I left my job as a Mental Health Social Worker, AMHP, BIA, Practice Educator and all that I wrote about here last December. While I can’t be too specific about my current role, it’s (unsurprisingly really) in a related field but it’s moved me into the background and away from a direct role with people. It’s been nearly ten months now since I changed jobs and it has led me to reflect on what ‘being a social worker’ meant to my identity and how I viewed myself as well as how others viewed me. It hasn’t always been easy but every time I look back with a hint of regret, I see newspaper articles like this one today and remember what it was that led to me leaving behind what was, and what remains in many ways, my ‘perfect’ job. I loved working with older people, I loved working in Mental Health – and while I didn’t enjoy (you can’t ever enjoy) the detention and assessment part of the AMHP role, there was a unique camaradie with other AMHPs and the access to continued support through forums and legal updates was unrivalled.
I felt I could make a different to some people’s experiences of mental health services by explaining them and guiding them through what was a scary and difficult period of their or their family member’s life and if I could take them out the other end, well, there’s no better feeling in the world.
But it got harder. We know there were cuts in the service. Despite the government’s mealy mouthed promises about there not being cuts in frontline services – there were cuts in frontline services and significant cuts. I want to explain why I made the decision to leave – and it wasn’t a decision I made lightly.
In my six years in older adults’ mental health services we had been through three major reconfigurations. What had started as three teams covering localities within the borough I worked in, became two and then became one unified team. This was partly by design (the switch from three to two) and partly by circumstance (from two to one when managers didn’t actually have enough people to have two separate teams so had to merge them). We had some ‘almost’ reconfigurations when there were proposals to eliminate the ‘older adults mental health’ team as a separate strand and move everyone into ‘age blind’ services. This didn’t happen fortunately as I think it would have been disastrous for the client group we worked with. In our older adults teams we worked in different ways and had a particular expertise in working with people with cognitive impairments and against ageist services that are deeply embedded in the National Health Service. Suffice to say, I was used to change.
I don’t think my employers were bad or the worst, by any means, indeed, I have considerable warmth for them. My managers were decent people who were incredibly supportive and the organisation provided some excellent services. Then the changes came again. The internal consultation process was tough – not least because the executive team treated us, as staff members, as if we were stupid. I worked in the same office as the ‘executive team’ and there isn’t one of them that would have passed a greeting to those of us in the CMHT. We were clearly beneath them. I don’t mind that to an extent, except when we are trying to make particular points about the quality of service that we are able to deliver and there’s no value or credence given to our views. But enough of that – so the consultation was about more changes – this time even more radical. There had already been ward closures but more were proposed and this time, it was justified because the community services would be able to provide better support. The tiny little problem with this was that it would do so with fewer qualified members of staff. Who needs qualifications anyway, they’re overrated.
As a social worker seconded into the Trust, I was slightly protected. Our local authority confirmed it wouldn’t be cutting any of our posts and in any case (although this really was moot as they were clear that the social work posts were never in danger) the AMHPs were even more scarce so I’d never have been in danger. However, we’d be losing nurses and occupational therapists. Instead we’d be getting lots of new band 3 and 4 support workers. I’m all for support workers. We never had them before – but I’d thought they would be an addition rather than a replacement to the core team.
So this was the improved model. The thing was, that so many people were unhappy and miserable about having to reapply for their jobs after many years and through not being consulted even in a cursory fashion that they .. or rather we.. looked for other jobs. Actually, I didn’t look for a job at this point. It wasn’t until a bit further down the line. People who were eligible for early retirement took it. Some people took redundancy. Others took different jobs elsewhere. It was often those with most experience that left. The replacements didn’t come quickly.
There were days last summer when I was the only qualified member of staff covering my CMHT – no other social workers, nurses, OTs – sometimes even no doctors – that was mostly because some people worked part time so it wasn’t very regular but the fact that it happened at all was worrying. I was doing more Mental Health Act Assessments yet my caseload was expected to be up to date. ‘Duty’ became a bit of a fantasy because it felt like I was constantly on duty. I can deal with stress and manage it but when you worry that the work you are doing is not safe anymore, it becomes time to look away.
A message to the Executive Team
So in looking back I’d say this to those executive directors who never had time to stop and listen despite us collectively telling them how worried we were about the quality of services we were providing and how we felt we were being asked to work in ways which were increasingly risky. If you want to provide a really good quality service you have to listen to people other than those within your own echo chamber of management or leadership who are invested in agreeing with you. Staff want to work in ways which are fulfilling. We want to provide good care to people but the systems we work in are stripping that potential away and if we can’t do that, we can’t continue in it. We don’t want to be cramming people into wards which are further and further away because you’ve decommissioned local beds. We don’t’ want to be providing what we know are poor home care services because the council will only pay minimum wage and commissions on cost rather than quality. We don’t want to have to look further and further away for poorer and cheaper residential and nursing care. We want to be doing the creative support planning with personal budgets but then, it’s hard to be creative with 5 hours care when someone needs to use that for support with washing and dressing for the whole week. We want to be advocates and we want to drive and provide good care but have no access to good care. We want to support families and carers but we don’t have the time or the resources to.
And for you?
You need to listen. You need to listen because sometimes the people who are going out there and providing the services you, as executives are responsible for, know what they are doing and know the communities better than you do. You need to listen to people who access the services and their families and actually change things on the basis of what you are told – rather than just listening to MPs or local press as the people who contact MPs are not more valuable than those who are unable to – they just have different skills. You need to be honest – most of all. We know the cuts are coming but when you tell us this is about ‘service improvement’ we can’t ever trust you again.
On the outside
Since I’ve left, I have been pattering between sadness and frustration. The things that pushed me to my own limits were working in ways I didn’t feel were sustainable. I struggled with my place in this system which was built like a house of cards but I don’t want to leave this post in despair as I have hope. I needed to take a step back and having done so, I realised for the first time, how much stress I was under. I just thought that was the way things were but moving into another role has made me see how much of my life was wrapped in constant stress. It doesn’t have to be like that. I miss the job and the people. I worked with wonderful people and great colleagues. I know there are fantastic social workers, nurses, OTs, psychiatrists and psychologists out there who are making a difference to people’s lives every moment and whose hearts are fully concerned with how to work better. The sadness is that so often they are engaged in battles with the organisations that employ them too. I would very much recommend social work and mental health social work as a great career move. You have opportunities to walk alongside people through their most difficult moments and learn from them about how you can take them through an often complex system that sometimes feels like it is falling apart.
The sadness is that sometimes the most difficult challenges come from within the organisations that employ us – it doesn’t have to be that way though. I’m sure there are many other experiences. While I don’t regret leaving, not really, I do wish I’d been listened to more. That more than anything, would have led me to stay.