I mentioned in passing that I was out at an early morning assessment earlier in the week. I wanted to reflect on some of the issues that arose without mentioning too much of the detail. It was the second attempt to assess as the first visit, Mr A had not been in. That was why we went earlier this time. We knew he was more likely to be in.
This assessment had been troubling me enormously but actually had a fairly satisfactory outcome. I think. Actually, the real difference made in that assessment was that the GP was present. Although he was reluctant to come to assess because (understandably) he did not want to ruin his therapeutic relationship – it was in fact, exactly that therapeutic relationship which enabled us to try to engage Mr A at home a little longer and see if we couldn’t avoid a hospital admission.
There was an interesting conversation beforehand though between psychiatrist and GP when GP claimed his therapeutic relationship was crucial and psychiatrist replied snarkily ‘so is mine – psychiatrists also have to build relationships you know’. It was a gem. It was also, for me, a massive lesson in making assumptions before attending but a good one.
But, if there’s one thing my almost-one-year of being an ASW/AMHP has taught me is that assumptions are there to be broken. You plan ahead and outline how you think assessments might go and can never fail to be surprised.
What didn’t help was returning to the office and having a couple of people tell me I’d clearly made the ‘wrong’ decision because I couldn’t possibly not have brought Mr A into hospital – along with a long list of risks which we had previously identified relating to the reasons we had gone ahead with the assessment in the first place.
Sigh. Honestly, I generally love my team but they do like to comment on all the ‘bad’ decisions I make – and even if I had felt Mr A should be in admitted forcibly to hospital (which I didn’t – or at least, I felt we needed to try other things before going down that route) – neither of the doctors would have signed recommendations anyway because we all agreed.
The more stressful decisions come about when you have two signed medical recommendations in hand and then make the decision not to admit. That has almost happened to me – what actually happened is that I had one recommendation and another doctor assessing with me who asked me if I wanted him to write a recommendation or not because it could have gone either way. I told him not to and we didn’t admit.
I get paid more now than most of the people on the same ‘level’ as me at work – namely, all the people who aren’t in senior or management positions. The reason I get paid most is solely because I get additional increments for the AMHP work. I’m also one of the younger members of the team. These two combined factors don’t always make me the most popular of people.
It can feel very isolating at times. I wanted to come back and discuss the assessment and mull it over. The other AMHP I work with has management responsibilities and also has much much more experience than me, of social work, of work in mental health settings and of ASW/AMHP work. But she was on leave. Anyway, I had three other visits arranged for that day. Actually, I had four but I cancelled the one which I felt could be postponed.
I probably would have taken today off if I didn’t need to complete the paperwork for a Guardianship renewal. Oh, and apparently I will find out if I’ve been approved as a Best Interests Assessor although it’s likely that I won’t actually find out until Monday as I’m out and about most of the afternoon. A weekend of two days sometimes just isn’t long enough. I made it to April with my two ‘emergency’ days of annual leave intact! I also realised (and I’m sure all this is related to my general current mental state!) that I haven’t had more than a few long weekends off work for over a year.
At least I have my holiday in July to look forward to! But actually, I’m very very tempted to book myself a week off – even if it is just a ‘stay at home’ week.
Sometimes I think I’m not very good at looking after my own mental health.