Gina’s background is that of a mental health support worker. The service that employs her provides services to families where a member of that family has experienced mental illness. She works autonomously within the community, using her skills and knowledge to provide support to families. While Gina’s story is long, its power is in the connection and relationship that Gina has developed with the family member whose daughter is experiencing mental illness.
I worked with a family in 2009; it was a mum who had a 15 year old daughter who was going through the CAFS [child. adolescent and family mental health services] system and had been fostered out with CYFS [child, youth and family services], she had behavioural issues and the diagnosis of borderline personality disorder, so the mum came through our system my primary focus was to maintain the relationship between her and her daughter because the daughter through her behaviour had created a lot of anger within the family. The parents had separated and re-married so she had two sets of family – one family didn’t want to know, the other one, the mum wanted to remove the anger and trust her daughter again and maintain a relationship. We worked alongside this mum mainly looking at why she felt so angry towards her daughter and educating her teaching her that her daughter wasn’t doing it to hurt her personally. One of the issues was that this mum wasn’t included with the process that was occurring down at CAFS and so they did a survey and I took the survey to the mum to fill in and then took it back to the service and they were really surprised, and asked if the mum wanted to meet with them but unfortunately the relationship between the mental health service and the family was of anger, because of that lack of inclusion, so I just said no she just wanted her voice put out there, if it helps any other family, then that’s great. We got to a point where mum was going to the netball games on Saturday to watch the daughter, they were doing things one on one because the mum was also pregnant again. So got to a point where she was saying like “thanks Gina for everything that you have done, I have learnt so much and I’m really happy where things are going and they can only get better”, I said “that’s great and see you”.
It was a year later, I was sitting at my desk and the phone rang and it was this mum and I was like “how are you doing” and she said “Oh Gina I am so glad you are still there”, unfortunately her daughter had suicided a month before I was not aware of this. I was just said “oh my God, I am so sorry”, she said “Gina I need to see you”. I felt a bit out of my depth”. When I hung up the phone I realised she was doing exactly what we talk about on discharge, if anything ever arises you can always make contact and so with it being so big, I started working with this mum who was now living rurally on a dairy farm. She now had two babies and another one
on the way and going through this. It was more than grief for her; there was a lot of guilt, so we tapped into grief intervention, we tried to tap into the mental health service because I felt she was slipping into a depression, we needed to work out what was actually mentally going on for her. She shared with me that her daughter had described sexual abuse, and for her it brought up her own. And it was like “oh my gosh, this is huge, do you want to work with that?” We tapped her onto a psychologist and so she started doing that journey, we began weekly visits one day she asked “Gina the girls need to go to pre-school or play group” and because she wouldn’t let her little kids go anywhere, she wasn’t having time to herself and I said, “well is that where I can support you, would you like me to take the girls to play group once a week?”. She just cried and she said “would you would you look after them?” I had to come back and talk to my boss about it. Because it was like a big responsibility so we did that process for around two months and it was coming up time for her unveiling. One day she said “look the girls aren’t going to pre-school today, I have a really big request”.
She said herself, her eldest daughter who was 18; the baby who had been born and her sister were going to Wellington to collect the headstone. She said “Gina, will you join us, will you come with us?” I was really blown away and I was just so honoured that this level of trust had been built, so I came back and spoke to my boss and it was like “do you expect to be paid?” Well I still had to have my presence of being a support worker and so they decided they would pay me for so many days and then I would have to take so many days – because would take a week to bring the headstone back – so for some of that time I had to take annual leave it was kind of like, OK I can still be me, I know what my boundaries and ethics. Where we were staying was about a 25 minute drive to my mother’s house. I had not spoken to my mum for six years I hadn’t seen her for eleven years. And I am like well what have I got to lose, so I actually made that connection and that family was really happy as they felt they could actually give something back and it wasn’t like an unethical thing. We brought the headstone back down, and then we had the unveiling, that mum became complete and there was just this sense of a connection and without that time and that support, I think she would have become a member of the mental health service.
Gina begins her story by describing a situation that gave me a sense of foreboding as the intensity started to unfold. While I had no knowledge of how the story would evolve, I felt intuitively apprehensive about what this story would reveal. Although Gina did not reveal the name of the mother described above, I made the decision to provide a human face to this story through providing the mother with the name ‘Louise’. I felt that this was a way in which to acknowledge the power of this story.
Gina describes how she worked with Louise through a very difficult period in Louise’s life. These difficulties included her daughter becoming mentally unwell, her relationship with her husband breaking down and her remarriage and subsequent pregnancies. She saw her role in this situation as one of providing support and education while working alongside Louise. Gina brought advocacy into the support when it was required. In telling the story, Gina described how she provided support for Louise when Louise was excluded from her daughter’s care and treatment by Child Adolescent and Family Service (CAFS). Gina was able to recognise the hurt and provided the voice for Louise to be heard when she was not able to do this. Louise is fortunate in that she has the support of Gina; however, Gina recognises that this may not be the case for all families. Under Louise’s direction, Gina approached the mental health service as an advocate to remind the service that where there is a family member accessing the service there is a responsibility to involve those family members. She sees the role of ‘advocate’ as a legitimate activity for a mental health support worker.
By all appearances the family entered a period of stability following this initial situation. Louise got on with her life as a busy mother and wife. While concerns are frequently raised regarding demands for services outstripping the supply, a negotiated agreement was reached between Louise and Gina that they had reached a stage in their relationship where it was appropriate to withdraw support. An aspect of the role of mental health support workers, which Gina reiterates, is the provision of education. This is education about mental illness, medication and keeping mentally well. The impact of the education provided to Louise is evidenced when she again enters in another crisis. One year later Gina took a phone call from Louise who had entered into another crisis. Louise turned to Gina in her time of need as they already had established a relationship built on trust. There was no suggestion that the service that Gina worked for expected a referral from another service, nor was there a suggestion that Louise would have to go onto a waiting list. Instead, through Gina, Louise was accepted back into the service with no barriers to impede her access. In her role as a mental health support worker, Gina and the service she was employed by had created an environment whereby families in crisis could readily access the service. Louise had confidence and trust that the door would always be kept open for her if she needed support. Louise reconnected with Gina almost a year later, because her daughter had committed suicide. The shock of this situation is evident in Gina’s voice on
the recording; however her professionalism allowed her to firstly recognise her own emotions associated with this dreadful news. Secondly she was encouraged that Louise contacted her support systems when she was experiencing a crisis in her life, as she had been coached to do. Subsequent conversations between Gina and Louise revealed that Louise’s daughter had verbalised to Louise that she had been sexually abused. This information caused Louise to confront her own experience of sexual abuse. While Gina continued to offer support for Louise, she was also aware that Louise needed interventions from someone trained in this field; Gina had an awareness of her limitations. She asked Louise whether she wanted to work on the issues around her sexual abuse and, as a result of this inquiry Gina ‘facilitates’ access for Louise to an appropriate service. Gina’s knowledge of other services ensured that Gina was referred to an appropriate service to engage in therapy.
Louise reached out to Gina for ‘support’ again when she needed someone she ‘trusted’ to be involved with her young children. These and the subsequent actions could be viewed as unusual. Some may suggest that the service that employs Gina is a mental health service not a childcare service, while others may see that the service is doing what is needed to keep Louise well. This raises the question of whether what is being requested of Gina is in the purview of the support worker role? Gina’s employer clearly saw this request as a legitimate part of her role when she affirmed Gina’s request to look after the children to allow Louise time for herself. Gina’s employer gave Gina the mandate to provide the support that was requested. Gina described the ‘trust’ that Louise had in her by allowing her to care for her two children so that she could have some time to herself. Her employer recognised there is a need for ‘flexibility’ within the support relationships. Gina continued to provide Louise with the support she needed.
Later, Gina was again approached to undertake a role that may sit uncomfortably with the role of support work. She was asked to accompany Louise to uplift the headstone for the unveiling of her daughter’s grave. Gina revealed that the headstone was being carved north east of Wellington. This required Gina and Louise to travel by truck from Southland, which is at the bottom of the South Island, catch the ferry across the Cook Strait and then drive another hour and half to where the headstone was being carved. This trip takes several days to complete. Gina’s employer was agreeable for her to undertake this travel, but limitations
were placed on what the employer was prepared to pay by way of Gina’s time. She was paid some of the time she will be travelled with Louise; however, for the rest of her time she takes a combination of leave without pay and annual leave for the remainder of the time. Gina took time to reflect on this situation and realised that she must maintain her professional boundaries even during very informal moments. She acknowledges that she was being paid for some of the time during her travel to uplift the headstone; however, there were times when she was ‘off duty’ but was aware of the need to maintain her professional relationship with her role being that of mental health support worker. She states “I knew what my boundaries and ethics were” but she also recognises that she can be herself, “OK I can still be me”.
Gina uses this understanding of ‘being herself’ when she describes how she used some of her time away to visit her mother who lived relatively close to where she was staying. While Gina does not make a conscious connection or identify with the relationship between Louise and her daughter, Gina had not made contact with her own mother for many years. Louise has made the connection with her daughter through the uplifting of a headstone; Gina connects with her mother through proximity. This connection demonstrates that while she identified as a mental health support worker during this experience she also realised that she is a daughter. Gina has perhaps used this opportunity to understand the strength of the mother- daughter relationship and the results of what happens when that relationship is cut short.
Gina verbalised that she was humbled and moved by Louise’s ‘trust’ in her and the fact that she turned to Gina at a time when she Louise required support and compassion that it was Gina she turned to. She describes how Louise sought to connect with her late daughter; for, Gina the connection was that Louise called out to her in her time of need. Gina believes that without providing this level of support, Louise would have not coped and would have ended up accessing mental health services. Gina’s employer trusted Gina to allow her to be flexible in the support provided. In her role of mental health support worker, Gina continued to provide family support for Louise. The ‘caring’ nature of the relationship between Louise as a family member of a person with a mental illness and Gina a mental health support worker has, as defined by Pinch (1996), the “potential to change society”
(p.86). However, Pinch warns of the indiscriminate use of caring but also applauds the benefits that caring brings for those that practice and receive it.