‘I have supplied him with clean clothes and bought his favourite biscuits to gain his trust’

A substance misuse social worker talks through her day spent providing motivation, understanding and gaining trust

Our community drug and alcohol team is made up of mental health nurses and social workers helping alcohol and drug dependent adults seeking treatment for their addiction.

We work with a wide variety of people: parents, people in employment, people with learning and physical disabilities and those with mental health conditions. We provide inpatient and community detox alongside psycho-social support.

GPs rely on our risk assessment skills

There is strict governance covering the pharmacological support we provide, and an integral part of my role is recommending methadone and buprenorphine prescriptions to GPs, who rely on our risk assessment skills and ability to form relationships with our clients to provide a safe and effective service. We also work closely with children’s services, Community Mental Health Teams and partner addictions agencies.

I start my day preparing for the Multi Agency Risk Assessment Conference (MARAC) to be held at police headquarters next week. This is a formal conference that usually lasts all day and my role is to feed in relevant information I have in order to assess the risk to victims and their children. Only cases of serious domestic abuse where there is a risk of serious harm or death will be heard; therefore it is a challenging day and I need to prepare adequately for it.

The life she wants is achievable

Later in the morning I have an appointment with a woman who has a mental health condition, is alcohol dependent and is currently sofa surfing. The last time I saw her she was very intoxicated and her mental health was causing her distress, so we were not able to undertake any meaningful work.

Today she has secured accommodation and is more focused on the session. I do some motivational interviewing with her and she feels able to make some changes this week and can see the life she wants is achievable, starting with reducing her alcohol use. We discuss her plans post detox, she is finding out about a college course, wants to engage in aftercare and eventually wants to work again.

Guilt and shame

After this I have an assessment with a man in a professional role who has an addiction to codeine which he buys on the internet. We discuss his triggers, which he believes are the stresses of having a responsible job, children and a wife who doesn’t understand his addiction. We discuss whether a planned reduction with relapse prevention support or an opiate substitute prescription with support would be suitable. The assessment is a long one because I feel his need to talk to someone after holding so much guilt and shame to himself warrants more time.

On my way home I meet a client’s mother at his flat to assess whether it is a safe environment for him to be discharged from hospital. This person is a chaotic poly-drug user, with complex mental health issues and a long history of non-engagement with us and community mental health teams.

Unable to protect himself

He has ongoing police involvement due to anti-social behaviour from other drug users in his home and as such is also facing eviction. I consider him the person most at risk of accidental overdose on my caseload and the least able to protect himself from others.

I have spent considerable time trying to engage this man. I have offered to take him to appointments, supplied him with clean clothes and even bought his favourite biscuits when visiting him in hospital in the hope he may begin to trust me!

The fact that he has allowed me to visit the flat is evidence that my approach is working and this is important because the flat is not suitable for him to live in at present. I recommend delaying discharge to give me time to arrange a needle clean-up and deep clean in conjunction with his mother and the mental health team.

Overall, a varied and busy day!

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