Friday, March 16, 2007

a life in my day

I never thought that working in a mental hospital would send me round the bend but lately I feel as if I am constantly fighting an uphill battle in which I am the only one that takes my job seriously, actually giving a toss about the young people that are in our care. It seems that the modern day motto of public services is ‘if only we had more money we could do this right’ but to me it just seems like a crutch, a way of pushing the blame around and not owning up to our own short comings. A much more productive motto is the one that my father has ground into me from the day I was born, ‘if something is worth doing, then its worth doing right’ and the older I get the more I have come to understand that this is not just a motto but is, in reality, a philosophical mantra.

Working in the public service I am constantly up against a barrage of misinformation, confusing red tape procedures and a persistent lack of communication to the point where not only does the left hand not know what the right has been up to but the index finger can’t even carry on a civilized conversation with the thumb. It is of late that this combination of obstacles has really begun to frustrate me to the point of exhaustion. Each day I wake up, cycle the 20 minutes overtop of east London’s sewage and approach the brand new building in which it takes three months to fix a burnt out light bulb and six to swap a few desks around, feeling surprisingly upbeat with energy and enthusiasm for the day ahead and tasks at hand thinking that I really have an opportunity to make a difference. But by the time 3pm rolls around I inevitably feel deflated and beaten for the most part by a system that is being forced to be something that it is not, effective.

Mental ill-health is not something that most people want to talk about. The conversation is broached every now and again when we hear a news piece about a lack of funding or catch a snipit of a conversation but for the most part we never talk about mental ill-health like we talk about cancer, diabetes or AIDS. It appears that this is one of the last bastions of publicly acceptable discrimination that is practiced in almost every professional discipline and by the population at large. We see those of us with the misfortune of developing schizophrenia, OCD or bi-polar disorder as damaged goods, people that we can no longer trust as they are unpredictable and wild, not real humans but rather animals that we should be afraid of.

The last place however, that I expected to see this discrimination was within an community that is primarily responsible for supporting these very individuals during their formative years of development. Now I must admit that for the most part, professionals within the field have a true desire to assist these young people but it seems that the collective body that they form when pulled together has morphed into some Frankenstein-like creation complete with bursting pustules, bulging electrodes and appropriate bumbling monster gait that is only focused on quick fixes and band-aid solutions – surely there must be a better way of doing things.

Case in point – a young adolescent with long history of parental neglect, abandoned by their father and seen as a painful reminder of past mistakes by their mother, burdened with almost complete rejection in favour of a shiny new baby decides that they have had enough and begins the preparations to take their own life. But not having tried this before and mistakenly assuming that it is as easy as it looks in the movies fails to complete, is discovered by the neglectful parent now racked with guilt and rushed to the nearest A&E. As it is the middle of the night the duty doctor, astute in the knowledge that they are required to meet targets, makes an immediate referral to psychiatric services shunting the patient along the conveyor and hey presto the next morning we have a new face, a new story and a new challenge.

The beginning is brilliant, as beginnings usually are since we see a clear path ahead, a chance to facilitate a wonderful recovery and who knows maybe even a good case study to report. The new patient settles in well, not without a few bumps and scrapes but on the whole they get the routine and while they are not engaging particularly well with individual therapy they are slowly taking up their place in the group. Progress is made, a few relapses are experienced, coping mechanisms are discussed and a consideration of the future is begun – and this, is where the whole thing goes pear-shaped.

Endings are not the easiest things to process at the best of times, think back to leaving the security of your family for the first day of primary school or sitting with your gran on her deathbed - in general, endings suck. Now imagine how difficult it would be for someone who for the first time in their life has felt cared for and looked after and is about to give all that up for a completely uncertain future in which their own mother refuses to have them home because they feel it is just too much work to live with their unpredictable child and they are exhausted and can’t someone else just take care of them? But you say they have a group of professionals trained in providing comprehensive psychological therapy and they should be able to stitch up a decent ending nice and neat, support network in place, regular contact with professionals, secure and safe home environment – no problem, right?

Only its’ not that simple and this is where the whole index finger and thumb analogy comes into play. For this ‘ideal ending’ to happen several dozen people from a host of agencies and government bodies need to come together and construct a cohesive plan outlining procedures, timelines and expectations, which we all know is just not going to happen. So instead, a patchwork quilt of social services, housing and mental health services is stitched together using the flimsiest of threads and we all pray that the worst doesn’t happen and that we avoid burying another one of our failures.

Ending are clearly where the whole system falls apart in tatters, literally and figuratively with everyone scrambling around attempting in vain to collect the pieces and stick them back into something that resembles the original ensemble but because they have no idea what it looked like in the first place they invariably put things back incorrectly, upside-down and inside out – it’s a bit like attempting one of those 3-D puzzles but not knowing if you’re make a shed a boat or a shed, leading to something in the end full of slash marks indicating the collective indecisiveness.

Is there anything that one person can do to put this behemoth beast back on course, engendering some sort of stability in endings and facilitate smooth transitions back into community living for these extremely vulnerable young people? In short, no but then I never was a pessimist. So I suppose I’ll continue on doing my little job that is worth doing the best way that I know how and hope, however naively, that just maybe someday I’ll rub off on at least one other person along the way.