Module 2: INDEX
As was discussed in Module 1, when working with people you know or suspect may be reluctant to accept care, it is possible that your attempts to provide support may be interpreted as a threat.
Research suggests three things that may help you overcome this and gain the person’s trust:
- Drawing attention to similarities and ‘the familiar’
People are instinctively more trusting of someone with whom they share something in common
- Being reliable, consistent and predictable in your approach
Trust depends on being able to anticipate what someone is likely to say and do in any situation – being consistent and predictable, even when circumstances are challenging, is important.
- Finding shared goals between you and the person you are supporting
Where someone sees that what you want from a relationship is also something they want, a strong bond is formed, and people start to trust your actions more.
Thinking of these three things, what can be done to build trust?
The support workers that took part in our study told us that one of their earliest priorities was to gather as much information about the individual as they could. This includes not only information about their physical and mental wellbeing, but also background information such as what they used to do for a living, their personality and likes/dislikes. Key information might include:
- How they like to be addressed
- Firmly held values, attitudes and opinions
- Music they like / dislike
- Cultural and religious beliefs
- Community links they have
- Their hobbies (even if they can no longer fully participate in them)
- Personal relationships
- Their ‘type’ of humour
- Their favourite / least favourite things
- What they’d like to achieve
- Happy memories & bad experiences
- How they feel about accepting care – does this change from day to day? Why?
- Their job before they retired
- Their personality traits
- Difficulties they’re facing
Having a better understanding of the person should help you identify things you have in common with the service user, and give you some clues as to what might be the best way to try and deliver care.
This is what one of the support work managers told us:
“One of the things that we’ve found is invaluable, is to do a bit of homework, to have a look at their notes why they’re on the social services, to see whether there’s been previous involvement. To try and get as much information as you can in your hand before you go, if it’s possible, just to see what’s really hacked them off in the past, what are the experiences they’ve had, bereavements, everything really. The more information you can get, the better equipped you are on the day to not say the wrong thing or to maybe just get in there with a comment that you know will do good. Find out what they used to do, all that and try to do it before we go.”
When reviewing what you know about the service user (either from the service user themselves, their family or other staff) it can be helpful to think about what you have in common that could be used to open a discussion with them, and to help build trust through familiarity and similarity. This could be anything from a shared hobby, to coming from the same geographical area.
This is not necessarily something as simple as possessing sharing shared characteristics. For example, not all men would necessarily find trust easier to come by with other men. Trust hinges upon complex factors, rooted in an individual’s history, and the research found that there is ‘trial-and-error’ in how support workers try to find some common ground. Knowing about the person’s history and trying to find a congruence between who the service user is as a person and the carer is key. Family carers suggested throughout this research that they may be able to help decision making around matching appropriate carers to the older person.
Other methods for identifying common ground included being able to pick up clues from the environment e.g. if you look at their garden, does it look like they enjoy(ed) gardening, or as in the example below, do they have a pet?
“I do like dogs and cats and pets, and things like that. So I do ask them if they have a cat, so it might be about a cat, they might have pictures up or something or lots of plants in the house or a very colourful décor. You have to sort of try and look around, without being prejudiced and judging, you have to be really careful. They might have like a cooking programme but that doesn’t mean I start saying I like cooking, you know, it might be coincidence that they were turning it off or switching the channel that has been on.
But I think saying a bit about them, makes them a bit human.”
Alternatively, if someone is very quiet, you could try telling them a little about yourself (maintaining appropriate boundaries and not being over-personal). For example:
“… if you start making a bubbly conversation, how was your day today, …you know, how did you spend your week, I’ve been to the local shopping centre. I give them my examples so, you know, they feel that trust, I’m telling them about me, that I love going to those shops, I love being around people, people walking, doing shopping. And they say, oh really, yeah, I used to do that or I don’t do that anymore.”
Where you struggle to find common ground with the service user and don’t seem to be making any progress in gaining their trust, our study participants suggested that it may be worth reviewing this with the team to see if someone else might have more success. Other team members may have a different style, or else have something else in common that might be a more natural match to the service user.
Another way many support workers tried to build trust was through visiting with or associating themselves with other people who already had a good relationship with the service user. This could be anyone from a family member to a neighbour or another health or social care professional, such as the person’s GP. Some support workers, for example, told us that they would say that the GP had asked them to check how the person was doing, or allude to the person’s family as below.
“Knowing if they have got friends or family, I’ll say their names so they think, oh, they know my daughter or they know my son. I go I spoke to [family member name] the other day, she said you were getting on alright. I was in the neighbourhood, I thought I’d come in for a cup of tea.”
One support worker also mentioned that where they were finding it particularly difficult to engage the older person they sometimes focused their early visits on the carer in order to slowly get the service user used to their presence.
The support workers in our study told us that even where they were not able to gain access to someone’s house in the first instance, it was important to keep trying as this both showed they cared and built recognition of ‘a friendly face’. This is highlighted in the quote below:
“I think that it’s being consistent. I think it’s about being that friendly face, you know, that they begin to recognise. ..most of them don’t understand why I’m going but they recognise my face. I think it is just that something triggers and sort of says well, if they keep coming then there must be a reason why they keep coming. I’m not sure you can quantify it, it’s just one of those techniques that I suppose I’ve learnt through the years that if you become a consistent person in somebody’s life, eventually they will work it out that you’re no harm to them…”
Finally, many participants told us that it was important not to take rejection too personally. Family members we spoke to explained that it can be very daunting for staff facing some of the realities of supporting people with mental health difficulties. For example, this family carer recalled:
“I do remember a member of staff who was a little bit frightened by my mum’s behaviour, which is understandable, and that person got upset and actually left the house. She was in the car quite upset. And a couple of times I remember visiting and there would be a member of staff in the car, not in the house, and they’d say to me, something has happened, she’s thrown something or shouted or screamed…People coped at varying levels I’d say. And it’s like that with anyone because, like I say, we had a screwdriver thrown at us and various episodes like that. And it can be very scary when someone’s like that and has lost control, and it’s just not in their nature at all; it’s like someone is controlling them.”
This family member appreciated the experience that support workers with expertise in mental health could bring to these situations.
“Although they [the support workers with expertise in mental health] also went through all of it, they went through the mill in terms of her mood swings and the anger and even the violence, the verbal violence for sure, they had all of that. But it was their response to it that was different; I think they just took it all on and managed to do their job despite all of that. It did feel different in those terms”
Remaining calm, consistent and predictable in your reactions, even when faced with challenging situations, is important in that trust-building process.
Case study 1: Saima
Hello, My name is Saima. I am a retired nurse and have a daughter called Yameena who I see as often as I can. In my spare time I like to contribute to my community by helping out at events and being an active part of my local mosque.
Saima was referred to the community health team by her daughter, Yameena, who is concerned about her mood.
Yameena lives about 50 miles away from her mum, but reports that when she visits, she is looking increasingly unkempt and is often in bed, even in the middle of the day. Her house is also becoming more chaotic as she is holding on to things she does not need, including out of date food. Yameena is also worried that her mum seems to be becoming increasingly disengaged from her friends and neighbours in the community.
Sayeeda has tried to find suitable support for her mum, and neighbours keep going round to check on her. However, she often doesn’t get out of the bed to answer the door. Upon visiting the home for the first time, you announce who you are and knock on the door, but she doesn’t come to the door to let you in.
Case study 2: Daniel
Hello I’m Daniel, I used to be in the armed forces, and have a keen interest in military history. I have been happily married now for over 40 years to Linda. We have two beautiful children called Lisa and John, although I don’t get to see Lisa very much. In my spare time I enjoy going for a walk and gardening.
Daniel is an 81 year old gentleman who has been referred to the community mental health team following a diagnosis of dementia.
Over the past 2 years he has become increasingly forgetful and he now relies on the support of his children (John, Lisa) to help meet his needs. However, both are extremely busy with work and their children, and as Lisa lives over 4 hours away most of the time it is John who visits.
John has tried to get support for his dad, but the home carers have found it difficult to get him to accept help and he has recently become increasingly aggressive in his attempts to repel care, resulting in a collapse of care arrangements. Worryingly, he is also now starting to wander, leaving the house in the middle of the night without being properly dressed.
Upon visiting Daniel for the first time, he opens the door slightly, but doesn’t understand why you’re there and repeatedly asks you to leave…
Case study 3: Jane
Hi, My name is Jane, I live alone and have no immediate family. I was married once, but this came to an abrupt end and I have been alone since. I used to get enjoyment from listening to music and going out for a walk when it’s quiet. I also had a friend I used to speak to called Gwen, but she passed away several months ago.Case study 3: Jane
Jane is a 73 year old woman who lives alone and has no family.
She was recently referred to the Community Mental Health Team by her GP after refusing help at home due to concerns that her neighbours were spying on her and that it would allow the neighbours to collect more evidence against her. However, the GP is concerned about the fact she has an infected cut on her leg and is looking malnourished.
During the course of her appointment, she reluctantly agreed to a visit from the CMHT. However, upon arrival she would not let you in and threatens to call the police if you do not leave.
