My first time as a 'peer supporter'

...Earlier in the year I had moved into a flat of my own. It was located in a multi-ethnic, working class area of the city. I set about the process of applying for nurse training. I discovered that if I could get accepted there were two hospitals within reasonable distance which had an intake the following May. I thought about doing some voluntary work in the meantime. It turned out that there was a day-centre for the mentally ill within ten minutes walk, I offered my services.

You can’t imagine a grimmer place to live, the centre was in the middle of a concrete shopping centre surrounded by high-rise residential tower blocks, but located underneath the concrete ‘piazza’ style shopping area. The entrance to the day centre itself was through what should have been the fire exit. (The main entrance was the ‘front office’ of the charity which ran it). The centre had just over thirty regular attendees, about half of whom lived in residential units supervised by the charity. It was a ‘social maintenance’ centre for ‘chronically mentally ill clients’ who had become ‘socially impaired’. My first challenge was to get to grips with the language.

In the vernacular of the centre, people were not ‘mentally ill’ they had ‘mental health problems’. They were not patients but either ‘clients’ or ‘service users’. In practice the users were ex-psychiatric patients who had spent long periods in hospital, been to various degrees institutionalised, and were now trying to live something like a stable existence ‘in the community’. There were three staff; a psychology graduate, a social worker and an art therapist. They were anxious to provide a safe and stable environment, but worried about recreating the kind of dependence that clients had developed in hospital.

Early on, I think the manager must have asked me to write down what I saw as my role as volunteer, for I found the following rough draft in my file:

‘1/ Objectives; a) help users/clients to help themselves, cope with
day to day problems, greater independence in the community. b) participate as a member of staff in promoting user-led service.
2/ How?; being there for clients, befriending, listening, providing information and practical assistance.
3/ Problems; clients reluctance to take responsibility, lack of motivation, confidence, dependence.
4/ Tasking problems; being with them and participating in their attempts to undertake new tasks.’
The document is not dated but must have been from the end of 1989. I was a volunteer there for six months. It feels strange reading it now, for since then, over the last twenty years several people have provided exactly the same service for me!

Strictly speaking it was not a ‘drop-in’ centre, but it felt like one. There were the constant changing faces of clients and their friends. Undoubtedly the atmosphere was dominated by the oldest client, he must have been approaching seventy, had been in hospital for many years, been diagnosed with paranoid schizophrenia, but now refused all medication, and was very thin. He was such a presence because he never stopped moving, mostly pacing up and down, sitting only for a minute or two at a time and even then swinging his legs rhythmically. Often, though the centre didn’t open to clients till ten in the morning, he would be pacing outside by nine when the staff arrived. Every day he walked six miles to and from his room in a ‘bed and breakfast’ that took DHSS clients. He appeared to ‘hear voices’ constantly and would mumble, or occasionally shout back at them. He looked mad, (sorry, ‘damaged’) and knew others thought he was. When he had to move, one of the staff helped out and said his entire possessions only filled two black bin bags. The centre was a kind of sanctuary for him, he was the first to arrive and the last to leave. He was at one and the same time a pathetic example of neglect, and a monument to endurance and the determination to survive.

The guy I came to know best lived down the street from me and had also been labelled a paranoid schizophrenic, but was very different. About thirty-five, very outward going and sociable. He took medication but was often drowsy in the mornings and a little overweight. I asked him many months later when I was a nursing student, (and had an essay to write on: ‘Is mental health a valid concept?’) ‘What does mental health mean to you?’ He replied; ‘…being in control…having my own thoughts, no alien thoughts’. His mental condition had become obvious to himself and others when he was in prison, but he had been lucky enough to serve the last six months of his sentence in a regional secure unit, a small scale unit for offenders with mental health problems. It was while we were sitting drinking coffee in my flat one day that I witnessed for the first time someone rapidly becoming psychotic, and then just as rapidly normal again. I must have inadvertently ‘cued’ him, for half way through a sentence he interrupted me and began speaking much faster in the voice of an evangelical preacher about his own sins and those of others. The contrast with his normal voice was striking, not just the speed, but volume, passion and incoherence. I thought for a moment, realised what had set him off, then choosing my moment said something about the topic we’d been discussing much earlier. Just as easily he came back to normal speech quite unselfconsciously. I’m afraid my curiosity and enquiring mind got the better of me. I deliberately cued him again, then brought him back as quickly as I could. That satisfied me, anymore would have seemed unethical…

…One of the activities open to clients was to attend the ‘health shop’ run by the local health authority and take part in the ‘stress clinic’. This was a course run by a young man who was later to become well known for developing ‘laughter therapy’ in Britain, based on the Indian practice of a group of people going to piece of open ground in the early morning or evening and deliberately making themselves laugh together for a while. One of the exercises in the stress clinic was to write one’s own ‘obituary’ and part of my attempt survives; it’s a bit embarrassing really, but perhaps it illustrates how I was thinking at the time:

‘Nick Hewling died this week at his farm in Provence aged seventy-four, where he spent the last twenty years of his life cultivating his vineyard and promoting his own wine. He moved to France after a distinguished career in the National Health Service, first as a psychiatric nurse and lecturer, then as a psychotherapist. However he will probably be best remembered for his best selling books on mental health. Although widely respected as an innovator in psychiatric care, he didn’t enter the profession until his early thirties, previously he had been… Later he was a professor at the University of … He leaves a widow and two children.’

Also I find a copy of a ‘life events’ stress questionnaire, where you mark up and score stressful events from the previous two years. (This was early 1990). Low stress started at one, fifty being the average or medium(?) and one hundred being high stress - I scored one hundred and five! (I think it must have been some sort of ‘adaptation’ of the Holmes-Rahe Life Stress Inventory). The facilitator also tried getting us to use what he called ‘stress meters’ to monitor our levels throughout sessions (as in Galvanic skin response, polygraph etc.), but with us monitoring ourselves - as the needle swung back and forth one quickly became anxious about what was making one anxious!...