‘My role as a support worker has defined me’

Faye Cox reflects on her transition from support worker to Assistant Psychologist on an acute mental health ward.

I arrived on the ward where I worked as a support worker, to a handover stating it had been a very difficult shift for the night staff. They had been working with a service user presenting with significant psychotic symptoms and self-harm, that had become unmanageable. The service user had been placed on a 2:1 observation level – staff were to be with them at all times. As I walked into their bedroom, I met with a presentation I had never seen before. Clearly very distressed, this person kept holding their breath until they turned blue. They had marks on their neck from tying ligatures, and mostly sat or laid on the floor having had belongings removed to keep them from harm’s way.

I was with a colleague, and together we also sat on the floor and tried to reassure the person as to where they were, who was in the room, and that they were safe. We kept asking them what was happening for them at that moment. They were unable to acknowledge our attempts at conversation, or respond. I can’t recall a time I have worked with anybody as distressed. As a result we reduced our observations to half hour stints to ensure staff were able to come away and process the situation. My team was amazing as always, and we worked together throughout that day to maintain this person’s safety whilst also supporting each other.

Over the coming days, I saw a vast range of symptoms in them, which could cluster into a multitude of diagnoses; catatonia, self-harm, not eating, whispering things which are incomprehensible, excessive exercise, and dissociation, to name a few. We also observed periods of lucidity where they were able to engage in a coherent conversation, and even laugh and joke. We were left scratching our heads. We discussed with the psychiatrist what could have caused such a distressed state; and how we could support them to get better. The variety within this presentation was astounding. I learned very quickly that it is rare that any single person fits into a diagnosis ‘box’.

Trauma-informed care

I encountered this case when I found myself working as a support worker on an acute mental health ward. In this role I understood what it meant to be truly fatigued, to go home late, to do the job of three staff because there aren’t enough – and to feel frustration when service users have been failed as a result. But I also learned that this was where I wanted to be. I was fascinated by the selfless nature of the ward team and was intrigued to figure out what was going on for the individuals in our care, how we could make sense of it and support them. 

In the interests of confidentiality, I will be careful in sharing the outcome of the scenario I’ve outlined. What I will say is the psychiatrist reached a diagnosis, we were able to treat medically and discharge with plans for significant psychological input in the community. Once stabilised, it became clear this person had previously experienced significant trauma and required some robust psychological support to work through it. The experience highlighted the importance of trauma-informed care – something I will continue to champion throughout my career. Whilst I had known for a long time that psychology was for me, this just confirmed its importance in making a difference for people. I hoped this person would be supported to recover and live a fulfilled life. 

When I had graduated, I had hoped an Assistant Psychologist role would be the next step. However, after many unsuccessful applications, I found a role in a private locked rehabilitation facility and worked there for one year as a support worker. I loved working with the service users and learning about their presentations and the general running of a mental health ward. I knew I wanted to develop my skills further and work somewhere faster paced, so I moved to become a health support worker on the acute mental health ward. Here we were dealing with significantly higher levels of risk, and some of the most complex service users I will probably ever work with.

Imposter syndrome

I had come from a place where service users were accessing care planned treatment with medication and occasional psychological work, to new presentations which were confusing yet intriguing, but at a level of crisis which was often hard to see. During this time, I wondered ‘how on Earth does a psychologist give therapy to all these service users?’. The answer was simple – they don’t! The role of a clinical psychologist here was consultation, a trouble-shooter, a teacher and a culture-changer, cascading psychological and trauma-informed care down to the roots. The psychologist there had transformed the ward into a forward-thinking, positive risk-taking environment where service users were encouraged and supported to take control of their own risk and learn healthier ways of coping. It was inspiring to see, and I wanted more of it.

When I was offered the job as an acute inpatient Assistant Psychologist, I was completely shocked – it was my first interview for an assistant role, and I had been chosen. Let’s just say imposter syndrome hit me hard! I was proud of myself but also terrified that I would not live up to expectations. I knew my experience on the wards would be useful, but I underestimated this a lot. Previous direct ward work has meant I have felt safe sitting with service users on the ward, I have had the interpersonal skills to engage them and the knowledge to know when risk is significant.

What has been even more useful is the ability to empathise with the staff on a personal level, knowing how stressful their jobs can be and being able to weigh when it is a good time to provide training and advice, and when I am most useful as a sounding board. If I hadn’t worked on a ward previously, I don’t think I would have been able to truly empathise with the team and the pressure they are under. As with most things, direct experience is invaluable when it comes to truly understanding how it feels to work somewhere, and since supporting the staff is such an important part of the psychology role in inpatient settings, it has been extremely useful. Of course, my psychological knowledge is nowhere near where it would be if I had done a Masters, or previous assistant posts, but I am learning… and in an environment with high levels of acuity, those person skills are essential. I feel comfortable in ward environments and working within a multi-disciplinary team; I don’t think I would have been as accustomed to that without my previous experiences.

Managing the transition

The transition from support worker to Assistant Psychologist was significant. I missed being part of a huge team, being with the service users 24/7 and the instant gratification from small tasks like making them some toast or a cup of tea. I had gone from a job where each shift was isolated with prescribed tasks and a strict time frame, to a role with ongoing projects, flexibility and a requirement to manage my own time. I anticipated that I would struggle to resist ‘mucking in’ and maintain boundaries within my role. This is something I have been consciously aware of, and still six months in when I hear the emergency alarm go, it takes every fibre of my being to not get up and run to the incident. 

But what I love most about being an Assistant Pscyhologist is the time and space to do all the things I wanted to be able to do when I was a support worker. I have time to formulate, to get to the root of a person’s difficulties and to provide targeted resources for service users at a one-to-one and group level. My role as a support worker has taught me how to engage a person into a conversation which puts them at ease and builds rapport so that the psychological work feels easier to access and may even be more effective as a result.

When a service user tells me they’ve not felt able to approach staff for support because staff are busy, I feel I can understand just what that means for them, because I myself have been that ‘too busy’ staff member and have seen the impact on service users first-hand. I once said to a service user in a psychology one-to-one session, ‘if you’ve asked for a chat and no-one came, go and ask again, they may have been side-tracked and will be glad you reminded them that you are waiting’– I know as a support worker I would have been glad to have been reminded. Little nuggets like this make more difference than you might think.

Valuing skills

When I worked on the wards, I used to feel frustrated at the pace. I sometimes felt like we were so busy ‘fire-fighting’ that we did not get time to sit and work with a patient to make sense of their admission. In my assistant role, I get to work with an experienced psychologist who is an expert in formulating complex presentation and risk. Every day, I learn something new and fascinating, and sit hoping that one day I will be able to do such incredible work.

The clinical psychology road is a long one, and the way into it may not necessarily be the way you would expect. Somebody at university once said to me that if you qualified at the age of 40, you’d still have at least 25 years of doing something you love, and that has stuck with me. You would be amazed what experiences you may draw upon in an interview, even those little bits of volunteering you did back at college; it all counts.

For me, my role as a support worker has defined me. While I strive to learn and achieve more, and to eventually work as a Clinical Psychologist, I will never forget or de-value the skills I have gained working alongside some of the most selfless people I have ever met. I will always think back to experiences with service users like the one described at the start, grounding me in the knowledge that there is always more to learn, but that psychological work holds incredible value in getting to the core of someone’s experiences. That’s usually the key to changing somebody’s life. I pinch myself every day that I get to do this job, but I remind myself where it started too. Support worker time is not wasted – it could be the most important job you do!

Faye Cox is an Assistant Psychologist in South Yorkshire.

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