‘The rapport with my social worker was a vital part of my mental health care’

Social workers getting involved in your life feels threatening. That’s why they need to build trust with you, writes Mark Ellerby

My family contacted social services after I had told them I was hearing voices. I had a vague awareness and, at times, insight into the fact I displayed certain psychotic symptoms (such as beliefs I was responsible for 9/11) and that other people might think I was mad.

This too seemed to be what my family was thinking. The difference between us was that they thought it was an illness but for me these thoughts seemed to be real. Once they made the call I could see the direction things were heading but contact with a social worker, or any other part of the mental health system, was the last thing I wanted.

At my first encounter with social workers they seemed to ask all sorts of leading questions about what I was thinking and experiencing. I found these questions threatening – again, it felt like they thought I was going mad.

It became clear that they wanted me to go to hospital. I was detained under the Mental Health Act and taken to hospital by the police. This did not bode well for good relations with my social worker.

When I got to the hospital my social worker was writing up a set of notes for the medical staff. I caught a glimpse of what she had written: “Mark has a two year psychiatric history”. I didn’t like it. It was chilling. It made me sound like I was dangerous and I remember wondering if this was true of other patients on the ward.

Over time I began to recognise that all of my first impressions about what mental health units were like and my fear of going mad were unfounded. The people on the ward were just ordinary people and I began to see myself as just having an illness.

Relations with my social worker started to improve dramatically. She got to know me and through striking up a rapport she became someone I could trust.

This rapport was facilitated by her obvious intelligence and professionalism and my getting to understand what the mental health system was and what it meant to be mentally ill.

When I was discharged from hospital my social worker was my support and my family’s support. They could depend on my social worker’s judgement that if I relapsed the system of community care could look after me.

My social worker’s visits became more frequent and I was able to build upon that relation of trust further. The social worker got to know me and my symptoms better and I began to look forward to her home visits.

That the service user/professional relationship could get to this point of congeniality was, I think, down to the social skills of my social worker. She built trust with me. By having friendly relations I felt I could open up about problems without the fear of immediately ending up back in hospital.

If I was experiencing symptoms I found it easy to explain my symptoms to my social worker. I trusted her judgement, but more than this she trusted my own insight and that of my family.

If I felt I needed to be back in hospital she would come out immediately to assess the situation and I believed I could trust my social worker’s judgement.

I have been told there is sometimes a professional stereotype with social workers that they tend to think families worry unduly. But my social worker came to trust my mother’s judgement and what she said was taken very seriously.

I think the one thing that can spoil the professional rapport with a social worker is when (though this did not happen to me) a patient might become paranoid about them.

If the situation becomes psychotic and a person has no insight into their illness, all the benefits of rapport might be jeopardised. In that case I would recommend that patients and families be allowed to change the professional, however well they know the client.

All in all I think a good professional relations between social work and their clients are an essential ingredient in facilitating good practice in mental health care, whether in hospital and the community. All in all, I’m very grateful for all the help I have had.

About the author: Mark Ellerby is the author of ‘The Stages of Schizophrenia’ books

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