Revolutionaries Behind Closed Doors

Capitalism intrudes on the daily life of a mental health worker.

Suffolk House is sixty-bed nursing home right on the edge of one of East Anglia’s bigger towns. You have to veer wildly off an A road to get to it; the path then zig-zags through an industrial estate and out the other side, to the edge of a forest. The signage looks temporary. It’s not a place that welcomes visitors.

The manager flashes his key card and lets me in. He’s a big, varicose-looking guy; his name is Watson but I’m not sure if it’s his first name or his last name. I tell him I’m here to see a woman called Rosie, and he swipes me through the second locked door into the home's mental disorders wing. He laughs as I pass.

“Rather you than me, mate. Do you know, the state that woman keeps her room makes me feel sick. Actually physically sick. It’s an embarrassment, quite frankly”. Further down the hallway, a care assistant stops me and says

“Good luck! I hope you’ve got your body armour on! And a peg for your nose!"

I’m used to comments like this. They hate Rosie.

A few minutes later I sit down in Rosie’s room. We chat about nothing; the local sites, the weather and whether Colchester has changed since she last lived there. She’s groggy from sleeping all day. Out of Rosie’s window you can see warehouses, although the curtains are never open. From the other side of the home you can see the Suffolk countryside, but you only get that view from the dementia wing, and Rosie isn’t allowed over there.

Part of the reason why Watson hates Rosie is because she smokes in her room which, to be fair, is a bad habit to have in a clinical environment. Rosie has a mild learning disability and a much less mild obsessive compulsive disorder. One of her compulsive behaviours is methodically tearing off wallpaper in neat little strips. Sometimes she bowls of water at the walls, trying to clean off the bacteria which she thinks live in the plaster. The room isn’t as messy as the staff make out but the signs of Rosie’s OCD are obvious; as well as the wallpaper on the floor, the curtains are stapled shut, and the windows covered in packing tape to stop them from being opened. There are towels covering the radiator, to stop bacteria from coming up through the pipes. Bacteria is a preoccupation of Rosie’s; she says it with a thick Black Country accent.

Rosie’s disability puts her at odds with the other residents in the home. The care she needs is very different; as far as she's concerned, she’s a lodger there, not a patient. When staff talk to her in that slow, high, ‘talking to patients’ tone she feels patronised and she tells them to fuck off. Rosie’s disability is not the kind of disability that Suffolk House like; they like people who you can bathe and toilet and dress, and who say thank you afterwards. They don’t like people who square up to you if you stand too close to them, and who spit out their tablets if they think you haven’t washed your hands.

Rosie has been detained under the Mental Health Act twice in the last few years, both times after being evicted from a care facility. It's not unusual for the Mental Health Act to be used like this, when forced detention in hospital is used to plug the gaps in the social care sector. Rosie was sectioned essentially so she wouldn’t end up homeless. When she was referred to me, Suffolk House were on the verge of serving her notice and they seemed to be angling after the same thing. The paperwork they sent said ‘urgent support’ and ‘severely disturbed’ about five times every page. Watson is on record as saying he wanted to get Rosie out before the next CQC inspection because he thought she made the home look bad. I think they thought I would section her so that they didn’t have to evict her. Kicking people out is bad for publicity.

Rosie’s problem is that there isn’t a service for her. The gaps in the social care and mental health sectors are well documented; every so often you’ll see a news story about chronic bed shortages in this area or that, or people being moved across ten counties to get into an inpatient unit. What journos decline to mention is that social care is almost completely privatised. The sector runs on a public-private-partnership scheme where clients are means-tested, statutory bodies commission care and private companies actually provide it. So Rosie gives all her money to the council, the council give £500 odd a week to Ability Care Trust and Rosie gets to live at Suffolk House. Normos don’t know this happens because the only people that use social care are old and disabled people, who no-one listens to; it makes me laugh when the middle-class Left caution the loss of the NHS, without realising that it’s pretty much already gone. Community Health and Mental Health services are run on contracts too, and when Primary Care is eventually privatised, it'll be run on similar lines.

The catch-22 in PFI-style social care is that, although the public sector commissioners still have a legal duty to offer comprehensive services, there’s no obligation on private sector providers to cater for anyone if they don't want to. Commissioners can bleed their budgets dry trying to make sure no-one gets left behind but the simple fact is that, if shareholders don't think that a service is commercially viable, that service simply won’t exist. Social care often isn't profitable since it’s consumers don’t have any money, so for-profit services are fragile and specialist services, those with the neediest client groups, are as fickle as the wind. This county has no specialist services for older people with functional mental disorders. After her last eviction, Rosie was on a psychiatric ward for ten months. If Suffolk House hadn’t taken her in, she might still be there.

Privatisation is my problem too. We try and hold managers to account but in reality, people like Watson hold all the cards. They can evict clients on a whim, and withdraw whole services if they start to seem like more trouble than they're worth to run. So while I can challenge Watson a little bit, I can't push him too hard. It’s hard not to feel like you’re walking on eggshells.

Rosie is being mistreated to the point of abuse at Suffolk House. Staff talk to her like a kid and insult her to her face. They go in her room and move her stuff around when they know this triggers her anxiety. Watson has advised staff not to offer her care in case she lashes out so she sometimes goes days without staff contact. The home nearly shut down after its last inspection and now it has to display a big sign on the front door saying “UNSAFE.” I know all this, but I can’t call Watson out even when I know he’s lying to me, because if he feels the heat too much he’ll simply kick Rosie out. Meetings with Watson are the worst part of my job. Watson throws tantrums and calls Rosie disgusting and spoilt, and I find myself saying things like “I know it’s difficult but maybe if you didn’t retaliate…” and “Rosie does have a right to wash herself if she wants to", like it's them that need help not her. I’m a social worker; I’m an agent of the government with a legal mandate to protect vulnerable citizens, but because Watson owns the resources, he has the power. The State protects Capital. I’m surprised more social workers aren’t anarchists. After the meetings I drive home too fast and listen to crust punk so loud that I can’t hear the road, and I think about putting Watson before a firing squad.

As well as the Mental Health Act, there’s a piece of legislation called the Mental Capacity Act which we use to assess whether our clients are with it enough to make decisions for themselves. We talk to the person about the pros and cons of the decision and if they can follow the conversation and weigh up their options then they’re said to have capacity, and they have the right to make the decision, even if it seems like a stupid decision to us. If they don’t follow then they lack capacity, and we make the decision for them. In Rosie’s case, she regularly refuses medication. Whether she has the capacity to consent or refuse to medication is a tough call; she follows conversations to an extent but she’s a slave to her compulsions, and where Rosie ends and OCD begins is not easy to divine. For a long time, we couldn’t decide whether Rosie had the right to refuse medication or whether we should be making her take it.

As it happens, Rosie doesn’t give a shit what rights we think she has. She knows she doesn’t like the tablets and she will kick the living shit out of anyone who tries to push it with her. The usual response in these circumstances is to covertly medicate someone by slipping their tablets into their food, but Rosie won’t eat anything that she hasn’t seen prepared because she’s worried the staff will try and poison her which, as it happens, isn't a million miles away from the truth. Legally, the staff could restrain her and force them into her mouth, but I’d like to see them try; Rosie glassed a care assistant for trying to wash her when she didn’t want to be washed. Given her willingness to defend herself, and the staff's unwillingness to get hospitalised, the legality of her right to refuse is a moot point. I’m reminded of Rudolph Rocker’s old adage, that constitutional rights are meaningless unless people are able to defend them. Rosie is a one-woman revolution.

The next day I get an email from our safeguarding team saying that Watson has raised an alert. I read the report- Rosie has slapped a cleaner, and stamped on a care assistant’s foot. The point of safeguarding is to protect older and disabled people from abuse by care staff, not the other way around, so Watson has clearly made a fuck-up. I call him and explain this to him, slowly, feeling like I’m explaining reverse racism to someone and trying not to get sucked into another endless argument.

“Why is it OK for her to hit my staff? If they did that they’d get locked up. You let her get away with murder…” I let him carry on until he runs out of breath and then tell him, as simply as can, that I’m not a cop. It’s not my job to punish people.

Watson is a horrible boss. He excuses the abuse in his home by blaming his staff. To fix what he saw as an ‘attitude problem’ among the workforce, he fitted security cameras in the break room. He's been on a crusade recently to break up staff social groups by not letting friends work the same shifts, as well as introducing a uniform policy and regularly refusing to grant sick leave if he doesn’t think the staff deserve it. I, personally, would rather flip burgers than work for someone like him. The staff take shit from Watson and take it out on Rosie. She pushes it right back on them, and they carry all that pissed-off iniquity around with them until they snap at a patient and get sacked or they quit.

I'm not saying Rosie is easy to work with. She has a hair-trigger temper and she can be jaw-droppingly racist towards the predominantly BME staff at the home. Her racist beliefs have shaped her obsessive compulsions; she thinks Black people have typhoid and she demands Black staff wash their hands before they come in her room. She doesn’t like them touching her stuff because she thinks their colour will come off on the furniture. Watson loves telling me that because he likes to pretend he gives a shit about his workforce, but he ruins the act by not keeping his own racism in check. He says words like “darker” and “coloured”. After Rosie hit a nurse with a phone Watson said to me

“This lady is dark, right? But she went pale.” Then he said it again. “She was dark, but she went pale”, like he thought I hadn’t got the joke.

Suffolk House's care and nursing staff are almost all BME women but it's managers are exclusively White men; rich country bourgies with gold rings and big cars. The kind of people who would have owned slaves. The rank and file workforce are mostly East African or Eastern European migrants- Watson puts pictures of the queen on the walls and hangs up Union Jacks anywhere they’ll stick. Rosie might be racist but at least she’s not in charge of anyone’s jobs. Caught between Rosie and Watson, it’s no wonder the staff are angry all the time. They bully her not him because they’d rather get punched than sacked.

The staff at Suffolk House are an elusive bunch. Watson does everything he can to stop me talking to the frontliners, but I make an effort to catch them when I can. I grab people in the corridors or I pretend to be lost; I make small talk while they escort me out and then I start picking their brains about Rosie. There are bootlickers, like in any workforce, who tow Watson’s line and talk about Rosie like she’s a kid with too many toys. But despite everything some of the staff still really give a shit. Watson presents himself as a mediator between Rosie and an angry mob of care assistants, but this is a fantasy. I found out recently that two nurses, called Leila and Tari, had been meeting with Rosie weekly on their own initiative to try and problem-solve. Between the three of them (including Rosie herself) they had written a ten-point care plan which included points like “Give Rosie space and time to make decisions” “Give Rosie medication when she wants it” and “If Rosie is anxious then ask her why she is upset instead of telling her off”. I can't tell you how rare it is in that kind of place to see staff actually listening to clients, let alone letting them write their own care plans. I could have hugged them. I asked if Watson had seen the plan and they asked me to say it was my idea. A few weeks later, Tari had been sacked. I didn’t see Leila again.

Care work is not easy. It defies the old Marxist model of work in which there are only owners and workers and the owners exploit the workers- in care, like in education and the prison system, there are three parties and the least powerful is the consumer, not the worker. In this industry, power and resistance underpin everything. Patients and workers fight each other, and management rule unopposed. I’m convinced Tari was sacked for trying to make peace.

The staff need to recognise their power over Rosie and act accordingly; Rosie’s violence towards them and their abuse towards her aren’t a tit for tat exchange. It’s not a fair fight when they get paid to work there and she pays to live there, when she lives behind a door to which they hold the key card. Still, it’s hard to get them to see their privilege when they probably feel anything but. It’s hard to get them to forgive Rosie when they're told she's their fault.

Things get better eventually for Rosie when staff start giving her breathing space. I give them Tari and Leila's care plan and pretend I wrote it, and I go through the home's records once a week for the next few months to check they were sticking to it. One consequence of Watson splitting up the staff’s social networks is that the staff never got organised. If Leila and Tari had seized control of the workplace, then I probably wouldn’t have needed to be there.

Rosie stops lashing out and started taking her tablets, but she stays shut up in her room all day and after a while she stops getting out of bed at all.

I go to see Rosie one last time before I close her case. I sit down in her armchair while she smokes, dropping ash into an old Fanta bottle.

“do you like living here?” I ask.

“Well it’s nice of them to have me. I’ve got a roof and that. Can’t complain.”

“Have things got better?”

“Yeah, well, it’s me mainly.” She says. “I got to learn to give and take a bit. I’m too hard on them, really. They’re only doing their jobs.”

At the end of the day, it is Rosie who has to change. Watson's Machiavellian PFI scam will ultimately go unchallenged. In the Spanish civil war, the CNT-FAI were defeated because they tried to make peace on unequal terms. Rosie's lesson for posterity will be the same. Behind the locked doors of a secure mental health unit, one small revolution is being crushed.

All names including place names have been changed. I've never been to Colchester and I don't work anywhere near East Anglia. If there is a home out there somewhere going by the name 'Suffolk House', well, I'm sorry.

Comments

Spikymike
Aug 20 2016 16:02

Apsych thanks for posting up your experiences here. We have a friend who suffers from a serious and deteriorating memory loss and OCD and whilst her family are dedicated in their efforts to assist her from their geographical distance (organising increased home-care and visiting regularly) and we have been able to offer only limited care ourselves , our friend is unlikely to be able to continue living independently where she is for very much longer. A care home would seem to be the answer but there are risks in her being moved away from familiar surroundings and anyway the families efforts to find anything so far half decent near them hasn't yet succeeded. We have another anarchist friend who works in a local care home as a cleaner but who's dedication often extends to a level of care for residents well beyond his grade and pay. The place he works in is probably better than many but the sort of problems described here seem replicated to an extent in his place as well. Collective sharing of experiences between care workers and with the family and friends of those 'in care' would be a useful start but it needs collective organisation and struggle in this area as well - easier said than done I know.

Apsych
Aug 25 2016 19:21

Thanks for your comment. Just PM'ed you smile