thanks so much everyone for your input, feedback and suggestions, they have been greatly appreciated. ive spent a couple of hours writing some stuff one and skimming over studies, research and papers (there is so much!)
I have an appointment with my pdoc tomorrow, which my SW will be coming to and then after that we are suppose to be calling up this manager on loud speaker to speak with him and for me to express my concerns around this. I am not overly comfortable with how this is occuring, id much prefer to sit down and hand this to him... or at least be able to sit and read off it... feels a bit awkward if i was to read off it over the phone. sigh
This is what i have got so far.... it doesnt really flow much, its just points as ive come to them.
In the last 12 months, I have had a change of psychologist, support worker, case manager, psychiatrist and a change in the way I access support with my dietitian. And all have had a hugely negative impact on my recovery and caused many set backs. The change in one of those supports triggered a very steady decline in my mental health which resulted in an 8 week long admission and ECT treatment.
Having changes in my support feels like abandonment. Its people telling me that they will always be there, that they are never going anywhere and that I will do whatever I can to support you, but then up and leaving. It people giving up on me. it rejection. And perhaps in reality none of these things are true, but from a brain that has been through many experiences of trauma, this is what it screams.
Having a change in support worker every 3 months would be incredible destabilising and unsettling.
As I come from a background of significant trauma, it takes me a very long time to build trust and rapport with people. And even though I would eventually cycle back through workers time and time again, it would still mean re-building that trust and rapport again for me.
What is your reasoning around these frequent changes?
Does it come from a trauma informed, mental health informed back ground?
What is your research and evidence to support this?
I use to work in community welfare and it truly baffles me that an approach like this would even be considered, when its so widely know that consistence and continuity of care is so vital in the care of and recovery of folks with mental health issues and just in general when caring for and working with people. My old work place unfortunately often had a high turn over of case managers, and I remember having to help pick up the pieces frequently when clients placements broke down, behaviours escalated and the very clear setbacks that occurred due to these changes in trusted relationships.
I have done my own bit of research this afternoon and I wont bore you with the pages of information, research and studies that have been done about how continuity of care is important, but here are some main points that i came across;
- There is evidence that people with serious psychiatric conditions are more likely to keep stability in their care when they allowed long term continuity of care
- Patients who receive continuity of care in general have better health outcomes.
- Continuity of care by having the same person seeing a client means that problems can be picked up quickly and clients needs understood better.
- Continuity of care is widely believed to benefit clients with long term, serious mental health issues as it reduces fragmentation of care. Studies also showed that continuity of care reduced the risk of unplanned hospital admission.
- Continuity of care is widely regarded as central to the provision of mental health services. It has recently assumed greater importance in conjunction with the decentralization of service delivery in mental health systems. Clinicians commonly assume that if COC is absent from the service provided to patients with chronic and debilitating conditions, the results maybe social isolation and threats to quality of life. The concept of COC is strategically first choice.
- Aspects of disrupted continuity of care can explain poorer outcomes for patients concerned, especially having to recount ones medical history multiple times is stressful, frustrating and (for me incredible triggering), and more so for people with mental health disorders that might have roots in traumatic events.
- Continuity of care is not about developing dependence on one person, but about gaining insight and perspective from a consistent, positive presence.
- Continuity of care is considered a corner-stone in the effective management of long-term disorders by services users, clinicians and healthcare policy makers. Its fundamental in several policy documents and is useful in service evaluation.
- Its a fundamental element of traditional care and is of growing importance as the population age and live increasingly with significant, ongoing lifestyle and chronic disease challenges.
- Its an essential feature of good quality care.
I experienced trauma from a very young age. It went on for a very long time. And I have continued to have experiences of trauma throughout my entire life. As a result of this I have grown up finding it very difficult to trust the world around me, and have formed an insecure, very anxious and disorganised attachment style.
Consistency is so important to me. and through consistency trauma can be repaired and healed. And this is not just for relationships with therapeutic input, its for all relationships in a survivor’s life. All support workers work differently, I know this first hand working with both (names removed) and also having interactions with other staff members. Chopping and changing every 3 months is anxiety provoking, destabilising and re-traumatizing.
Its about predictability. Predictability helps build trust, because without trust, there is no safety (which is really REALLY important to me) and without safety it is game over, its no longer a source of support, instead it becomes an additional source of distress, which in a way is how I felt working with (name removed). I didn’t have that predictability with her, I didn’t have that trust, I didn’t have that safety.
No consultation or care for those impacted.
As I have a large support team around me, consisting of; a psychologist, psychiatrist, case manager, GP, dietitian and an eating disorder psychiatrist, all of whom quiet often have a lot to do with my care, I can only begin to imagine how frustrated they will be at having to keep up with who my day to day support worker is. I had (name removed) attend a GP appointment with me recently because (name removed) was off, and my GP actually asked (name removed) to leave the room as she did not know her and did not feel comfortable discussing my care in front of her.
