What does a Mental Health Social Worker do?

I think there’s a lot of misunderstandings about what I actually do at work. What do social workers who are in mental health services do? What do social workers who work in adult services do?

I hope by reading, some people get to learn a little of my day to day role but I also thought it might be useful to set it out more explicitly.

I’ve worked in adult services and I’ve worked, as I do now, in mental health services but I’ve never worked in childrens’ services so I can’t comment at all about the work that is done there. This is my attempt, not to explain social work as a whole, but to explain the bit of social work that I’m familiar with.

I work in a multidisciplinary Community Mental Health Team. We have a consultant psychiatrist attached to the team as well as a few (the amount fluctuates!) other doctors. We have occupational therapists, clinical psychologists, assistant psychologists, community psychiatric nurses and of course, social workers. We always seem to have students around, whether psychology trainees, OT students, nursing students or social work students (and even some medical students pop in occasionally).  I sit opposite a psychologist and between an OT and a nurse.

Although no week is typical, I’ll give a few examples both of the generic role and the way that social work fits into a mental health setting, in England, at least (because I’m not sure if there are differences in Scotland, Wales and Northern Ireland).

Work is allocated for ‘care co-ordination’. Care co-ordination is akin to what we would have called ‘care management’ in Adult Services although there are some differences and responsibilities under the Care Programme Approach.  It basically means we take responsibility as a kind of ‘key worker’ for individuals who are ‘taken on’ by our service.

Allocation should be done on the basis of appropriate professional expertise so for some issues that have a more ‘social work’ tilt about dynamics, organising personal budgets or residential placements might be preferred as allocated to social workers, some that are more rehabilitation orientated might be allocated to an Occupational Therapist and more medical or medication management might be allocated to a CPN but that is a very broad brush to paint and in practice – most people are a mixture of all the different needs and so are allocated generically. If I have need a of specific OT assessment for one of the people that I am care coordinating, I will ask one of our OTs and similarly, I care coordinate one person who receives a monthly depot injection from one of my nursing colleagues.

So what is care coordination/care management about? Well, we start by working with and on a care plan and this should be led by the user of the service. If there is a carer involved it would also involve them and we put together plans. In my service which works predominantly with older adults, there may well be care services needed and this is now all delivered through personal budgets so I would take someone through the supported self assessment questionnaire, the resource allocation system and develop with them and/or their carers, depending on capacity issues on a support plan and way that services would be delivered. This would be reviewed and implemented in partnership.

I will also arrange respite placements  and services when they are needed and review services as they are delivered.

Alongside this, I would also be responsible for monitoring any changes in mental state and might provide some brief therapeutic interventions mainly through basic CBT type models according to additional training which has been given in the NHS Trust I work in as they are trying to ‘skill up’ all care coordinators!  When I meet with someone, my discussion ranges for more broadly than about their care needs specifically. Sometimes it is about sourcing and finding ideas, services and people that might be able to help, namely through group work which is run across the service or through referrals to specific psychologists attached to the team. Sometimes it is much more difficulty to quantify – and log – and record.

I work with carers and work through carers’ assessments and services such as they are. Often I feel one of the most important aspects of my work is carer support as we rely so heavily on some carers. I might liaise with different organisations on peoples’ behalf if they can’t manage or need some assistance. Sometimes I help with Attendance Allowance or Disability Living Allowance claims but there are council teams that do that so it would only be in circumstances when I might know someone particularly well and be concerned that someone who doesn’t know them that well might ‘underplay’ some of their needs.

Sometimes it is about liaising with creditors, gas and electricity companies, housing etc with various degrees of success. I like to think of myself as an advocate at times.

Although at times, I am very far from an advocate. I am subject to specific ‘terms of reference’ of my job and have no control over things like budgets that can be assigned to various people with various needs. I would ‘present’ the needs of service users I work with to various internal funding panels so on that basis I need to advocate clearly.

We have to review the services that are in place regularly. I would attend meetings at day hospitals and on wards when I am allocated to people who currently attend or are inpatients.

I work to plan and organise discharges from hospitals both the psychiatric hospitals and the general hospitals when people whom I am allocated to are inpatients. There are some very obvious time limitations on these pieces of work and no-one wants anyone to be in hospital any longer than they have to – but equally no-one wants someone to be discharged from hospital before they are well enough to be – which is another very important consideration.

I conduct safeguarding investigations as well. Alerts come up with what can be surprising frequency and there are prescribed procedures through which we approach these investigations. It’s hard to generalise as they can be very different. Interestingly most of my recent ones have involved residential services in some way or another. I think I’ll come back to the process of investigating abuse in another post as it is altogether a subject in its own right. We tend to get more of these investigations in older adults services than occur in the working age adult services.

I am an Approved Mental Health Professional (AMHP). That means that I am on a rota to carry out Mental Health Act (MHA) Assessments . There is an important difference between a Mental Health Assessment which is a more generic term for an assessment of someone’s mental health and a specific ‘Mental Health Act Assessment’ which is a formal assessment under the 1983 Mental Health Act which can result in a compulsory admission to hospital without consent.

The role of the AMHP could be a post all of its own and it probably should be so I’ll condense here for clarity because it has increasingly become a part of my day to day role. I organise and arrange these assessments by arranging for ambulance service and doctors attendance (there have to be two medical recommendations written by doctors – one should know the patient (usually their own psychiatrist or GP along with an independent doctor who has had additional training). I also attend a magistrates’ court to obtain a warrant to enter if it is likely that we would not be allowed access to a property. I  arrange police support if necessary and would also organise a hospital bed if necessary.

There are legal forms to complete and I have an obligation to be mindful and respectful of legal rights and human rights when involved in these processes.  I am obliged to attend a specified amount of ‘legal updates’ every year to maintain my approval as an AMHP and every five years I have to be ‘reapproved’ which involved me taking a legal test and submitting some reflective pieces and examples of my work as well as carrying out a set number of assessments per year (no problem with the numbers – I’ve done the requisite annual number in the past week!).

I’m also a BIA (Best Interests Assessor). This means I have specific duties and responsibilities to carry out assessments under the ‘Deprivation of Liberty Safeguards’. Again, that probably demands a post or two of its own. Suffice to say that every so often I am called out to do a specific type of assessment on this basis.  I had to attend additional training to be able to do this and have to attend update workshops and training to retain my approval.

Apart from the things I’ve listed, my job involves other pieces of work. I write social circumstances reports for tribunals. I occasionally have been involved in assessments and writing reports for Guardianships and in taking part in the process of approving or extending a Community Treatment Orders. I frequently carry out Capacity Assessments for various reasons.

I’m a practice assessor too so when I have a student, well, I have a student to supervise. I tend to enjoy having students around. It does create more work though and there’s no recompense in terms of reduction of caseloads! And the universities and local authorities wonder why we can’t offer as many statutory placements!

My work is often one of juggling and trying to prioritise and reprioritise on the basis of risk management. What is more important for me to complete on any given day.

I haven’t even mentioned data input or writing case notes but takes a fair bit of time. We have regular audits of our ‘productivity’ – we have to input our ‘outcome measures’ and re-input them regularly so our management overlords accept that we are actually spending our time at work, working effectively and not just twiddling our thumbs and playing Facebook games.

The amount that we have to ‘report back’ is, of course, growing at an exponential rate.

So that is my job – as briefly as I could manage and I have missed out some of the million subtleties that might change on a day to day basis.

I generally enjoy it. I love the variety that is thrown my way on any given day. Some days it frustrates me and there are rarely enough hours in the day to get what I want done, done. This may explain some of my frustration with the bodies who all say they ‘speak for social work’.  Have they explained the role of social work outside child protection? Would you know, if you are not involved in the ‘system’ what a mental  health social worker actually does?

But really, that’s another fight for another day. For now, well, I need to go to work!

But I had over to you, dear reader. Is there anything that surprises you? What you expect? What have I left out – as I’m sure I have missed a lot of things!

On Being Shadowed

Beckenham Hospital. Located in Croydon Road an...

Image via Wikipedia

Last week, I had the pleasure of having a second year social work student shadow me as I worked. She was a student in a voluntary agency that I had come across because she had been doing some work with one of the service users I work with. I asked her if she wanted to come and join me to see ‘the statutory side of things’. Bless her, but she almost bit my hand off.

We usually have students in our team but we don’t at the moment. I have had students shadowing me from time to time and  I try to give people the opportunity when I am asked and am happy to offer the opportunity to students I come across if they are interested in seeing how we work.

I miss having students. I really enjoy the teaching element of the practice teaching but, as I explained to the student herself, the reas0n I didn’t take a student in this ‘round’ of placements was because I was not convinced I would be able to protect them from the pressure of work in the office at the moment and I was concerned that they might be used as an ‘extra pair of hands’ in an extremely sparse office. It might not have been the best learning environment, although, come to think of it, it would have likely been a realistic one.

I am toying with the idea of being an off-site practice teacher next time round.  I enjoy talking students through linking theory with practice. I enjoy discussing recent policy and research and the implications for practice. I enjoy teaching all in all, actually. I enjoy the enthusiasm and the realisation what they learn at university can be used to practical effect.

There is something wonderfully invigorating about showing an enthusiastic student the work that makes up practice. We visited a couple of people and she watched as I completed some paperwork – ok, that bit might not have been so thrilling – but it allowed me to talk through the process of writing and the reasons that the forms are compiled in the way that they are.  It allowed me to reflect on some of the tasks I might ordinarily take for granted or complain about and step back with a realisation of what a well-completed and well undertaken assessment can mean.

We had lots of conversations about law. I think there was a law exam coming up. My particular joy was looking at the case study they had been given for their law test and being able to talk my way through it without barely catching  a breath. I clearly haven’t forgotten as much as I thought I had about Community Care Law (I’m fairly hot on Mental Health Law if I do say so myself – simply because I use the Acts (Mental Health and Mental Capacity) literally on a day by day basis in my job).

We also had a Mental Health Act Assessment come up while the student was around and I left her behind to read up on the codes of practice. I won’t take students to shadow Mental Health Act Assessments. I remember being pulled up on this while doing my Practice Assessor Course but I stand by my principle.

Firstly, Mental Health Act Assessments take place by their nature at a time when the person being assessed is in a high state of distress or illness and whether they would be able to give their consent to someone ‘observing’ is questionable. Personally, I believe strongly that the Assessment is about the person being assessed and not for me as a professional to control any more than I do through legal measures. So much control is taken from the individual that having students around reinforces the already massive power imbalance.

Finally, there’s no need for a student to attend. Of course AMHP trainees have to attend. They need to carry out observed assessments of Mental Health Act Assessments in order to complete the qualification but general social work students do not. Just as general medical students do not.

I explained to the student that I did not want her to come with me. She showed some disappointment but this is an area I feel very strongly about on an ethical basis and I promised when I returned that we would have a long discussion about the use of the Mental Health Act. Which we did.

I thought about how often the student/practice teacher relationship emphasises the student as the recipient of ‘knowledge’ but in practice, the teaching is a two-way process. I learn a lot from every student that comes. I learn about the impact of different lived experiences and different viewpoints. I learn about how my work is perceived by different cultures and communities. Things that I  might take for granted, I learn to challenge.

The teaching and learning relationship allows more considered reflection and while the nature of the role is that the experienced practitioner is placed in the position of ‘expert’, we can look at the same theoretical bases that we use in relation to students as the experts of their own learning and experiences.

As for the student, she seemed bright and enthusiastic. She wanted to do well and I have no doubt she will.  She had a background in a completely different area but she showed an empathy and understanding that will serve her well in the future. When she thanked me at the end of the day, I think I might have well forgotten to thank her.

I am sure I got as much, if not more, from the day as she did. She probably didn’t realise that.

Weekend Links 8

I want to start in solidarity with a couple more British Mental Health Social Work blogs – go and visit them and comment as an incentive for them to continue writing. I really want a community of blogging social workers to grow! I think that nothing will raise the profile and voice of our profession like a strongly networked and linked community of active and aware social workers who engage with social media.

So there’s Ladybird who works in an Early Intervention in Psychosis Team and has a really helpful weekly post of ‘useful links’. Last week she concentrated on carers and mental health. The nature of her job is that the carers and users will be young adults so the concept of ‘carer’ can be quite different to mine as I am used to working with older adults. She collates genuinely useful links and I have the page bookmarked.

Jamie Middleton is an AMHP and a member of the Interim Board Member of the College of Social Work.  It’s vitally important that the needs of Mental Health Social Work are expressed and actually the subject of his post last week was the announcement that the Isle of Wight is considering ‘de-integrating’ their integrated teams and moving social workers out of the CMHTs (Community Mental Health Teams) and back to social services offices. I’m biased but there is a massive need for social workers to remain in CMHTs (disclosure, I work in a CMHT!) to promote a multi-disciplinary approach and to be mindful of the social models in mental health work and care. I agree with Jamie.  On that note too, I’m really toying with the nature of the anonymity of the blog. It would be wonderful to write without a pseudonym but I’m not quite sure how to address the issue with management!

I also came across this blog by S.Wangene in Kenya. It’s good to get a social work perspective outside the anglo-centric world view and it was interesting to read of parallel issues about promoting good end-of-life care in Kenya.

Still in my trip around the virtual world, SocialJerk shares a great post about the links between films and social work in an Oscar-themed post. As someone who has made a concerted effort to avoid Black Swan because it sounded like it might have overplayed the mental health stuff, I’m actually reconsidering after her post!

I loved this post by Melinda at Classroom to Capitol about ‘starting where the client is’ in the context of growing activism. Rising political engagement and activism is something I’m exploring at the moment and it was a very timely and beautifully written reminder of the context that occurs in and the context around peoples’ lives.

On A Case Manager’s Verse there is an interesting question posed about whether it is helpful for a practitioner to  have a shared experience with the client. I haven’t responded yet to the post as I’m honestly not sure.

And in a similar fashion, Fat Social Worker discusses the issue of when a social worker has or has had mental health problems and  how to manage that.

And at ‘Always Something to Complain About’ she talks about her own experience of withdrawal from Cymbalta. She also has a great post where she links to a site that has been helpful to her in providing inspiration. I won’t link it here, you’ll have to go to her site and find out about it. It’s worth doing though!

Kryss at the New Social Worker has just passed her exam to be licensed. Well done to her and her post gives some advice to those who take these exams in the US.

Possibly useful for Dorlee at Social Work Career Development who is contemplating her upcoming exam and looking for advice!

Finally, I know this goes beyond my usual ten links but I can’t leave it out.

How not to do Social Work has a really interesting insight into age assessments which mean something very different in his service area.  When I see ‘Age Assessment’, I think about some of the horrendous BIA forms.. but that’s another story for another day. His story is far more interesting.

And although I know she isn’t a social worker but I include The Small Places  here anyway because the blog is so enormously useful to social workers like me (who work a lot with the mental capacity legislation), comments on the Stephen Neary case.

If you don’t know what that is, do click on the link to read about it. I’ve purposely refrained from making any comment about it in the past.

And that’s my slightly over-extended round up of links of the week in my own personal view. I’m in a chattier mood today!

Have a good weekend all!

Rising Admission Rates

Yesterday, via Twitter, I was alerted to the publication of the ‘Mental Health Bulletin  – Fourth Report from Mental Health Minimum Dataset (MHMD) returns 2010’. I know it’s a bit of a mouthful but briefly, it means statistics about admission, treatment and care by Mental Health Trusts around England.

There are a few tidbits of information that are worthy of comment and commentary.

The most obvious ‘headline’ figure presented is that there has been a 30.1% rise in people held in hospital under the Mental Health Act between 2008/9 and 2009/10

‘from 32,649 in 2008/9 to 42,479 in 2009/10’.

That’s a staggering initial figure for a change in a one-year period so I wanted to look at some of the possible reasons for this.

The survey itself indicates a large part of the change – being that

Some part of this increase was due to improved recording between 2008/09 and 2009/10, because a small number of trusts failed to provide MHA information in 2008/09. On a like for like basis, excluding the data for trusts that failed to return information in 2008/09, there was an estimated increase of about 17.5 per cent in the number of people being detained under the MHA – from 32,649 to 38,369

I’m not entirely confident I understand the baseline statistics but taking advice from those who know better, I’m happy to stick with that 17.5% increase.

My initial gut feeling and certainly the situation that tallies with my own practice experience is that the influence of the Mental Capacity Act has been crucial in leading to an increase in detentions that I, personally, have signed over the last year.

I understand that I might have a slightly non-representative view as I am a specialist in older adults’ mental health and primarily carry out Mental Health Act Assessments for Older Adults therefore I may see a disproportionately high number of people who may lack capacity due to organic mental ill-health (e.g. dementia).

However, the impact of DoLs (Deprivation of Liberty Safeguards) has led, through something of a drip-drip process and through caselaw – particularly GJ v Foundation Trust which established that there can be no ‘choice of law’ between the use of the Mental Capacity Act and the Mental Health Act for a ‘mental health patient’ in a ‘mental health hospital’, to an increase in admissions under the Act.  Actually, I genuinely believe it allows a far far greater protection than the DoLs process allows but I might be getting over-technical. Suffice to say that there has been a substantial increase in the amount of people on the older adults wards who are now detained ‘under section’ – who may well have, last year, been informal patients.

Of course, the issue of capacity or lack of it doesn’t solely relate to older adults but the examples I give are from my direct experience.

I’ve turned down a couple of Eligibility Assessments under the DoLs framework, suggesting the people whom I have assessed have been ineligible for a Deprivation of Liberty Order because they would otherwise be eligible for detention under the Mental Health Act. I’m just one person, I know,  but I know of other people in my Trust who have made similar decisions.

It may be a reason for some of the increase in detentions.

I’m not sure if the  cuts agenda has had a significant impact on status of admissions yet save the generalised increased levels of distress and higher potential levels of mental illness that may occur when the economy is in a depressed state.

In  our Trust there have been a massive reduction in the amount of inpatient beds available. Does that mean people who  might have been brought into hospital earlier are not? Possibly.  It may mean fewer  informal admissions take place due to the lack of beds and therefore situations deteriorate so an admission has to be on a compulsory basis. That may also explain why the length of time of stays has increased.

The other unsurprisingly depressing point made from the data is that

Whilst the number of people using services rose across all ethnic groups, the percentage rise was noticeably larger for the Mixed ethnic group (a rise of 17.7 per cent). The Mixed and the Black and Black British groups now both have rates of access to services that are over 40 per cent higher than for the majority White group (at approximately 3,800 per 100,000 population compared with about 2,700 for the White group).

The most obvious explanation of this relates to institutional (and overt) racism and a differentiation of the way the treatment and treatment decisions are made on the basis of cultural backgrounds.

If anything needs to be actively addressed it is this inherent difference in the system and services that seem to allow such disparity to exist.

Another interesting point that was in the main document was that

The number of women detained under the MHA who came into hospital via the prison or the courts rose by more than 85% since 2008/9 ….  The number of men in this category rose by 48.1% since the previous year’.

Again, staggeringly high figures. I wonder what significance changes to prison services has and will have on admissions to psychiatric hospitals via the court system. It’s not an area I have more than perfunctory experience of so I can’t comment in detail, except that it’s an interesting aside.

In fact, looking at the bare figures, it seems that these increases have made up a good proportion of the overall rise in compulsory admissions under the Act across the board.

As I’ve been reading through the document I came to the conclusion that I could easily cover about 10,000 words worth of analysis of the information provided!

What I would say though it that it’s worth checking the entire document because the information contained on the breakdown of admissions on the basis of gender, age and race make for lots of potential analysis and interest in the nature of work and how it is changing in mental health services in England.

Looking ahead to 2011

I’m almost reluctant to write up my thoughts for the coming year and it is a battle to contain my more pessimistic urges.  I wrote this post and sat on it for a while because it came across as too depressing.

I try to be as optimistic as I can in my day to day life. As even if optimism/pessimism make no difference on actual outcomes, at least I’ll go down happier if I think positive!

I’m finding it really hard to find much positive to say about my thoughts for 2011 though.

Cuts

That’s an easy theme. No doubt that it will be the main background through which 2011 is played politically both nationally and locally. In my personal and professional life.

As we turn increasingly into a fire-fighting, crisis management service there will be less, if any, space for preventative work. The government and the local authority won’t headline this because it goes against every piece of evidence about long-term savings but the savagery of the cuts will affect those who just come in below the ‘life or death’ bandings.

Protests

Again, this is barely a prediction. Protests and rallies have already been called. They will be increasingly well-attended. I fully intend to participate myself. As people realise their actual tax credits decrease their real income, there will be a wider anger directed towards the government and the poor political process that has served us so badly.

Care Funding

Yes, the next commission will report. It will benefit most those who have the most to lose. Poor people who might have to sell the houses that they own to pay for the care that costs a significant amount of money. Inheritances will be preserved. What that does to the quality and support for those that don’t have, well, we’ll see. I’ve tried being positive, now I’m just cynical. The government have an agenda to protect their own political classes. They have no desire whatsoever to produce a more equitable scheme of funding. No political party does – which is why these consultations have dragged on for so long.

‘Big Society’

Big Society will be discussed and debated. And will be shown up for the sham that it is in the face of funding being withdrawn from voluntary organisations. It will be an opportunity for private enterprise to ‘invest’ in communities. Youth centres  sponsored by McDonalds. Libraries sponsored by BP.

Social Work

The College of Social Work comes into formal existence this year. It has already made some kind of deal with Unison for union membership. I expect it will merge with BASW (British Association of Social Workers) too. I hope so anyway. It will continue to be run by academics, managers and retired social workers because no-one on the ‘front line’ will have any time to be involved in the processes and committee upon committee will be attended by professional ‘consultants’ who may once have been social workers but remain so far removed from actual client contact that they will have no idea about whom they allege to speak for.

I remain hopeful that there will be some kind of positive outcome.

 

They’ll be more scandals, more appalling practice and more horrified ‘Daily Mail’ stories. No interest whatsoever will be shown in any of the good work that is done every day. Again and again.

 

Social Media

This is a new one for me. Twitter become much more of a key network for me. I love it for so many reasons but mostly because it gives me more of a character than just a blog does. I love some of the conversations that I’ve been able to have with people whom I would never have had the opportunity with engaging with on any other forum.  Local authorities are increasingly involving themselves in micro-blogging. I’m surprised that there is less in terms of standard blogging as far as government is concerned. It remains the domain generally of individuals and local politicians rather than local officials on behalf of the organisation for whom they work rather than as individuals.

If I really knew what what happen in this sphere, I’d make a fortune but in the meantime I’ll say that there will be more online consultations and more discussion and debate. And more blogs,  podcasts and debates which involve users and carers. It’s a great opportunity and could potentially increase voices sometimes lost in the political process.

NHS

Efficiency savings. Ha. Real growth in spending. Ha. We are losing services hand over fist and the government is able to get away with this kind of whitewash. It will continue and services will struggle.  I’ll have to move on from this subject because it really does fill me with fear just thinking about it too much.

And some more local predictions for me and my team

Reconfiguration

Yes, it’s coming. Another one. I think the third now in just over 2 years but this one is a big one and it’s going to affect not only our team but the entire Trust. Changes have already started and it’ll be the main theme for the year as jobs are lost and downgraded. More staff leave through the so-called ‘natural wastage’ and aren’t replaced.  It seems there may be a change in the way the AMHP service is arranged locally as well. I try to ignore rumours and whisperings and let all the possible plans go over my head somewhat until anything is confirmed.

I’m lucky in the sense that I genuinely love my job. I was talking about it to a colleague yesterday who asked me if I was looking for other jobs and I honestly don’t think I could work for a better team with better managers/consultants/colleagues etc. That’s a pretty special place to be and while I couldn’t, hand on heart, say I love the work I do every day, I wouldn’t want to be doing anything else. In my dreams when I win the lottery, I still work, just part-time!

Training

I hope to take another student social worker on this year. I might look into possibilities of being an off-site practice teacher though as it was a real struggle with workloads to manage having a student in the team. Of course, it didn’t particularly help that I needed to go into hospital the last time I had a student.  I also worry a little that the lack of staff in the team might lead to managers seeking to push additional work towards a student.  The local authority training budgets have been slashed so I don’t think I’ll be able to continue with the Higher Specialist Award in Practice Education (which is my longer term goal.. ) this year or probably for the next few years as quite rightly any funding should be focussed on those who have not accessed training and if there’s one thing I have been doing of late, it is accessing any training available.

Blog

One time in particular I was very close to closing this blog down. I even set up a parallel non-related one as a kind of outlet to keep me going and give me something to write about in the expectation that I would stop writing about work-related things. Anonymity can be a burden at times.  It was just a little too hard to completely let go. I would say it’s about 50/50 as to whether I’m around next year to reflect on these predictions at all. I do enjoy writing though and sharing my thoughts about issues as they arise. I hope to continue that whether published or not. It really does help me with my self-reflection and maintaining my interest and connection with current affairs.

I don’t really stick to resolutions but I do want to read and participate more widely in the blogging communities. I was better at it last year and this year have become more insular due to time and health mostly but I want to re-engage more over the next year.

And I have a suspicion that when I do write, it will be a lot more political in tone which leads to..

 

Social Action

One of my resolutions last year was to be more involved in Unison and BASW, seeing as I pay the subs. This year, I’m particularly going to focus on Unison – the issues and general themes of cuts, cuts and more cuts go far beyond social work specifically. This year I also attended an event put on by SWAN (Social Work Action Network) and it really got me fired up. I hope to go to more of their events. I really want this government to know how much their cuts are hurting and whom they are hurting. I find the injustice in the focus of the cuts and the ‘blame’ narrative sickening. I feel I have to push against it at every angle. I can see myself getting far more involved politically on  many levels.

There is a lot to fight for.

 

And I hope there is not even one single day of sickness that I take to make up for last year (yes, I feel unnecessarily guilty.. ).

Finally, I hope that everyone has a hopeful and positive year ahead. It won’t be easy but that’s why it needs more effort than ever before.
Fireworks #1

Happy New Year.

The Complainant

A desk in an office.

Image via Wikipedia

It was never going to be a visit I was looking forward to. While our manager no longer sidles up to us and drops a physical paper file on our desks by way of allocation, she now sends emails with links.  This one though, she came to ‘virtually deliver’ personally.

The fact that she apologised on allocation set off all my little internal alert antennae. She then explained that she would de-allocate one of the others she had intended to allocate to me as this one needed more ‘social work’ skills. Hmm. Intriguing.

Then she told me she almost felt like she was setting me up to fail. Aha, I thought, a challenge. That should be interesting – or would be if I had a little more time available.

It was to be a priority.  Mr F had made a complaint about the input of social services. He had made complaints about the input of his GP. He had made complaints about just about everyone he had come into contact with.  He knew the team consultant from clinic visits  (and about whom he had not complained)  and had called him directly with his litany of complaints and had been assured that ‘something would be done’.

And so it was it virtually landed on my desk. The complaints were understandable – to an extent – Mr F felt he and his wife needed more than the eligibility criteria would allow him to access. He did not felt the assessment had taken into account all the relative information and anyway, he said, he found the preponderance of endless forms, assessments, reviews to be overwhelming and positively unhelpful.

I promised to visit and he asked me why. ‘You will just take out a form and ask me more questions that have already been asked’. And I made an assurance to him.

‘How about I visit, just to meet you and the family – and I promise I will not take a piece of paper or a pen out of my bag?’.

He seemed dubious but he concurred. That without doubt is something that the AMHP work has made me confident enough to do. I never conduct Mental Health Act Assessments with pen and paper as it draws a barrier. I often jot things down when I am speaking to someone in my general course but I felt that this visit needed some basic relationship-building before we ran off into the distance to ‘fix all that was not right’.  It is also a luxury I could not have afforded in my previous incarnation when I worked in the social services office. I had a form to fill and an hour for a visit. I needed to ensure I at least made notes even if I didn’t go through the form (which I tried not to do) in the house.

My main aim was to just build up enough trust to visit again.  I was asked what I would do that was different and answered honestly that while I didn’t think I could necessarily provide different services, I might be able to look at the issues through different eyes.

As it was, I did pick up a few things that had not been offered previously, mostly relating to carers’ services. From arriving with trepidation I entered a warm and welcoming environment of a man struggling to get to grips with his wifes’ encroaching and all-encompassing dementia. He wasn’t angry, he was just desperately sad.

He wanted help but he didn’t know what help he wanted yet. He had been offered and cajoled but I think it wasn’t a matter of wanting to complain, just a matter of wanting more time.

I felt hopeful after the first visit. Yes, it had gone on for a couple of hours but I felt we had both made some progress at looking at some other services that might be available but mostly I think the complaint wasn’t substantially about eligibility criteria. It was about coming up against services that shroud themselves in guidelines and paperwork (virtual or not). I suspect before long the honeymoon period will be over and a complaint will find it’s way to the council about me as well. But I hope in the meantime I can at least provide some kind of support.

My concern though, as I look at my diary for the next months ahead, is how much these two hour conversations eat into my limited time to do other things. Talking probably helps more than is accounted for. Feeling that someone is listening is enormously important just as a validation of humanity rather than a process of a bureaucratic function.

It’s not hard to understand what effect the cuts will have in situations like this.