How to survive in social work

 

One day, while I was still working in a Community Mental Health Team, one of our nurses returned to base in tears. She had been visiting one of her patients, a woman with bipolar affective disorder. She knew she was relapsing and had been trying to support her and her relatives and had been striving to avoid a hospital admission for several days.

The patient had shouted at her. She hurled very personal insults at her. She berated her for failing in her job, for letting her down, for not being a good enough nurse. It hit a nerve with my colleague. It triggered her deepest fears. Was she a bad nurse? Was she incompetent? Could she have done more to prevent this crisis? Was she so useless? Should she hand her notice in right away?

The team did their best to support and comfort her. She was a good enough nurse. She had done her best. She had seen a relapse coming, and she had done everything she professionally could to avert it.

This incident made me think about how mental health and other care professionals survive the job. It made me think about how I had managed to continue to function as a (hopefully) effective social worker for four decades.

In my first few months as a social worker, I was allocated Gwen. She and her children were very well known to services and had had many social workers over the years. I was the latest.

I knocked a little nervously on her front door, and when she opened it I introduced myself.

She looked me up and down and did not seem very impressed.

“Well, you’d better come in I suppose, she said, scowling.

I followed her into her front room. She closed the door behind me, took a deep breath and then proceeded to treat me to a tirade of complaints and insults which continued for at least 30 minutes. Throughout this deluge of vituperation, I stood silently and listened diligently.

I stood there mortified. Judging by her comments, I was the very worst and most totally useless social worker in the entire world.

While this destruction of my character continued, it suddenly occurred to me that this had nothing to do with me at all. She was ventilating. She was expressing her anger and despair at the system, and at the world in general. I just happened to be conveniently there. It wasn't personal. It wasn't about me at all.

I learned right then that if I were to survive as a social worker, I had to separate the professional persona and my professional functions from the personal, from the individual me. As I realised this, I suddenly felt a lot better. I waited patiently for her to finish, then got on with the job in hand. She never shouted at me again.

It's a simple lesson, but not necessarily easy to learn. But it helped me to deal with the often hostile and verbally aggressive people who I have had to assess under the Mental Health Act.

It has even helped me to remain mentally intact and sufficiently detached to manage the few occasions when I have been physically assaulted during the course of my work.

It's not actually about you.

An Unusual Social Work Dilemma

 

This video is about an unusual dilemma I found myself in while working in a Community Mental Health Team.

One day, I was asked to follow up a patient who had recently been discharged from the local psychiatric unit.

Elaine was 20 years old. She had been admitted after taking an overdose. Looking at her discharge notes, I saw that she had been born with foetal alcohol spectrum disorder.

She was a pleasant and polite young woman, but I could see that she had some of the facial characteristics often associated with the disorder.

She told me that she had had some physical problems associated with her congenital issues and had needed some heart surgery as a young child. She told me that she had been brought up by her father, and had never met her mother.

She also told me that she had always been impulsive and had taken the overdose after a disagreement with her boyfriend. She regretted it and did not think she would do it again.

Now here’s the thing. Although I had never met Elaine before, I knew a lot about her, from even before she was born.

Because 20 years previously I had worked with her mother, Janine.

Janine had had a serious alcohol problem. She had been in a very unstable relationship with a university lecturer. They were living together, but had frequent arguments, some of which had resulted in the police being called out. All of this culminated in her being thrown out of his house one evening.

At the time, I had helped her get a room in the local hostel and had also attempted to work with her to manage her alcohol problems. It was then that she had discovered she was pregnant.

She continued to drink very heavily and was very erratic about engaging with antenatal care. Consequently, a child protection case conference was convened.

Because of the high risk of the baby being born with foetal alcohol spectrum disorder, the unborn child was placed on the child protection register. It was resolved that the child would be made subject to an emergency protection order at birth.

Despite my efforts to encourage Janine to engage with antenatal and alcohol problem services, she continued to drink, and inevitably, when Elaine was born, she was removed from her.

Her father managed to obtain custody, and Janine then disappeared.

Now here was the dilemma, which had only arisen because I had worked in the same area for so many years.

Elaine had lived with her father more or less since birth, but she had never met her mother, and knew nothing about her.

But I had known Janine and was in the unique position of being able to give Elaine some information about her birth mother and the circumstances of her birth.

However, I was also aware of issues of confidentiality. I shouldn’t divulge any information about a service user to another person without their permission.

So should I just sit there and keep quiet about it?

Or should I tell Elaine that I had known her mother and offer to tell her something about her?

Why did I become a social worker?

The Masked AMHP when he was a hippy

As I approach retirement from the job I have been doing for the last 42 years, I’ve started to think more about what led me into social work in the first place.

Several years ago I wrote in the Guardian about how I ended up becoming a social worker. It was almost accidental. No child has it in their mind that they want to go into social work; for one thing, it is not generally a high visibility profession, unless something goes wrong, and then social workers always seem to be identified as the guilty parties.

But there were a couple of incidents in my adolescence, long before I actually applied for, and got, the job of social worker, that with hindsight first put the idea of being able to help people into my mind.

The old lady

The first incident was when I was 16, when I was still at school studying for A Levels. The Post Office were wanting temporary assistant postmen to cover the pre-Christmas period. I managed to get one of these jobs, to earn some pocket money.

I was assigned to assist Bill, one of the permanent postmen, on his round. This involved carrying a huge bag of post around a housing estate, while he went here and there in his van.

But part of his round involved having to drive to more remote houses. He went to a rather dilapidated looking bungalow and then asked me to deliver a small bundle of what appeared to be Christmas Cards and a couple of parcels. He said that he didn’t want to do it himself as the occupant would keep him in conversation for hours.

I knocked on the door and after a while the door opened. An elderly and frail looking lady was standing there. I noticed that she had dried food attached to the whiskers on her chin.

The bungalow beyond was dirty and ill cared for, with random piles of newspapers and cobwebs hanging from the ceiling.

 An almost overwhelming sadness gripped me as I gave her the cards and parcels.

She seemed desperately disappointed.

“Isn’t Bill delivering today? Such a nice man. We always have such a nice chat.”

“No,” I replied. “He’s … busy, what with the Christmas rush and everything.”

“Oh, well, never mind.” Her voice petered out, and she closed the door.

I felt for the lady’s loneliness, and her disappointment at not being able to have a conversation with the postman. How many people did she see in a week? The experience haunted me.

Surely there must be services that could help someone like her, I remember thinking.

The driver

The second incident taught me something else.

I was 17 years old, and trying to be a hippy, with long hair, a beard, bell bottomed jeans, and sandals. (Give me a break. This was the early 1970’s.)

It was the summer, and I was hitch-hiking in England. I don’t remember where I was going to. It may have been a pop festival. (Weeley?)I had a rucksack, and a sleeping bag, and was hoping for some sort of adventure.

A very upmarket car stopped to give me a lift. When I got in, I was surprised to see the driver was an immaculately dressed woman in her 40’s. Women never usually stopped for a young male hitch-hiker who looked a bit like a hippy.

I couldn’t help noticing that her face and bare arms were covered in a blotchy rash.

We drove off. Looking straight ahead at the road, she said, “I expect you’re wondering what’s wrong with my skin.”

She didn’t wait for a reply.

“It was my husband. The person I love most in my life. He went to the doctor one day because of a pain in his head. The doctor sent him for tests.

“My husband had a brain tumour. It was inoperable. Within 6 weeks he was dead.

“The funeral was 2 months ago.

“I thought I was doing fine. I thought I was managing. But a couple of weeks later I woke up one morning and saw that my whole body was covered in this rash.

“The doctor told me it was nothing to worry about. It was a reaction to the stress.

“Nothing to worry about.

“I‘ve lost my husband, the love of my life.

“Nothing to worry about.”

She continued to tell me her story for the rest of the journey. When it came time to drop me off, she looked at me and said, “You don’t know who I am. I don’t know who you are. We’ll never see each other again. Thank you.” She smiled for the first time during the trip.

Even though I was only a 17 year old self-absorbed teenager, I realised that something significant had happened.

She needed to tell someone how she was feeling, someone she did not know, who was nothing to do with her family or social circle, someone who would not judge her, who would not argue with her, who would just listen. She just needed to talk.

So simply by being there in the car with her, and sharing that journey, I had helped her in some way to come to terms with her bereavement.

I realised that making a difference to people might not be so difficult after all. And it was oddly satisfying to realise I had helped in some way.