The Secret Social Worker: 'It feels relentless and the gaps are just too big for us to fill'
Illustration by Tracy Worrall
6 min read
A mental health social worker takes us through a typical day in the job, from disappointing patients to dealing with abuse and threats
I am a newly qualified social worker working in an NHS community mental health team in a big city. The role of ‘mental health social worker’ is a relatively new invention. When we hear ‘social worker’, we often think of children’s social services and their statutory interventions, but I work with adults with mental health diagnoses, providing support in their day-to-day lives. If that sounds vague, that’s because it is.
My job was created to tackle the widely reported mental health crisis in the UK without having to recruit expensive psychiatrists. I struggle to define what I do, but this affords me some creativity to help people in whatever way I think best.
8.45am
First, I swing by a patient’s property en route to the office to see if I can make contact. She was referred to the team by her GP several weeks ago and assigned to me for an initial assessment of need. She has not been answering the phone, so I’m visiting unannounced.
With no answer at the door, curtains drawn and no signs of habitation, I’ll have to report back that there are concerns. In this instance, if nobody hears from her, the next step could be a Mental Health Act assessment, for which entry can be forced.
9.30am
We have a multi-disciplinary team meeting in which colleagues present cases for discussion. We hear about some distressing situations, where people are really struggling mentally. Often, they are affected by poverty, uncertain immigration status, cramped or mouldy council housing, discrimination, or family relationship difficulties. The team – made up of psychiatrists, nurses, psychologists, occupational therapists, social workers and peer support workers – try to decide on “an appropriate treatment pathway” in each instance.
11am
I meet with a patient on my caseload for a general welfare check. I have to notify him that he is not eligible to start psychology sessions because he is drinking heavily and smoking cannabis, which disappoints him. Sometimes the thresholds seem arbitrarily harsh, but I suppose they have to draw the line somewhere.
One patient’s family member calls me a “useless, stupid girl” on a weekly basis
11.30am
I attend a ward round in hospital for a patient who is under section. While doctors are hoping to discharge her soon, as her mental state has stabilised, we still don’t know what kind of support will be provided in the community to prevent relapse. I have applied for a Care Act assessment to be carried out, but there is a backlog.
Her next of kin attend and use the opportunity to hurl abuse at doctors and nurses for perceived poor care, for example losing items of her clothing in the laundry. I am always in awe of the level-headed serenity of mental health ward staff who take countless stressful encounters in their stride.
One patient’s family member calls me a “useless, stupid girl” on a weekly basis. As I’m new to this world, the verbal abuse still stings. I’m hoping I’ll get used to it soon. That’s more challenging when it comes to threats, of course – like the time a patient told me she would return with a weapon to smash my face in because I couldn’t give her a shopping voucher.
12.30pm
Next is office admin. On behalf of one of my patients, I am applying to a local charity for a grant to cover the purchase of a new fridge, as hers has broken down. I’m also renewing a different patient’s freedom pass, while researching local singing teachers for another who has expressed an interest in trying out new hobbies. And I’m chasing clozapine labs (an antipsychotic drug) for blood test results too. The recording of notes seems endless: every time contact is made, even a two-minute phone call, it must be logged.
There are rewarding moments, but I can’t honestly say I have not had doubts about my decision to do this job
2pm
One of my patients visits the centre because he’s having a hard day and needs to talk. He has forgotten to leave his dog at home, and we have a strict no-dogs policy, so we talk outside. He just needs a chance to vent some of his frustrations with life, and looks less burdened when he has finished. No concrete outcome achieved here, but it highlights the value of a listening ear.
3pm
Time for a home visit for a welfare check. This patient becomes much lower in mood when the weather is grey, and today it has been rainy and overcast, so I’m saddened but not surprised to find she is tearful and overwhelmed. We sort through some of her bills and pay her rent over the phone. She can’t face emptying the cat’s litter tray – luckily, I’m not squeamish, so I do it for her. Despite the drizzle, I stress the importance of some fresh air, and she agrees to get dressed and walk around the block with me.
4pm
I head to the police station for a meeting with a patient who reported an assault some time ago. Officers say an arrest is imminent. This is such positive news for my patient to hear, although I am aware of the importance of managing expectations as we move to the next stage of the investigation – if a prosecution is not secured, my patient’s mental health is likely to deteriorate again. I am learning that a sense of victory does not last long in this job: good news is swiftly followed by bad, and progress is not linear.
Illustration by Tracy Worrall
5pm
It should be time to switch off, but the mandatory note-taking is on my mind. To make sure the details are accurate, I log on at home to write up all the interactions I had today on the database. I won’t have the time to work on my caseload tomorrow because I will be ‘on duty’, meaning I will be answering the phones and handling walk-in patients all day.
This is just a glimpse into what I do. There are rewarding moments, but I can’t honestly say I have not had doubts about my decision to do this job. It feels relentless and the gaps in provision are just too big for us to fill. Basic resources aren’t good enough either. Just one example: we’re supposed to have lone worker devices (safety alarms) for home visits but they’re old and broken, so nobody uses them.
The work I do offers insights into the strain that the NHS is under, and into the human condition. Sometimes people think the NHS can work magic and “cure” mental health problems, but it is never quite that straightforward. Often, what they are asking for doesn’t exist, or waiting lists are years long. I’m usually just there to be the messenger – and hope they don’t shoot me!
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