Day in the life- OT in reablement

Get to the office, look at the referrals that have come in on the computer, pop them on the spreadsheet so the team can see what work we have coming in.

Check my emails after a day off- 16 unread, not too bad!  One voicemail to listen to.

Care Support lead comes for chat- asks Occupational Therapist to speak to Customers who may be achieving their aims (therefore allowing new people to enter the service). 

Telephone calls to Customers and then complete closures for ones who agree to stop having reablement care support as they are completing the task themselves.

Print up paperwork to take on a visit to review someone having reablement support via a local care agency.  Customer has been at home for two weeks but already presented back at A+E and may have some cognitive issues.  Prior to visit, family call and inform Occupational Therapist that Customer has been re-admitted over 48 hours therefore visit cancelled.

Occupational Therapist tries to arrange another visit to another Customer that requires their care and equipment needs reviewed, no such luck.  Occupational Therapist realises she has an oil leak, so is quite thankful no more visits today.

Occupational Therapist spends the rest of the day focusing on paperwork and ordering equipment for other Customers already seen.  Oh and trying to remember to squeeze in lunch!

So, whilst this doesn't demonstrate much in terms of the visit content, it does demonstrate how often our day changes rapidly from one day to the next, and from what may have been originally planned.  It also highlights how important transport is to our role and how it effects the work we can do.

Is your day quite varied and fluid or are your days more predictable? I'd love to hear :)

 

Engaging staff in CPD

Oh dear, this blog has been rather redundant hasn't it? Time has not been my friend in recent times but I have managed to find an inch of time and want to use it to discuss something i'm currently working on; Engaging staff in our CPD time.

As a service we take our CPD time as a team on location and use it to aid our learning however we like.  I have recently taken over charge of the sessions and have been trying to get an idea from the staff about what they feel their needs and interests in this area are.  Its been like getting blood out of a stone I tell ya! So i'm currently in the process of exploring why people aren't engaging with the process and how to give meaning back to it.  After discussions with a few colleagues, one of the issues that came up was the fact that the sessions are often not considered relevant by OTAs which I guess must disengage them.  Other components I am keen to explore include;
Using it as a way of tapping into people's areas of development in conjunction with their competencies.
Use of Social media for resources, CPD and PPI.
Use of Apps in OT.

So this is where I am up to at the moment and thanks to the #OTalk tonight I feel really inspired to drive this forward and make the most of the sessions. Let me know if you have any ideas to add.

National Suicide Prevention Week

National Suicide Prevention Week is this week and it is a topic close to both my personal and professional heart. We have all in some way been affected by suicide, whether we realise it or not.  That friend who appears fine from the outside.  That family member.  That train that is hours late due to a fatality. 

During my professional career I have had several instances where suicide have affected my work, and in some working environments it has been what felt like the main topic of therapeutic engagement.  There are numerous reasons for suicide ideation or tendencies which are complex and for some people, difficult to understand.  It still remains a taboo subject that gets swept under the carpet and is difficult even for us as professionals to sometimes address.  

When on my 2 years on rotation, I was very lucky to receive ASSSIT-
Applied Suicide Intervention Skills Training by
Grassroots Suicide Prevention; what I didn't realise until now, is that this training is specific to my locality but in my opinion should be far wider spread than that.  The training is not just for professionals, but the idea is that it should be like first aid-taught to all in lamens terms.  The goal is therefore to provide us all with the skills to recognise when people we see down the street, our friends, our family...to recognise if they are in need and give us the tool kit to support that person to get through their crisis.

Here is an example of the effect this training can have...

“It seems that due to experiences in my life I have become some kind of expert, some kind of authority on communicating a particular story to people; a story about depression, about mental health and about suicide.

My father was very ill with depression and was in so much pain for so many years.

I was 13 years old when he attempted suicide. I watched him stagger around the kitchen vomiting in the sink, after taking an overdose.

I have another memory of when he refused treatment. I saw him being strapped into a chair and wheeled into an ambulance outside our house as he refused to go willingly.

I was 18 when he died by suicide. I came back to find a police car outside our house. My sister walked down the drive and told me “Dad’s dead”.

He had “done something silly”.

The world became an unreal place, I remember thinking; ‘this isn’t happening to me, this happens in films or on TV’.

Some people shunned us, but others stuck around. This is when I learnt to tell my story and to say ‘My Dad committed suicide’, or the preferred version, ‘My Dad took his own life’.

We weren’t permitted to have Dad’s funeral straight away, there were investigations, we were only permitted photocopies of the suicide notes he left behind.

To commit suicide was a criminal offense until the introduction of the Suicide Act in 1961. Even though it is no longer a crime the words ‘to commit’ have stuck. This is how I learnt about the stigma of living in a family surrounded by suicide.

The story got easier to tell as I became detached from telling it, but the reactions were no easier. The word suicide may be acceptable when used in a joke, but in the real world it can be too heavy for people to cope with. I would feel it weighing down my sentences as I explained how my father had died.

Like my father, I have depression.

Like my father, I have experienced suicidal thoughts.

Like my father, I have attempted suicide. Unlike my father, I did not succeed.

In March 2012 two days after my 37^th birthday, I attempted suicide. I had taken a ‘serious overdose’. Life had thrown me upside down.

I had gone from managing my depression and trying to get off my medication, to being seriously depressed and suicidal, in a few short months.

I hadn’t been suicidal before. I didn’t know what it felt like or what signs to look out for.

Being suicidal meant my mind was not just full to capacity, it was overflowing. There was no longer any room to cope with anything. I was in so much mental distress and pain that the thought of death was a relief. I didn’t see any danger in death. I saw it as the only possible solution.

The overload on my brain meant that other, normal functions didn’t work. I had very little idea of what was going on and I was unaware of how much danger I was in.

I didn’t realise that I was saying goodbye to people and organising my effects. I was giving away things that I no longer needed. I was beginning to relax as I slowly ticked off the list of things that I needed to do. It was practical and logical. We are all going to die. I was just going to die that bit sooner.

I didn’t ‘complete’ suicide.

It took some 30 odd years from when my father died to have one new and very important word. Complete. Not commit.

I had a new way of explaining suicide. I picked it up from working with professionals who had learned Applied Suicide Intervention Skills Training (ASIST) from Grassroots Suicide Prevention.

I remember the joy when Shauna from Rethink’s Survivors of Suicide group left a message, ‘cheerfully’ using the word suicide. One of the key things I noticed when working with ASIST trained people was their ability to use the word suicide freely and easily. I was greeted by people with whom I could have a conversation, without the shock and fear that I had experienced all my life. There was no stigma, there was no judgement. If I used the word, they used it back. This was such a relief.

There was so much care and attention given to each member of the Survivors of Suicide group. It was heart warming. Within each session there was a safe and clear structure. We were asked to check in at the beginning of each session on how we were feeling and how our week had been. We had a session of open discussion about our experiences with suicide. At the end of each session we were asked to checked out with how we were going to look after ourselves that evening, our ‘self care’. Talking openly about suicide can be extremely exhausting and we would each say something we were going to do that would make us feel good; something as simple as hot chocolate before bed, or watching something on TV.

Another specific detail that I came to rely on was being asked “Are you safe to leave?” and “Do you have a plan?”

In July 2013 I took the ASIST training with Grassroots. It was the most amazing two days of training that I have ever had. Normally I am someone who has to work hard at retaining information, someone who sits back and lets other stronger more knowledgeable people step forward.

In the world of suicide I have experience, I have opinions and I have a voice. And this voice will be heard! I couldn’t have stopped it if I had tried. Where others hesitated to use the work suicide I used it immediately and without burden. I could speak about it from more than one stand point; as one bereaved and as one who has attempted and survived. 

It is oddly empowering and very weird that my darkest life experiences are now useful, like I'm some kind of accidental expert who talks about things that are normally shut away.

Not only do I have the ability to help others who feel suicidal, I can also apply suicide intervention to myself. I can ask myself ‘am I feeling suicidal?’ and if the answer is ‘Yes’ I now have plenty of ways to make sure I keep safe. The first thing on my list is to tell someone.

The following words kept me going through my recovery. They are something I found on the Grassroots resources page. I read this and I cry with relief that somebody knew my reality. Somebody knew how to explain it for the first time.

“Suicide is not chosen; it happens when pain exceeds resources for coping with pain”  (http://www.metanoia.org/suicide/).

That's all it's about. You are not a bad person, or crazy, or weak, or flawed, because you feel suicidal. It doesn't even mean that you really want to die - it only means that you have more pain than you can cope with right now. If I start piling weights on your shoulders, you will eventually collapse if I add enough weights... no matter how much you want to remain standing. Willpower has nothing to do with it. Of course you would cheer yourself up, if you could.”

To find out more about Grassroots Suicide Prevention, and to learn about ASIST and other suicide prevention training programmes, visit www.prevent-suicide.org.uk

If you are struggling with thoughts of suicide and need to talk to someone, contact the Samaritans by phone 08457 90 90 90 or email jo@samaritans.org. 

 

BBC Three's series "Don't call me crazy"

I am a massive fan of BBC 3 for one reason only; their ability to pick series on issues that get my attention and get my OT brain ticking.  A few of these include; one about sex as a person with a disability, the dating show for people with disabilities and their latest which looks at a range of mental health issues affecting teenagers. 

This latest issue automatically grabbed my attention because I had always dreamed of being able to work with this client group in this setting.  In the run up to the programme starting my initial thought was "Are they going to recognise the input of OTs?" because i've noticed in the past they often over look the role or note the OTs role wrongly as a nurse.  Thankfully, not only do they get the OT role right this time, but they even dedicated a page to the OT on the unit on the BBC 3 website. 

I think BBC 3 got it right with this series, getting the balance between an insight without intrusion or judgement near on perfect in my opinion.  I like the way they narrate the series in a non patronising manner and recognize that these are complex issues and situations we are observing. 

It struck me when watching the latest installment that they are particularly good at not labelling the teenagers according to their "diagnosis", instead narrating the teenagers stories and merely describing their needs and issues they are faced with.  You simply observe their behaviour in a balanced way; seeing all sides of their personality and life which enables you to get an idea of what their strengths and needs are.  Watching the programme reminded me why I love to work with this client group; their resilience, passion and nurture requirements which provide so many opportunities for holistic work.

On a wider issue, I think these programmes are so important in reducing stigma for mental health in particular, but also the other issues in the other series they have produced.  I think BBC 3 should feel proud of what they have achieved and I personally really hope they continue to provide useful insight in order to help break down the barriers that still exist.       

NHS V Social Services

In January I began work for Local Government, a switch from my previous experience working for the NHS.  So what I noticed is different?

Organisation:
Even before my first day, it was evident how organised they were compared to my previous experience in the NHS.  Now, maybe this can be attributed to better management, but I also think this has a lot to do with the systems in place.  From my first day, I had computer access, an email account, diary, printer access and training booked for the computer system.  THE FIRST DAY! It took month to get half this stuff within the NHS!

Training opportunities:
Maybe this is bias due to my NHS career being on rotation, however I got no training barr mandatory at all.  I think this impacted my confidence as an OT because we weren't given the skills to add to our tool box so to speak.  Since starting at Social Services I have been on really excellent training which have really helped me to gain confidence in my role, for example basic and advanced adaptations.  These two courses taught me about looking at and drawing scale drawings for extensions, bathrooms and whole houses in order to be able to meet client's needs.  For some people this probably sounds a bit technical or boring but I love it! I can't wait to put this skill into practice and have actually just picked up a complex case involving a 1st floor extension so I cannot wait to get stuck in.

Attitude:
Interestingly, people working for the NHS seem to recognize the fact it is a National Service, so although they tend to moan about situations, they also seem to let the service off a bit, almost understanding why things are so bad.  I've noticed within Social Services that people tend to moan. A lot.  I have come to think that people have perhaps had it so so SO good in the past, that they don't know how lucky they were! I personally, find it really hard to see how they moan as much as they do because for me things seem heaps better than they are in the NHS. 

Reflection: Anxiety

There are a fair few good olde posts on Mental Health floating around at the mo including the lovely Jennifer's series on peoples' stories.  These, plus the fact I have just rotated into a Mental Health role within my job have got me thinking about my own journey.

Today I got to attend our weekly supervision with the Psychologist and this week was about a few new types of therapy, Mindfulness Based Cognitive Therapy and Compassionate Therapy.  I won't go into them because that isn't what this post is about but what the session made me realise a few things about myself:

1. How far I have come managing my anxiety.
2. Recognise objectively how and why Cognitive Behavioral Therapy can make things worse and how it did infact make me worse.
3. That number two is not actually necessary a reflection on the person themselves but a reminder that different things work differently for different people.
4. That mindfulness really was what galvanized my recovery. 
5. The fact that alongside mindfulness I learnt to use compassionate therapy to get rid of the things that were negatively impacting my anxiety and working harder on the things that positively impact.


 

A reflection on 10 months into a Rotation

I'm very aware that I have not updated this poor blog for quite sometime.  I think a large part of the reason for this is that I have been largely uninspired for the last ten months.  I have spent the last ten months working two rotations in an acute hospital, covering Respiratory and Orthopedics.

I'm not going to lie, I had a feeling acute hospital working would not be for me but having had no experience of it on placement I was up for "giving it a go".  My first gut feeling was right.

Don't get me wrong, there are some aspects of it I quite like but unfortunately these don't outweigh the pitfalls.  The last ten months have taught me an awful lot, such as how to work quickly and problem solve on the spot.  I have even enjoyed the thrill of working quickly and balancing my caseload, prioritizing.  I have not enjoyed the lack of respect for the OT role within the setting, no matter how much education or promotion we do and consequently the amount of unsafe discharges that are done daily/hourly/minutely due to professionals wanting to get people out as quickly as possible to avoid "breaching".  This leads me onto a mini rant, medical professionals so obsessed with treating the medical issue and forgetting that it was likely a social issue that lead to that medical issue bringing the patient into hospital in the first place.   

End rant.

I have thus spent the majority of the last ten months moaning at my work mates, who are also frustrated due to lack of staff and so unable to do their job to full potential.  I also find the setting lacking my two favourite things about OT: Rapport and person centredness.  I have always been great with people, this is something all my educators have commented on and so to be in a job lacking both, has been quite unfullfilling!

Until now.  On Friday I went to visit my next rotation and I felt immediately in my element! Even setting up a cross stitch group and building rapport with my caseload already! THIS is where I want to be! Creative freedom, time to get to know and support patients: Older Persons Mental Health.

I'm sure some of you are probably thinking "Well you never should've done the rotation then, if you knew where you wanted to go".  Life is just not that simple i'm afraid, at the end of the day, we just don't have the options to wait around for our perfect job.  Alongside this, I wasn't entirely sure if I would be able to handle a career in Mental Health, due to the risk of burn out.  This is where a rotation is key, it really does help you find your way to where you want to be, whether it is by doing a rotation and knowing it's your calling/worst nightmare or if it's piecing together your favourite bits from the jigsaw from different rotations to make the perfect job.