Tuesday, 27 September 2011

Still voices

Summing up thirty years in psychiatry.

Hanging on to the safety rails of salary and pension as community psychiatry careened from model to model, buffeted by the winds of political change has been a job in itself. Not a job I am proud of and one that proved at odds with the reason I sat in that precarious position for so long.

There were very few days of  safety. Lamentably many days of sadness, anxiety and frustration. Weeks and months at a time characterised by the worry that someone might choose to further destabilise the near catastrophe of the journey by indignation and complaint. Hours of thought blocking resentment at the blindness of a huge concern, unwilling to allow that research might support experience and permit the simplest progress. Minutes at a time when personal safety was compromised by public fury, stimulants or alcohol. Seconds when the blank looks of colleagues signal failure to accept that dogma cannot offer therapy. That communicating hope is a skill best learned as a child and developed through learning, not manualised in adulthood and offered as an alternative to creativity. The child in us all is ever ready to learn. This is the most valuable lesson of all.

The ability to deliver and participate in therapy is a rare skill. The ability to negotiate an alternative to therapy when the organisation suggests that it be used in any case, demands courage and a belief in the process of assessment. For as long as I can remember, psychiatry has been guilty of over treating members of the public rather than allowing proper periods of 'watchful waiting'. Largely, it must be said because it has never been clear who will be watching and who will wait. The identified patient is often the last to acknowledge that assistance may be useful. Families, feeling abandoned for real or fancied reasons are in no mood to wait or watch any longer. These are the desperate, in need of a lifebelt that will provide immediate safety, not a lifeline that they need to work their way towards. These are the puzzled, frightened folk, often living in social exclusion or refusing access to inclusion by dint of cultural mores, family influence or poverty.

The last few years of my career were spent in community provision, in General Practitioner's offices and in Mental Health team offices local to assessed need. My job has been typically varied at the senior end of a nursing team where management was not necessarily the next logical step. Moving from Primary Care in doctor's surgeries to Secondary Care and vice versa is relatively common and often provides the most effective saving grace for a practitioner. Retraining and garnering new skills (learning appropriate protocols) happens by default. There are 'easing in' periods and useful elements of each other's disciplines are portable across the perceived divide. Those of the team who have gathered enough moss to feel at ease in this variety of milieux are usually close to retirement age. Usually becoming more and more valuable. Usually in supervisory roles and usually tired of the whole thing.

It has been nearly a year now. My retirement has given me the opportunity to record my thoughts and feelings about the work, but not the inclination. It has taken longer than I thought to allow the wheels to spin down. My memories are not so weighted towards recently departed events but rather, the whole of the thirty years is gradually becoming a more meaningful account. More easily accessible and with less heat.

I have found the causes of modern institutional eccentricity more readily understandable as the relatively primitive meets what has undoubtedly become enlightened thinking further on. That there are such marked differences in such a short time has proved frequently alarming. I can feel the good that has come of our parts in this transition and now, nine months on, no longer need to vent my anger at the system. Rather, in celebration of those of us in therapy, this may serve to throw a small but significant part of British mental health care into relief. There..

..here goes..