By Daniel Smith
One of the main reasons I chose to be a social worker was a desire to improve care for people with mental health problems. But if there was one thing I worried about before starting the Think Ahead training programme, it was completing paperwork – I never wanted to do a desk job!
At the minute, I’m learning on the job in a medium secure in-patient psychiatric unit. It’s quite an unusual placement and it means spending less time with service users in comparison to other participants on the programme, who work in community mental health teams.
There is also quite a lot of paperwork in my role. I write reports for tribunals, I process benefits claims, and I conduct assessments with people who want to visit the units. If I’d known this was going to be the case before I started, it probably would have put me off applying to be a social worker as there’s nothing worse than carrying out bureaucratic tasks when you could be out there helping people.
But my attitude towards paperwork and how I approach it has recently changed – thanks to one particular service user, who made me realise what a difference it can make to a person’s life.
Feeling at ease
One week, I was tasked with writing a social circumstances report ahead of a tribunal for a service user with a complex dual diagnosis. The individual had been in a secure unit for around a decade and staff were considering whether they should be moved to a lower security unit.
The report needed to include a lot of information – a summary of the individual’s forensic history and the circumstances that led to them being detained, as well as their personal background. It also needed to make recommendations on what should happen next.
During the writing process, I spent time with the service user and carried out an interview. Other social workers have found it hard to establish a connection with this individual in the past as they can find it difficult to speak to new people.
I focused my questions around how they felt being placed in the unit and what they would like to happen in the future. I thought it was really important to make them feel like they had the right to say whatever they thought and to speak freely.
To my delight, the interview process really helped me to build up a rapport and allowed the service user to open up to me a little. We were then able to work together to identify goals for a better quality of life, working towards discharge.
They also explained that they would really like to reconnect with their family, and others.
Getting a call back
A few days later, I got a phone call from a senior social worker on the ward saying that the service user had asked to continue working with me to identify people who could visit them. We have since identified several people, and we’re working towards arranging visits, setting out realistic but ambitious goals – this feels really positive!
When I’d initially been assigned to the case I thought, “oh, that’s another bit of paperwork to complete”. However, realising how this piece of paper in front of me was positively changing the life of the service user made me think again. By adjusting my approach and focusing on the outcomes, that bit of paperwork had allowed us to have a really meaningful conversation.
Although I don’t yet know the outcome of the tribunal, I do know that it was a really critical moment for the service user – it brought out things they had never said before, and it identified a new pathway towards their discharge. It also led towards the service user deciding that they would like to engage with therapy to help better manage their emotions and develop coping strategies.
And, on a personal level, it made me realise how meaningful reports, and paperwork in general, could be and had been in this scenario – sometimes you have to do a bit of paperwork to give someone freedom!
Considering social perspectives
However arduous, I now see how paperwork enables me to make a real difference to the people I work with.
As well as allowing me and the multi-disciplinary team I work with to provide good person-centred care, ensuring service users have a good quality of life and giving them more autonomy, paperwork helps me to identify what social determinants and structures might have contributed to the person becoming unwell and being detained.
Paperwork often helps me to highlight the social issues that contribute to someone’s mental health problems, so I am able to get my multi-disciplinary colleagues to consider social perspectives and the person’s wider situation, rather than just their diagnosis – this has made a real difference to people’s care, and to the care plans we’ve developed.
Daniel Smith is a Think Ahead participant working in a medium secure in-patient psychiatric unit. The author’s name and details about the service user mentioned in the account have been changed to protect their identities.