My ten years as a social worker

Like many people I didn’t have a career focus during my twenties and found myself stuck in a job that I didn’t enjoy. With my thirtieth birthday fast approaching, I decided it was time to do something that I believed in and felt worthwhile and took the plunge by getting a job with Leonard Cheshire disability charity. Despite the pay cut it turned out to be a life changing career move for me. The role was partly administration, but I soon discovered that I much preferred (and was much better at) the relationship aspect of work. Keen to develop upon this, I then moved to a job as an employment support worker assisting people with disabilities or mental health problems to find or retain employment. Around this time I undertook the COSCA counselling skills certificate which was my first introduction  to Carl Rogers and the person centred approach. These theories, skills and values have formed the foundation of my professional practice. I was keen to learn more and managed to get a place funded through City of Edinburgh Council on the RGU distance learning BA hons, which allowed me to study whilst working. Whilst this was a busy period which often meant studying in the evenings and weekends, it was a rewarding experience which has led to other interesting opportunities. Ten years working as a social worker have flown by and whilst the job can sometimes be stressful and challenging, it is never dull and I feel fortunate to have a job that I enjoy.  

My first social worker role was with the Alcohol Referral Team, a peripatetic/officeless team providing social work assessment for people with alcohol problems, predominantly by linking them into community based services. Through this role I became increasingly aware that substance use alongside impairment (often as a consequence of long term substance use) could be a barrier to accessing support.  Many services assumed that missed appointments were due to lack of motivation or poor decision making.  It was this recognition alongside research and findings such as the Mental Welfare Commission “investigation surrounding the care and treatment of Mr H” which sparked my interest in my next role, providing social work for people with alcohol related brain damage (ARBD). This was a new initiative which was initially based across the acute hospitals in Edinburgh and Lothian to assist the discharge planning for people with ARBD. The aim was to facilitate discharge from hospital and to improve outcomes as it was recognised that people with ARBD often had lengthy and repeated admissions. Whilst my experience of working in a multidisciplinary approach has undoubtedly shown that it can provide the most effective interventions, within hospitals it can often be challenging. As a social worker you can sometimes feel that your worth is based upon your ability to magic up resources to facilitate discharge.    

ARBD is synonymous with fluctuating capacity which becomes even more difficult to assess if the person returns to alcohol use. Trying to promote choice and facilitate empowerment, whilst ensuring there are safeguards to protect those who lose the capacity to do so themselves is rarely straight forward. Hospitals are not set up to facilitate long term rehabilitation and there is a huge pressure on resources - mainly beds. In Edinburgh we have been lucky to have a unique initiative - Milestone House Alcohol Related Brain Damage step down unit. This is run by Penumbra in partnership with a multidisciplinary team providing in-reach from NHS Lothian, and City of Edinburgh Council. It provides 10 beds which reduce the pressure on the acute hospital beds and an environment which supports rehabilitation and recovery.  The resource has produced significant savings and much better outcomes for people with ARBD – a win win situation. I provided in-reach social work to the unit from its inception until last year and therefore witnessed the significant impact it had upon the people’s lives.  For example, “Bruce” had twenty five presentations to hospital in the space of six months. This included severe ammonia burns from lying in urine. In addition to concerns about his personal care he also struggled to maintain his accommodation which despite several cleans had returned to an unsanitary state.  Bruce was a well educated man and presented as articulate and intelligent. He would not accept any visiting support and there were increasing concerns about his situation. The multidisciplinary team at the ARBD step down were able to provide a specialist assessment which looked at the extent of his cognitive impairment and the impact upon his ability to manage risk. The conclusion was that he lacked the capacity to make decisions regarding his welfare. A local authority guardianship application resulted in interim powers to decide what support he would receive with the workers allowed access to his house if required. Bruce was initially angry about what he perceived to be an intrusion to his privacy. He was linked into an advocacy service that supported his attendances to the Sheriff Court hearings where he made his displeasure clear. Bruce’s relationship with the support workers improved over time, as did his situation, to the extent that he accepted support on a voluntary basis. The powers were no longer required so the guardianship application was withdrawn. Bruce has now been abstinent from alcohol for over 18 months with no hospital admissions. He continues to manage to live independently and advises that he’s now thankful for the input from the unit.  

I am currently seconded to City of Edinburgh’s pilot project family group decision making for Adults. The model which originates from New Zealand and is grounded in the Maori culture brings together key people from a person’s network (not necessarily biological family) to make decisions and plans. Family Group Decision making has been used within City of Edinburgh Council for the past 15 years within Children and Families where there are child welfare concerns. The new project seeks to build on this success by its use for adults.  It can be used in a variety of situations such as: reducing carers stress, supporting recovery from substance use, supporting recovery from mental health problems,  preventing homelessness, reducing isolation, for people with learning disabilities etc. The model is based upon the principle that adults and their networks have the ability to make rational and sound plans about their future. The process of a network coming together, listening to each other, agreeing a goal, and making these plans can serve to reduce shame and promote social connections.

For example, I recently facilitated a family meeting for “Carol”. Carol has long term problems with alcohol use which was having a severe impact on her health, mobility and ability to look after herself, her money and maintain her accommodation. She’d had a lot of professional input but had been unable to sustain abstinence from alcohol. Family Group Decision Making became involved prior to her admission to hospital for her sixth planned detox.  This was the first time that her family had been involved in planning.  During the preparation for the family meeting her adult children were able to vent feelings of anger, frustration and helplessness about their mother’s self destructive behaviour. The meeting itself was the first time that the family had come together as a group in years and whilst emotions were high the family were able to abide by the rules of meetings (future focused, blame free and person centred). A key feature of the model is that the family are given private family time to produce a plan. During Carol’s meeting Carol and her family came up with a plan which focused upon her role within the family as a mother and grandmother . This included doing normal family activities – having meals together, spending time with grandchildren, attending exercise classes with her daughter -   all of which contributed to her sense of purpose, identity and role within the family. I found the meeting very moving as there was so much love and understanding within the group, even when discussing the risk of relapse, and the potentially dire consequences.  It was very different to the meetings that I would organise in my previous roles as a social worker and clearly had a big impact on Carol and her family.

Two months on Carol remains alcohol free and connected to her family who are delighted to have their mother/grandmother back.  Carol is still supported by her social worker in the short term  to access community based services and to address housing issues, but she is now independent and no longer needs the package of care which had been requested prior to her admission. Whilst there were clearly a lot of other factors involved, not least the importance of timing, it has served as a great reminder to me as the significance of an asset based approach. It was Carol and her family who knew what would work and their ownership of the plan appears to have been the key factor in its success. 

In addition to my role as a coordinator I am also a satellite mental Health office (MHO) which means that I am regularly on the duty rota and also take on longer term MHO work. I’m really interested in the challenge of trying to promote the psychosocial perspective within a domain which appears heavily dominated by medical and legal perspectives. I also have an interest in the recent Scottish Government moves towards the increased use of supported decision making within the context of Mental Health and incapacity and how this will be achieved.   

I have recently joined the SASW committee. I’m encouraged by the wealth of experience within the committee and looking forward to hearing the different perspectives and contributing towards debate about practices, policies and legislation.