Welcome to Social Work Stories, a podcast exploring social work practice through stories and critical reflection.
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But for now, on with the episode.
Liz, I feel a bit, um, uh, reticent to say this, but because I know so much of the country is still under so much rain and cold, but the sun is shining today.
It is indeed. Look, have we just suddenly just gone straight into the friends who have nothing more to say except for commenting on weather?
Oh, is that what we've been reduced to now?
Have we been in it? It could possibly be.
And if you're new to the social work stories podcast, can I just say welcome?
We don't spend each podcast episode talking about the weather.
But welcome everyone. It is the social work stories podcast.
I'm Dr. Mim Fox and I'm here with my friend and colleague, Liz Murphy.
Hi, Liz. Hello, Mim. Hello, everyone.
We're in particularly good moods today.
The sun is shining and we have a kicker of a story today, Liz.
We do. We do. Here, recording on Durable Country, we have a story from an American social worker.
Hot off the press. I love that there are American social workers out there.
So engage with our podcast Liz that they're picking up their recorders and sending us their stories from practice.
And it's great because especially with this one, there's so much about how she describes the role that has just blown my mind.
So my understanding, and of course, this is as you're about to hear this social worker talk a little bit about her work first.
But my understanding, Mim, is that this is a social worker who's working in, let me have written it down, a behavioral health hospital that looks at acute care for rapid stabilisation and medical detox.
American's fantastic at labeling what they do so much better than us.
I think there's probably a fabulous anachronym, right?
What would we call this?
Would this be a mental health?
This, I think this is a combination of what we would know as a drug and alcohol rehab centre and a mental health acute facility.
Right. That's what it feels like to me.
But it could quite possibly be even have a medical accident and emergency component to it.
So you know how emergency departments for us are located very much in that medical acute hospital.
It sounds as well like there may be an emergency room component to this service as well.
Right. Well the other thing that blew my mind is the sheer volume of patients that come through this institution.
So I'm not going to say much more other than this is a story that's set in this type of institution that Mim and I are trying to get our heads around.
But it's one of those stories, Mim, that on the surface it would appear to be a simple tale of social intervention.
I love that you just said that with a straight face, it's a simple tale of social work intervention.
Like does that exist? A simple tale?
Well no. And look, I think it comes back to my point that I think we've said a few times, never be filled by the simple tales.
Never be filled. The most simple are referrals often tend to be the ones that you'll remember on your retirement dinner.
So I want people to think, listen to this, appreciate the surface nature of it.
Then we're going to reflect on the many layers that, but that she also reflects on the beautiful.
Yeah, I want this person as someone I can supervise.
I know. And I enjoy everyone.
I used to work at a behavioral health hospital that provided acute care for rapid stabilization and medical detox of patients.
I really loved working in the intake department which basically functioned as a mental health ER that operated 24 hours a day, 365 days a year.
The job was really fast paced, deferred, gratefully from day to day, and required a lot of critical thinking and decision making with and for our patients.
Our role was to provide crisis intervention, comprehensive intake assessments, and evaluate for safety, risk, and medical need, to either facilitate admission to the hospital or make appropriate referrals to the community.
This facility averaged four to five hundred admissions per month, and probably twice that amount were assessed and referred out.
We only got to spend a few hours with each client before either admitting them or referring them out.
So we rarely got any sort of closure on their cases, which was definitely one of the downsides of their work.
And unfortunately seeing them again usually meant that they had relapsed or experienced another mental health crisis.
There are so many client stories that I have experienced.
Many of them I've forgotten.
Some of them I wish I could forget.
And some that I really hope I never forget because they have shaped me into the person I am and have helped me grow into the social worker I am still becoming.
I took a while to think about what case I wanted to select and ultimately decided on one that seems really simple on the surface.
It doesn't have any shock value, doesn't have a tragic ending, or really any grand gesture on my part.
But I love it because I think it's one that sits at the heart of what social work means to me.
I worked nights at the hospital where we averaged 10 to 15 patient assessments per 12-hour shift.
If any of y'all have ever done shift work, you know how physically and emotionally exhausting and demanding it can be.
Others worked alongside counselors and registered nurses to do the intake assessments.
On one particular night I performed an intake on a 30-something unhoused black woman who was chronically mentally ill, unemployed, and had almost no support system or access to resources.
I remember her being very pleasant and cooperative with the assessment process despite the fact that she was clearly distraught about the situation that brought her to the hospital.
She was definitely a high-risk patient and met admission criteria for rapid stabilization.
Although she was glad to be able to receive some help in treatment, I also noticed some hesitation at accepting admission and going through the admission process.
When a patient was admitted to the hospital, policy stated that the staff member was to go through all of the patient's belongings to sort out what they could take the with them to the unit, what needed to be held in storage until discharge, and what was contraband.
That neither needed to be turned over to law enforcement or discarded.
Contraband included things like drugs or alcohol, other paraphernalia, weapons, or really anything that could be considered a health or safety risk.
Several food and drinks were thrown away and other items were reported to security or police depending on what it was.
Since this patient that I was working with was living on the streets, she had brought multiple large rolling suitcases with her that I had to look through.
As you might imagine, these rolling suitcases contained all of her earthly belongings.
Had the suitcases were about a dozen Tupperware containers full of what looked like dirt and cotton balls.
It was definitely not one of the most unusual things I had ever seen, but it did make me curious enough that I opened up one of the containers to see what was in it.
To my great surprise, there was a large black and brown tarantula staring back at me.
Luckily I'm not a person who is queasy or scared of spiders or else I might have thrown that case across the department.
But I kept my cool and glanced at the other containers that had similar contents and could immediately tell that they all held spiders as well.
Needless to say, live animals would be considered contraband by hospital policy.
At that point I realized why she had been so hesitant about admitting to the hospital and why she had spoken out when I told her that I needed to look through her items.
At that point, I can only imagine what was going through her head, but probably she was weighing her need for acute stabilization with the need to keep her animal safe, which were also what she said she bred as a source of income.
I can still hear her voice, begging me not to hurt her spiders, not to throw them out.
She was considering leaving the hospital against medical advice or ANA because she was so concerned about what would happen to them.
One of my co-workers of course wanted to enforce the hospital policy and told me to throw them out, but I just knew I could not do that.
Instead I sat down with the patient, told her that I would find someone to take care of her pets while she received treatment.
She was so relieved to hear that, just to have her needs heard, understood, and validated.
I think for this patient, having a professional in a position of authority, say that they would take care of something that she deemed valuable, I don't think she'd ever really gotten that type of consideration.
She probably just assumed that I would throw the animals out, and that's why she didn't want me to go through her belongings, and that's why she wasn't sure about being admitted, even though her health and safety wasn't such great a risk, she really needed it.
For this patient, the relationship with her animals was stronger than any attachment she had to another person.
But then it was in the middle of the night, because I worked at night shift, so I couldn't call anyone, and I was stuck with half a dozen live tarantulas on my desk for the rest of the shift.
For the next couple hours, I used all of my free time between documenting, working with other patients, to make a list of every animal shelter or rescue group that I could think of that might be able to help.
The oncoming shift was not at all pleased with me when I handed them a list of places to call and begged them not to throw out the spiders.
Fortunately for me, a social worker from my supervision group was working that shift, and agreed to take over care of the animals in call all of the places I had come up with.
She ultimately found a temporary home for the spiders at the local Children's Discovery Center, who had a number of reptiles, spiders, and insects on display.
I really wish that I could have been there to deliver the news to the patient, but my coworker was, and she reported back to me that the patient just cried with joy about how we had done this seemingly little task that meant the world to her.
One of the reasons that I really love this case is because it was so simple and so human.
I hope I'm not the only one who feels pressure as a social worker to do something big or something important, something revolutionary that will garner us recognition in the field.
But through reflecting about this case, I can really see how something that I consider small could actually be incredibly meaningful and big to a client.
It really brought into perspective the importance of understanding our clients from a holistic perspective.
It would have been really easy for me to discount her worries, dismiss her fears, or even worse, just steamroll her into the admission process without taking into account how important her animals were to her.
Truth be told, she would have met the criteria for involuntary admission if we had not been able to overcome that main barrier with her and she had insisted on leaving AMA.
And of course, as a social worker, involuntarily admitting patients is something that I consider to be a last resort as it's never my goal to infringe on anybody's rights if I can help it.
One of the first things that a professor taught me when I was in school is that the client is the expert in their old life.
There are a number of barriers that our patients have in accessing care.
We could probably talk for hours about all of the systemic problems that are in our country.
Most of the issues are macro level and require social workers to participate in policy work, advocacy, community organizing.
But some require a much more human touch.
And I find that a lot of social workers, myself included, get stuck in a trap of doing for the client or acting as though they know what's best and the client just needs to follow.
Getting that perspective in check is definitely one of the challenges that I think we all face whether or not we want to admit it or not.
I know for myself, sometimes I get in the idea of, well, I've seen this before, I've heard this story, I've known somebody else who's gone through this and I just want to be able to tell my client what to do, what I know might work.
But constantly keeping myself in check, I think is one of the things that will take lifelong practice for all of us.
I also recognize that this mindset is rooted in the white centric paternalism that's at the root of social work.
And there's a constant battle between that and respecting the dignity and the self-determination of our clients.
I think that that's one of the biggest challenges that social work as a profession faces.
This case was a great example to me of how we as social workers need to just advocate for our clients, which sometimes means going against company policy and it's justified, going out of our comfort zone or our job description to help a patient.
And also how much we need to rely on our colleagues to meet the needs of our patients.
Social networking, professional networking with other social workers and other agencies within the community to create that web of services for our clients, I think is one of the most important things that we can do.
In this case of my friend had not been on that next shift, it's quite possible that that patient's tarantulas would not have had a happy ending.
And this is one of the things that I love the most about the profession of social work.
It's a combination of scientific inquiry, evidence-based practice and theories and humanity, being human, being there for the patient to see what they need, see what they want and do what you can to help them.
When I listened to this tale, I was driving along a country road thinking, listen, this lovely, this is like something like listening to the moth, beautiful storytelling style.
Then when we got to the part of opening those little Tupperware containers, that's when I nearly read off the road.
Oh, I know. Oh, I don't have a spider phobia.
But I might have developed one had I been that social worker.
I can't you just imagine.
And this is at nightlies.
She's at nighttime social worker, right?
So and after our social worker, so there she is, it's nighttime.
She's taken care of a series of Tupperware containers.
Alone in a office. Alone in a office or behind the ward desk or something.
And there she is. You wouldn't have just opened it, you'd open it and then you would have as quickly closed that lid again as you opened it.
And then you might have done another peak just to check that you actually saw what you saw.
Didn't, didn't. And then the light pans down into the Tupperware container and there it sits.
This big black brown tarantula.
Oh, wow. Like just. Oh. And what I loved was in her description of those Tupperware containers.
Her love and care that this person has gone to and bringing them into the hospital.
So like these Tupperware containers have not just been quickly put in, you know, this person has come into hospital in a state of distress, in an acute mental health scenario, right?
Homeless. Like there's a whole range of things happening for this person and yet the thing that they have remembered to pack and pack nicely is Tupperware's full of really good soil with cotton wool balls in there, right?
With the lid on. Like these are, these have been put there with love, care and concern.
Yes. You know, like that idea of leaving the burning house and taking the most precious belongings, that's what's happened here with Tupperware's full of spiders.
You know, you and I could just riff now for another hour and write the movie that goes with this.
And listen as we will. Yes.
But maybe over, you know, a cup of tea later.
Absolutely. But maybe we should go to some reflections of our own around this beautifully told tale.
Yeah, yeah, yeah. Yeah.
Look, Liz, I love the absolute compassion with which this story has told.
This social worker is really coming back to the basics of social work intervention in a, in a health facility where like, you know, she describes that white paternalistic approach that's happening and we have this person of colour who is in such distress.
And like I just think we really need to come back to what is the social work role within such an authoritarian and hierarchical setting.
And I think this story really illustrates it, right?
Just coming back with compassion to what is the most important person, for the most important thing for this person?
Yes, the meaning making.
Yeah. That we often talk about.
Yeah. The meaning making of this.
But you know, you talk about compassion absolutely.
This woman is working with heart.
But there's also a small acts of resistance going on.
And I wanted to pick up that theme with you, near me if I can, because I think one of the statements that the social worker makes is, you know, we, many of us going to social work thinking, yeah, well, bring on the revolution.
That's right, let's save the world.
And what if it isn't about those big gestures?
Yeah. What if it is about these daily acts of compassion and resistance that social workers like this one applied to their work that might seem simple to the actual worker, but it was anything but this particular woman who came in and, you know, you and I talked earlier about this could have been a sliding door moment.
This social worker could have towed the party line and could have treated these spiders like contraband.
Yeah, that's right. I think in fact, one of her colleagues said, get rid of them.
Get rid of them just throw them out.
And that act of sticking to the party line would have probably meant that that woman then would have been held in that hospital against her will, devastated because her spiders had been, you know, dumped in a local dumpster.
But she chose a small act of resistance around this.
Yeah, and I think that act of resistance was aided by the resources that she pulled around her, right?
So being that night time after our social worker, she's always got in the back of her head, what's going to happen when I clock off and someone else clocks on, right?
So what's actually that hand over going to look like?
And she mentioned that coming on shift during the day was someone who was in her supervisory team.
And I think that says a lot more than the words she used does, right?
Like, you know, what she was saying was that there was an ally in that team.
There was someone coming on who thought about the work in the same way that she did, who came from that holistic person-centered approach.
And she was able with full awareness and knowledge of what she was doing, hand over the priorities for this client and know that that was going to be followed through.
And I think bringing your resources around you, when you're doing those very small acts of resistance, then make them bigger.
They expand the capacity to impact the person, I think.
And, you know, in reflecting about small acts, when I think about the sheer volume of work that those social workers were, we're talking 10 to 15 assessments per shift.
Oh, it's a downed in Liz.
It's a actual product line, right?
Like a factory. Yeah. But this other social worker that she was able to hand the bat over to was creative enough to find a home in, what was it?
The children's ward or the children's...
It was a shelter. It was a shelter of some sort.
But like, I think you're absolutely right.
Oh, it's incredibly creative.
But also, could you hear in the language that she was using that these spiders were never referred to as insects or things or...
Or hairy black nightmares.
Yes. They were referred to as animals throughout the whole thing, which actually positions the spiders alongside dogs, cats, other pets that people might have.
And it occurred to me that this...
There were two aspects, if you think about a system's theory or ecological model that the social worker might have been coming from.
There were two aspects of this client's life that she was thinking through, right?
So she was thinking through the connection, the companionship, the relationship that this person had with these spiders.
But there was also that other aspect, wasn't there, that the person said that the spiders were source of income.
So actually, this was...she was breeding the spiders as an income generator, which means that actually we're looking at financial...
That financial circle, if you kind of imagine the ecological model in front of you, you've got the financial circle as well as the care and connection model, idea.
And maybe even identity.
Yeah. What if she was known in her local community as the woman you went to if you needed a spider?
The spider breeder. Yeah.
Could have been part of her identity.
It certainly, I think, will be a memorable part of the identity for that social worker and reflecting on that.
I think you're absolutely right there, though, Liz, like that idea that this actually...
These spiders in these type of air containers meant so much more to this woman and her entire world than just one of those spheres.
Actually the spiders had reached a number of areas for this woman and for the social worker in all that compassion and all that working from her heart, being able to sit and listen and say, this is actually really, really vital for this woman.
This is more important than just flushing them or just getting rid of them now.
Did you love the way that she brought it back to values?
So she rigged values? Yeah.
So dignity, yeah. Self-determination.
Yeah. And it's the person-centered approach, isn't it, right?
And coming back to the sense of humanity.
Yeah. So important in a work environment like that where you're seeing that extraordinary number of people come through.
You're working around the clock, doing...
I think we sometimes talk about like the doing the work, like, you know, just the assessment, the intervention, the discharge.
You're going through, through, through, and actually being able to break that cycle, like you said, it's an active resistance.
But it's also, I think, a way of self-preservation and job satisfaction, actually, because being able to cut through that monotonous, everyday work and being able to see where the scope for change is and the scope for impact that you have with the person is, I think that's going to keep you in the job for much longer lives.
Well, it's an imperative for that reason, but also so that you don't become part of the paternalistic machine that she refers to, because it bit be so easy, as we know, just to kind of be task-focused and just to churn through these assessments.
But stopping and reflecting and actually resisting the so-called party line around contraband and moving things through people, she actually was defying that particular model.
It's actually quite brave.
That work, isn't it? I want to pull back now to something she also said about how when she was first working and was taught by a professor that the expert of the client's experience and lived experience is the client, right?
That they are the expert of their own life.
And that's, this story really shows that, I think, that you're positioning expertise in the person who owns that, that live story, that live story, right?
So I think so often, especially when you're tired and you're going through day after day, it's really easy to come in and say, well, I know what's best for this person.
I hold expertise, right?
But to be able to send to yourself back to say, actually, this person is the expert in their life.
I'm here to support the meaning that they make of their life and the priority and needs that they have is really essential in this sort of work, really essential.
And I found this a great reminder because I think anyone who's worked in hospitals, especially in the A&E department, will have had the referrals, well, I've never had the spider one.
I certainly had the, the budgie in the cage that required feeding or the dog that was locked in and the older person had been brought in.
And that was the only companion that they have.
And I think what I would like to do with my social work department is use this as a key learning tool because we've all had the referrals, right?
And it's so much easier to go, that's not my job.
It's not part of my job description to actually breaking to someone's house and feed the budgie.
It's not my job. But I think this is a timely reminder about the thinking and the meaning making that goes on behind these kind of referrals.
All of those things that you just described me in, they enrich the practice, but they actually bring us back to our core values as social workers.
Why we do what we do, because it's a stuff like this, like that woman will actually, I guess this will be memorable for her too, that there was a time when someone actually heard me and kept me, I don't know, is that family income strength bit of both?
Yeah. I think it's also that whatever happens in her mental health journey from here on, she'll be able to focus on it that much more because she's not worrying about her experience.
So, looked after her. Yeah, you just flashed me back, Liz.
I had a case so long ago. It was in an intensive care unit and there were farm yard animals in the house.
There were goats and pigs.
And you've just taken me back there and I remember spending hours on the phone to the RSPCA, trying to figure out what we were going to do about these farm yard animals because this person was now hooked up to a ventilator with no next-of-kin, no, you know, person's responsible around them.
And I think actually this comes up so much more often in our practice than we think.
We're actually, you know, forgetting if we don't remember where we position other than human beings in someone's world, this is stuff that keeps women in violent relationships because they can't leave their horses.
Yeah. It's one of those things, it's social work 101, but let's revisit it and think about it from the perspective of small acts of compassion and resistance as opposed to, oh, yeah, no, absolutely.
So we're talking about it right now from a hospital perspective and of course this story is from an inpatient acute setting perspective.
But obviously this lesson Liz, I think, is for social workers across the board, right?
It's not like other than human beings are, you know, only resigned to the hospital sector.
This I think is something like you just spoke about with domestic violence.
This is something that crosses sectors.
And I'd be really came to hear from our listeners about what other sectors this actually comes in a lot too.
I'm assuming and know that it does come up in a correctional facility setting, right?
But beyond an institution, this is going to be something present in the community sector as well.
It would be something I would really be interested to hear from our listeners about.
Look out. I can't wait to hear.
And also more stories from our American listeners.
Oh, yeah. I think there's some really interesting practice going on and it's really fascinating to hear what the differences are in the way we structure our service provision, in the way that we think about our interventions in those spaces, right?
Like we can only learn from each other.
We learn one story at a time I find men.
Yeah, we really do. We really do.
I really love this story and I'm really, really thankful that it was sent into us, Liz.
Like to. Really awesome.
So on that note, I'm going to say goodbye.
I hope everyone's doing well out there in Australia like we said at the beginning.
Everyone's been tuffing it out with too much rain.
It's been absolutely freezing.
We're not used to it in this country.
So let's bring on some installation for our house.
That's what I'm thinking is, to be honest.
But we hope everyone's doing well out there.
Take care of yourselves.
Jump online, getting in contact with us.
We love to hear from you.
Take care everyone. Bye.
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