Terror Bulletin (otherwise known as: a psychiatric report.)

I’ve been analysed. Again. This time by Aaron Frazer, a Trainee. That is: a Trainee Social Worker who wrote an Outcome of Assessment report based on the questions asked by Rohini, a Community Psychiatric Nurse. A five page document that could have been condensed to three pages without any content being lost. An irritating letter full of inaccuracies where Aaron can’t even spell my name correctly. Like almost everything in psychiatry, the answers you get depend on the way you ask the question and the assumptions you make in framing it. The word-processor will give you any solution you want, provided you change the inputs in the appropriate way. To consider Aaron’s report as a punctilious recording of our encounter, you have to convince yourself that at all times Aaron was ‘objective’ and you have to believe that there was a structure to the cross-examination.

Aaron from his Social Worker point-of-view wrote, ‘The patient’s social and personal history was not explored within this assessment, primarily because it is well documented in his clinical history. Below is a discharge summary (sic) from August 2012’. My first concern, I was not in hospital during August 2012 nor was I discharged in August 2012. It’s a minor point but if you cannot get the small details right then what hope do you have of getting the bigger picture. Second concern, this Mental Health Trust’s computer records only go back to a point in 2010 despite my being known to services for decades. And thirdly, using previous ‘filler’ is just an exercise in ‘cut ‘n paste’ to pad out the document and adds complexity while coming across as an afterthought.

‘The patient presented at the appointment appropriately dressed and with no evident signs of neglect or poor personal care.’ My fingernails were filthy, my hair was unbrushed with a tendency to make me look like a hedgehog, my jumper was soiled by food stains and I ponged. So, no signs of poor personal care. I do wonder how many derelicts they see on the Harrow Road on a daily basis before ‘poor personal care’ becomes noticeable? Of course, if Aaron thinks I am from the labouring classes then that is what one would expect, if on the other hand, I had worn a dark-blue pinstripe suit to reflect my former working-life what would the output be?

This type of document merely acts as an irritant and adds little, if anything, to my care. Irritation is derived from the errors and the lack of judgement contained within. Basic errors such as getting ‘subjective’ and ‘objective’ garbled. A lack of sensibility around my entering an intense emotional state brought on by a series of inadvertent intrusions on personal grief. And of course, at all times, the patient is viewed as an unreliable witness. As an unreliable recorder Aaron attests ‘The patient stated that he required the local authority to provide (a) cleaner to do a deep clean of his property.’ No, I did not say this or make a case for such. It was Aaron who entered the notion of a single visit to my property by local authority cleaners to perform a ‘deep clean’ and despite professional resistance in the consulting room I objected. Oh, I know that my flat is in a terrible state and gathered from being in the mental health system for eons, by now, I have a good idea what works for me and what doesn’t.

My psychoanalyst said, ‘The report comes across as a disciplinary hearing.’ Anyone can see this system of work is plain wrong, so why a supposedly competent Trainee Social Worker would chose to work in this way is anyone’s guess. The serious point being – Aaron Frazer is destined for a career of writing reports in this style – and consequently he runs the risk of repeatedly wasting tax-payers’ money. The more ridiculous parts of his letter will be incorporated into my novel. If he wishes to claim authorship Aaron will be welcome.

PS For the benefit of mental health professionals who have difficulty understanding the meaning of the word ‘report’ Aaron’s letter is a ‘report’ because it contains recommendations.
PPS What are my formal qualifications? The report claims that I left school with no formal qualifications and this, in the face of my relaying that I am qualified to write care plans. Were you listening Aaron?

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