Month: January 2016

On ‘secret diaries’

Secret diaries. The preserve of people who can’t tell you the truth, despite desperately wanting to. Sometimes they’re interesting because, if we’re honest, most of us are nosy and voyeuristic. Some are boring. I will never care what a financial analyst does all day (#sorrynotsorry). But the point of a secret diary is that it’s meant to reveal a mystery in some way. I am trying to think of one which was about someone in a mysterious profession but I can only think of ‘Girl with a one-track mind’ which is going to give you totally the wrong idea about me. Evidently I don’t read enough secret diaries.

BUT. The Guardian has a mental health series on at the moment, and it has featured a few secret-diary-expose-type-things. Yesterday (or maybe on Tuesday – I don’t know and it doesn’t really matter) there was this: ‘The secret clinical psychologist’s diary‘. I commented on Twitter (obvs) that I thought more could have been made of it. Now, I don’t know who wrote it, but I know someone wrote it. As I generally try not to be a douche (no, really, I try quite hard to be a non-douche) I am going to say why I thought more could have been made of it without being cruel.

I think psychologists do a lot. Really. I have been qualified a year and I do a LOT of work. That goes for every health worker I know. But to the outside world what we do is a mystery. Diaries like this are the way – anonymously – to explain it; to make people see that we do more than ‘talk to people’ and drink tea and hug it out. I don’t think the piece says enough about the consultation we do; the teaching; the supervision; the meetings; the paperwork; the demands of the clinical work. Only one clinical case is referred to. This might be because of confidentiality but I obviously don’t know. The final paragraph refers to inpatient work but no mention of this is made in the earlier part. Now obviously I don’t think this psychologist only saw one person in their working week, but the articles doesn’t make much mention of the sheer variety of the work. I am sure, also, that the time constraints are enormous and the pressures immense. In my view, it’s no bad thing to say that in the public domain. In fact, in the current climate, I think it’s essential. We are under siege but no one is listening. People in power think they can slash our resources without any impact on our wellbeing or the care we can provide our patients with. Well we can’t. Public sector staff are beyond stressed at the moment. The stats are freely-available. We need to publicise what we do so that the public at large gets a better understanding of it and of unsustainable it is.

You will see why I was frustrated, I hope.

I think it’s great when people want to do this stuff; I just don’t think we should be afraid of saying ‘we work damn hard in a job that can be difficult and stressful and exhausting and in which we see and hear appalling things’. Really, that’s all my frustration is: don’t play down what it is you do. We have a history of playing down what it is we do and I don’t think it benefits anyone.

I toyed with the idea of writing my own diary but there are issues. I can’t write it under my own name because I am easily Googleable and my patients might be traceable. I can’t write it anonymously because I have a very particular writing style and it would be patently obvious that it was my work. And I’m too lazy to make it up and invent patients (also I should be writing other things at this very moment in time so, you know, PRIORITIES.

So there we are. Sadly I can do nothing about the points I raise above but it’s really not for want of motivation. If you want to know the nuts and bolts of what I do, ask me. But, in case you’re interested in the more general stuff, here you go.

I work in an Older People’s Community Mental Health Team. Primarily I see people over the age of 75 but sometimes they’re younger. Many have dementia; some are low in mood or anxious. Some are in poor physical health; some are at risk of falling or vulnerable to abuse or exploitation. Most live at home but some are in residential care. I do some inpatient work, but that’s not the bulk of my clinical work. I have no consulting rooms so see everyone off-site. I cover an entire borough of London so I travel a lot.

I work with patients and their carers. Dementia can wreck entire families and often carers need support. They may be watching a loved one disappear before their very eyes and the strain is often enormous. Typically, I will try to help the person with dementia to manage their memory loss and I might also do some family therapy to think about the impact of dementia on relationships. Often I do assessments of challenging behaviour – not uncommon in dementia – and try to implement strategies to reduce the risk of harm to both the patient and their carers. Sometimes I talk to carers about the grief they are experiencing; about the difficulties of looking after someone who may no longer recognise them when they are still trying to maintain jobs and families and lives of their own.

Sometimes it is heartbreaking.

I use an eclectic therapeutic approach. Different approaches work for different people. I spend a day a week in a family therapy clinic and I am also training in family therapy. In addition to traditional therapy I also do neuropsychological assessments for dementia. These assessments can take up to eight hours to complete, plus time to score and write a report – possibly up to six pages of dense text. Sometimes I have the difficult task of telling someone they have dementia. I try to do this in the kindest way I can but it is never, ever easy.

A couple of times a month I am ‘on call’, which means I deal with all referrals to the team. I might have to deal with GPs or Social Services or do an emergency assessment. I am on the phone to Social Services a LOT. They all know my voice now. Sometimes patients or their families call because they are worried about something. Often, we can sort it out by telephone. Sometimes we spring into action immediately. Flexibility is the name of the game. It has to be.

Each day I have a team meeting to check how everyone’s diary is looking and to see if they are worried about any patients, or to see if they need a second person to accompany them on a visit. When you work in the community you need to make sure your colleagues are safe at all times, so there are multiple processes in place to make sure our whereabouts is logged.

On average, every week I will do two initial assessments with a colleague to see if the person has been referred to the team best able to help them. There is a lot of paperwork attached to these assessments, and more generally. Risk management is a big part of the job. In teams like mine, we see people who are often actively suicidal, or whose use of alcohol might place them or others at risk. Emergency meetings with Social Services are not infrequent. We will do whatever we can to keep people safe – we will arrange for smoke alarms to be fitted; for kitchens and bathrooms to be adapted so that people can stay at home for as long as possible.

I go to meetings. I have a weekly business meeting and referral meeting; I have regular supervision and I also supervise some of the work done by a couple of other people who are new to the team. This means that we have to prepare for all their clinical work, that we have to discuss it afterwards and that I have to go through all their reports with them. I enjoy it, and they are bright and keen to learn. I do some informal consultation with other members of the team if either of us needs some input around our clinical work. I am clinical lead for my team so I go to additional meetings to talk about non-clinical issues. Now and then I write reports to do with service development. If my colleagues are away I might visit their patients to make sure all is well.

I eat lunch at my desk, in a hurry, most days. Every day I take a book to work. Almost every day I end up discussing clinical issues or dealing with admin over lunch. Often I feel like I’m chasing my tail. Sometimes I realise I’m up do date with all my paperwork and I feel smug, but it never lasts very long.

That’s an average week, I think. I might have forgotten something, but you get the gist. And you will see, I hope, why I get frustrated when people undersell themselves, and us.