Benefits

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.

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