Being Here

…I went to see Gravity at the weekend, and came away with my head spinning with various thoughts, to the point where I’m likely to see it a second time, this time with a notebook with me.

The plot is set-up perfectly by the trailer – two astronauts are adrift in space following a wave of space-debris destroying their ship.  How and if they survive is the content of the film, the visuals are dizzying and terrifying and the soundtrack is based on the panicky breaths of terror.  It’s a wonderful film and deserves every accolade coming to it – this is a film that will continue to be spoken about for years.

Grief, personal responsibility, existential fear, survival, human-ness, power and scale are dominant themes.  The cliché of seeing the earth from space and appreciating the vastness against the tiny “insignificant” ants of humans that must be swarming on the landmass below – I am always struck by the multiplicity of thought that exists unseen…it’s the same thing when I go to London, hundreds and hundreds of people all who got up this morning, who have a plan of their day, who are afraid of things, who are ignoring some things, hoping for others…the amount of mental data that I know must exist all in the same place at the same time is something I find incredible and frightening.  I can’t quite believe that all this can exist all at the same time in the same place.  Seeing the shots of the earth, spinning, floating, falling – I know there are humans beneath as there are above but somewhere I can’t afford to think of them, not all at once.

Any “survival” story carries parallels of “journey”, and the way that my reading and thinking are these days, I think of the “therapeutic journey”, and analogies swarm.  Visually the film is full of images of rebirth and (inverted) evolution, and stories of grief and “letting go” are evident. How will the protagonist get through the film…?  Is there such a thing as “home” anymore? 

The two main points that have stayed with me for further consideration are the debris, and the refuge. 

Debris

This is the “event” which creates the drama.  Working in space-suits outside their ship the astronauts are informed over their radio of debris from a destroyed space-station that is coming their way at high speed.  This is the debris that will cause so much damage, that rips them from their “safe” places and sends them hurtling into the dark.  Some reading around the issue has shown that this is an actual scientific theory – that sufficient quantities of debris in space would have catastrophic and cumulative results wherein the coming shrapnel would destroy other ships, creating further debris and spreading the net of destruction wider and wider. 

The issue of where the debris came from may have been explained fully in the film – in those first opening scenes I was concentrating so much on those disorienting visuals, steadying my own breathing as I was swept into empathising almost too much with the vertigo of the main character; I may have missed the details.  It seems that the debris was created by Russians attempting to destroy old, redundant, useless satellites.  In a sense, it doesn’t particularly matter how or why the debris came; it came.  The astronauts will not be helped or saved by an understanding of the origin or trajectory of the missiles, they have to survive them.

And throughout the film it keeps on coming, showers of shards flying and floating – sharp and heavy to pierce and kill, to open to the elements and lay ready for death.  As the theory predicts as the initial cloud hits the astronauts’ ship, the amount increases as the fragments of their ship join the spiralling debris.  The laws of gravity in this context mean that they cannot predict the course, speed or direction of it, and once the cloud is upon them they either survive or they don’t.  Our heroine is sent spinning out of harm’s way, but also out of the reach of her colleague and the reach of the radio-voices.  She is temporarily safe from the destruction but only getting further and further into the dark.

To my mind, the debris and shrapnel appear as “trauma” as we think of it in psychiatry…destructive and disparate, unknown and unpredictable – or perhaps that’s my own experience.  The origin is important but does not dictate the course – and it is a recurrent thing that appears to grow each time it reoccurs.

I am interested in the fact that the debris comes from the destruction of satellites, stations that have outlived their usefulness.  There is a connection between the debris and the refuges that come later in my thoughts.  For now I am interested in how satellites, aerials, wings, parachutes, doors, levers, foot-holds, windows and all the other components of such technology become bullets, spears, daggers and everything else that the astronauts seek to avoid in the shower of debris that comes to kill them.  How can something so functional become something so lethal…?  The transformation lies in the trajectory, the speed, the angle of the destruction and of the flight.  So this antennae becomes a weapon, this door becomes your wrecking-ball, this divorce becomes a breakdown, this assault your suicide.  It is not the content of the thing itself but the speed, the angle, where you were standing when it hits, where you were looking.  In “predicting” how traumatic events (or events which could be seen as or become traumatic) affect people there are so many variables the outcome is unpredictable.  And this is not justification for dismissing or neutralising the role of trauma, but just acknowledging the chaos therein.  A very risky endeavour and one often studiously avoided. 

Refuge

Having withstood (albeit in terror) the shower of arrows and knives, our astronauts spin in a terrible panic, no sense of up/down/above/below.  Their goal, and the structure of the narrative from this point is to do with getting from one space-station to another, via jet-pack, via escape-pod, and to complete a number of small journeys in order to be able to get “home” to earth.  There is the contrast between the abyss of space and the safety of each space station…visual resonances to wombs abound and each “resting-place” on the journey appears idealised. 

The first station they reach – shots of them grabbing frantically at anything just to “hold on”, the parachute-lines trap one of the astronauts, whether this is a good thing or bad thing remains ambivalent.  It is difficult to talk too much without revealing vital parts of the plot, but the statement (I forget the book) about how quickly a refuge becomes a trap is one that shines out again and again.  The transient nature of refuges, how they become “stopping points” and resting-places rather than destinations.   To connect the debris and the refuge is to note that each wave of destruction can turn what was a refuge, a safe place into further debris…your haven becomes your horror.   And even the final point of the film, the rest, the resolution is momentary only before the next “movement” is begun. 

I think about journeys.

…as I may have mentioned, over the last year local mental health services have changed considerably.  Multi-disciplinary teams staffed by CPNs, OTs and psychiatrists (employed by the NHS) and by Social Workers (employed by the Local Authority) have separated out or disintegrated – working in different offices, different policies and procedures, different computers systems, different everything. Social Workers now assess for indicative and personal budgets to meet a persons’ needs under the banner of “Personalisation” – with a view to improving service user choice.  We assess the net value of a persons’ suffering and shop rationally to install a “package of care” or “residential placement” to ensure that “the customers’ needs are met” while the council’s budgets are balanced. 

I personally am now on the wrong side of the purchaser/provider split. 

My training was in mental health work.  Hearing Voices, CBT for psychosis, for self-harm, for anxiety states.  Systemic understandings.  Motivational interviewing.  Narrative work and Wellness Recovery Action Plans.  Tribunal reports, mental state examinations.  Managers hearing.  Mental Capacity Assessments.  Safeguarding.  Now some of these tasks remain, but the overwhelming role for Social Workers now is that of “Case Management” for “customers”.   And I hate it.  I hate it on a personal level because sums, costings and negotiating contracts is my idea of a particularly obtuse level of hell.  It is frustrating and demoralising to know on a daily basis you’re not going to understand 90% of what you’re required to do.  “Doing what I’m told” is my current policy, but the fear I get when a call from “The Brokerage Team” invariably means some box doesn’t correspond with another/two numbers which should or shouldn’t match do or don’t – completely overwhelming.  They tell me things to explain, their explanation makes no sense. 

So yes – personally the changes are dreadful and I’m trying to escape.  But increasingly I’m able to articulate what is so disturbing about the changes that have settled over the last year.

I was talking with a colleague, a community care worker, about the effects of the changes on both the NHS staff and ourselves (the net result seems to be a citywide burnout with service users getting a much poorer service).  The Community Care Worker voiced the opinion that this current situation was “real” social work, arguing “but the reality is, all that care, all those services, some-one’s got to pay for it! The money’s got to come from somewhere and that’s what social workers do”.  I countered that this is what social workers do now as a result of the changes, but that totting up the costs of care and support is not the role of a social worker. “Yes but someone has to pay for it!” the community care worker repeated, “credit crunch, austerity, all that, it’s got to be paid for”, and again I said “yes but that isn’t what Social work is”.

Which begs the question “what is social work”…?  This is asked repeatedly, and answered repeatedly.  The College of social work says it wants to improve media understandings of what social work is.  The way Social Workers are portrayed on TV (which is very much a window into and out of the world) is frighteningly unrealistic (and always, always Child Protection Social Workers, as if Adult services do not exist) and I’ve said for a long time we need a SW soap opera. However this goes beyond people’s understanding of the role (and more education and transparency is needed, I’ve lost count of the number of times I’ve been told that support worker, social worker and benefits advisor are “the same thing really”).  What is currently happening to social work is more insidious and destabilising than mere lack of understanding.

If, as the community care worker said, and as the current working practices demonstrate, social workers are now there essentially to assess for costs and negotiate contracts for care, then we have been turned into representatives of an employment agency for private-sector companies, travel-agents for residential and nursing homes.  The nature of statutory provision is fully immersed in this purchaser-provider split, and we are the accountants, the brokers, the shoppers.  This is privatisation. There is no other word for it.  This is a neoliberal reality where the word “social” is taken to be synonymous with how much a person will cost or contribute to their existence.  The people who have been composed of text are now composed of numbers.  The “social” has been destroyed.  Group-work is dead.  Day-care and activity-based input is dead.  We are no longer in a position to articulate challenges to wider social problems or work towards their solutions.  All we are able to do is assess whether or not a “case” or “customer” is a viable option for accredited providers to be awarded the contract, calculate individual cost and individual contribution, and negotiate the best deal for all concerned.

We have been privatised and the “social” has been quietly and devastatingly converted into rational consumerism.  This is what social means these days.

…so back after another period of being off sick with my own mental health stuff…fourth day back now and it’s business-as-usual, scour all available avenues for escape to another job, continue banging my head on the wall along with my colleagues. The ones who aren’t passive-aggressive/right-on egotistical frauds.  There’s something about having to vote for gluten-free Mondays in solidarity of our coeliac colleagues, having to complete risk assessments for Christmas decorations and for putting up a cheerful postcard at ones’ desk, being reminded not to sing Christmas carols as it “may be discriminatory against people who do or don’t believe in the Christian message”…I digress a little.

Purchaser/Provider

We had another staff meeting where we learned more about the next barrage of organisational and operational change to hit us.  I say “learned more”, I mean that we were told “we don’t know the exact answer to that just yet” and “it’s a transitional time” and “there are a number of changes as yet undecided” but reassured that there were “change action groups” being planned, although we were “not as yet” invited to them but that they would be “invaluable” in helping us “work in our new roles”.  We hesitantly suggested that if these groups were essential to us working effectively, it might be useful for us to be invited to them..? We were assured that this would be “fed into the pre-working change action groups”.

I am tired of using the phrases “Orwellian” and “Kafkaesque” to describe my working life.  An older colleague of mine who has been round these nonsensical cycles a few times put her head in her hands and said “I just wish I didn’t care about it but I do”.  I offered her some PRN medication from the stash I have in my bag (necessary) and we laughed.  A bit.

We spoke in the team meeting about the difficultly in “sourcing providers” who were able to work with the most complex cases (or “people” as I like to call them – we are being told to refer to them as “customers”), those with diagnoses of personality disorder, those with chaotic lives.  When they needed “placement” (or, again in the old-fashioned vein, “somewhere to live”) there were a number of people we were struggling with as the care agency staff who populated these places or provided support to people in their own home were not trained to work with this presentation, didn’t have the skills or experience and so were refusing on grounds of eligibility, leaving the person without support.   A room full of Social Workers, AMHPs and Community Care workers, with so many years of experience and a lot of specialist knowledge about working with this particular demographic, providing the consistent and safe interactions needed to help regulate the rollercoaster lives and emotions of our service users.  The Social Workers no longer provide interventions with service users but “manage packages of care”, so although we are qualified, registered health professionals, the reality is that we are now travel agents, accountants, personal shoppers. It is “not within our remit” to see service users regularly, build relationships, support them, act as counsellors, advocates, mediators, all the things we used to do.  We work out how much their suffering is worth per week and ensure that the council get best value for money in how we spend these “individual budgets”.  The Community care workers are not allowed to carry out MH-specific interventions and are supposed to help with shopping, “getting out and about” or tenancy support.  The Community Care Workers are to be radically reduced across the city in the “new world” we keep being told about and we will lose three-quarters of them.

The people trained and experienced in providing the input that people need are now prevented from doing so in favour of brokering agencies to do it cheaply, and then bemoan the fact that the agencies don’t have the skills to work with these complex people, leading to breakdowns, increased need…this is the purchaser/provider split that we have been pushed into and it doesn’t work.  It seems to be economically inefficient as well as being counter-productive to what people need.  They need meaningful and consistent interactions with well-trained and knowledgeable professionals.  They get short visits from a constantly-changing sea of faces who are under-trained, under-paid, harassed and baffled by the complexity they encounter. There’s money to be made and visits to be done; move on, move on.

The holy consumer

I took a call in the afternoon from a care home for someone in hospital, there are a number of legal issues to be considered in this person’s case, a DOLs/guardianship debate, but for now a placement needs to be arranged.  In the new role, this is the bread-and-butter of what we do.  As a psychiatrist on a forensic ward told me “you don’t need to talk to them, you just need to book a bed somewhere” and was genuinely amused that there may be an assessment process.  The system of identifying a placement is long, torturous, needlessly bureaucratic and involves brokers, a monthly funding panel application and various other things.  The fragmentation of my team, the NHS team, the brokerage team, the finance team, the ward and the provider makes for difficult working.  The brokers have no knowledge of legal issues, I have no knowledge of nursing/medical issues, the ward/NHS team have no knowledge of our systems.  Somewhere in between this the broker and I have numerous cross-purpose conversations about permanent placements, block-booked-beds, funding streams and commissioning protocol.  The provider phones me up to give me a verbal advert for the placement (“furnished, sea-view, en-suite, £900 a month!”), doesn’t really want to know about the legal details, just wants to know if you’re going to buy the placement.  Explain that we need to know if they can meet service users’ needs, and that if they can and give us a quote then I have to plead a case at the funding panel.  Provider wants to know now if I can “guarantee” we will pay for placement before they go to assess.  Explain this isn’t how it works.  Provider grudgingly agrees to go and assess.  But not before I get another advert for how many staff they have, what services they offer, what their price range is.  I am very aware of my role in the consumer chain. I am a travel agent, an accountant and a personal shopper.  Once the person is in the placement, the contract and regular payments have been drawn up, they rarely contact the social worker again for on-going assessment or input.  Why would they?  The money’s been paid, the transaction (sacrosanct) is over.

The whole deal with personalisation is that it is supposed to offer more “choice” in terms of provision of support for service users.  Choice is a good thing.  Rights being upheld is a good thing.  But the word “choice” is not necessarily transferable to all realities.  I don’t mean that certain kinds of people shouldn’t have choice or are incapable of choice, but if the options on offer are not what the person needs or wants, is that really a choice…?

I return to the perennial issue of personal therapy and direct payments.  We are being encouraged to support people towards direct payments as a way of ensuring their freedom of choice, their needs being met in the way they decide.  I have met so many people who want to pursue individual therapy and counselling.  The IAPT waiting lists are monstrous and they will not work with service users under secondary mental health services or with any thoughts of suicide or experience of self-harm, which cuts out swathes of the people who desperately need therapeutic input.  The NHS staff are too stretched to offer this regularly to people on their caseloads.  Psychological/ psychotherapeutic input on the NHS appears to be so tightly-controlled as to be inaccessible – in the years I have worked as a mental health social worker it is only the minority of people who are referred for this input, and it does tend to be middle-class white service users, predominantly women.  So perhaps direct payments would be a way of helping people access therapy from the private sector…?  Except not.  This is classed as a “health need” and direct payments cannot be used in this way according to the law.  Unless one is a carer.  For a carer, receiving therapy or counselling is a social need.  For a service user, it is a health need and therefore can’t be met by direct payments or personal budgets.  And somehow this is not deemed discriminatory.

A great many of the service users I work with are so baffled, stymied and stuck with their emotional difficulties, cognitive issues (usually from the cocktail of sedatives they are required by law to take) and perceptual disturbances that they feel unable, unwilling, uninterested in brightly participating in “choice of services”.  Some lack mental capacity to do so, some cannot even conceive of the idea of support or help, or goals or recovery, and are so locked in their own misery and fear that they cannot, cannot make use of the limited resources available to them.  They need consistent interactions but not-within-our-remit blah blah blah etc.  If they are unable to engage with the consumerist activity, I am required to do so for them.  They become a unit to be processed, a package to be delivered and paid for.  Shoppers unite.

Yes some people with disabilities (if that’s the term we’re using) are fully able to engage with the process of negotiating the “care market”.  This doesn’t mean everyone should, or can.  Service users who only exist as consumers of units of care.  And if the units of care aren’t relevant to meet their needs?  Then they have the wrong needs.  Then they are not customers.

There is a lot of talk about how relevant the “personalisation” agenda is for people with mental health needs.  There is talk about wanting mental health services to be equal in scope, status and outcome with physical health services.  But ideas of parity, equality and equivalence are getting mixed up with “one-size fits all”, where one size doesn’t fit all.  The portioning and contracting out of care to more and more fragmented providers seems to give less choice rather than more.  But we raise the banners of consumerist freedom and choice all the same.

Again, a blip.  A winding up/winding down of these terrible experiences of feeling trapped, useless, incompetent, invisible.  More changes coming, further destruction of the role, seemingly no way of escape.  Add to that some perennial family stuff, my partner being suddenly bereaved and away dealing with all of that, and a serious bit of toxic-colleagues/poor management as our role changes beneath us yet again – I go back to my GP for a review after last year’s chaos and again am signed off work.  Attendant guilt, feelings of weakness etc. 

Round and round the brain it goes, and somewhere in the drudge of those thoughts, that presentation, this exhaustion I start to grapple with the question “am I depressed or do I have depression?” – it’s a question that in various ways has occupied me for years, applied to myself and to the people I work with.  Is what I’m experiencing now a response to a series of events?  Is it a part of my personality?  Has it become a part of my personality as a result of events?

The question arises between “having” and “being”. 

“Depressed” as an adjective, “depression” as a noun.  Does “being” indicate more or less transience? Does “having” indicate a permanency or something we pick up, put down again…? And what (in all of this) has happened to “doing”…?

I think about diagnosis (of depression, of anxiety, psychosis, whatever…) in this sense as an object – and think of us as “object-seeking” (as well as “meaning-creating”) creatures as humans.  Winnicott discusses the value of the transitory object (blanket, teddy) as part of the developmental process, a bridge between the internal and external world.  What of diagnosis as a transitional object…?  I “have” this – it communicates my internal world of whirling misery, black gaping emptiness, hollow thudding confirmation of the worst bits of the worst days you remember and the ones you fear to come; and links it to an external world of waiting rooms, outpatient appointments, medication, helpful leaflets, treatment plans, evidence-based outcomes.  Phew.  But does this always work?  Is it this gap between our expectations of the efficacy of this external world (all the promises) and what we experience (the meds mostly don’t work, the therapies take years, you can’t cure unhappiness or repair abuse) that keeps it all running…?  Does hope work best with anxiety…?

(Insert difficult concepts about Lacan’s real and imaginary, the name of the father, the promises and traps of semantics, language as deceiver, as comforter)

The changes that have come over me since the local authority and council ended their joint working arrangements have been huge.  I have had a substantial pay-cut, my hours have changed from shift-work to a Monday-Friday 9-5. I have a different office, different colleagues, work under different legislation and policies, have different computer systems, email addresses, keys, badges, phone numbers and paperwork.  There is absolutely nothing about my working life that hasn’t changed. 

It is killing me.  My new role is as baffling as it is pointless.  My breakdown of the last year was what made me “unsuitable” for AMHP training this year, and the cumulative stresses have undoubtedly impacted on my repeated (and I’m sure hilarious) attempts to pass my driving test.  I am of “high expressed emotion” at the best of times, but since these changes knocked me off my feet my emotions run high at work, I know.  I am doing what I can.  But I am trapped.  The role of Mental Health Social Worker has (as I predicted) changed so much it is no longer what I can do.  The health trust is not appointing “social workers” at this point.  I cannot realistically look further afield until I get my license.  There doesn’t seem to be an escape route.  Taking anything with less pay would mean I have to sacrifice my Psychoanalysis course which appears to be my only other escape route (and more hopefully is what I have decided in my natural environment).

So with a plan to cope with this pretty horrible situation, I had decided to focus on practising “Conscious Emotional Detachment”.  Not feeling destroyed by the systems in place.  Rising above it.  Here is my summary of how today went.

Journey to work

I walk past a bin-man hosing chewing-gum off the pavement.  I feel lucky knowing that (fleas and mushrooms notwithstanding, and the building boasted both of those in my first few months there) I have an office, a chair and desk of my own with nice photos of things and people I love around me.  I can organise my own workload, there are teabags and rice-cakes in my desk-drawer.  I wonder if everyone working in local authorities struggles with the feelings I’m struggling with, if they are able to maintain a distance between what they feel and how they respond.  I wonder if I’ve chosen the wrong thing and can’t work out if this is more or less frightening than the idea that I chose the right thing but that the music changed partway through.

Getting into work, 8am-9am

I log in and read my emails.  I have one from a nurse whom I frequently have to report to her manager for not responding to emails/documenting untruths/telling service users incorrect things about my role and my assessments.  I had emailed her on Friday to try (again) to get confirmation about a meeting.  She rather peevishly replied saying she hadn’t invited me because she thought I couldn’t come and anyway they’ve rearranged it a few times already so does she really need to arrange it again? Do I really need to attend?  Can’t she just tell me the outcome and I’ll do the paperwork…?  I email her back again asking for confirmation, yes I can come, no I need to attend, I can’t write an assessment without being there, yes I do need to write an assessment.  I copy in her manager.

I have another email from another nurse.  A service user had declined an assessment of social care needs so I’d attempted to close the case.  Admin had told me off for this a week or so ago as there was a s117 duty that hadn’t been reviewed (after-care arrangements for people who’d been in hospital) and that even though SU had declined assessment, I still had to review the s117 status.  I’d emailed the nurse to explain this and ask for details of the next Care Planning Meeting.  The nurse emailed back to patiently explain that the SU had declined assessment and that she’d told me this “months ago”.  Reiterated I had been told to review the s117, not the general social care needs.  She appears to ignore this email.

I have to contact the manager of another team about authorising a Direct Payments care plan I’d written.  I finish an assessment I’d started on Friday, and write a support plan for a Community Care Worker.

Rest of the morning

Cup of tea.  I tell my colleagues I’m experimenting with “conscious emotional detachment”. They laugh, they know what I’m like.  Is it like dissociation from trauma…?  Asks one.  We all agree that’s the most sensible option and laugh.  One of them asks if I’m ok, saying I look upset.  Genuinely I don’t feel upset but some tears come.  I’m amused, saying I feel emotionally fine, wiping my eyes.  We all agree that this is a good example of detachment and I am congratulated on my dissociation from myself.

I return to computer.  A “duty” issue came in on Friday that I deal with – wherein a carer for a service user needed an “urgent” carer’s assessment to organise “emergency” care over the phone.  I had been in the middle of tidying up a safeguarding referral that turned out not to be a safeguarding referral.  My senior practitioner adamant I had to just find out the days/times the carer wanted a service and to “just organise it”. Of course this comes in at 3pm on a Friday.  I speak to the carer on the phone, get a picture of what’s going on.  Senior prac and I sit up with ludicrously-complicated “costings matrix” which doesn’t quite correspond to the assessment format.  It takes us a few goes to come up with a “score” that we both agree on after adding up points for each question (like a Cosmopolitan Quiz). It turns out he is not eligible for support.  We do it again and again until we just about make him eligible for something.  We are allowed (according to the matrix) to arrange for a one-off payment to enable him to organise carers/sitting service, rather than us arranging it on his behalf.   I phone him to tell him this. He’s pleased we’re helping but why can’t we organise carers for him rather than him having to worry about a “lump-sum”?  He is worried about how it’ll affect his benefits/pension/taxes.  Do I know the tax-rate..?  No I don’t.  It’s now past 5pm on a Friday, I need to get the manager of the carers’ team to authorise it rather than my manager, because this is from the carers’ budget.

 (lunch)

So today I have to chase this up.  Carers manager says I did it wrong, I shouldn’t have done an emergency carers assessment with just him, I should’ve done a full assessment of him and her.  Explain that a referral for her hadn’t been sent to us until this morning and that I had been instructed to complete an urgent carers assessment by my senior prac as it was an emergency.  She says that the outcome of the assessment shows it wasn’t an emergency, so based on the outcome of the assessment I should never have undertaken the assessment.  I query this in terms of logic.  She’s not impressed.  She thinks I should go see the family and assess all of them at once.  The duty worker today is able to offer this.  The care manager starts reeling off the acronymic lists of various direct payments forms I’ll need to complete and send to finance.  I don’t recognise the acronyms and ask her to slow down while I scribble down what she says (the procedure for this is not available on the intranet nor on our database – why would it be?) – she is highly amused and suggests my team “gets a carers’ champion” as I “obviously don’t know what to do”.  Explain we have two, that they are both part-time Community Care Workers and do not set up Direct Payments so would be not much use in this situation. 

When I’ve finished this phone call, duty worker says she’ll go out and see the family.  I need to get away from my phone and computer for a short time.  I lock myself in the toilets, my head spinning with form numbers and sums and numbers and that.

I run into the person who was on duty on Thursday.  They apologise saying they hadn’t documented it properly, that the “urgent” carers assessment I’d been instructed to write (which had incurred the ridicule of the other manager) hadn’t been at all necessary.

I come back to my computer, another email from finance querying a £300 per week difference on a care-plan that another social worker signed off which I took over (after original SW quit due to stress) vs a care plan as agreed by the care provider.  I don’t know which one is right, have to email another manager to find out what sum the funding panel agreed months ago. No reply,  but further annoyed emails from finance.  Duty worker asks if I’m alright and it’s at this point I burst into tears.

I don’t understand the work.  The procedures do not appear to be widely-shared but are instead picked up by osmosis. There are more exceptions than there are “rules” and as a result I have only experienced exceptions.   Most other people in the council are really unfriendly to the “newly-back-into-the-council” social workers and are annoyed that we are still learning the funding/commissioning work they have done for years.  Our old colleagues back in the NHS now treat us with open contempt. 

Cups of tea, hugs, apologies, balsam tissues.  I continue and write up two more assessments. My computer access to the NHS database is currently paused as a manager-manager-manager didn’t complete a specific form nearly a year ago.  I can’t access OT reports.  I am getting angry emails from psychiatrists asking why I’ve not “found a bed” for a patient they want off the ward.  I can’t write assessment until I get OT reports, I can’t get OT reports until computer access sorted.  I’ve spent over a week trying to get the computer access fixed and am no further on.

A nurse phones about another service user, saying that they’re reapplying for DLA and do I have a copy of their last DLA application form.  No, I say.  We don’t have anything to do with benefits, we don’t keep copies of such application forms, and the person last apparently applied for DLA years ago.  “Yes but I thought that being the social worker you’d have a copy of their old DLA form”.  No, I explain again, we don’t have anything to do with benefits and we don’t keep copies.  “Yes but it’d just be much easier for me if you do have a copy of their old DLA form because then I can just copy what’s written down”.  For the third time I explain that we do not have this.  The Nurse is quite annoyed.

That’s it.  Not a great day for emotional detachment.  Tomorrow is another attempt.

This is a revelation I had while bleaching some teaspoons.

Things are given to decay.  There is destruction, withering and ruin.  Thankfully I am one who is already aware of this, who faces up to it with steely existential wisdom, accepting the angst.  Topping it with gold and glitter where I can, staring it in the face.  Laughing through it in spite of it.  I have nothing but creation and free will on my side.  I do not believe in determinism and angrily campaign against it in my work, my writing, my everything.  If I can do the things I do with flair, I can distract myself and everyone else from the dreadful reign of chaos that is sure to follow me, the destruction and misery I leave in my wake just by breathing or being. 

However.  I am appreciating this may not be the case and put forward two or three tableaux that sort of make up this revelation.

A flat I lived in before had a really bad damp problem.  Awful.  And of course a crappy landlord who refused to do anything about it.  We eventually moved flats for this and other reasons.  Some time later, I was able to articulate to myself that I somehow felt I had caused the damp.  That it had come from me, an inner disgusting-ness that was leaking out onto the walls and coming back into my lungs, in the mould. I couldn’t remove it, nothing would help.  How could I remove it or clean it?  It would return, it came from me.

I moved into a flat by myself eventually.  The lightbulb went in the hall.  It didn’t occur to me that I could change it, I got used to walking in the dark.  My boyfriend is a super-rational engineer with a toolbox built into the boot of his car and a solution to almost every single problem. He expressed disbelief I still hadn’t changed the lightbulb.  I bought lightbulbs, attempted to change it but something was wrong with it, the glass came out from the metal.  Terrified I replaced it and said nothing.  Again he noted I hadn’t changed it, and I eventually explained about the glass and the metal.  Not a problem, out came the toolbox, fuses off, removed the metal, put in the new lightbulb.  Light in the hallway again.  I was so pleased I might’ve cried.  He asked me why I’d waited so long and if I’d needed help he would’ve helped me change the lightbulb.  Again, sometime later I was able to articulate to myself that if I had said “oh the lightbulb needs changing and it’s a bit buggered”, then it would be proof that I had done it, had broken and infected things, and that it was just the way it was.  The light had gone and could not be replaced – what of it…?

And now these teaspoons.  Boyfriend had bought me some silver earrings for Christmas a couple of years ago.  I wore them one night out and left them on his kitchen table before we went to bed.  In the morning he offered to “make them shiny again” with the silver-polish he uses for his cutlery.  I had noticed they had dulled, but again in this familiar pattern had thought “well that’s that.  They were shiny, now they’re not.  All things fade” – but with a quick application of his silver polish, amazingly they returned to their former shine.  Impressed later that day, doing some cleaning I decided to bleach the sink, bleach some teaspoons which were long-tarnished with the residue of millions of cups of tea and coffee.  Again I had previously thought that was that, they were just like that now, it can’t be helped.  But no.  As simple as a soak in the bleach and a bit more of a scrub than normal and they are shining. 

And I thought about the difference between the way I look at the world, and the way boyfriend looks at the world.  I do have a penchant for the macabre, for the daily terrors and pitfalls that inhabit corners.  My professional reading and practice leads me into trying to understand psychosis, self-harm, suicide, darkness and unreality. Perhaps looking and analyzing is what I can do.  I can do this.  However I do not know exactly how to fix things.  If things can be fixed…?  I have that post-modern outlook which assures me of no answers, no truths.  I have found it freeing, exhilarating.  But somewhere I must feel that although solutions and understandings can happen for other people, that while I refuse to accept determinism (psychological, social, political…) for other people, for me it is already written.  A given.  The other people around me cannot possibly experience damage, decay, loss (in the physical sense), they are just lucky.  It genuinely has not occurred to me how much repair and maintenance are required in daily life, and that doing so is not a confession or admission of guilt.     

Me, a nurse, a service user.  Service user tearful.  Sad, anxious, in a terrible state all in all.  They’d come off their antidepressants.  Now I’ve done this before and it’s been horrific.  After the events of the last year, I’m back on them, and am really, really aware that I would have to tail them off this time rather than stop abruptly.  I believe they call it “discontinuation syndrome”…not a resurgence of the depression or whatever.  The effect of the drugs.

And this service user is feeling the effect.  We are there to talk to them about accepting help as they’ve been declining this (the professional way of saying “telling us to go away and stop wasting our time”).  I’m not going to talk about medication, I never thought this was my role in the multidisciplinary teams and I’m not going to step into the role of drug-pusher now.  Whenever someone spoke about wanting to come off medication, I’d always advise them to talk to a doctor carefully about it, and for this to be planned rather than a snap decision. But I leave the “persuading them to go back on meds” conversations to the nurses. 

This nurse was great.  A master-class in illogical, self-contradictory statements of almost no sense at all.  It was amazing.  The service user explained that they had stopped the medication due to experiencing unpleasant side effects.  They described them to us.  The nurse brought out some informative literature she had about the medications and the known side effects.  The described experiences were not on the list.  Perhaps they’re not side effects…?  I suggested some more normalised explanations for the side effects (ie an eye-test needed, not having eaten enough) which the service user said they felt might be the case.  We all agreed that what they had described were not the known side effects of this medication.

We began talking about the service user accessing a course of “Cognitive Analytical Therapy” – the nurse explained “this is a really good treatment, it’s tried, it’s tested.  We would never suggest anything that wasn’t tried and tested, we would never suggest anything to you that doesn’t work.  All of these medications and therapies work, otherwise we wouldn’t be able to suggest them to you.” – so far so reassuring.  But then in the next breath:  “Of course, the things we’ve tried before didn’t work, the other meds and the ECT didn’t work but that’s ok because we’ve still got lots of ideas”

…so what we give you definitely works, except that nothing we’ve given you so far has worked.  What is someone meant to do with that…?  Is the service user at fault for not having been “cured”…?  Or are the remedies and interventions untrustworthy…?  Either one is at fault, or our helpers are useless.

…and then shortly afterwards the nurse reclassified the experiences they’d already agreed weren’t side-effects as side-effects, promising that the next medication they prescribed (that would DEFINITELY work) wouldn’t carry the same side effects.  Which we’d already established  weren’t side effects.

Excellent work.

A person, depressed on and off. Badly so. Stays in bed. Doesn’t eat. So closed and locked within themselves. Brittle. Ambivalent about support. Care team try one antidepressant. It doesn’t “work. They start them doing CBT. It’s going ok, they’re going to each session and doing the “homework”. Care team decide “it’s not working” and begin a campaign of persuading her to have ECT in order to “treat the treatment-resistant depression”. Person repeatedly declines. Care team repeatedly suggest. Person eventually “agrees”. Has ECT. Several sessions. Returns home. Takes overdose. Hospitalised under section.Referral made for “social care input”. Person declines it. Referrer re-refers. Person declines it. Family member requests “social care input” (although family member and referrer cannot articulate what they mean by this, “just something, I don’t know, to motivate them or make them less depressed or something”. Person grudgingly agrees to a trial period of support. Person declines first and each subsequent appointment. Discuss with referrer. They express frustration. “They just don’t want to be well! It’s really annoying” before saying “actually they are really well at the minute but I’m frustrated they’re declining input, it’s like they don’t want to be well”

“…but they are well…?” I ask
“Yes but they don’t want to be” they reply, smiling at my
confusion.