An Assessment


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.

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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.

7 thoughts on “An Assessment

  1. Your team sound like mine! It’s that wonderful sort of confidence which can only be displayed by having no involvement in the situation. It’s amazing how daring my colleagues can be if it has no impact on their own career!

    I think it’s a bit like watching a movie, a thriller maybe, and filled with couch confidence passing judgement on all the characters.

    Lola x

  2. Your post is a very good outline of complex issues which impact you and other social workers; it also clearly identifies to other professionals what we have to deal with. You actually show a really good sense of looking after your own mental health by using appropriate means that work for you ie. blogging, Twitter and others networks to create a powerful support structure around you. I can identify with this as so many social workers I work with do not create positive cirlces around them. I teach this in my book ” Stress Relief for Social Workers”.
    I am very interested in you taking on additional duties despite what seems a very responsible and demanding job. Let us know what that’s about, and well done for making a difference!
    Gradle

  3. I don’t detain patients at all, of course, since as you say that’s both technically and pragmatically the AMHPs decision to make an application.

    However, on undertaking s136 assessments out of hours with AMHPs it’s far more common for an AMHP to persuade me that a recommendation and admission is appropriate than it is for me to seek admission when they don’t.

    To date, I’ve never yet considered admission under the MHA 1983 and not had an ASW/AMHP wholeheartedly agree.

    I think this, of having the same values within the CMHT and the LA’s AMHPs (on positive risk taking, least restrictive settings, ill ease that hospitals can be a toxic environment, of MHA 1983, level of patient autonomy) contribute massively to a stress free working environment. If everyone’s of a similar view, and that view’s sensible and generally generates optimal patient care, the agreement and collaborative assessment, formulation and decision making is so intuitive and effortless that it happens without stress or strife.

    This is in stark contrast to another area I worked in where teams “got along” because the (then) ASWs, who felt burnt out and frazzled and over worked and under valued and incredibly unsupported and vulnerable just capitulated agreed to whatever the medics/clinical team suggested.

    Although in both scenarios there’s agreement, I’m happily in a place where assertive and feisty and very capable and motivated AMHPs (who really are knowledgeable and can help me out on technical and obscure nuances of the MHA 1983) agree because we all thing it’s right, since we’ve similar values.

    Without this, I can’t see how you can defuse the stress of MHA 1983 assessments and the varied opinions giving ill ease and a lack of peer support compounding the ill ease.

  4. Lola – Yeah, that’s what it seems like sometimes!

    Gradle – I actually think the blog etc has helped enormously through being a more positive outlet for some of the stresses I have been feeling. The book sounds very useful!

    Shrink – It sounds like you have a wonderful team around you (as well as your own working practices!). I’d love never to use the MHA – it feels incredibly oppressive because it is. My only hope is that when I do, it is because there are no other alternatives. Of course, I’m still fairly fresh having been warranted for under a year, but I am extremely determined and bloody minded when necessary and hope that it will serve me in good stead in the future.

    Honestly, I think I’ve had more respect from stating opinions positively and clearly than from ‘going along with’ views that are given. If that ever changes, I hope I quit!

  5. It’s wrong that there isn’t a space for (at the very least, neutral) debriefs in your office.

    Isn’t this also about the way social workers generally feel about how the profession is interpreted by the general public and the media?

    Maybe your colleagues are really affected by the low status, the invisiblity/visibilty issues relating to confidentiality and at the same time, media sensationalising more than we realise?

    Maybe if they could have a regular diet of positive cultural nutirents about social work they’d be refreshed and motivated!

  6. There should be a space for debriefs, Soapsoane, but I think somehow it gets lost along the way. Fortunately, I’m quite good at demanding it – going to the head of services if necessary.
    Generally, the office is quite supportive, it was just a particularly difficult day for me which probably reflected a little too much in the post!

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