Ep. 76 - An Opportunity for Recovery: Social Work in Emergency Mental Health (With Transcript)

Our first episode of 2023 starts off with an incredible story of a Mental Health Social Worker in a Hospital Emergency Department. We hear about a patient who comes in needing support, and how the social worker makes quick decisions about his approach towards her needs. We hear a rich internal-dialogue of a skilled clinician going about their work, providing dignity, person-centred care, and a holistic approach in his practice. Mim and Lis then discuss the story, their own experiences, and a few key approaches for us to take away from this practice piece.

A transcript for this episode can be found below.

Be sure to check out the latest episode of our sister podcast Social Work Discoveries!

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Credits:

Hosts - Lis Murphy and Dr. Mim Fox

Producers - Justin Stech and Dr. Ben Joseph

Assistant Producer - Felix Kiefel-Johnson

Social Media Coordinator - Maddison Stratten

Social Work Stories©️ (Copyright 31 January, 2023)

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Episode Transcript:

Opening Credits:
Welcome to Social Work stories, a podcast exploring social work practice through stories and critical reflection. This podcast is recorded on Aboriginal country, which was never ceded. We acknowledge the traditional custodians and cultural knowledge holders of these lands, and pay our respects to Aboriginal elders past, present and emerging. We offer a warm welcome to any indigenous listeners who are part of our podcast community around the world.
If you have thoughts or feedback for our team, or just want to find our whole back catalogue of episodes, check out our website socialworkstories.com. But for now, on with the episode..

Lis 0:54

Welcome to the Social Work Stories podcast. My name is Lis Murphy. And I am joined here today by my lovely co host, Dr. Mim Fox. Hello, Mim.

Mim 1:04

Hi, Lis. Hi, everyone.

Mim 1:06

Welcome back.

Lis 1:07

Welcome back. Yes

Mim 1:09

Yeah, it's been a busy summer, it's been a good summer. Time to get into it.

Lis 1:14

Let's get into it. I just want to get into this one straightaway. Because it's a practice piece.

Mim 1:21

I know. It's a practice piece. But it's a practice by set in a really busy setting. Lis, right. Like it's fast paced this one.

Lis 1:29

And I'm chuckling because I think you just have to listen to the way in which this wonderful social worker tells his story. It is like, it's very fast paced.

Mim 1:41

Yeah, you know, when we talk about embodied environments, where you can tell about an environment because of the sounds, the smells, the vibe, the feeling, this is one of those stories where the social worker is actually telling you the story of being in an emergency department. But telling it with the feeling and fervor of energy that happens when you're working in an emergency department

Lis 2:05

and the pace

Mim 2:06

Oh, yeah, the fast pace

Lis 2:07

when I was working in emergency. And I would take students in with me, I used to have to say to them, you've got to pick up your pace in walking, and talking.

Mim 2:17

Yeah.

Lis 2:18

And it took about a week for that to happen. But I reckon this is a great piece for people to listen to, because this is a normal pace for an ED health worker. But I will also want to reassure listeners, we're going to trans have a transcription too, because there's so much that he's telling us in relation to working in the psychiatric or the mental health space. And this is a night shift as well. And this is quite an unusual environment for social workers to work in. So it's really special. We don't see that as much in New South Wales Health. This is set in Victoria. And so there are some very fundamental differences that will we'll pull out memory now, you know, Post story discussion, but it is a special one.

Mim 3:06

You know, Lis, I've always felt that my time working in emergency departments, I felt really comfortable in that space. And I think you know, people always say to me that I talk really fast,

Lis 3:17

you were built for ED work.

Mim 3:19

Yeah, I think maybe that's why I felt so comfortable. Because actually, I do move really quickly. I was one of those kids where my mom would have to stop me at the side of the road, physically with her arm across me because I would walk out onto the road really fast. So I think the emergency space, it's a special one, right?

Lis 3:36

Yes.

Mim 3:37

Yeah. Look this recording as well. We want to do a shout out to Felix, he was a student with us through those really hard lock downs that Victoria had, that went on for a really long time. And, and he did this recording at that point in time, which I think is true credit to him, right? Because actually, we've had some amazing stories come out of that period.

Lis 3:58

Thanks, Felix. Let's listen to it now Mim

Mim 4:00

sounds good.

Social Worker 4:05

I was working a night shift and night shifts are funny. The first lesson I learned on night shift with his doctor telling me that when there was a whole heap of sweets in the middle of the room that apparently there's no calories if you eat on night shift. I learned quickly that is inaccurate despite the fact that a doctor said it's so I don't eat so much now. Nightshift can replace that with fruit which no one may care about. But it does give you a sense that night shift is a little bit different. And it is often busier. The peak time for mental health presentations in emergency departments is generally about eight o'clock in the evening. And to start a night shift. You start at 9:30 in the evening, and you work through till about 8:30 the next morning, and there's a lot less people on it's basically you as the mental health clinician there. And I guess at the end of the day, my job is about risk and assessing risk. But also I say to people that I teach and train that every risk needs a plan. So when someone is talking about what issue is going on and what the risks are.

Social Worker 5:00

We need to be mindful of that and putting something in place that can support them. So there are a lot of risks that come down. And people generally just think it might be the suicide risk, or the self harm risk or the aggression risk. And those are predominantly what we often deal with, unfortunately, and sadly for the people for that experience that, but there's a whole range of other risks that we have to consider when we're meeting with people and supporting them, like employment and housing, family, and social, all those. We're social beings. And as a social worker, we have to pay, you know, great importance to those things. And those can be burdened by people that might have long term illnesses, for example. Also things like you know, sexual safety, risks, driving risks, there's so many more that I won't go through in great detail, but we have to support people through that and try to put in a plan. So night shift, the story I'd like to talk about is a person that was has a history of experiencing bipolar affective disorder.

Social Worker 5:54

And I just guess to set the scene, nightshift is an interesting beast, it's kind of quiet at about three in the morning, because we're trying to get people to sleep, we turn off as many lights as we can. But it's often interspersed with loud noise. If you've ever spent a night in emergency department, you know, it can be very difficult to sleep, whatever you're there for. And imagine having a mental health problem on top of that. You're probably on a hard cubicle bed, there might be lights around, there's nurses coming in taking obs, there might be someone doing tests on you, doctors can come in, people come in to all sorts of hours, you've just got to sleep and they want to ask a question or ask another question. You hear the phone ring, you might hear people in staff base, having a bit of a laugh, or a bit of a talk or a conversation and things like that, you might wonder, are they laughing at me, especially those that are experiencing, you know, a mental health problem, you might see your clinician in there. That's the nature of emergency, I guess you need to as a worker, get through those night shifts and get through those roles and have a conversation with your colleagues.

Social Worker 6:51

But as a person that's in emergency, that's kind of the atmosphere that you might be experiencing a little bit of a lull at times, then sometimes interspersed with a very loud crisis. So someone might be coming in with a mental health disorder, which is, you know, quite disturbing for them on those around them. You might get intoxicated persons coming in late in the evening, as well, you might have some that he's having a stroke or a heart attack and a lot of distressed people and a lot of loud machines going off and beep, beep, beep, beep, beeps, and, you know, all those sorts of noises of equipment and trolleys being wheeled around. So that's kind of night shift, it's a bit of an interesting beast. I was in the process of supporting another person that had come down, feeling, you know, sadly, quite suicidal. And whilst I was assessing that person, there was quite a commotion just behind me.

Social Worker 7:38

So I was in a cubicle about probably 30 meters from where I was, we have what is called the, we call it the ambulance bay. So there's a back door, where people can come through, ambulance and police, rather than going through the front triage area, which is where people see the triage nurse. And the Australasian triage scale gives them a triage category. And they either wait in the emergency department waiting room or they come through. But because police and ambulance obviously have a demanding role, we have a separate process for them. So they came in, and I looked across and there was a middle aged female dressed in a red two piece bikini with about six police and very distressed it was quite unfortunate, quite sad for her. Very angry about being brought into the emergency department, very angry about the imposition of having mostly male police bring her in, and how would you feel about being dragged into emergency when you don't want to come in. It's just, no one wants to go to emergency generally to begin with.

Social Worker 8:36

So I mentioned being brought in when you're thinking that you're going about your own business. So I noticed that and I don't know if I mentioned it was in July. So it's kind of like the smack bang in the middle of winter, at about three in the morning. It's not really conducive to being in a red two piece bikini. So I noticed that and I finished supporting the person that I was assessing. And then the next thing I do and there's a lot of background that'll that'll happen before you go and assess or support someone. And that is to get the background information. I think that a lot of people don't realize how much behind the scenes information can go into supporting a person and coming up with as much of a thorough assessment as you can. So the first thing I do is obviously is you know, my mental state and my visual observations were to look and put two and two together. Police, two piece bikini, middle of the night in winter. That's quite obviously raising some alarm bells for safety for me. So we have various systems in Victoria where we can look into someone's past history if they've been involved with our services. So it might be the network that I worked for. We have our own notes electronically, or statewide databases. So I looked at both of those to get a bit of an idea of history before I went in. And I discovered that this person on the state database had a long history of a diagnosis of bipolar affective disorder.

Social Worker 10:00

There was also a history of struggling with substance use, there was a history of treatment orders. So there's different types of treatment orders. And in Victoria, in 2014, the language changed slightly. But there was a history of community treatment orders, which is where it is compulsory for you to receive mental health treatment, and engaging that mental health treatment in the community. And there was also a history of inpatient assessment orders where they needed treatment in hospital as well. I noticed a long history of case management, gaps of about three to six months in between where she wasn't case managed. And but then returning to case management. When I looked at our notes, I had a read that, you know, under the Mental Health Act, we'd like people to have a say in their own treatment and to not be compulsive, and we'd like them to be what we call voluntarily, rather crudely or informal, but where someone is able to take control over their own health. And that's the ultimate aim. And that's what we look for when we, one of the things that we talked about in recovery based treatment. I looked at that and and I noticed that the person was kind of disengaging, they weren't any acute risks. And under the Mental Health that the clinician felt that, you know, it wasn't really suitable to be placing her on a community treatment order.

Social Worker 11:11

But the typical pattern was, as I'd noticed beforehand, that she would disengage with treatment, not take her medication, perhaps use some substances, have some difficult social circumstances, then wind up really unwell and then needing to be put back on treatment orders. So that's a really important background. And whilst I say that my mind is not made up at that point in time, because I do like to keep an open mind, and I do want people to be involved in their treatment. Those are some alarm bells. For me, that's some pretty compelling evidence that someone is really at risk, and potentially the community is at risk as to because one of the other things I can look at into someone's history is when they're unwell, a history of aggression, for example, on alerts. So before I have a chat with her, once again, I want to arm myself with as much information as I can. Because at the end of the day, whilst I want to support people, I do have to do an assessment. And I have to assess risk, to make sure that the people that I'm supporting are safe and the community around them are safe. When I talk about community, I'm also talking about family members, vulnerable populations, as well as the wider community.

Social Worker 12:15

So I spoke with the police that brought her down, seems that they've been trying to catch this lady for some period during the day, there were reports that she was in a public place, and I won't be too graphic, but I might just say that she was practicing in some sexualized behavior. And I guess it was behavior, I've got young children that I wouldn't want them to see. And I certainly wouldn't want this poor lady to be you know, when she's well, I would imagine that that's the sort of thing that would be really confronting, if you were aware of some of the things that you were you were engaged with, during that and it's just, you know, quite a risk for her as well. So there was some fairly serious sexualized behavior going on that would put her and those around her at risk. So there'd been some reports by the community about that with some descriptions. The description was that she was in public places in you know, a two piece bikini, in public, and people were concerned,

Social Worker 13:08

That had been happening during the day, but they hadn't been able to locate her. A patrol was out at about 2:30 in the morning and they noticed that this lady was at a traffic camera, kind of like one of those traffic camera boxes, and was basically punching it and still in her two piece bikini and it's about three or four degrees outside. They picked her up. She was very very unpleased about being picked up by police. So backup was called and took about six police officers to be able to contain her distress. She was essentially at the traffic camera box damaging it because she thought it was a poker machine that had stolen all her money. So you can see one of the things that we look at his thought processes and stream of flow. She was obviously quite confused by what was going on, which was really unfortunate.

Social Worker 13:59

So as part of my background information, we call it collateral information. I had a chat with one of the police officers about their perspective, this was one of the first responders and they gave me that background information as well. Police have powers under what we call section 351 under the Mental Health Act here in Victoria, to compel someone to come down to an emergency department for an assessment. I think it's important to remember police are not mental health clinicians. They are put in a whole range of difficult circumstances. And I think that they're acutely aware of how distressing and traumatizing this can be for a person. They tried to encourage her to come into the police car, not the van. They'd spoken about how angry she was how she just wasn't making any sense how she looked cold. They thought that she needed some medical attention as well. And they brought her down. She was basically yelling and screaming at them the whole time. It was a very difficult experience for her. My first concern was any acute medical concerns. She was shivering, she's blue in color. Once again she is dressed inappropriately for the middle of winter, in the evening. The medical team came in and she was warmed up effectively and given some treatment, because she'd been unwell for a little while, she neglected herself with some of her fluid intake and drinks and things like that she'd also had some alcohol recently as well, and some substance use. So I mentioned this because you know, we are a team in emergency, we all have a range of things to do from the nursing staff to make sure that the observations are fine to administering medication to the medical team to be making sure that, you know, she's not going to decompensate and that she can recover and we can make her feel better as well. Because you can imagine experiencing a mental illness and then on top of at all being unwell physically.

Social Worker 15:41

Reflecting on how I felt at the time, you're a bit on edge, I sensed where this was going. I sensed that she didn't want to be here. And I sensed that it was likely that she was going to require hospital treatment. And I sensed that she wasn't wanting to go in. And I was trying to think about this or getting her information, getting her story how I would draw it out, being aware of you know, trauma informed practice, while I'm talking with her, that there's every chance that she's experiencing a trauma. She's here where she doesn't want to be, there's security and police around, she's confused. This is going to be very distressing for her. Now emergency can be, it's a wonderful place where we do wonderful work. But it's not a quiet recovery atmosphere. At the moment, we are working on how we can change this. There are some wonderful alternatives in Victoria.

Social Worker 16:27

Part of that, I guess the ways that we can make people feel more comfortable is through I guess, as a social worker, the use of self, and by myself being approachable, and friendly, and recovery based and human and trying to connect and being aware of all the traumas that she's probably experienced in the past, and that she's experiencing now. And to hear that, but knowing that her way of communicating is going to be really difficult for her because she is in a crisis. And whenever you're in a crisis, if you've ever tried to contain yourself within a crisis, you know how difficult it is, if you're feeling unwell, you're scared, if a loved one is feeling unwell, you're scared, so you are vulnerable to a range of different emotions, you will I guess. So I'm wondering how I'm going to approach her I'm also a little bit worried. It's always unpleasant, when you have to put someone on an inpatient assessment order. And it's particularly unpleasant when you know the emotions are running high.

Social Worker 17:18

So I went in, and I guess my first thing was to try and welcome her and you know, just try and make her feel at ease and feel comfortable. "Hi, I'm really sorry that you're here. This must be very distressing, Are you warm enough? I understand you're really cold when you came in, can I get you a cup of tea?" I often tell, I've heard some staff say I don't do cups of tea and I've told people well, you can spend 15 minutes trying to build rapport with someone or you can offer them a cup of tea. And it's the same with if your clinician offering to take your shoes off if it's safe to do so it's a such a human thing to do. So offering someone a cup of tea or coffee or hot drink or cold drink. It's a really human social things that you do as friends who come in and go "Oh can I make your cup of tea?" and it's automatically kind of going to that slightly more relaxed system. Sadly, none of this was working. And I was trying to talk with her about what's been going on, what she, you know, what she feeling what's, you know, what's her perspective of what is happening, what she'd been doing today. And I guess as part of an assessment, I'm assessing stream of flow of thought, I'm assessing how someone is able to express those thoughts, whether it is logical based, or whether it is what we'd call tangential, or whether it's really fast and rapid, or whether this poverty of thought, because those sorts of things will come into, you know how someone is able to make an informed decision about their, their treatment.

Social Worker 18:36

She was talking rapidly, she was crying, and then she might laugh briefly, and then she'll get very angry, she'll want to leave the police will have to go in. She just wasn't engaging with me. Because let's face it, she's seen people like me before and she knows generally the outcome is sadly it's often mechanical restraints and sedation. So she just didn't want to engage with me at all. And really, it was mostly go away, eff off. You know, there's nothing wrong, I want to go home. Why am I here? All those kinds of things, trying to ascertain that it's not judgment, non judgmental way as I could, trying to ascertain risk. Are you feeling well? Do you feel yourself? Are you feeling that, you know, if you go do you think there's any risks for you? Do you remember this afternoon? There were some incidents, there's been reports from the public that apparently you're doing X, Y, and Z. Does that worry are you? Is there anyone else that would worry about you? Would you worry about anyone else in those circumstances? Trying the best, I guess, to engage in a calm manner. But sadly, this was about 10 minutes. And it was really just a cycle of, frankly, I guess, a barrage of insults at me and it being here and at the police, and really focused on why she was here. Before I made the decision to I guess place her on an inpatient assessment order to put her into hospital. I thought I will be totally thorough about this and try and get some collateral and speak with a relative and there was a relative being her mother. So I thought I would have a chat with her mother, see if there's any other treatment options any other way we could get around this. You know, if the mom was able to say, look, in the past, when this has happened, she's responded well to this, or even if she's gone into hospital, this medication is better than that medication, or don't put her in with, you know, all male nurses and then things like that.

Social Worker 20:16

So trying to be as recovery based and as least restrictive as I can. The mum said that basically, she's been missing for weeks, she's been very worried about her. She's spoken with police as well. I guess this is where I go back to the Mental Health Act. And in Victoria, we have a number of different parts of the Mental Health Act. So in emergency a clinician, such as myself, if you're an accredited mental health clinician working with a public health accredited service, you can pay someone on what we call an inpatient assessment order for 24 hours. And there's different assessment orders. So there's the inpatient assessment order, which lasts for 24 hours. And within that period, you have to see a psychiatrist, you are compelled to see a psychiatrist. And then beyond that, the psychiatrist can decide to extend that inpatient assessment order if you know, they think something might be resolved in the next 24/48 hours, or place someone on a temporary treatment order. And then beyond that, there's community treatment orders and things like that. So it sounded like the decision was that I'm going to have to place her on an inpatient assessment order. And I guess at this point in time, I'm feeling a little bit apprehensive. I pop back in there, and I offer her a bed and I say, I'm really worried and explain why. And I'm, I say to her, this is going to be a confronting and a difficult conversation. And I want you to know, you can ask me any question you like. And I'll give you a straight answer.

Social Worker 21:32

Because it you know, it's kind of come to that point with this, there's no point in dancing around fluffy language, you can still be caring and direct, but just give that clarification that that's where we're going. You know, I think I'd like to put you in, into the hospital. This is why we come in, we'd love to support you, you know, when put this place, you know, we've got gender sensitive areas, you know, we've got intensive care areas, we can really provide you with some intense support, because I'm really worried that you're not yourself. Any questions. So I guess at this point in time, I'm feeling quite apprehensive. People have tried to assault me in the past with TVs and knives, and pens, and all sorts of things. And especially in these circumstances where people feel that I'm acting unfair. So I was a little bit worried. I was a little apprehensive, but at the same time, I wanted to support her. And I wanted to try and make her feel a little bit more comfortable, a little bit safer. So I worked with her and we had an open conversation, at least I tried to, which was being in a caring way upfront with her and saying, offering her an admission saying would you like to come in.

Social Worker 22:33

She didn't want to and she became quite agitated at the prospect. I placed her under an inpatient assessment order, because there was to summarize an imminent risk to her, an imminent risk to the community, there weren't any less restrictive opportunities, you know, to treat her, it had to be done on the ward and she needed to see a psychiatrist for further treatment. I know that that areas a little bit controversial for some social workers, and for some people in general, that are uncomfortable with putting people on assessment orders, and making them compulsory. I would love it, if we lived in a world where there are enough services in the community that we could prevent that there are enough supports. And I think that the fact the fact that people end up compulsory, for the larger picture, not entirely, but for the larger picture is a flaw in the system overall. And that's disappointing. My view as a social worker is I want someone to recover, and I want someone to have a full life, they're not going to recover, if they leave the department and they kill themselves, or they die by misadventure, or they have a serious adverse event, or, you know, she develops a sexually transmitted infection that has a serious consequence for her.

Social Worker 23:37

So I guess my role in placing someone on an inpatient assessment or as caring and as gently as I can, is the first step to their recovery. And I know that's controversial, and it's a wider discussion in itself. But that's where I sit in emergency. It's by this time a little bit after four in the morning, this person has a significant risk to herself and the community. And that's where we sit. So I informed her of that, I let her know of her rights, she does have rights, we have a booklet. Sadly, she got very angry, she tried to leave the department, and we needed to provide her with some sedation, really, for her safety and the safety of those that were around her. She was very angry unfortunately. After about four hours, she was transferred to our intensive care area on the ward. And I believe that shortly after we were able to send her to our gender sensitive area.

Social Worker 24:23

I often in emergency don't get to know the outcomes of what happens. So you know, people often talk about what's that like? So I've seen this real crisis. And basically for the end of it for me is to pop someone on the ward and then, then I have to move on to the next person. And people wonder about, you know, what happened to who? What happened to them? How do you sit with that? And I guess I'd say is, I'm comfortable enough with my role, which is being there for people in crisis and it fits back to my values as I mentioned at the start of a social worker. We see a lot of recovery in emergency and I'm blessed to see that. I deal with people that I am in admiration of, not just the workers that I work with the people that have tremendous adversity, and they managed to get up each day and keep going. And occasionally they have these really difficult times where they require our support.

Social Worker 25:10

I am fortunate blessed, I will see people come into the emergency department suicidal, they might have tried to kill themselves, they might have serious ideation, I'm able to talk with them, I'm able to talk with their family, or any other, you know, relevant others that are important to their care. And after just a few hours, they can walk out of the department with hope, no longer feeling suicidal, that is an amazing shift. And it is just, I guess, a real blessing at the risk of sounding completely sucky to be involved in that, not to cause it, it's not me, it's the skills of other people and their resilience that do that and their supports around them. It's just my job to, to utilize those and to tap into those as I do an assessment and support people. So I guess upon reflection with cases like these, they're difficult, she has had the best chance to recover. And that's important to me. And I guess that's what I deal with in emergency a lot is that opportunity for people to recover.

Lis 26:09

Can we talk a little bit about the unique nature of this particular social worker's role Mim? So let's just reiterate, this is a social worker working in an emergency department. His main role is to do mental health assessments in an emergency setting, and it's at night. So let's just reflect we've both done on call any emergency we've worked in emergency.

Mim 26:38

Yeah.

Lis 26:38

What do you recall an emergency department being like, especially at, let's just say, 8pm?

Mim 26:46

I think we're talking about an incredibly busy space Lis. We're talking about a lot of noise, the bright bright fluorescent lights are on all the time. And you've got even though they're a curtain sometimes put up between beds, it's not always and those curtains are very flimsy. So you can hear every single thing that is happening with every single patient. And the discussions between every single staff member on that floor.

Lis 27:13

Right. So lots of noise, bright lights, people rushing through distressed relatives,

Mim 27:20

there's always people who are distressed in that space. Right.

Lis 27:22

And so imagine this poor woman coming in being brought in by police. She's very unwell walking into this place.

Mim 27:31

Yeah. And it's the place she's been in before, right?

Lis 27:33

Oh, I would imagine many times.

Mim 27:36

Yes.

Lis 27:37

And so let's now reflect on this social worker. And what he tells us in relation to how he works with this particular woman.

Mim 27:46

Yeah

Lis 27:47

Again, Mim, let's peel back the layers. I want to start with the assessment process.

Mim 27:53

Okay

Lis 27:53

Using a trauma informed lens. So this is someone who steps us right through how he would work with this person. He's doing a lot of observation work. So here's a woman that's been bought in, in middle of winter. And we're talking Melbourne, so I think one to two degrees in a red bikini.

Mim 28:11

Yeah.

Lis 28:12

So already, observation one, been brought in by police highly agitated, probably yelling

Mim 28:19

Yes.

Lis 28:19

And then he goes in and looks at her history through the notes.

Mim 28:24

Yeah. And I love the emphasis he actually put on like that history reading, right? Like how important it is to ground yourself and what's happened before. There's pros and cons, I think we've talked about this before, there's pros and cons of knowing too much or not knowing enough, right? But actually, when you've got someone who is clearly used to that emergency space, and being unwell in that emergency space, then knowing that history and what's come before is going to be really essential.

Lis 28:48

Yeah, yeah, absolutely. And then he moves from that historic space into a conversation with her too. So I really liked the use of just normal assessment skills. I think the conversation where he got a sense of the pace of how she was speaking, what her thoughts were like.

Mim 29:08

Yeah.

Lis 29:09

And then there was a conversation with the mum, So lots of levels just in the assessment process.

Mim 29:16

Yeah, absolutely, and I think also the thinking through, he was really clearly able to verbalize all the points of risk that were happening around this person.

Lis 29:26

Can you pull them out a little more?

Mim 29:27

Yes. So he wasn't just thinking about the really obvious risk factors, like, you know, is she, is she unsafe to herself or to other people? What does the history tell him about that, but what does her current circumstances tell her about that, tell him about that? But he was also thinking about things like, like you say, she's in a bikini, it's the middle of winter. If we discharge her now, we're discharging her to the streets to a seasonally unsafe situation. Yeah? If, and it's not, it's not a judgement about the bikini. It's about seasonally, what risk is this woman at? Right? I think there was so many layers of risk that he was talking through, that really, that when you say an assessment process, I think it's not just the assessment that he's doing with the woman. It's the assessment he's doing in his mind, in the background at the same time.

Lis 30:20

Mim, there was another element to the risk assessment. And that was to this woman's reputation.

Mim 30:27

Yeah

Lis 30:28

That I thought was really sensitive and respectful. And that is, I think he mentioned that there had been some highly sexualized behavior going on in the park. And he was being very reflective of, I wouldn't want my kids to see but I know that once she's, well, what would she be thinking about that whole incident? So there's also that time, like throwing himself into the future as well. So a very much a recovery lens.

Mim 30:58

That's right. And I don't, I think it's not just respectful. There's it's also an acknowledgment that mental health is not a stagnant point in time, that actually people go through an amazing amount of an array of factors and variables that influence their mental health over a lifetime. And that actually, where she is right now presenting in the way that she is right now, is not who she is going to be in the near future, or the far future, right? This is just a slice a moment in time. And that, for me, is really grounded in honoring her and her journey in this world. And, and respect.

Lis 31:36

Indeed, I think he talks about it as being the first step.

Mim 31:39

Yeah, that the idea of that coming into emergency. You know, it's a crisis space, yes. But it's also an opportunity for recovery. That's the phrase, he used opportunity for recovery. And I really love that.

Lis 31:52

And if you think about it, like let's step out of the mental health domain for a moment, you think about someone who's come in who's been traumatized. And in a car accident, we do the exact same thing with them.

Mim 32:04

Yeah,

Lis 32:04

We will sedate we will place them in ICU, and connect them to machines that are going to care for them for a while, whilst their body's recovering from the trauma.

Mim 32:17

Yeah

Lis 32:17

In some regards, is lots of parallels, right?

Mim 32:21

It's a recovery space in a different way, isn't it?

Lis 32:23

Yes.

Mim 32:23

Yeah. You and I were speaking with some British social workers the other day, and they were talking about being in an emergency department and responding. And, and they were saying that social workers often out there in the emergency department. And I think that they're in the hospitals in other ways, but not necessarily in that crisis space. And I do think this story really illustrates what the role of social work can be in that emergency space. Right? That it's, this social worker is particularly a mental health social worker. Right. So actually, there's a mental health lens, on the core work that he does there. But we've had a number of episodes, I think, Lis now, which has shown different angles of working in emergency. And I think the argument for social work to be there in that crisis space, so that it's not only a response space, it's also an opportunity for recovery, and opportunity to move forward is really, really important.

Lis 33:19

I agree. Can we take a moment to talk about use of self?

Mim 33:22

Yeah.

Lis 33:24

I loved how he articulated how he uses himself in being friendly, in the recovery based way in which he works. Being connection focused, and I think I had to have a chuckle, but even things like the rapport building of the cup of tea.

Mim 33:43

Oh, God, I love that Lis. So the idea. I love when he said, you can either make a cup of tea, or you can spend 20 minutes trying to build rapport. And I thought, isn't that like such a fundamental lesson for student social workers to learn? Right? Just the simple acts of kindness and respect go so far in developing rapport and actually stabilizing a relationship with someone who you are the you this is the one moment they are meeting you and you are meeting them. Right, this story that he told was actually quite short. It was actually quite small, but it was a classic emergency intervention.

Lis 34:22

It was but there's also that element that I also wanted to pick up Mim about his this social workers, our responsibility in actually removing this woman's liberty, albeit 24 hours. But I think the way in which he discussed that this is someone who's not taking this lightly. He's actually removing her liberty for 24 hours in order for her to start this recovery. But it wasn't you could hear it the constant debating in his mind about where she is in that mental health illness of hers, and what it's going to mean if for 24 hours, we have our psychiatrists assess her, what is that going to mean? And even to the point where he was very open with her, about what what he thought needed to happen, and I loved how he even shared his, his language around that.

Mim 35:16

Yeah.

Lis 35:17

And that constant debate in his mind about openness versus her agitation, and whether he was also putting himself at risk, or anyone else should she be discharged, including, of course, herself

Mim 35:32

Iit's that professional responsibility less, right. And I think if we, let's look at this, just from the practice standards for a second, and each country, right, will have their own practice standards that they work towards. But you know, in Australia, we're grounded in dignity of person, respect, professional integrity. And I think those those ways that the social worker orientated themselves in the assessment process, and then the decision making process. It's it looks very small on the surface, but actually, it's really heavily grounded in those core practice standards.

Lis 36:07

Thank you, Mim. And this is like a little heads up to students that are about to start their placement. You've just heard a social work academic talk about how you use practice standards in examining the practice of Social Work. Beautiful.

Mim 36:26

Yeah. So if you're writing those learning contracts, mid placement reports, and placement reports, that's how you demonstrate the practice standards, I would challenge all social work students to go back Listen to this story with their practice standards in front of them

Lis 36:39

With the field educators

Mim 36:40

With their field educators, because we know field educators as well are not always up on the practice standards. And just see, where are the moments in this story that you can align the practice standards to? Because I do think it's actually really clear, this is one of those stories, where the social worker really clearly demonstrates those eight practice standards.

Lis 37:01

Wow, what I like, I love this conversation, and what a great way to start 2023 with it, really like students starting placement, we're going to take students,

Mim 37:11

I know there's so much stuff happening this year. Right, Lis? Like, it's, it's building up to be a year of surprises and unveiling and I have to say, there is something that happened over the summer that was very quietly happened, that actually we haven't announced which is we hit over 500,000 downloads, half a million, people. What is that virtual Social Work community out there doing right? Crazy downloading of podcasts? I think

Mim 37:39

I love it.

Lis 37:40

So a big thank you to our listeners, but also a big thank you to the social worker who shared their practice story

Mim 37:47

And all the social workers who have it's actually an astounding virtual community that's being created here and of practitioners just sharing and learning from each other. I love it.

Lis 37:57

Me too.

Mim 37:58

Yeah

Lis 37:58

let's never stop. Let's just keep on. Let's just keep on listening to these stories and having conversations about

Mim 38:05

Yep, absolutely. But listeners, that's now being said very clearly in the audio space. So I think we can hold all hold, listen to that, right.

Lis 38:12

That's my retirement.

Mim 38:15

Take it easy leaves and all of you happy 2023. We hope you get some good rest this year, some nourishment and some great conversations with each other

Lis 38:23

Indeed. Bye for now.

Lis 38:25

Bye, everyone.

Closing Credits:
Thanks for listening to the Social Work stories podcast. All of the stories we share are de-identified to respect and protect the people involved. We create this podcast because we're passionate about building the Global Social Work community and strengthening our practice no matter the context. If you want to help us grow the podcast tribe, and continue the work we do, we would love it if you can subscribe or follow the podcast in your favorite podcast app. That way, you'll be sure to get every episode as soon as it's released. While you're in your podcast app. If you can leave us a five star rating and write a review. It would mean so much to us. You can connect with us on Instagram, Twitter, Facebook, and LinkedIn where you can share our posts with your friends to help spread the word. And you can always find us at our home on the web, socialworkstories.com The Social Work stories podcast is made by Lis Murphy, Dr. Mim Fox, Justin Stech, Dr. Ben Joseph. And Maddy Stratton. Thanks so much for listening