Spend this cash on social workers not pricey logos

Published: 18 June, 2010

• THE contrast between Richard Rosser’s entertaining letter and the sad anonymous one following it (June 4) led me to consider a better possible use for NHS Islington’s money than expensively fashionable presentation ideas like logos and stationery.

Recent statistics show that Islington’s health is in many ways worse than the London average, particularly its incidence of mental health problems. Depression, one of the commonest of these, can be classified as reactive or endogenous; the former due to external circumstances and the latter to idiosyncratic  tendency. However it is diagnosed, the psychiatrist has only one range of treatment tools – medication. 

This may well be an inappropriate response to reactive depression, which requires removal of the cause or development of ability to cope with it, rather than a drug. Practical constructive counselling is needed instead. For this psychiatrists lack appropriate knowledge, but such assistance takes much longer than scribbled prescriptions.

I observed this in the busy London hospital where I was a social worker. At first, I had no idea how to help the psychiatrists who constantly referred patients to me. But to save their very limited time – they could grant only 40-minute appointments every three weeks – I asked patients about their family situations, life stories and childhood experiences, and even in Freudian mode about their dreams. This often took me well over an hour, piecing often confused and rambling statements into a coherent summary that would save the psychiatrists’ fact-finding time. Presumably, they found this useful since they referred me a constant stream of cases.

Gradually, I started seeing things somewhat differently, questioning the preliminary judgement that such depressive patients  were “mental”. Some had practical problems awful enough to make the most naturally cheerful person desperately – clinically? – depressed. Pills didn’t help them at all; in fact, some side-effects could make them worse. 

A true case comes to mind: a suicidal mother of young children who couldn’t pay her electricity bill, so her lights had been cut off. For weeks the family had been living in the dark. A search revealed that she would be entitled to a benefit she didn’t know about. After helping her to apply for it and pay the bill, her lights were switched on again. When I next saw her, her depression had almost vanished. The practical help with her immediate problem encouraged this lady’s trust, so she then confessed to an underlying emotional problem she hadn’t mentioned to the psychiatrist before, enabling him to make a truer diagnosis of her temporarily overstressed mind.

This sort of experience led me to see that psychiatric referrals may not always be appropriate or helpful in superficially judged “mental” cases of depression. Shrinks aren’t trained to deal with many practical problems. With too little time for time-consuming practical counselling, their only solution is to medicate, with, I suspect, a low success rate but at considerable cost for prescribing expensive drugs.

One suggestion for NHS Islington’s choice of how to spend its funding: pay social workers to support the psychiatrists dealing with mental health problems, since these often originate from social conditions shrinks are not qualified to address. Their reduced caseloads would allow them to devote more valuable professional competence to genuinely psychotic cases. Surely this could be an experiment more worthy of funding than an attractive logo.

ANGELA SINCLAIR
Highbury Hill, N5