Kay Bennett is an Approved Mental Health Professional and social worker in a Community Mental Health Team based in the South East. She works within secondary mental health services, supporting people longer term who are referred from a GP, and makes decisions about whether individuals meet the criteria for admission to hospital under the Mental Health Act, something she tries to avoid if at all possible. She continues her insight into her working life and the challenges her clients face day to day.

Warning: This blog contains sensitive depictions of mental illness, depression and suicide that some readers may find distressing.

Support structures and resources: the Social Model

Society puts vulnerable people at a further disadvantage in many, scarcely visible ways. The social care model looks at how social circumstances and someone’s environment might influence the health and welfare of an individual. If someone has a medical disability it might mean they require a wheelchair, but society is not adapted to help wheelchair-dependent people. This is similar for mental illness which is fraught with stigma, assumptions and difficulties accessing society as whole.

Social workers like myself consider the history of those we work with and their environmental factors impacting mental health. Early intervention and prevention is key although not matched by available resources which are increasingly shrinking. A lack of safe and affordable housing and support with benefits and budgeting is a stress point. Clients can become struck in emergency temporary accommodation for a long time as well as enduring benefit changes or delays. This contributes to stress and worry which in my experience leads to deterioration of mental health and associated symptoms, alongside longer recovery times and increased costs to services down the line.

The social model of disability can often be overshadowed by the medical model which whilst important is usually considered less expensive and quicker to implement. The strain on social care services is severe and I am often trying to plug gaps whilst clients remain on waitlists for weeks or months for various support services. The pandemic has increased wait times causing problems with throughput and an increasing strain on services.

It can be a challenge for clients to access flexible and timely support with benefits or attending appointments meaning that social workers like myself must undertake direct support which we may not be best placed to offer or simply not have the time to do. It is the practical support which appears to make such a difference to the well being and recovery of individuals.

The Pandemic: isolation, social media and paranoia

During the pandemic our service, for the majority, was unable to offer face to face appointments. People who were already lonely became increasingly isolated. I visited homes and undertook assessments under the Mental Health Act wearing full PPE including masks—this is not ideal for people who are frightened or experiencing paranoia. Colleagues and I would sometimes pull our masks down briefly and show our faces to reduce barriers to engagement.

Social groups and wellbeing sessions were offered online which reduced the ability of clients and carers to connect with others. Not all people have access to the internet or a good phone with internet so there were issues with connectivity. Worse, the pandemic generated a lot of conspiracy theories online, and the flavour of public discourse—the doubt, mistrust, and fear—exacerbated anxiety or symptoms of psychosis. There were occasions within assessments under the Mental Health Act when symptoms observed were reflective of stories online and several people I assessed during the pandemic were considerably worsened by the challenges facing society at large.

Many of our clients were not capable of getting to their COVID-19 jab appointments without support although there was often a lack of staff to respond to this. The ability of service users to access their GP, medication and attend clinics became increasingly difficult. I have been encouraging clients to return to social activities and community groups to reverse the impact of increased anxiety and isolation linked to the pandemic.

The pressure on the care system during the pandemic has been widely reported, but to experience the impact of suspended services or care visits being cancelled for clients was a challenge. Access to mental health hospital beds is a longstanding problem due to cuts however this worsened within the pandemic due to wards going into lockdown due to COVID positive cases. Unwell clients who required a hospital bed but who had not received their jabs faced further delays causing an inability to move people from temporary assessment rooms. This meant there would be no space to admit anyone else from the community for a period. Police forces for example would have been required to transport individuals many miles to surrounding counties to access a hospital with a vacant room. Pre pandemic however this was still, and remains, a common occurrence.

At other times we had no option but to assess people in rooms with a lack of ability to socially distance from clients but also between other professionals. Supporting people post discharge was a greater challenge due to lack of available community services and face to face contact. This also had a direct impact on carers and families who felt increasingly unsupported and on their own with sometimes only phone calls available for support.

Making a difference

Working within mental health and with other professionals is a challenge and we regularly hear about and manage distressing situations. Support from the team and colleagues is essential and something which I value highly. I have needed to learn to separate my work life from my personal life, establish boundaries and develop resilience. It is not always possible to achieve this balance. My therapy is baking; I love food and cooking is a transitional activity that takes me from work to home.

Although the role is a challenge and overloaded with bureaucratic and resource issues, I really enjoy my job. I am making a difference and I love the diversity of people I meet. I go through thick and thin with people. That can involve some big lows but also big highs.

One client who has engaged in deliberate self harm for many years, had experienced time in prison and is doing well in 24-hour supported living is hoping to get married. She kindly invited me to her wedding, which I had to decline, but I suggested we celebrate with coffee and cakes. Another client is enjoying their new job and others have settled since obtaining further support from live in carers at home. I have helped people get better and move on with their lives, overcome trauma and increase periods of stability and happiness.

Careers in social work

A career in social work is fantastic for those with a desire to promote the rights and opportunities of marginalised individuals, who enjoy working with people, have strong values and sense of social justice, embrace a level of unpredictability, can become a positive mentor and accept you may not always be liked! Social work opens doors to so many opportunities working with people and communities.

Social care and health professionals often feel great satisfaction within our roles and strive to achieve the best outcomes for those people who we support.

A final word: be kind to yourself

I recommend people be kind to themselves and recognise that it is okay to feel however they feel. The first part of trying to get help and make a change is to identify a problem or need. It is okay to feel anxious, sad or lonely: our emotions are there for a reason. Do not feel you must snap out of it, be honest with yourself and ask for help, and have faith that most circumstances are temporary.

Sources of help 
Some useful organisations and helplines for anyone experiencing any of the issues discussed in this blog are:

Shout 85258 is a free, confidential, 24/7 text messaging support service for anyone who is struggling to cope. Since launching in May 2019 its team has had more than 1,300,000 conversations with people who are anxious, stressed, depressed, suicidal or overwhelmed and who need immediate support.

Samaritans provides emotional support throughout Great Britain and Ireland to anyone who is experiencing emotional distress or is struggling to cope or at risk of suicide. Much of its support is delivered through its 24/7 telephone helpline: 116 123 

SANEline is a national out-of-hours mental health helpline offering specialist emotional support, guidance and information to anyone affected by mental illness, including family, friends and carers. It is normally open every day of the year from 4pm to 10pm on 0300 304 7000.

Go back to Part 1 of this blog

 

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