A crucial element of support work appeared to be in facilitating access to other community services. This builds on the notion that a service user’s journey should be one of ongoing support, rather than one punctuated by cliff-edges. During the HOPES research, we learned that support workers would contact a wide range of organisations and groups to provide the necessary networks for ongoing care. Many support workers had links with voluntary groups, and would know other key service managers by their first name. They would also problem-solve to identify key individuals who may be able to help. Examples include contacting the local church, or the housing association, or others that may be able to provide occasional input that might make a difference.
However, the research found that the support work role was much more than just ringing around, and the nature of these networks and how they were used were nuanced.
Introducing other services and support
The way in which other services are introduced appears to be important. There are many ways in which this might be done. Mostly, new support would be introduced in a very gradual way, with initial ‘low-key’ contacts. For example, a day centre was introduced by one support worker as follows:
“So, it was more about introducing him in a roundabout way, oh, we’ll stay for a coffee, and then next time we’ll go for a coffee and have a game of bingo, and to lunch. And at the initial stages I would stay with him. I’d have a cup of tea with him, and I’d play bingo with him. You know? So he’s not sort of being left to his own devices. And then gradually, I would disappear in the next room, or go and talk to somebody and leave him talking to whoever else was at the table”
The following example suggested that support workers in this area built significant bridges with community support after cognitive stimulation therapy came to an end, enabling entire cohorts of service users to be referred as a whole:
“So after the CST sessions finish, we facilitate a group meeting, a group introduction to a day centre. So myself and my fellow support worker will be at the chosen day centre and we’ll have our own table there and the seven people that have finished their CST sessions are invited to come and join us. So we introduce them as a group to a day centre. We do it with individuals as well, but we do it that way sometimes. Well, we do that every time after the CST groups finish because the people often want to maintain friendships with the people and the social contact, so we facilitate that. And then we also introduce people to the Alzheimer’s society meetings, cafes, singing groups, whatever is going on at the time. We introduce to them and that’s where this chap was sort of discharged back to the GP. He was going to day centres; he was going to the Alzheimer’s society and he was engaging with everything”
Introducing other services was quite a challenging prospect for many support workers. There were examples of where it could (and did) go wrong. In one instance, the visit to a new day centre was described as “just a cup of coffee”, but on visiting the older person became very distressed. The day centre was attended by many people with quite advanced care needs, and this provoked a very strong and negative reaction from the service user.
“So we went and it absolutely frightened him to death. There was people there who were more impaired than he was, there was people there who had other mental health conditions, not necessarily dementia. And I felt quite deflated because I felt that if he was going to be with other gentlemen, then he probably would be able to get some sort of camaraderie and, you know. But it just completely backfired on me, it really did and I never saw it coming at all. He was extremely upset, he got very angry. …
And I felt that I’d put him in a position where I should never have done that, but I did it in the best of intentions that I thought right, you’re a gentleman, you live alone, you could do with some social inclusion, this is a specific group for gentlemen.. And I just thought that would be so ideal but how wrong I was…
He was very vocal about, you know, “did I think he was like those others”, “did I think he was a mad person”, “what do you think of me if you think I would be interested in something like that”
And I never got that back. I did visit for some considerable time after but he got less and less tolerant of my visits.
Getting to know key people
Having good working relationships with local service managers allows support workers to tailor the experience for the service user, making access that much easier. For example, one support worker was considering a day centre for a lady she was supporting, but was careful to ensure that it had a small, non-threatening and ‘homely’ feel to it. Her knowledge of local services meant that one particular day centre would be suitable. She also knew the person who ran it, and was able to arrange a “trial run”, where the older person would join just for a short visit. It appeared that the service manager felt comfortable making a special arrangement, since she trusted the support worker and had previous experience of this working well. We found many examples of support workers building these networks, across formal services but also third sector and community/voluntary groups
Tip: When recommending attendance to a group specifically developed for those with mental health needs, liasing with the group beforehand can help ensure that you are encouraging the service user to join a group that they will find helpful.
Where the service user is shocked or frightened by the severity of illness in those attending this was found to breakdown service user and carer trust very quickly.