A week in my mental health service clinic: ‘I love meeting families and trying to work out what to do’
Sheila O’Flaherty is a senior psychiatric social worker with the child and adolescent mental health services for north Co Dublin
Sheila O’Flaherty, a senior psychiatric social worker, in Swords, Co Dublin. Photograph: Dara Mac Dónaill
Each day is slightly different
Each day is slightly different. On Tuesdays we have the team meeting. There are 12 of us including psychiatrists, psychologists, a speech and language therapist, a dietitian, an occupational therapist and three social workers. My title is senior psychiatric social worker. We see people back-to-back during the day.
Wednesday is for morning groups. We do a couple of urgent intakes on Thursdays; referrals from the emergency department of Temple Street children’s hospital. Those people would have gone to the hospital in various forms of distress. If your child has mental health issues and you end up with them in A&E, that is extremely stressful.
We do individual therapy all the time, every day. We cover a very diverse demographic. Our catchment area is very varied; Portmarnock and Malahide are quite prosperous, and Balbriggan is the new Ballymun. And we also cover Rush, Skerries and Oldtown which are rural, and a whole other world.
I did my degree at Trinity College Dublin and then I did extra training at the Children’s Hospital in Oakland, California, which was fantastic.
People and attitudes
You might be seeing fed-up parents, or maybe fed-up parents with fed-up kids. A lot of the time parents have mental health issues themselves. It’s complex.
For 50 years we were the Mater Child Guidance Clinic. This year we were taken over by the HSE, so we’re in transition. They’re trying to create some clarity and co-ordinate resources better, which I actually think is good.
Our computer systems are so slow that if I am trying to search for something I use my phone. I mean, we’re still on Microsoft Windows 97.
Self-harm is the new thing. Up to 20 per cent of Irish teens have self-harmed. Family communication is the whole big thing now. We have to hold on to families and work with them.
There’s a lot of trying to tease out what is going to work for each individual family. In child and adolescent mental health, the family is crucial. You have to work with the family. You’re seeing the child for an hour or a couple of hours; they’re living with the child 24/ 7.
I have about three appointments in the morning, and three in the afternoon. I have tea at my desk at about 11am; if I’m doing a group, I eat later. The groups take about two and a half hours. A group could contain parents and kids from 12 or 14 families, with about 20 people in the room. They take a lot of work to co-ordinate but I love the groups. I absolutely love them.
Longest waiting list
Families haven’t been getting the support at an earlier stage and then things become more difficult. We haven’t been able to see the families with chronic, ongoing difficulties.
The primary care system is under so much stress, a lot of the problems we see are more severe than they otherwise should be. Particularly with eating disorders; they’re not being caught, and by the time they come to us the problem is quite entrenched and you might be looking at hospital admissions, and that’s not a very good way to offer a service.
I love Swords; it’s young, it’s vibrant and there’s a lot going on. It’s under-resourced, and has just the basics for young people. There’s no swimming pool, for example. The health centre was built in the 1980s.
I work in the ‘new’ health centre, which opened in 1997, and adult mental health [services] are in there with us. Group sessions are held in another building.
We don’t have enough space, although I do have an office. We could see more families than we do if we had the space. We’re looking into that.
Detective work and consultation
I love meeting families and trying to work out what to do. There’s a bit of detective work, and it’s great to be part of a team, to talk to your colleagues. For example: Is this kid selectively mute, or is it a speech and language difficulty? It’s fascinating finding out what we can do differently for them.
Usually at about 1pm I break for lunch. We have a staff room but I try to get out and walk. There’s a 30-minute loop you can do. I usually take about half an hour for my lunch. I bring a packed lunch, sually leftovers. I eat in the staff room or at my desk.
I usually finish at 5pm, when the health centre closes. Weekend cover is provided in Temple Street and every [client and potential client] has to go in there.
Every now and then we run a session from 4.30pm to 6pm; a few times a year we run the groups in the evenings for the young people.
And we should, because with so many of the kids we see, we’re working on getting them back into the school system. We don’t want to be taking them out of school, or their parents out of work, in order to come and see us.
At home, I don’t dwell on things
Do I think about work? Occasionally. But I’m not constantly talking about my clients. I’m just busy. I don’t really dwell on it. Every now and then, if there is a near-suicide or overdose then absolutely, but on a day-to-day basis, no.
I think that better community resources in the first place would make a big difference; to have a proper family resource centre that would deal with the parents’ mental health at the same time as the child’s. And, therefore, services could address difficulties sooner, instead of families just having to wait.
One thing that would improve my life personally would be cloning; if I had another me, or another me and a half. I fantasise about cloning. I need a housewife or a househusband.
I think I probably will work at this until I retire. I’m open to going somewhere else, such as Ballymun or Darndale, or doing slightly different work. I do feel lucky.
It’s not every day I’m thrilled to go in to work, but it’s always an opportunity to learn. You’re always learning. And you feel like you’re making a difference for families.
Sheila O’Flaherty is expressing her personal views in this article and does not speak for her colleagues in the HSE, nor for her employer.