What happened in Cornwall

Therapeutic effect and value

A couple of weeks ago I went to Cornwall for a week, on a work trip.

Aside from facilitating a workshop on ‘Boundaries working with clients diagnosed with Personality Disorders’, I shadowed colleagues, attended partnership meetings and team meetings.

What I enjoyed most that week was shadowing my colleagues. It  provided an opportunity to be reminded about the value of everybody, in every walk of life and every circumstance. Including the remarkable work my colleagues do.

I shadowed a IMHA (Independant Mental Health Advocate) in the morning in a mental health unit which included a forensic ward, a PICU (Psychiatric Intensive Care Unit) and rehab wards.

In the afternoon I shadowed a IMHA attending a CMHT (Community Mental Health Team)meeting with one of his clients, who wanted to speak with her consultant psychologist to gain a deeper and more thorough understanding of what having a diagnosis of a personality disorder means for her. One of her questions which has stayed with me, was “How do I know what parts of my behaviour are me and which parts are the personality disorder?”.

My colleague and I were discussing our experiences of working as mental health advocates and how we evidence our work with clients. When we have a caseload, this can seem an obvious and simple thing to do – when we dont have a case to work on for someone and are instead building trust and establishing a reliable and consistent approach to being with someone, which may encourage them to speak up or to ask for help, even just to share their difficulties and not know what they want, how do we evidence that work?

My colleague called this ‘the therapeutic effect and value’, we as advocates can and do provide.

This is one of the reasons clients stories are so important. Let us not lose a vital human component of the job we do.

Do you have a story you would like to share?

Smile

Yesterday I spent much of the day in Portsmouth with my colleagues based there.

After I rudely and gratefully gatecrashed their team meeting, I met with an advocate and one of her clients. I was story collecting and this client said he would be happy to share his experience of advocacy with me, so that I could write a story on his behalf and in his words.

Just before I met with this client, I spoke with my colleague {Advocate, IMCA Lead and Assessor}. She shared something with me, which has stayed with me and is quite profound in its simplicity.

“In hospitals, when I am visiting, I smile, beam at people. They smile right back. There may not be many spoken words but we have communicated all the same.”

Squirrels

I had a fantastic and successful training day in Southend-On-Sea, Essex on Wednesday, delivering training to nine people who work in the third sector from trustees to volunteers, counsellors, psychotherapists and benefits advisors.

The training is called BAC – Basic Advocacy Course.

People do not have to be advocates or involved in advocacy to receive the training, as it is about developing awareness and understanding of the principles and purpose of advocacy.

When delivering this training, it is often my experience that people know more about advocacy than they realise and that they have advocated for others, without calling it advocacy.

This one day course provides an opportunity to brush up on existing knowledge, demystify advocacy and increase awareness of underlying principles, including those considered to be the four core principles.

The training also includes the approach and purpose of advocacy. Two of the most important things to make people aware of, and that most people do not know, is firstly, that advocates, whichever category they fit into, do not work to best interests. Often an advocate is the first person an individual has met in relation to their case, who isn’t having a say in what is best for them. Advocacy is client led. Decisions, actions and planning are always chosen by the individual.

An advocate is like a squirrel with rounded cheeks stuffed full of nuts – an advocates tool bag is crammed full of information from research they have carried out on behalf of the client, to offer them in support of making an informed decision and considering their options, and the potential consequences of each decison made, in moving their case forward, to an outcome they would like to reach. Even with IMCAs (Independant Mental Capacity Advocates), the advocate will always work with the client using creative communication approaches to ascertain the clients wishes. If this is not possible, then any decisions made on behalf of the client are always ‘the least restrictive option’ {to the client}.

Secondly, advocates are independant. Advocates do not work for a NHS Trust or any other professional agency or manager. It could be argued that this is not truly accurate due to funding agents – this could be said of any service which receives funding.

An advocacy service may need to supply reports and comply with the tender on which they were commissioned, this does not mean the service will be run or advised by the commissioning body. This will have been worked out during the tendering process. The advocacy service has a responsibility to ensure they uphold their end of the professional service they said they would manage and operate under, and are accountable for this. Providing this is done, advocates work with autonomy and independantly. It is very important clients understand that no one is influencing the work the advocate is carrying out with them, and that advocates demonstrate this by managing all stakeholder relationships with boundaried professionalism.

All parties are concerned with the task at hand, which is supporting vulnerable people. 

I thoroughly enjoy facilitating this learning and development and feel satisfied I have done a good job, knowing there are nine more people who have a basic understanding of advocacy, which they can apply to to their current roles.

To find out what advocacy principles are, what advocacy is including all of its genres, who can receive training and how they access it, please go to: www.seap.org.uk/training/ 

Advocacy Training is the preferred provider of advocacy and related training in the UK and are prided in delivering high quality, interactive, practical training that can be applied back in the workplace, having a direct impact on practice and services. Extensive experience in delivering advocacy skills training has grown from over 10 years delivering high quality, independent advocacy services.

Just one moment

 

I am reflecting on the sad news of Robin Williams death which is possibly as a result of suicide. He was a remarkable man who had me laughing and crying throughout his many films and TV appearances. Robin also reminds me of my then little girls growing up and our family favourites.

But you don’t have to be like Robin, with fame and financial stability to be worthy and valid of sharing mental health illness experiences.

We hear it so many times … mental illness affects everybody from every walk of life, regardless. Full stop.

Please speak up.

If not for yourself, then for or to someone else.

Notice others. Don’t be afraid you will be their trigger. Don’t allow others’ silence to keep you silent. Don’t allow yourself to be silenced by stigma and discrimination.

I know how hard it can be to speak up. I know how it feels to be noticed. I also know how it feels to be swallowed by mental distress and become invisible. And I know how it feels to be heard and understood. I know how it feels to be given space and time to cry it out.

 I know these things because I speak from experience.

 Throughout my lifetime I have had heart-breaking and stressful life events, which have seen my mental and emotional health react in ways which are scary and debilitating.

 When some loved ones spoke up for me it wasn’t to disempower me, but to get me on a road to wellbeing. When they asked me how I was feeling, not as a polite question they didn’t really want a response to {and people can tell the difference, having a mental health illness does not make an individual less knowing!!}, but as a sincere concern they have and a noticing of another, to let me know they cared and that I mattered; made a difference to me at the moment.

 My nan died several years ago. She lived to a great age. One of the first things I was told after her death was that she had lived with bipolar disorder her whole life.

 She never told a soul. That made me very sad.

 Let us try to remember, each fragment of time is just one moment. Holding still for that one moment will help us move into the next moment. That’s all it is .. just a moment.

 Please find your voice; for you or for another.

 HOW YOU CAN LET PEOPLE KNOW YOU WANT SOME OF THEIR TIME,

 If you find it hard to talk;

 Put it in a poem

 On a post it note

 Write a rhyme, a rap, one sentence

 Find it in a song or a piece of music

 Leave a book or a leaflet laying around

 Put on a film or recommend a dvd when with others (this may help start a conversation)

 I would love to hear your thoughts on any of the above.

 

Coming up…

Next week I am based in Cornwall with the rest of the BDD team, sharing practice and all things development, with our colleagues and partners from the south west region.

I have the opportunity to shadow my colleagues who work into hospitals, which I am very much looking forward to.

I will also be facilitating an experiential workshop on ‘Boundaries working with clients diagnosed with Personality Disorder’, which I am excited about. 

Its going to be a great week.

Blown Away

When I asked colleagues to share their stories with me, relating to advocacy, be that their own experience of receiving advocacy support, why they do the job they do, projects they are involved in and anything else advocacy related which has inspired, informed and impacted them, I expected to be moved.

Simply because I do not know of one single advocacy story which is not emotionally moving and thought provoking.

What I did not expect, as one of my colleagues said to me whilst telling me her story, was to be “blown away”.

I will not disclose her clients personal journey; with my colleague as her advocate, but what I can share is my colleagues (who is an acting supervising advocate) experience of working with her client, and my learning from speaking with her and being involved in the telling of both of their stories.

So that I could write a story for my colleagues client, I read the case notes, with both of their permission, to get an idea of the client and how best to put together her experiences in a way which would do her story justice and give her a voice.

In one part of my brain, that was very much going on; in another part my thoughts and feelings about the extensive and consistent advocacy offered by my colleague, and how she was managing her feelings and the exposure to some very raw and complex material from her client, was, as my external supervisor used to say to me, getting ‘buzzed’.

After this, I spoke with my colleague twice on the telephone, about the work she has been doing with her client and shared with her my thoughts on her outstanding, in my opinion, boundaried yet totally supportive way of working.

I also shared with her, my thoughts when reading her notes, which were always professional, clear and factual. I sensed when she may have been feeling overwhelmed and needing some respite from the intensity of the support she was engaged in. Her writing style changed; she would not write in paragraphs, her grammar was a little misplaced and it all seemed to pour out of her in one long sentence as if in a mantra of, ‘gotta get it out, gotta get it out’.

 My colleague told me that she isn’t very good at accepting compliments and that she was “blown away” by the comments from me and the support she was feeling, in acknowledgement of her consistent caring professionalism.

 She said to me, “I am only me”.

 …

I could try to explain all of my thoughts and emotions working with my colleague to get her story out there, about her experience as an advocate, as well as working on her clients material to allow her to be heard. I could try to explain how immensely proud I feel of her, and how privileged I feel to be able to share in her clients story, which is after all, her life experience.

Instead, below I will include an anonymised email which I sent to my colleague:

 ‘I am only Me’

What I want to achieve by sending you this email, is a source for you to have, where you can look at it and be reminded of our recent discussions, and despite being ‘only you’, you did hear me correctly the first time when I said I thought your approach and philosophy with your client was incredible and moved me completely.

I also hope this proves to be a valuable support resource and reminds you that being person-centred means you will, by default, become ‘attached’ with your clients when they present in such a way as yours. Her psychopathy due to her brutal assault makes certain that she presents with many insecurities, mistrust and relational challenges, which I believe you managed in a professional yet caring way. You did not abandon her, nor did you patronise her or become over involved. Your boundaries were very clear.

Speaking to you on the telephone I realised that your insight has also been very clear and most likely what contributed in supporting your ability to remain professional, boundaried and real.

Your description of grief I found particularly impactful, as this is also an experience I have had, as I shared with you. It would be easy to feel ashamed or embarrassed that there has been an attachment of some type with a client, yet realistically when we work in such ways with some clients, then it is in my opinion, unavoidable, because over and above being a professional we are a human being.

I am impressed by your reporting and consistent approach with your client and even though you do not give a hint of it within your notes and reporting, I could tell when you were feeling stressed, distressed and overwhelmed by this case. Your writing changed; there were less paragraphs, grammatical errors and typos. As if you just had to get it all out as quickly as you could. It could be a parallel process of your clients and yours urgency in your respective arenas, to tell and be heard, with some transference and counter transference thrown in. This can often be seen as ‘vicarious trauma’. I wonder if you have heard of this phrase.

I think what you show in your work is not a skill which can be taught, but is something we either have or do not. As a trainer I do not think I could teach someone how to skilfully and humanely manage a case the way you did this one.

It would have been very easy to have been pulled into your clients world and become less effective for her, and your notes do not show that this was ever close to happening to you. Even when she would text you something about her suicidal thoughts at the close of a working day, you always held your boundary without neglecting her as a human being and showing your care and concern for her.

You have reminded me that with enough love and time, we can be effective for one another and that alongside our own support system; we can make a difference to each other. Working within the public sector for some time previously, I forgot what hope was and got caught up in everything having to be evidenced to be proven beneficial. You have put me back into that place of holding hope for someone when they have none left for their self. This is the type of thing which cannot be evidenced by a short term contract and with measures … how does one measure what changes a simple text or an acknowledgement of an others well being can effect?

What a great cycle for all: your client has learned from you, you have learned from your client and I have learned from you.

Questions we covered:

• What have you learned as an advocate, what has your client taught you?
• At the end of your journey, who will support you? (Be mindful of 6+ months down the line – bereft advocate)
• Biggest change in you since working with your client?
• Debrief through your story?

We also spoke about it being common for clients to not want to ‘infect’ others by telling of their experiences as to them it is so overwhelming, they cannot imagine or even think that it would not have the same depth of feeling to others as it does to them.

By way of a reminder, her are some things you shared with me:

“Made me grow as an advocate”

“She impacted on my knowledge base”

“Learned a lot about touch – I do not touch clients anymore” (Personal & Professional boundaries for you and them)

“I felt lost closing her case”

“I am only me”

“It is hard for me to take praise”

“I have really learned about attachment theory”

I shared with you my experience at a previous place of work when I had to change wards I worked on very suddenly, and how that experience made me feel for some time afterwards. I believe your story of working with your client will really help other advocates to relate better to this organisation, as I know they feel that no one else within the Org. works with clients like they do.

We talked about my thoughts when reading your notes and noticing times when I felt you may be stressed or overwhelmed, due to the style of your writing changing. Your notes were always strictly professional but your writing style changes. This was when I knew I wanted to understand how this felt for you. You said you had not realised that you had been on a journey until very recently, and I asked you to remain aware of subtle changes within you over the coming months, particularly when everyone else thinks it has all died down and things are quieter for you.

This email may overwhelm you, due to the length and content all in one go. It has taken me several days to put this together, so please take care of you. Maybe print it out and keep coming back to it.

Advocates don’t give advice so I wont offer any: but a thought I have is that it may be emotionally reparative for you to take just one or two steps back for a while, whilst your client is content to fundraise etc. and take this as a golden opportunity to reflect, even though it may feel strange and as if there is a void.

I am always on the end of the phone, email etc.

Happy reading and I hope you have been able to enjoy a little of this beautiful sunshine.

 …

Privileged

This is another remonder of why I chose this career,  and why it is important for me to have hope.

I am incredibly privileged to do the job I do, with the colleagues I have and the people I meet.

 If you want to know more about advocacy, visit http://www.seap.org.uk