I have been supporting a client for the past month and a half exclusively by text message. Has anyone else done this sort of thing? Usually we would discharge a client if we went more than 30 days or so without face to face contact, but in this case the client is at a high risk for suicide, so we wanted to try and stay connected any way we could.
And it seems to be paying off. He finally consented yesterday to go to a hospital - not just any hospital mind you, but one hospital in particular, in the next city. If we could send him in a taxi (not something we normally do) and if I could guarantee that they would admit him, and guarantee they would be "better" than the other hospitals in our area. I told him no way I could do that, but I did get approval to send the taxi.
I'm glad I did. The admitting psychiatrist actually called me this morning to get some history and let me know my client would be admitted. This is unprecedented! Last time I sent out the local Mobile Crisis team and they took him to our local hospital, they had discharged him before I even got back to work in the morning! I know there are lots of reasons this may have happened, but it's still very frustrating and also compromised my therapeutic relationship with the client. It's so rare that hospitals follow up with us in this way. The psych even stated that he could see this client needs long term care more than a hospital stay, but was willing to admit him in hopes that we can facilitate that while he's in.
I love when things work out this way. It remains to be seen of course what will come next with this client, but so far so good. And after I worried that my texts were just floating in the abyss, probably not affecting him at all. It's still not my favourite way to practice, but just goes to show any connection is better than no connection.
What a great start to my long weekend, happy summer everyone!
Awesome! Thanks for sharing and happy weekending.
ReplyDeletehi
ReplyDeleteas someone who probably falls in ti the same high risk category at time i too have been supported by text as thuis was the only way i felt safe with contact. the care co-ordinator and community team were happy to do this and it more or less worked . importantly it meant i didnt turn my phone off as usual which then prevents me accessing help in crisis/ alerting others/getting support/ family keeping in touch and me being out of sight.
However while this team happy to do so as met my needs the crisis team for the very same area and trust (inner london) refused to do this as it 'wasnt their policy'. Same Trust differnet approach and the reason why crisis services in this area are so heaviliy criticiesed as not meeting the needs of distressed clients. As someone who didnt give access to them on the doorstep then this would have been a safe alternative and already assessed as such by a team who knew me. Was seen by me and others inc their colleagues as a ounitive measure as would not let them in. This is why Camden has highest suicide rates in the country as in crisis you are expected to fit in with what they offer or have no support at all. So many opt for no support.
Interestingly myself and others had been legally advised by a QC that text messaging as described in the blog and with me is reasonable adjustment for disability under the Equality Act and thats how it should be seen. That is the starting point for assessing risk against.
So glad you took initiative and shows that client felt listened to and managed to make wise choices while limiting the risk. It will have preserved important therapeutic relationships. More MH workers should do this