During the Ebola crisis in Sierra Leone spanning 2014-16, I remember vividly reflecting on how both care professionals and even family members were not able to comfort and support those suffering the full ravages of such a terrible disease. In busy frenetic cities such as Freetown, the very fabric of how people lived and interacted with each other changed quickly to one of caution and fear. There was a need for social contact to alter along with a need for wide ranging precautions. Anthropologist Dr Jonah Lipton studied the outbreak and noted even within this context how adaptable people can be. One of the things that unites all of us in social work is a desire to work directly with people; those in many cases on the margins of our communities, whether as a result of poverty, illness, disability or a myriad of other social pressures. Tied to this is a need for relationships - social work is often premised on developing relationships of mutual trust. So to a large degree, it was almost unknown how we as social workers and more importantly the people with whom we work with could adapt as the COVID-19 crisis has demanded.
My service consists of Approved Mental Health Professionals carrying out Mental Health Act assessments and for many of us it is inconceivable that this work might not be carried out face-to-face. In fact, because of the complex dynamic of Mental Health Act assessments, in Worcestershire as in the rest of the County, nearly all Mental Health Act assessments continue to be carried out face-to-face. Nonetheless there remained a need to adapt and consider carefully each request for an assessment and to incorporate the use of PPE into our practice as way of protecting us all from Coronavirus. Along with colleagues in other areas we have also explored whether or not audio visual technology could be used in some circumstances. This involved listening carefully to the guidance from the Department of Health and Social Care, thinking about the legal issues and the possible impact on our service users. We determined that in some cases audio-visual assessments could be used as means of reducing risks to service users and our staff and we identified a potential way of working in some planned assessment work, where the risks of exposure to COVID-19 was higher, such as on hospital wards and in care home settings.
I have now been involved in a small number of assessments using auto-visual media and I was deeply concerned at not being with the service user, as though I was diminishing the importance of the assessment. To reconcile this I needed to think about how we’d adopted this approach as part of a wider effort to reduce the risk of COVID-19 in our hospitals and care homes given the terrible scale of the crisis. I met one man, Tom who was on an older adult mental health ward with COVID-19 patients - he was experiencing a psychotic disorder and did not want to stay on the ward, much to the concern of his care team and his family. I joined a meeting to carry out an assessment, which involved considering whether or not the Community Treatment Order Tom was subject to should be revoked. The consequences of this would mean Tom would be transferred to Section 3 of the Mental Health Act and he would be required to remain detained in hospital for up to six months. At the start of the assessment Tom was in an interview room with his doctor and supported by a member of the nursing team. It seemed an intimidating environment for a person experiencing a severe mental illness, particularly as, for very good reason, the staff were all wearing full PPE. Nonetheless I suspect for Tom, struggling to understand the details of the COVID outbreak, it must have been frightening to be surrounded by people wearing protective clothing. We did our best to explain and reassure Tom by trying to convey the need to protect each other from the virus. During my interview Tom looked directly at the webcam and we could see and hear each other clearly. In strange way it felt very personal and I was conscious that I must have seemed more natural than my colleagues wearing PPE because we were able to see each other’s faces. At one point Tom took exception to one of my questions and lent towards the laptop pointing his finger to express the strength of his feelings - I found this reassuring because I saw it as an indication he felt able to express his views in the same way as if we were together in the same room.
As with almost all social workers I’m keen to return to more familiar ways of working that involve direct contact with service users. However, this experience has taught me that in the right circumstances, audio-visual media can allow meaningful engagements to take place. As with those that experienced the awful outbreak of Ebola in Sierra Leone, we all need to be adaptable and make changes in the way we work. The important challenge for us in social work is to mitigate areas where this can damage our relationships with service users.
David Palfreyman, AMHP Lead, Worcestershire County Council