Three Questions
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Reflections on my first month at St Mungo’s South Camden.
As I’m sure my fellow fellows will agree, frontline work is intense; so much time is spent responding to the immediate needs of the moment, that space for reflection is rare. The act of sitting down to write this blog post was therefore pretty daunting; taking a step back to look at the past month, to analyse and unpick my experiences in the hope of making them clear and coherent enough to share with you, the reader, seemed an impossible task. How to do we set about explaining something that we are only just beginning to understand ourselves?
The Year Here team did warn us that this would be the case. The insight gained from being catapulted into frontline work is intended to be deeper and more complex than the kind of learning that many of us have engaged in before; it’s messy and unpredictable, it’s challenging, it’s unrelenting and it’s draining.
It’s a learning that starts with questions, not with answers and, as someone who likes solutions, I’ve had to learn to give value to these questions, to enjoy the unpicking, the interrogating, as an integral part of the learning and (eventually) the ‘innovating’ process. In this short post, I’m going to share with you three of the questions I’ve asked myself, and hope you’ll forgive me for the fact that they don’t yet have answers…
At this point, I should probably introduce my placement. I am working across the six sites that make up the St Mungo’s South Camden Mental Health Accommodation Services and have been tasked with finding ways to improve the spending of something called the Individual Specialisation Fund (money that exists to engage clients in activities that promote positive mental wellbeing, life-skills and relationship building). There are currently just over 60 clients across the six projects, all with varying levels of support needs.
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Question One
When arriving in a new environment, the first and perhaps the most daunting challenge is to learn a whole new language. From the names of medicines and drugs to services and job roles, the vocabulary seems second nature to everyone else; the terminology that makes up the day-to-day of a service like this one is so ingrained that most people use it without questioning why it is used or what it really means.
The word client, for example, is used to refer to everyone who accesses St Mungo’s services. As a new arrival, I found this a pretty strange label, one which sounded wrong to hear and even more wrong to use. It seemed to have little regard for the humanness of the people it was referring to, reminding me more of consulting firm lingo than that of a service existing to help vulnerable people. When I interrogated my supervisor about it, I learned that it was actually chosen by the ‘clients’ themselves, who beforehand were being referred to as ‘residents’ or ‘service users’ (which was, rather unfortunately, being shortened to ‘users’). The word client is supposed to suggest agency and movement; it acknowledges the individual as the active user of a service, as opposed to a passive recipient.
Yet I’m still not sure it’s the most positive choice of word. And if it is, it seems to me that 95% of the time it is not necessary to draw the distinction between ‘client’ and ‘not client’; it suffices just to refer to people as ‘people’. I know that some of my fellow fellows have been asking the same questions about their sectors too: Should we call them students, learners, children or kids? … Are they residents, patients, clients or customers? … and does it really matter which word I choose to use?
So, I guess my first big question is this: what role does terminology play in the mental health/homelessness sectors and how far can (and should) it be challenged?
Question Two
Before starting Year Here I was working in Athens, in a shelter and community centre for particularly vulnerable displaced people from all over the Middle East and certain parts of Africa. Along with the question of terminology that I have addressed above (I found the label ‘refugee’ to be unnecessary 95% of the time) a theme that I was consistently struck by was identity. Being a refugee was not an identity of choice, and yet it was one that defined every interaction and almost every stage of the daily routines of the people I was working with.
Similarly, the identities of the people I work with now at St Mungo’s are often constructed around their state of homelessness, their mental illness and, in some cases, their substance use. Their day-to-day routines largely perpetuate these identities and their interactions with members of the public tend to further strengthen them.
St Mungo’s is currently working with a new ‘asset-based’ approach to ‘move-on’ (two more frequently used pieces of terminology), uncovering the skills, interests and passions of clients as a way of raising aspirations, improving mental wellbeing and eventually facilitating their moving on from St Mungo’s services into independent accommodation. And yet many of the clients have become so ‘institutionalised’ (another term that is frequently used in the sector), that they have entirely lost sight of the skills, interests and passions that made them them. In fact, many of them were never encouraged to discover these things when they were younger, so it’s far more than just a question of ‘uncovering’ interests and passions — it’s about creating them.
With this in mind, my second question is this: how is identity constructed and perpetuated within the homelessness/mental health sectors, and to what extent can (and should) we challenge these identities?
Question Three
‘They’re adults. We cannot force them to do anything.’ I hear this a lot. And it makes lots of sense. Yet apathy and lack of engagement arguably make up one of the biggest and most frustrating barriers that I’ve seen St Mungo’s staff come up against on a day-to-day basis. In practice, it looks like knocking on doors and getting grunts in response, like empty activity sessions despite multiple promises of attendance, and like frequently silent corridors until late in the afternoon because still no one has woken up. It’s especially tricky because bipolar disorder, clinical depression, psychosis (amongst other mental illnesses) along with the quantities of prescribed medication that most of the clients take daily, all affect their relationships with the outside world, frequently causing lethargy, narcosis and an overall lack of engagement. Yet I have seen first hand the undeniable good that comes from clients engaging in the vast range of activities that St Mungo’s offers (even when they were reluctant to engage at first). From cinema trips to cooking lessons, massages to one-on-one skills-based sessions, yoga classes to art groups, the opportunities exist to be seized, but so rarely are.
So my third, and final, question is this: to what extent should clients be made to engage in activities that could help them to develop life skills and/or have a positive impact on their mental wellbeing?
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Whilst the past one thousand words have focussed largely on the challenges and questions thrown up by my first month on placement, I feel I ought to stress just how positive an experience it has been so far. As someone who loves people and stories, I have relished getting to know so many new people (‘staff’ and ‘clients’ alike), hearing their stories and sharing new experiences with them. There has been a lot of laughter, too many interesting conversations to count and plenty of ideas for the four months to come…
