by Dan Mushens
Recovering from physical illnesses can usually be remedied by a successful course of treatment over a specified period of time. However, recovery from mental health conditions can often be viewed as an open-ended personal journey towards ever changing and fluid destinations, with goal-setting and reviewing along the way.
Most care and support providers strive to promote the independence of the people they support, by using reablement theories and a recovery-focused approach. Combined, these build on the belief that people experiencing mental ill health each have a degree of resilience and other inherent resources which can be used to aid recovery.
But, this isn’t always the case. Take Mrs A; she is in her 60s and lives alone in Glasgow. She has been a heavy drinker since the 1970s and was diagnosed with alcohol-related brain damage (ARBD) about five years ago. This primarily presents as memory, cognitive and mobility deficits, as well as some breathing difficulties.
Empowerment and autonomy
She continues to drink daily and receives support from two different providers. My organisation places an emphasis on promoting recovery of the ARBD deficits, while the primary agency involved with Mrs A focuses on meal and medication prompts and other associated daily living tasks.
Mrs A has a keysafe outside her front door allowing family and support staff to enter the home whenever she can’t answer, for example, because she is asleep, didn’t hear the door, or is intoxicated. Although it sometimes takes a few rings on the door or even a phone call to prompt Mrs A to answer the door, affording her the opportunity to personally invite us into her home promotes empowerment and autonomy. However, the other agency accesses the key safe as the first option. This often results in Mrs A now ignoring the door when I arrive even if she hears it, because she knows staff will use the keysafe eventually and it saves her having to get up.
Another example of hindered recovery relates to when Mrs A needs to go shopping. As she visits the shops daily to buy cigarettes and alcohol, we support her to budget in advance and prepare shopping lists so she can also buy groceries while she’s there. However, the other agency offers to go to the shops on her behalf which Mrs A now prefers as it means she doesn’t have to carry as many bags home.
Mrs A also used to collect her medication in a blister pack from her local pharmacy, which she walks past every day when visiting the shops. However, the other support provider changed these arrangements and Mrs A now has her medication delivered to her door each week. I feel she now misses out on having both a social and professional relationship with the pharmacist and staff and feel that it’s another opportunity missed to promote some recovery.
Attending healthcare appointments can also be problematic. I supported Mrs A to maximise her income as well as successfully apply for a concessionary bus pass which allows a carer to travel with her for free too. This was intended to increase the opportunity for Mrs A to access transport into the wider community and attend hospital appointments.
However, Mrs A can be low on motivation, is often reluctant to leave the house and occasionally decides she’d rather not get a bus or taxi to appointments but miss them altogether. The other organisation now prefers to use their personal vehicles to chaperone Mrs A to and from her appointments. This has created a dependency so that Mrs A often declines to arrange or attend any appointments during my support sessions. I appreciate ‘the ends justify the means’ dilemma, but feel using personal vehicles should be the exception and not the rule.
Other examples include supporting Mrs A to make phone calls. I will encourage her to make the phone call herself with prompting and guidance, but the other agency will make the call themselves on her behalf. Similarly, when offering support to prepare meals, I actively encourage her to take part in the process, whereas the other provider will often make a meal for her and even deliver it to her in bed!
Lack of support time
The issue has been raised a couple of times during multidisciplinary review meetings with restricted support times being identified as the underlying reason for lack of a recovery-focused approach. It must also be said that the relationship between the two agencies is actually very good with lots of communication, but it’s the promotion of recovery which I’m keen to improve.
I’m certain that the vast majority of care and support that is delivered by employees employed across the care sector is done so by dedicated people with the best of intentions to a very high standard.
However, I also believe that until recovery and enablement theories are embedded within organisational culture and individual practice, then we’re unwittingly doing a disservice to the service user.
Dan Mushens is a social care worker based in Glasgow