Rage


Yesterday I was at the end of the phone when a carer  called – furious that the service was not able to deliver what had been expected of it.

Honestly, the rage was mostly deserved. There I was, trying to explain why transport for an appointment had not arrived, why a carer hadn’t been/hadn’t recorded he had been (not sure which – I veer towards the former but care agency swear blind it is the latter) over the long weekend and why I had had to postpone a visit from last week to this week.

And although I have a fairly thick skin, the savagery of the attack took me back a little.

Angry Face by Piez.piez at flickr

I’m not blameless by any means – I could have popped in at some point last week – but it’s a part of the often unexplained need to prioritise immediately any work related to Mental Health Act being one of two AMHPs (Approved Mental Health Professionals) in the service that can often lead to postponing what plans may have been otherwise made. We’ve had quite a few assessments come in over the last week or so.

One thing I learnt and I think this was on one of these managing complaints courses I’ve been subjected to over the years was that when someone is angry and annoyed with the service, we shouldn’t try to make excuses or divest responsibility to other services or people because that isn’t going to help.

So I apologised – and for what it’s worth, it was an entirely genuine apology. I am truly sorry that this happened. I wish I could put together a fully functioning care package. I wish, when I call the care agency to ask why someone has not been, that I believed them when they told me that person went and just ‘forgot’ to sign in. I really honestly truly do.

I passed on verbally and followed up with a letter with all the relevant complaints departments – the local authority, the primary care trust and the mental health trust.

These though are the moments when you realise the power of the media. As well as being told that my job was so easy that Mrs X’s seven year old  child could do it – I was also held personally as an example of how the social work profession is full of over-paid (!) buffoons who have fallen out of college because they couldn’t get through their GCSEs. And weren’t intelligent enough to get onto media studies courses.

Although I was quite good at masking the initial blows and know logically that the anger wasn’t really personally directed as me as an individual but rather the ‘me as a representative of an organisation’ ,  I was very close to asking my manager to reallocate to a nurse as that is what the carer wanted.  As I was told, at least nurses are useful.  When my mother is allocated a social worker instead of a nurse, does that mean she’s getting an inferior quality of service. Does that mean her medical needs are being ignored. After all, what do social workers do that a seven year old child couldn’t?

And you know, I have had a good think about it.

I suspect that today, if everything was followed up as planned yesterday, will rest a little easier. Sometimes just being angry at the representative of a service can be enough.

I do hope so but as it is, today, I have another swathe of cancelled ‘routine’  visits in the wake of a sudden call for a Mental Health Act Assessment.

I hate cancelling. I hate cancelling with little notice. I wish we could operate some kind of ‘duty’ system that the other CMHTs have which would mean that I could block off days just for AMHP work – but as long as there are only two of us – it is impossible to put a hold on everything else while waiting for calls that may or may not come in.

The explanations for the cancellations are usually a genuine but fake-sounding ‘emergency that has come up’. I hate saying that as it seems that I am diminishing the needs of the person I had planned to visit but as long as there is an immediate need for a possible assessment for a compulsory admission to hospital – that really does have to trump everything else. It is contractual. I am (rightly) obliged to place Mental Health Act work above everything else.

I don’t explain that part though. There is a time to soak up rage. And a time to explain and defend. They never occur simultaneously, I’ve found.

8 thoughts on “Rage

  1. A social worker not emotionally available will feel nothing and be like an automaton. A social worker too emotionally invested will be overwhelmed and burn-out. Someone in balance will have off days and good days. Sounds like you are in balance. Keep the faith!

  2. That’s the fundamental difficulty, isn’t it? How hard it must be to develop the kind of empathy where there could be the capacity to ‘turn take’ in Social Worker, Agency and Client relationships. The contracted out levels of ‘trust’ seem to generate structured confusion as a natural byproduct.

    I had a similar situation this morning. I’m not a social worker, I work in Marketing but my sister suffers from Bi Polar illness, our mum died last year and the family ground is full of aspirations that were never met as well as the need to grieve and come to terms individually for all four of us.

    Over many years I’ve let my younger sister make impossible demands on me to bail her out of many difficult situations, too often and too deep to come out of them myself with any sense that she has any respect for me, or sense that I have a life.

    I realised this morning when she rang at 7pm and I was having a lie in after having had virtually no sleep (and my partner told her that when he answered the phone) that when she continued to ring after he’d gone to work, that she really didn’t care: if she wanted something she was going to get it, at any cost.

    When I answered it in my usual dutiful way, I realised that, because of her depression, I’d always made allowances for her situation I was trying to control things that niether of us have control over, which probably have the effect of making her feel worse, more dependant and in need of a solution from me.which I can’t give.

    I think this is the caring, resourceful, empathic insight that enrages people. (It’s very humourously expressed in Clare in the Community R4). The contracted out situation is a real magnet for spreading blame and mistrust. I think that you have options: to try to make agencies more aware of their accountabilities and how they might lose work when they get contracts and, also, to be given the scope to explain at the outset of your relationship with the client the quality and accountability of agency service and how the client has power to withdraw acceptance for a level of service below standard.

    That’s the theory but we need campaigns to improve service quality!

  3. Do you have that many intrusions through AMHP work involving older adults? Or are you on a generic AMHP rota and get pulled by everyone in working age adult services and 136’s?

    As someone who’s only sought to detain two of my patients on a section 3, ever, and managed just a couple section 2 admissions last year, it’s rare that I bang on an AMHPs door for an urgent MHA 1983 assessment. And I thought in older adults, that’s often the case. My colleagues have higher detention rates, but still it ain’t common.

    We trouble AMHPs for advice (“Shall we do a DOLS on Mr X or is this just restriction?”) and more planned stuff (“Can we look at Guardianship this week, for Mrs Y?”) but we don’t intrude into AMHP time unless we’re really needing to.

    The sad flip side being, when I do seek an AMHP urgently, I really really need one there and then, right away, so it will intrude into their planned visits.

    I don’t know if that’s better, really – I seldom call AMHPs for an urgent assessment, but when I do it’s invariably grim and immediately necessary!

    I’m waffling, my point is simply that I sympathise with you and can’t really see how colleagues could work to reduce the stress of you balancing accessibility/appropriate priority against minimal intrusion into delivery of planned care.

    • I think we have an average of just over one assessment a month. I know it doesn’t sound much but I don’t really know what to compare it to. They have tended to bunch up though.

      Where I am now, well, the two of us only do over 65 assessments but it’s a fairly sizeable population in the city centre cand includes general hospitals and a specialist psychiatric hospital so I don’t know if that makes a difference. I occasionally have been asked to step in at the general hospital if needed because we are pretty much on site. Equally, I’ve done a 4pm on Friday (oops, noone checked the dates and the section runs out over the weekend) assessment on a ward just because I was on-site for another team.

      I think some of the time factor has also been due to three guardianship applications but actually, I think there is no solution and I was just having a general gripe.. I know it isn’t very pretty but I had a bad day!

      Of course when I talk about an average, it doesn’t ever work out like that. Over the last two weeks, I have completed three assessments and have another one pending, possibly next week.. which is extraordinary.

      My main gripe is actually the refusal of the other AMHPs in the ‘working age adult’ CMHTs to provide any kind of cover for us.. rather than colleagues in my own team.. especially as they are always happy to ask..

  4. The comments I get from parents I deal with concerning cancellations are that few mind a late cancellation but many resent a “no show” !
    This is sometimes recorded simply that no meeting was held and in court is often made to look that the parent never attended a prearranged meeting ; a misleading truth !.
    A little rage justified in such cases?

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