On trying to do therapy when your patient has no food or money

Last week, I called someone I was due to see that afternoon to remind them I was coming round (standard practice in learning disability, and good practice in general). ‘How are you?’, I asked. ‘A bit pissed off’, they said. ‘I’ve got no money and no food’. I couldn’t get much more information by phone, but assured them that I’d be over shortly and that we’d sort something out.  In the meantime, I had a chat with this person’s care co-ordinator (one of the benefits of working in an open-plan office with your colleagues) and we made a referral to Social Services because this person didn’t have a Social Worker. In fact, this person has little support, despite needing quite a lot, because when they moved area they didn’t know how to get that support moved with them. As a result, there is a constellation of difficulties: mental health, physical health, financial. I took the referral for a distinct mental health problem and am probably the professional they know the best. I seem to have become a demi-care co-ordinator, telling the actual care co-ordinator what the problems are. Which is fine – I’m happy to do it, but it makes me furious that I am the best option this person has, because it’s not my area of expertise. I don’t know about district nurses or benefits. But at previous appointments, this person has been worried by ATOS assessments. There is no way this person could work, but ATOS sent a letter with an appointment for an assessment. This person forgot to go and was terrified their benefits would be cut. I dealt with that, and it seems to be fine for the moment, but suddenly this person had no food.

So off I went to see them. This person and their partner had had their benefits cut. They had no money. Their phones had been cut because they couldn’t buy credit. They had no food and no benefits were due for five days. They already owed the local shop for food and the owner would give them no more credit. They had no friends nearby and no family who could help (not that they could contact them anyway). I offered to call their friends/family when I got back to the office to see what I could do, but there seemed to be little else I could offer. Then Social Services called and the person I was seeing asked me to talk to them. I explained the situation and tried to see what we could work out. They could apply for a crisis loan, but had to do so by telephone or online (as if that was an option). No social worker would be allocated until Monday and they apparently couldn’t help with money problems or filling out forms (as an aside, in one of my previous jobs, I was told that social workers couldn’t help with housing any more. How, exactly, does this help the people we work with, most of whom have money or housing worries and lots of whom can’t manage forms without support?). I got, I confess, a bit shirty with the social worker. I think social workers do a really hard job, and I would never want to be one, but I get so FRUSTRATED at the way the system seems to have been designed by some Kafkaesque entity which declares that the more help you need, the harder it must be made for you to be able to access it. In the end I agreed to make some calls when I got back to the office and we tried to do so some psychology (you know, my actual job). It was ridiculous, of course. If basic needs haven’t been met, what the hell is a bit of therapy going to do? Nothing. Not a jot. But it was our last session and we had to tie up some loose ends. So we tried. And I felt stupid trying. And all I could think was ‘if only I could give them a tenner’. But I couldn’t, for lots of reasons, which even now I find hard to justify to myself. And I hated myself for it.

So I left, promising they would get a phone call as soon as possible. I got to the office and phoned the Council Food Bank department. I requested a voucher and persuaded them to give extra food for another adult who happened to live at the same property (which they don’t usually do). I spoke to a delightful person who was very accommodating and who didn’t make me beg (though I was more than prepared to beg, shout or emotionally blackmail) and I then called my patient back and told them to get to the Town Hall before five to pick it up. Even so, all the food banks were closed (they only seem to open in the mornings) so they may have been unable to get food until the next day. The only option would have been the Salvation Army or similar, but, again, I don’t know enough about the services available to be much use.

This makes me furious. This person has a learning disability and a mental health problem. They are vulnerable. They find it hard to access services. They cannot fight without help. To them, the system seems impenetrable. If neither I nor my colleagues had been there when Social Services called, who would have dealt with it? Who would have called the Council? Would they have slowly starved over the next five days, a little like this gentleman, who died as a result of ATOS and their ghastly assessments?

In my line of work, we see people who need help in all sorts of areas. People with mental health problems are more likely to have a whole raft of other issues, such as poor physical health and social isolation. They are less likely to be able to work; more likely to be dependent on the decency of the State. Unfortunately, the State does not treat these people with much in the way of decency. The Bedroom Tax, the cuts in Housing Benefit, the scum at ATOS; all of these are making life Hell for vulnerable people. Half a million going to food banks! In Britain! It’s a a national disgrace. And somehow we’re expected to treat depression or panic attacks or help people with the voices they hear. How? If you’re cold and hungry, panic attacks become rather less of a problem in comparison.  But the dilemma is this: we can say such people are not ready for therapy and reject the referral, or we can accept it knowing that we can’t do much about the mental health element but that we can do something about the other stuff they’re having to manage. And, actually, that shouldn’t be the choice.  There needs to be a decent system of support that can help with housing and money and forms.  But until there is, people like me, who are a bit crap at that kind of stuff, actually, because we only have the faintest notion of what it’s all about, are the best option. And that is also a disgrace.


    1. As a fellow psychologist who has been shouting from the rooftops about the ridiculousness of therapy in this toxic environment for the last 10 years it is so refreshing to know that there are so many others trying to tell our “leaders” that their policies don’t work, can’t work. For example at the current levels of success IAPT will take 60 years to clear the immediate backlog of people with psychological difficulty. the answer doesn’t lie in therapy but in changes to our priorities!

      It is time we started saving people not money!

  1. Agree, agree, agree, and agree. As an aside I have, as a CPN, on more than one occasion dipped into my own pocket to buy food for people I work with (though I completely understand why you couldn’t).
    It IS a national disgrace.

  2. I work as a support worker, the sort of service that would really help your client, and we get incredibly frustrated that we don’t get people referred to us when we can do a lot to help.

    1. That’s the immensely frustrating thing. I know these services exist, but I don’t know where or how to refer to them. This is one of the problems with being a trainee who only spends six months at each job. I have to refer to one agency so they can do an assessment and refer to another. How much easier it would be if I could just do it myself.

  3. The people who are really to blame for all this are the lazy scum (and yes, they do exist in large numbers) who have made all the cutbacks necessary in the first place. It’s obvious SOMETHING had to be done, surely? Maybe there’s a better way of getting help to the ones who genuinely need it, but nowhere do you come up with any better ideas, which is a shame. Perhaps half these “agencies” should be wound up, then those in need could just follow the redundant council workers, who WILL know where to go to get help.

    1. I disagree. The reason the cuts are in place are because some people got rich using some very questionable methods and destroyed our economy. In addition, lots of people avoid paying tax (or have had their tax bills ‘waived’). There are some who abuse the welfare system, but far more abuse the tax system.

      If I had my way? More social workers. Give them back the jobs they used to have (such as dealing with housing). Get rid of ATOS; allow clinicians to make recommendations about who is and is not fit for work. Allocate a support worker for anyone flagged up as needing it. Allow people to access services during the evenings and at weekends (which is when most crises occur). Bigger mental health teams; our caseloads are rising exponentially but we are crumbling under the strain. More training for people like me so we have some diea of what to do in situations such as this. Better information sharing between agencies. It wouldn’t fix all the problems, but it would be a start.

    2. The numbers of people ‘falsely’ claiming benefits is miniscule, and far lower than those who don’t actually claim everything they are entitled to (for various reasons). Most of this country’s ‘benefits’ bill goes on pensions, yet you never find people arguing that pensioners should get less. It’s attitudes like yours that have lead to the increase in hate crimes and enabled successive Governments to systematically dismantle the welfare state.

    3. In 2006 I was quite ill and thought I could keep my business going. I failed and went bust. Homeless and unwell I met a huge number of people in similar situations and did not meet one who was playing the system. I’m sure there are fraudulaent claims because a small percentage of people in all walks of life and all situations are dishonest but, when your life is on the line, all one craves is the stability of normal life. Without a welfare state I would be dead and without the support I continue to receive I would be unable to work. Calling people scum when they already have a great many issues to deal with is hardly going to encourage them to become more productive.

  4. More social workers? To train the ones we’ve got, and to train you, and to all become better and better at helping each other? We don’t want a welfare state like we have today, which has basically become an end in itself. Without an army of social workers to call on, people would help themselves, and help each other when in need like they used to, instead of passing the responsibility away from families and onto the state, which means you and people like you.

    You don’t do it to help, out of the goodness of your heart; you do it for pay. It’s your chosen career path, and a well paid one too. Better paid than a bus driver, I think, although I suspect of much less use to the community. Could people manage if you retrained as a bus driver? I’m sorry to have to tell you this, but yes, they could, and we’d all be better off, except for you, financially of course, and possibly those who boarded your bus while you were busy organising trains, taxis and aircraft for people who don’t use buses. Believe it or not, just because someone doesn’t agree with you doesn’t make them wrong. You’re obviously not mixing with people outside your circle, which is most definitely closed.

    1. Get a grip man. You might not want the welfare state we have today, but I’m sure your opinions would be different if you’d ever needed it. Anyone with an ounce of compassion or empathy in their heart will disagree with you.
      The welfare state *today* is pretty awful. A few years ago, it wasn’t so bad. In a few years, it may well be worse. Sure, it might not be perfect, but if you think the solution is to tear it down and then *maybe* rebuild it again in an undetermined number of years when the economy is *maybe* looking a little healthier, then you’re downright wrong. How can you happily sit there and support the dismantling of a system aimed to help people in need? Because one person in a hundred misuses the system? Yes, I agree those people shouldn’t do that, and we should avoid that happening if possible, but would you pour all the soup away just because one person sneaked themselves two helpings?

    2. Your argument about uselessness of social workers is pretty much negated by the death of Mark Wood. There was nobody to help him and to keep an eye on him. Yes, we should all be living close to our families, have reliable neighbours and dependable friends popping in and out each other’s houses at all times. However, it’s just wishful thinking. If Mark Wood had a social worker or a CPN who saw him regularly, he probably would be alive today.

      I am sure you are not suggesting that physical health is in some way more important than mental one. So, if we do away with psychologists, we should get rid of all doctors. After all, they are paid for what they do, too. Surely, we could all learn what herbs to take and cure ourselves. Setting bones cannot be that hard either, eh?

      It is wrong to express an opinion about something you never experienced and have no idea about. Just because you haven’t needed a social worker yet, doesn’t mean it will always be the case. I don’t have a car – should all petrol stations be closed because I have no need for them? Rubbishing someone’s job is also out of place. As is trying to make them feel guilty about getting paid for it. I so hope you delete your comment.

    3. what do you mean by “not mixing outside her circle”? you mean those with no heart and tory leanings? those who will see people commit suicide or die on the roadside and not help. just walk by on the other side. you mean those who dont care about others, only themselves and their bank accounts. this lady is worth a hundred times more than any of those types. more than that even.she has a heart, she cares. and THAT is what is wrong with this country. too many people like you who only care about themselves. your time will come.you will need help one day. and it wont be there because people like you have got rid of it.good luck on that one….

  5. A very good piece Masuma. I hope you don’t find the work too frustrating because without people like you staffing the safety nets there would be a great many more casualties.

  6. Thanks Masuma for talking about this. I have mental disability. And it is SO hard, to engage anybody in ANY conversation about the realities of life with mental disability. Practically everyone has nothing to say, and doesn’t want to hear. There is so much stigma and unhelpful talk around bpd, for example, that it took me 3 years to find out it is something you can actually recover from. That information was buried deep under all the negative stuff out there. Which, you have to wade through. When all the opinion is moved to aside, there are individuals and groups of people with mental illness, working away every day of their life doing everything they can, to understand and recover from mental illness. So they can eventually have some kind of life. Quite why we aren’t taught mindfulness/emotions/relationships/welbeing…. concepts such as boundaries, key psychological phenomena like projection…. at school from a young age… I don’t know? Also… need to mention voluntary work. The concept of employment needs broadening. New types of contracts/ arrangements where people can contribute how they safely can…. is the key. i.e…. if you wake and feel well, come in, do this. As soon as you feel unwell… fine to go. People want to contribute to society. It’s where a basic sense of self esteem and feel good feelings come from. Similar to all benefits or none, it is often full employment or none. The spectrum needs expanding, definitions of work need expanding. We need to talk about… what CAN you do…. is there any way you might be able to do anything at all. Ten minutes. Somebody with a really serious disability might be able to sit and concentrate long enough for ten minutes, once a week. And serve 1 customer at a supermarket. The reality is, that companies are nearly always profit driven. Do they care about disabled people contributing how they can, as soon as it means they would have to supervise and train them and have more costs? And support them to grow in confidence and through difficult scenarios? If a company puts their hand up, i’m the first in the queue. The reality is…. when someone with mental illness is up against someone without… everything else equal… who’s going to get the job? I mean really. And it’s the same across everything in life. The reject crop. And when you consider that mental illness is often created and exacerbated by OTHER PEOPLE bullying/hurting/abusing/mistreating someone… the whole thing is dire. This barely scratches the surface. I’ll tell you what life is like with mental illness and claiming benefits…. painful. And anyone who says otherwise, most probably, has no idea!

  7. asboltonndy Bolton, any chance of you putting down the copy of the daily hatemail for long enough to form some opinions based on facts? The, “army of social workers” you allude to are needed because of the so called,”care in the community” policy that left the type of person referred to in the original post to largely fend for themselves because it was expected to be cheaper (letting them drop dead from starvation must save a packet.) It is my opinion that you are a rather obvious and ill-educated example of a large group of, “I’m alright Jack.” members of our community who want to ensure that little or no care is offered.

  8. kinda strange really how the government promote ads for mental health with one hand and then make people with these issues fund the ads with the other, need i say more !

  9. asboltonndy Bolton, I’m not normally a nasty person but people who say things / jobs are not needed in the community today like you did above,….well i hope one day very soon you will need a job ,NHS, benefits, social workers, therapy,. psychological help, district nurses, or housing advice, through no fault of your own.food banks, and money you’ve been deprived of by sanctions etc. that you suffer the stress millions are suffering right now, homeless, destitute etc. because frankly you deserve it. they dont.

  10. now im wondering if we should all email every article like this to MPs at the top, if they get a constant daily barrage from their population then i wonder if a bit more notice would be taken, after all it takes time and money for someone to go through and check and delete these emails

  11. “This makes me furious. This person has a learning disability and a mental health problem. They are vulnerable. They find it hard to access services. They cannot fight without help. To them, the system seems impenetrable.” Hello hello hello. I’m Clare. I’ve commented here and on your posts on Facebook. And…. i’m getting frustrated. Because you have not even acknowledged me. Yet have found the time to update your daily happenings to the world. And make sarcastic jokes about earning money from talking about other people’s suffering. Do you think we cannot speak? do you think we cannot write? Do you think we cannot communicate the frustration you speak of? We speak. We speak all the time. The reality, is people don’t acknowledge us on a personal level, outside neat boundaries, professional roles and office hours. I’ll tell you what makes me furious… having mental illness, trying to connect, and not even being acknowledged. That same person bragging about success and hits on social media saying they are helping us because we cannot represent ourselves. You are wrong. So wrong. I hear no words of your own raw pain. You speak of frustration. Have you ever been homeless? All of you people reading this. Why don’t you leave your computers and go and actually ask somebody with mental illness how they are. Ask them about their life. Listen to their words. You won’t find them joking about being given a pound for every person they share information with. Ask them about loneliness. About fear. About what they dream about at night. Invite them out. Be there for them when they desperately need somebody. Anybody. Ask them about their dreams. Just… anything. Apart from sitting at a computer, Clicking buttons patting someone on the back for writing a few paragraphs. About other people. Particularly when that person won’t even click a few buttons back for any sort of reply. This isn’t care. This is cliquey. Like another party which we haven’t been invited to. My comment was ignored further up. Whilst nearly everyone comments on a short, negative comment near the beginning. Understand, we have no problem speaking. It’s being ignored, that is the problem. And it happened even right here. As a small realistic insight… the Samaritans wouldn’t have been an option. They give you a dirty rag and tell you to sleep outside. How do I know that? personal experience. Who cares? Nobody.

    1. Clare, don’t feel too angry – as well as having a number of physical ailments I have also suffered from short-cycle bi-polar disorder for many years. Many people might not feel it necessary to mention their own mental health issues when commenting on blogs. But as 1 in 3 people have mental health problems at some time in their lives it’s certain that you are not the only person commenting here who has experienced those problems. So take heart that you are not alone and that some of us will know what it feels like.

    2. Claire. i have commented twice above. no one commented on my comment either, but i did not expect it. i commented to get my feelings out on this subject. if someone wished to answer they would have done so. i do not have mental illnesses ,though i do get down, frustrated etc. mostly because im now getting old, have a load of medical conditions, mostly physical disabilities. i also get angry. its natural to do so. i can feel your pain, your frustrations etc to some extent but will never know exactly how it makes you in particular feel. no matter how much you try to explain it we who dont have these problems, can only listen, and feel so much. you have to have these things to fully understand what its like to live with them/ same as physical conditions that are lifelong.they too bring their own feelings of sadness, anger, why me, bad days, down days, good days ,up days. painful days, emotional times. you are not alone in not being answered love.

  12. What a brilliant article. Just shows its not easy and the system only makes things harder. Many people think if you have a certain disability you sitting on a pot of gold! Hardly and the piddly amount that is received goes towards the difficulty the person experience on a daily basis. In fact we would rather not have the money and have the person miracuously be recovered of their disability. I hope people read this and open their minds realising the difficulties. I also wish the different boroughs and cities would speak to one another so when the person has to move the new area are informed. There are too many gaps /holes creating the whole system to near failure. Thanks for sharing and understanding life as it really is.

  13. This blog is four years old but very relevant today. I am dealing with a vulnerable family member who has just been abandoned by social services for not being helped by the extremely limited services they offered (run by agencies that I am sorry, in my opinion, just wanted the money and didn’t give the care they were supposed to). I alerted Social Services that there were vulnerability concerns, that his situation was getting worse. Asked if he could be referred to a vulnerable adult department. All totally ignored. In fact his case was totally closed down. I was told I/he could still email the person who was handling the case – all attempts to do so were ignored. Now he is in a abusive relationship, with no money and desperate. So I, with no expertise, with my own problems (which mean I have to be extremely careful to not cause more stress for him) am going to try and help him and I don’t really know what is the more helpful response. As said, I have no expertise. But there is simply no one else.

    Frankly I don’t know how ‘social work’ can still bear the name. The young man concerned has seen a private counseller, who told him some rather odd things, then tried to put up the fees to £200 a hour (for a student lol, quite ridiculous).

    This for someone who gets easily overwhelmed, can’t deal with people very well, abused through the education system but who still keeps on trying to make a life for himself.

    One thing I have learned, therapy means little, social services means less in today’s society.

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