Working lives: Claire Barcham’s best and worst decisions

The best

Delia was exactly the kind of person I love working with. She hated social workers (she had once chased a colleague down the street with a knife) and refused all interventions but was eventually sectioned.

Her son had been taken into care and adopted at an early age – one reason for her dislike of social workers. Her parents were dead so her pets were her family, especially her Great Dane, Albert. She wasn’t interested in talking to me, but her face lit up when she talked about Albert. I offered to set up a dog contact session.

My manager thought I was bonkers but I remembered the look on her face, and persevered. As I arrived, there Delia was, sitting in reception, clutching some biscuits, knowing Albert would love them. It was a major step forward. Delia had only ever known people in authority to promise much but deliver little.

By focusing on what was important to her, and promising only what I could deliver, I built a relationship with Delia which continued when she moved back into her own home.

The worst

I had been qualified 18 months when I met Mathew, a lively 12-year-old who lived with his three-year-old sister, mother and grandmother. The initial referral related to concerns from dieticians about the girl, who would only eat food if it was liquidised.

Even now, 15 years later, I remember the first home visit. Mathew (not in school because “he had a cold”) was keeping his sister entertained. While mum sat stiffly in a high-backed chair, grandmother told me her daughter was an only child whose brothers had died of unexplained illnesses and head injuries as infants. I came away confused and concerned.

Then one day Mathew’s leg was in plaster because, his mother said, “his leg kept collapsing under him”. I was horrified, but couldn’t find out any more.

Mum and grandmother were becoming restive and soon I had to hand the case on to a friend and colleague. Within six months the case had been closed after the family made written complaints about being “harassed”. After initially saying there may have been a fictitious illness, the community paediatrician withdrew due to insufficient evidence.

I saw Mathew once more – in the middle of the day, when he should have been at school, shopping in a local hypermarket with his family. He saw me and acknowledged me discreetly. That, together with the image of him in plaster, are the pictures I carry with me.

But I still can’t help feeling that something was very wrong. Perhaps if I had intervened more assertively something might have broken. Or perhaps not.

Claire Barcham is a training and development co-ordinator at Camden and Islington Mental Health Trust in London and national co-ordinator of the Approved Mental Health Professionals Leads Network for England and Wales

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