A Plumber’s bag and ten extra minutes

I will always remember my consultant social worker comparing social workers to plumbers. ‘Just like a plumber can’t do their job without their plumber’s bag, said Jo, ‘a social worker can’t do their job without their social work toolkit’.

Just like our social work training equips us with the theoretical knowledge and skill to work as social care professionals, social workers too need their own toolkit bags. Taking a few moments to reflect that I was indeed working in a social work team and not a building site, it all clicked into place when I started to build my own social work tool bag. No one can tell you what to put in your tool bag, it’s your bag. Some may have support plans, a pen and a consent form. I had colouring pens, an A1 size flip chart pad and Sharpies. 

I was privileged to work in a new, social work-led mental health, forensic and substance misuse team for my first year as a qualified social worker. In this team we worked with people and change; we would work with resistance, distress and ambivalence.

We ran social work and peer-led groups sessions weekly and linked with our local community to offer opportunities to adults living with mental illness. We also supported people with enduring mental illness into voluntary work and some into paid employment – it was the best year a newly qualified social worker could ask for.

An alternative approach

In this team, I was introduced to an alternative (or creative) approach to social work under the tutorage of my assessed and support year in employment (ASYE) practice educator Lawrence Taylor. 

He always helped me try and see and feel what it would be like to be in the shoes of the people I work with. How would I want to be treated or assessed?

I recall once time working with Sam, a 18-year-old adult with autism, obsessive compulsive disorder and bulimia. Sam rarely spoke but when he did, it was only about philosophy or space. Sam preferred texting, emailing or drawing, but again it was mostly around his areas of interest. 

I opted one day to bring in my brand new pack of Sharpies and an A1 flipchart pad; we had a semi directed session about the future and goals and each took it in turns to ‘share and tell’ out picture with a narrative.

They were all pictures, but Sam was empowered to tell me in his narrative whilst I quickly jotted down these important points on my pad. When reflecting back to me what each picture meant to him, we were able to hold a short, but meaningful conversation about what would evenly lead to his support plan.

I was able to complete a detailed assessment of his needs, wishes and goals and we worked closely for the next few weeks towards getting Sam back to college. The A1 pad and Sharpies were now my wrench in my social work tool bag. As the months and years pass, I’ve added small figurines, toy cars, characters from the film Inside Out, MoodCards and a pair of magnets. 

Time to plan

Fast forwording four years to 2020, I had moved on from my social care mental wellbeing team into a seconded Approved Mental Health Professional (AMHP) Hub. Along with this came the more legalist approach of social work assessment in the form of Mental Health Act Assessments.

I feared my ‘Plumber’s bag’ would be out of action for some time, having to coordinate the detailed assessment undertaken with doctors under the Mental Health Act and facilitate the safe admission or home care of individuals in a mental health crisis.  

As Covid-19 restrictions came into place, the AMHP hub continued to operate 24 hours a day, seven days a week. As other friends and colleagues were working from home, reviewing individual and families remotely, AMHPs were still very much out conducting face-to-face assessment (or interviews). 

The county I serve is a mixture of rural and urban, the drives often require a scenic and traffic heavy route through the South Downs. During the Covid-19 restrictions with less traffic on the road, I found myself getting to places with extra time to spare (which in reality meant on time, as a social worker, I’ve always been working 10-15 minutes late since starting this career).

Having this extra time meant that I had opportunities to plan for my intervention a little more.

Alternatives to talking

I recall one day planning to assess Betty, who was in hospital under section 2 of the Mental Health Act 1983. Her consultant has asked for an AMHP and second doctor to assess to consider if Betty should now become subject to the provision under section 3, as she required a longer period of treatment. 

Betty was 40-years-old. I was fortunate to have assessed her the previous month, so knew a little about Betty’s history. She was assessed under the Mental Health Act and detained under section 2 following a lapse of her illness and what is being described as selective mutism. She would not talk. 

When I assessed Betty the previous month, I tried a variety of different approaches including writing, drawing and eventually using my laptop to type a variety of closed and open questions to which Betty was able to respond – this indicated to me that she was able to read and felt more comfortable responding to written questions / using alternative communication methods. 

Whilst waiting for my independent section 12 approved doctor, I was thinking about how I could be as inclusive as possible to Betty in her assessment rather than reply on my laptop. The Code of Practice for the Mental Health Act chapter 14.42 directs AMHP is to consider alternative communication methods to increase participation of the assessment and to break down barriers to maximise the person’s involvement in the assessment.

Rekindling creativity

I decided to have a look in my Plumber’s bag in the boot of my car. I found my MoodCards; I selected a variety of moods and emotions from the pack (which you can see from the picture range from positive moods/emotions such as happy, hopeful, satisfied to negative moods/emotions such as sad, worried, depressed et cetera). 

At the beginning of the assessment MoodCards were introduced to Betty along with the purpose of the cards. I made sure they were in reaching distance from Betty and I also made no further reference of drew any attention to them for the rest of the assessment (as a means of using them as a semi-directed prop). 

After approximately 30 minutes, and during a protracted period of silence, Betty reached for the blue ‘Sad’ card and said: “I feel sad,”.  She then replaced this and picked up the orange anxious card and Betty said: “I feel anxious too”.  These two cards open a meaningful, but limited dialogue with Betty talking further about the feeling of unease and worry on the ward.

An extra ten minutes

You may not see from the picture, but unease and worry were not emotions or mood that were on these cards. We had a small conversation and the doctor made some suggestions about medication which could reduce her feelings of anxiety. 

Whilst Covid-19 has impacted a range of services which has been awful and distressing for many, I have found having those extra ten minutes to plan for my intervention has been an opportunity for me to rekindle creative approaches to my practice as a social worker and an as AMHP.