This Week in Mentalists (84)

Morning everyone. Time for This Week in Mentalists.

Fighting Monsters discusses the requirement to juggle needs with resources.

Although there is no doubt in my mind that we (and by that I am referring to those working in Adult Social Care) would love to provide all the necessary services to all the people who might benefit even in the slightest, the resources just do not exist.

This is where you see the social worker as gatekeeper role which was envisaged in the NHS and Community Care Act. It is an adjustment of the mind to move from the promotion and advocacy role that is presented in training to the gatekeeper role and keeper of resources that has morphed into care management in some senses. Of course decisions about funding rarely lie with social workers and are taken way up the management line, it is still a mindset that is encouraged when assessing – what is this person entitled to? What criteria do they meet? Rather than what could possibly be provided to add quality to their lives.

I remain a bit of a fanciful dreamer, even after almost 10 years of practice and I know money and resources are limited so we cannot possibly give everyone what they want but there has to be a balance somewhere.

My only hope is that the personalisation agenda will move things on somewhat and that individualised budgets will prove to be as wonderful as the literature makes them sound.

Becoming Hannah is taking a blogging hiatus.

Marine Snow is back from hiatus, and is going on a date. This causes some emotional fallout.

Of course what doesn’t help is having to ride out this constant emotional barrage, and without the aid of an eating disorder to quash it. Don’t get me wrong, it is by far better to feel like this than to not, but impulse is strong and learnt for a long time, to beat away emotion when it surfaces. Numerous times of late I’ve come to put an arm on ED’s shoulder to support myself, and realised I don’t need to. It leaves me slightly confused for a moment, as if there is something totally alien about my life now. For example, how does a normal person prepare for a date? For me, any upcoming social engagement would be fuel to the fire of restriction. All excitement lost in the battle to be thinner, and lighter for the occasion. To starve myself beautiful and worthy. Oscillating between triumph at a lost pound, and grief over pounds yet to lose until I am “ready”. But now it strikes me that to be thinner for this occasion would be ridiculous, and unnecessary, when he wants to meet me, not me and ED. For this meeting, being well is a benefit, because it might lead to new paths. Sharing a part of me that I am only just beginning to know myself. Feeling these amazing feelings is frightening.

The Wife of a Schizophrenic is attending counselling.

I have an appointment with the counsellor again on Friday and I’m absolutely dreading it. I don’t want to go because I’m still so upset by the things she said last time. I don’t trust her anymore. She made assumptions about me without even giving me the chance to speak. I expect she thinks I’m trying to blame all my problems on the way Mr Man was treated in hospital in 2002, which I’m not, but she wouldn’t know that because she didn’t let me explain. It certainly was a major contributor to the anxiety that I was already suffering, but as you readers and other carers will understand, struggling to keep Mr Man safe was traumatic enough. They can’t comprehend that. Despite all their training and qualifications, none of them truly know what it’s like to try to keep the person you love safe, when they are genuinely suicidal for so many months, or even years. None of them know how hard it is to watch the person you love give up on life and lay in bed in their own urine, refusing to get up, refusing to eat and refusing to drink. None of them know what it’s like when the person you love is persecuted every day by frightening hallucinations and there is nothing you can do to protect them from their own mind. And none of them know how it feels to place the person you love into the care of others, only to realise that you have placed them in even more danger. None of them understand these things.

Andy at the Mental Health Nurse Lecturers Tea Party discusses suicide.

I was wondering though about how we as professionals really feel about suicide?

Personally, I do feel some uncertainty. I believe that somehow we need to sort out how we as a country are going to work with people who want to end their lives with dignity. There are large numbers of people who suffer from incurable illness and chronic physical and emotional pain who wish to have some control over when their lives will end. I don’t think that this should be left up to families to travel abroad (risking prosecution) with loved ones to assisted suicide clinics. I also think we would be better off if we didn’t have to rely on the likes of this ‘Euthanasia Doctor’ who recently visited the UK.

On the other hand, I spent many years working in in-patient mental health settings where I often cared for people who were considered at risk of suicide. Although we talk about the importance of ‘person centered care’ and working in collaboration with people – lets be blunt. This involved helping to detain people against their will. There was often (not always) a feeling that the person receiving the care was trying to outwit us. If they succeeded in doing so then a likely result would be the death of that person. Were we right to try and prevent this? – I believe that we were. Is this an ideal way to be treating people? – certainly not – does anyone have any better ideas?