Misunderstanding kindness

There are widespread misconceptions about kindness in mental healthcare, and these can be detrimental to the support provided. Psychologically safe truth-telling is a cornerstone of practice, even when such conversations may be distressing. ^{Reference Hunt, Bailey, Lennox, Crofts and Vincent3} Yet, in cultures in which psychological safety is lacking, staff may feel pressured to equate kindness with politeness or niceness, avoiding difficult dialogue to protect themselves or their patients from discomfort. ^{Reference Ballatt and Campling1,Reference Hunt, Bailey, Lennox, Crofts and Vincent3}

Contemporary mental healthcare recognises the importance of a person-centred approach, but providing choice is not the same as giving patients everything they want. ^{Reference Mol4} In this sense, kindness can be misapplied as the tendency to say ‘yes’ to demands and to avoid candid, sometimes challenging conversations. For example, in therapy, colluding with a patient’s risk to avoid painful topics may feel kind but can reinforce the difficulties that sustain distress. At a service level, extending an in-patient admission without addressing the reasons the patient may not want to be discharged may affect their recovery. At a safety and system level, organisations may inadvertently reinforce this agreeable form of kindness as a way of minimising negative experiences or complaints.

The misapplication of kindness has significant consequences. Eroded boundaries and attempts to accommodate every demand may lead to staff burnout, either through the strain of unsustainable effort and the moral injury that arises when staff feel torn between what is right for the patient and what the patient wants. ^{Reference West, Dyrbye and Shanafelt5}

An organisational culture that focuses solely on patient preferences can discourage the difficult but necessary conversations that are often central to recovery. ^{Reference Spandler and Stickley6} Avoidance of such dialogue risks therapeutic disengagement and stagnated progress. Indeed, evidence suggests that a propensity to over-help can be detrimental to outcomes. ^{Reference Spandler and Stickley6} It is in this context that intelligent kindness becomes essential as a form of kindness that is boundaried, reflective and grounded in what best supports recovery, rather than in simple agreeableness.

Kindness, compassion and empathy

Kindness can be understood both as an attitude and as a set of actions. It involves a disposition of care and concern for others, expressed through behaviours that make this stance visible in practice. Empathy – our capacity to sense and experience the distress of another – provides an important perceptual basis for this. Empathy is bidirectional, in the sense that it can support the enactment of kindness, and expressions of kindness can in turn reinforce empathy. Although compassion is often described in similar affective and behavioural terms, ^{Reference Gilbert2,Reference Strauss, Taylor, Gu, Kuyken, Baer and Jones7} the language of kindness here emphasises the dual aspect and the importance of making caring intentions tangible and focused on what is best in everyday interactions.

When one element is present without the other, problems arise. Actions delivered without genuine concern risk seeming hollow or performative, undermining trust and therapeutic engagement. Equally, a stance of care that finds no constructive expression can leave staff overwhelmed by suffering, unable to translate empathy into purposeful practice. Intelligent kindness brings these strands together. It is a deliberate, principled orientation that integrates affect with action. In this sense, intelligent kindness provides a foundation for care that is both authentic and sustainable within mental healthcare services.

Kindness that doesn’t feel kind

True kindness is complex and does not always present in ways that are immediately recognisable or even experienced by the recipient as acts of kindness. In some circumstances, kindness may only be understood retrospectively, once distress has eased and the longer-term benefits are apparent. This is particularly relevant in mental healthcare, where short-term discomfort and good, long-term mental health and well-being can often be in tension.

There are several examples of kindness that may not feel or appear kind. Restrictive practices, when delivered with humility and care, may serve to keep an individual safe at a point of acute risk. ^{Reference Bowers, James, Quirk, Simpson, Stewart and Hodsoll8} In specialist eating disorder units, firm boundaries around calorie intake may be life-preserving. ^{Reference Guarda9} Similarly, honest discussions of a poor prognosis or acknowledgement of side-effects such as significant weight gain associated with some antipsychotic medications can be experienced as painful yet remain fundamentally acts of kindness. ^{Reference De Hert, Detraux, Van Winkel, Yu and Correll10}

At the same time, these practices carry the risk of being experienced as punitive, coercive or uncaring and may place strain on therapeutic relationships. Intelligent kindness does not diminish these ethical complexities. Instead, it focuses on the undertaking of such interventions with humility, transparency, and a genuine commitment to the dignity and long-term mental health and well-being of a person. This requires staff to hold in mind both the affective and behavioural dimensions of kindness, ensuring that even when kindness is not felt as such in the moment, it remains ethically grounded and directed towards the safety, welfare, and outcomes of the patient.

Framing such actions within intelligent kindness also protects staff. It allows practitioners to see difficult decisions as principled acts of care rather than arbitrary impositions, helping to safeguard against moral injury and burnout. In this way, intelligent kindness sustains both patient care and professional integrity, ensuring that kindness in mental healthcare is not sentiment alone but centred on principled and sustainable practice.

The real face of kindness

Given the complexities of what we mean by kindness in mental healthcare – and the importance of intelligent kindness in navigating these complexities – it is important to show how this concept is enacted at every level of the system. Too often, kindness is positioned as an individual virtue, something enacted in one-to-one interactions. However, without relational, organisational and systemic support, the burden falls on staff alone, leading either to pseudo-kindness – gestures unsupported by substance – or to harshness that can result in safety incidents and possible burnout. When kindness is framed using the principles of relational, courageous, boundaried and systemic practice, we can see how it requires alignment across the micro (clinical or support encounter), meso (team and organisational practices) and macro (policy and structural) levels. ^{Reference Ballatt and Campling1,Reference Hunt, Bailey, Lennox, Crofts and Vincent3,Reference West, Eckert, Collins and Chowla11}

Relational kindness focuses on building understanding in the face of complexity. At the micro level, this involves staff taking time to explain decisions and helping patients to see the immediate and longer-term benefits of care; ^{Reference Spandler and Stickley6} the ways in which psychologically safe communication is delivered, especially concerning difficult decisions, can determine whether therapeutic relationships are strengthened or strained. At the meso level, relational kindness is about creating team cultures of respect, collaboration and communication. ^{Reference Mol4} At the macro level, it requires services and policies that enable continuity of care and protect time for meaningful relational work, rather than reducing encounters throughout.

Courageous kindness asks both individuals and institutions to face hard truths. At the micro level, staff may need to be honest about difficult realities and be open to complaints or negative feedback. At the meso level, teams require psychological safety so that staff can raise concerns and advocate for patients without fear of how this might be viewed within the team and beyond. ^{Reference Hunt, Bailey, Lennox, Crofts and Vincent3} At the macro level, organisations must embed transparency and learning into governance, ensuring that accountability mechanisms encourage openness rather than defensiveness, which must also be mirrored by relevant regulatory bodies. ^{Reference Edmondson12}

Boundaried kindness recognises the dignity of limits. At the micro level, this means staff being clear about what can and cannot be provided, while still affirming the humanity of the person they are supporting. This relies on clear and transparent communication with patients, teams and organisations, as clear communication of boundaries protects well-being and helps the boundaries to be seen as protective rather than punitive. At the meso level, it means services setting realistic pathways and expectations to avoid moral injury and burnout among staff. ^{Reference Williamson, Murphy, Phelps, Forbes and Greenberg13} At the macro level, commissioners and leaders have a responsibility to align expectations with resources, rather than setting front-line workers up to fail.

Finally, systemic kindness reminds us that acts of care are never isolated but have effects across micro, meso and macro levels. It is shaped by the networks, cultures and policies in which care occurs. Individuals can offer kindness in small encounters, but only if meso-level supports – such as adequate staffing, supervision and reflective practice – are in place. At the macro level, kindness must be treated not as a discretionary extra but as a structural necessity, embedded in regulatory frameworks and organisational strategy. ^{Reference Mannion and Davies14}

Seen in this way, kindness is not reducible to an individual-level disposition or ‘nice to have’. National Health Service rhetoric often invokes compassion and kindness (for example, the Francis Report), ¹⁵ but there remains little evidence on how these values are structurally operationalised and sustained within mental healthcare. This illustrates how the enactment of kindness requires the collective to take responsibility across all levels of practice.

In conclusion, in this paper, I have sought to unpack the real face of kindness in mental healthcare, considering what it is, and what it is not. Drawing on insights informed by close work with mental healthcare teams, I have argued that intelligent kindness must be understood as relational, courageous, boundaried and systemic. It is not an abstract virtue but a practical orientation that seeks what is ultimately good for patients and considers the welfare of staff, reflecting professional practice and organisational priorities. This may be so even when it is not immediately experienced as such, and when these efforts are shaped by pressures across micro, meso and macro levels. At its core, intelligent kindness requires balancing safety with genuine choice, without collapsing into either avoidance or coercion.

What intelligent kindness is not is simple agreeableness or acquiescence to every demand. Such superficial kindness risks eroding recovery, undermining dignity, and exposing both patients and staff to harm. Intelligent kindness may sometimes mean holding difficult boundaries or facing complaint and dissatisfaction, because its goal is recovery rather than appeasement.

For this reason, intelligent kindness cannot rest on individual goodwill alone. It must be enacted across micro, meso and macro levels. This comes through relational practice in clinical encounters, supportive cultures within teams and organisations, and systemic structures that embed kindness as a collective responsibility. This may at times threaten the optics of being ‘nice’, but if the aim is to deliver safe, effective and humane mental healthcare, intelligent kindness must be recognised as a structural necessity.

Recognising kindness in this way reframes it as a shared responsibility rather than a personal virtue – one that requires sustained commitment from staff, organisations and policy makers. The task ahead is to ensure that intelligent kindness moves beyond being an aspiration and towards being structurally enabled, so that it can serve as a durable foundation for mental healthcare.