Team that lights the way

People living with a mental illness are gaining a new lease of life thanks to a pioneering band of support workers. Andrew Cole finds out more
  
  


Four years ago, Mark Davies was at his lowest ebb. He had suffered a nervous breakdown as a result of the pressures of his job as a trading standards ofÞcer, he was out of work and he could see no way back.

Today Davies is not only working, but he has found that his experience with depression has boosted his role as one of a new breed of workers whose chief purpose is to listen to and support mentally ill clients on the road to recovery.

"At the time, I wouldn't have thought this would be any use in later life," he says. "But with the odd client, it does help to say I have some experience of being ill. They appreciate that you've sampled a little bit of what they've suffered. It's strange to Þnd that you can have this experience that you think is so negative and actually see it being used positively."

Davies is one of 13 support, time and recovery (STR) workers employed by the east London borough of Havering under a pilot scheme for a national initiative that seeks to rationalise the plethora of mental health support jobs and offer clients both time and companionship. In two years, the initiative aims to employ 3,000 such workers across England.

None of the Havering STR workers has professional qualiÞcations, and they come from backgrounds as diverse as the children's charity Barnardo's and fast-food chain McDonald's. They are closely supervised and receive support and training while on the pilot.

The idea is to help people with conditions ranging from depression to schizophrenia, always on a one-to-one basis and usually in their home. Most of the workers have between 12 and 18 clients - referred by the local community mental health team - whom they will normally see once a week for between one and three hours.

Although the basis of this work may seem simple and uncomplicated - offering a sympathetic ear; helping out with beneÞts; taking someone shopping, etc - the process is highly structured and focuses on achieving results. And the emphasis is always on helping people to help themselves. STRs are not gloriÞed home helps, insists Davies. "We are there to encourage and empower."

That can sometimes be a tricky distinction. When Davies Þrst started as a support worker, for instance, he would occasionally offer one of his clients a lift to the laundrette when it was cold and wet to save him having to wait for a bus. This changed when Davies's superviser pointed out that this was not helping the client in the long run. "She said: 'What's that chap going to do if you're not there?'," Davies recalls. "He needed to get into a routine that he could follow by himself, and I wasn't helping that."

So if the kitchen needs to be cleaned, Davies will suggest a plan of action and then share out the work. And if there is a problem with beneÞts, he will try to persuade the client to make the phone call and ask the questions while he remains on hand to prompt where necessary.

Another client had run up an overdraft, but was frightened to go to the bank to sort it out. Davies persuaded him to set up a meeting with his bank manager and accompanied him, though Davies remained in the background as much as possible. "He made the last payment last week," Davies says.

Many aspects of the job will be less tangible (though just as crucial) to recovery. "Often they may just want to chat," Davies says. "They tell you their worries and concerns and that's where you can sit down and emphasise the positive aspects, pointing out the progress they've made in the last few months."

These are early days in the project, but it already seems to be having an impact. Sarah, who has bipolar disorder (manic depressive illness), was diagnosed eight years ago and spent years in and out of hospital. It was only when Havering's community mental health team became involved that she began to make progress - and she attributes much of her improvement to the STR team.

"When I Þrst moved into my flat, they helped me to get furniture and they've also helped me sort out things like phone bills and gas cards, which I knew nothing about because I'd always relied on someone else," Sarah says.

The team now visits once a week and gives her a chance to talk about her week. "If there are any problems, they can help me deal with that. They can be everyday things like explaining what this letter means, or going with me when I see my psychiatrist," Sarah says.

"STRs have got me back on my feet because they actually believe what I'm saying. They also say you can recover, which no-one has told me before. They accept me and like who I am, and they genuinely want to help. That's made me believe in myself so much."

Sarah is so impressed that her ambition now is to become an STR herself. "I'm just determined to be one," she says. "I don't need to be paid - I just want to help the public understand people who have mental health problems."

One of the biggest challenges the team faces is steering a line between offering friendship and support and being mistaken for a friend or conÞdant. Most clients are needy, vulnerable people. Often they have been estranged from their own family and they can be inclined to "adopt" STRs as their surrogate family.

"We are friendly, but we're not friends," insists Havering project manager Mark Tebb. "That is a really important distinction. We work on these boundaries at every team meeting because it's just so important."

Because of such clear boundaries, STRs cannot accept presents from their clients, even at Christmas. They also have to insist on paying for their own coffee if they go to a cafe. The limits of emotional support also have to be clearly deÞned. "If somebody is crying or is very upset, there's a natural human tendency to want to offer physical contact, and perhaps put your arm around that person," says Tebb. "But we really discourage it because it's crossing that line."

Despite this, everything is focused on maximising the amount of face-to-face contact. Tebb reckons that during an average 36-hour working week, most STRs spend about 30-32 hours with their clients. The rest of their time is taken with supervision, training, team meetings and writing up notes.

The pilot has only been in operation since last June, but many of the STR workers have operated previously as practical community support workers. In most respects, says Tebb, the work itself is very comparable. What has really changed is the level of support and training offered.

This is impressive compared with the ad hoc arrangements that were experienced by many support workers. Everyone completes a six-week induction programme as well as weekly supervision meetings. They also receive a foundation training in mental health. And they are also encouraged to work for NVQs (a national vocational qualiÞcation) and study for the level-three mental health certiÞcate, a qualiÞcation that could help them into either nursing or social work.

Davies has the certiÞcate in his sights. "I'm not looking for a high-flying career or anything, but it's nice to know the opportunity is there," he says. "The other side is that the training improves you as a person as well as improving the quality of care you give to the client."

He now looks forward to every day at work - something he never used to do. "I love the people I work with and the clients are nice people, very genuine," says Davies. "It's a rewarding job and you get a lot of satisfaction if you can see it through from beginning to end. You also get a thank-you at the end, which means so much."

New vision: support, time, recovery

· The national STR project aims to create a new army of workers whose principal function is to provide clients with the support they need by giving their time and so aiding recovery.

· The role marks a recognition that targeted one-to-one support in the community can make an enormous difference to the lives of people with mental health problems. But it also reflects the shortage of mental health professionals and the need to find alternative sources of staffing.

· A total of 20 pilot sites, including Havering, have been set up around the country, each of which is expected to have 25 workers in post by April. The pilots will then be replicated nationally with the aim of having 3,000 STR workers by April 2006.

· STRs do not provide any clinical treatment, counselling or medication, nor are they patient advocates. And they always work closely with the nursing and medical teams. Although pay rates will be a local matter, they are likely to range between £11,000 for a foundation STR and £19,000 for a senior STR.

· Inevitably, many will come from the ranks of existing support workers,but it is hoped the emphasis on providing practical help to clients will appeal to a wider range of candidates, including carers, the long-term unemployed, people without traditional qualifications and the users of mental health services themselves.

For more on STR workers: www.doh.gov.uk/mentalhealth/mentalhealthstrguide.pdf

For more on mental health issues: www.society.theguardian.com/mentalhealth

 

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