress the imbalances of health injustice to tip more in their favour.

The maternity notes don’t tell the full story of their rightful owner, the care and carelessness she receives: “The things that aren’t recorded almost say as much as what is there.”

These were just three of the powerful stories told as part of the #Objectified season, a partnership between the Museum of Homelessness, the Public Programmes team at Manchester University NHS Trust and the Greater Manchester Patient Safety Translational Research Centre. As 2018 drew the duvet over its head, this interactive exhibition and series of events laid bare the health of homelessness. Through carefully curated objects, verbatim performances of testimonies from different perspectives on homelessness, we explored the hidden causes of homelessness, the science behind stigma, what it means to be healthy and homeless. And we asked: can an object and its story change perceptions of homelessness? Can they change how we should do health care and research?

Manchester, where #Objectified was based, counted 278 people bedded down outside in 2017, a 41% rise on the previous year. GPs, charities and council workers referred double that number to a scheme which strives to find permanent housing for people with the most entrenched experience of homelessness, including those dealing with alcohol and substance misuse, and mental health challenges. Life expectancy when homeless drops to 30 years less than the national average. Let me repeat that: you will live around 30 years less than Jo or Joanna Bloggs, if you are homeless. You will have twice the rate of physical and mental illness. You will also find it hard to access healthcare, because of institutional barriers, stigma and negative experiences.

Our Mayor, homeless organisations such as the Booth Centre and Mustard Tree, charities, and individual citizens are leading ambitious initiatives to tackle homelessness. How can we be similarly ambitious in patient safety research, to become more inclusive and reflective of the living experience of homelessness? This was the focus of our event on Actions for Change event in November 2018, the culmination of the #Objectified season. Together, with those experiencing homelessness, people from health and social care organisations, Universities, cultural organisations, commissioners, policy makers and homelessness organisations, from the UK and as far afield as Australia and Brazil, we drew up plans for actions and research to improve the quality and safety of health and homelessness. The event was just the start.

What’s the story of impact?

A week after #Objectified, I’m at another event. I’m Chairing a half day workshop on the impact of public involvement in research. How do we know the difference that working with people with living experience of health conditions makes to research? To people’s lives? How do we know that we’re doing involvement ‘right’? How can we ‘measure’ it?

Two of the speakers – Simon Denegri and Judith Williamson – urge us to be more subtle, be more nuanced in how we conceive of impact. To evaluate our practice in order to improve it, not prove that we need to do it. To move beyond metrics for the sake of filling dashboards and indicators. To think of individual people – patients, citizens, researchers – as well as the overall quality of research and public involvement. To think of impact as the enveloping caress of enlightenment, rather than the blunt force trauma of consequence.

We close the workshop with an interactive session on evaluation methods – quantitative and qualitative – for assessing and reporting impact. But I leave with Simon’s words ringing in my ears: “we need to tell the story of impact differently”.

A tin of tuna (or: my alternative tale of impact)

Of course, we evaluated #Objectified. But I didn’t need a survey or feedback form (though I don’t deny their value, if used well) to tell me its impact story. It was written all over the faces of the people who took part: the exhibition-goers, the researchers, the healthcare professionals, the artists, those with living experience of homelessness, the venue reception staff who snuck in at the back of our Actions for Change event to see what was going on. We became enlightened by the stories of the objects, the stories of each other, and the stories of the science telling us what happens in our brains when we dehumanise people. And how stories can chemically change the connections in our brains, can influence our everyday actions and our research, to think differently about homelessness and health.

For me, it also went deeper than that. I’d been given the honour of introducing the Actions for Change event. While preparing, I realised the impact that #Objectified had had on me. And it came in the form of a tin of tuna. You see, it gradually dawned on me, through the partnership with Jess and Matt (the Museum of Homelessness) that I had been homeless for a while. I was at University, my mum had died the previous winter, and it was the summer “holidays”. My family home was far away and long gone. I had a bar job – cash in hand, of course – but was ‘sofa surfing’ with friends and acquaintances. I was lucky, friends were generous. But options weren’t always simple: choosing between a place to stay with the seedy bonus offer of ‘fringe benefits’ and staying up all night to find a friendly park bench. When I could, I always cooked the same thing: a tin of tuna mixed with pasta and a tin of tomatoes. Easy, cheap, healthy. Eating it made me feel safe. #Objectified helped me make sense of that time in my life, and forgive myself for some of the decisions I made then.

Handle with care

So yes, an object and its story can change perceptions; objects and stories can influence how we do health care and research; and beyond, they can enlighten our sense of self, our understanding, our chemistry, our behaviour. Stories of impact – not forgetting stories of data, evidence and experience – well told, have the power to persuade.

All the objects and stories in #Objectified were, strikingly, handled with extreme care and caution. My tin of tuna – now, an honorary object in the Museum of Homelessness – was welcomed with white gloved hands, as a delicately curated jewel for awe and wonder.

Sometimes, stories are not quite so respected. I have witnessed ‘patient stories’ becoming commodified. Often used to demonstrate a point, or as a not-so-subtle form of marketing (the value of research, say) they can be used to serve a purpose rather than be treated as a treasure in their own right. A form of human currency that becomes grubby with thoughtless or over-handling.

So, let’s realise the power of stories and the impact they tell. And handle them with care.

Even when you’ve got nothing, you’ve still got your story” (David Tovey, formerly homeless artist, educator and activist).

tuna

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