Social work and its many rewarding destinations

November 24, 2020

Ana Mcginley

A social worker is born

My social work story begins with the realization that my 4-year bachelor of arts degree was not leading anywhere except possibly a career as a professional waitress or phone salesperson. I had dreamed of going to university to learn about English literature classics, art history, and anthropology.

My dream came true, but this dream had limited capacity to fund my future life. Lucky for me, during my degree, I had branched out – mainly for social reasons – and enrolled in a few psychology courses. My university launched a 2-year post-graduate degree in social work in the last months of my bachelor’s degree, and psychology and anthropology subjects I had completed were prerequisite subjects. I signed on for a career in social work.

As a final placement, I joined a social work department, staffed by 1.5 social workers, in a grand old hospital.

Fieldwork placements – a push into the deep end

The program was divided into 4 semesters, with the first and third semester being fieldwork placements in various health and welfare services. I joined an inner city community mental health service – and was soon familiar with many of the haunts of the chronically mentally unwell, mostly located in the city’s underbelly. I spoke to many people who were dealing with delusional thoughts, auditory hallucinations, hopelessness, and baggage that comes from being mistreated constantly as a child.

I learned how to recognize when someone was so close to the edge that they needed to be transported by the police to the hospital. I know that instant coffee is often handed out with medications and kept in a locked cabinet, so people don’t overdose on it. I learned that governments underfund services for people with chronic mental illnesses, and that financial decisions are made for many reasons other than to improve the quality of the lives of this population. This placement provided an abrupt introduction to the possible ramifications of mental illness, including a lifetime of poverty.

General hospital social work

My second placement found me in Sydney. I transferred states to complete the last year of my degree after personally discovering that the male professor leading the course of radical social work was more a misogynist than a feminist and that this was accepted by faculty leaders. As a final placement, I joined a social work department, staffed by 1.5 social workers, in a grand old hospital in Sydney’s CBD.

This placement broadened my skills and knowledge as a general social worker. My timing was great, as the full-time social worker resigned at the end of my placement period and I was offered the position. It was a wonderful opportunity that would be short-term as the state government had decided to move the hospital to cheaper real estate in the suburbs.

Social work in a psychogeriatric unit

My next position was with a psychogeriatric health service – now referred to as an older adult mental health program. I provided social work assessments and interventions to anyone over the age of 65, inpatient or outpatient, with mental health issues. The service was the most important memory disorders diagnostic program in the country, which was staffed by psychiatrists, gerontologists, neurologists, psychologists, pathologists, nurse specialists, occupational therapists – and this sole social worker.

People with unusual memory or cognitive problems were referred to the program and underwent 3 weeks of assessments that were conducted by all team members from the perspective of their specialization. As a social worker, this involved collecting a collaborative, or not, history of the person’s life and presenting problems from a spouse or close family member. At the end of this period, all team players would meet to discuss the test results and to decide on a diagnosis.

The person and their family members would be brought into the room and given the diagnosis, which was often a type of dementia. The team would then leave the room, and I would stay with the family to deal with the emotions that come with being diagnosed. Even now, I wonder why team empathy was delegated to a 23-year-old social worker.

Child protection and the ugly side of humanity

Job 3 took a change of direction as I joined a specialist child protection team based at another major hospital. The team was responsible for assessing children who were non-verbal, or not able to talk about the allegations of abuse that had been allegedly inflicted upon them. Generally, the children were referred by the government department of family services or the police, both overworked agencies without adequate training in the field.

Considering how easy it is to botch up collecting evidence needed to prosecute a child abuser, this was a huge oversight by the authorities and left vulnerable children in terrible situations that would impact their entire lives. This work is incredibly confronting as you are exposed to the ugly side of humanity. I learned how to talk to 4-year-olds about allegations of abuse, and to elicit information from adults about inappropriate sexual or violent behavior that involved their, or other people’s, children.

I saw babies with cigarette burns on their little bodies and counseled grieving parents whose child had died suddenly due to SIDS. I knew that a family was allowed to take a child’s body home from the hospital for the night, but that this needed to be transported in the trunk of the car. I also learned that a good legal defense team could get someone off a murder charge, even if a child had died because of their actions.

Guardianship and establishing a case of mental incompetence

My ability to investigate, interview, and write legal reports, secured me a position as an investigation and liaison officer with a legal tribunal that appointed guardians and financial managers for people with decision-making disabilities. The tribunal was located on the top floor of a lush building in a beautiful neighborhood. I rarely had face-to-face contact with the people involved in the applications I investigated, relying on information collected by mail, phone, and electronically.

Most applications were made for people with dementia, who were in need of residential care, but did not want to leave their homes. There were also large case files for people with chronic mental illness or intellectual disabilities, including those who had been institutionalized for decades, and needed an independent person to make future decisions regarding accommodation, healthcare, and finances. The treatment of this last population, prior to the tribunal’s existence, was sometimes shameful to read. For me, this job was the chance to recover after being in child protection and to experience what social work looked like in a better-funded government agency.

I was able to secure funding for what was to become an annual festival, called “Music to Move Your Mind” – which raised awareness about mental health in the format of a community-based afternoon of markets and music.

Alzheimer’s advocate at the state and international level

I left the position to travel, with the plan to eventually settle in the UK for a few years. My qualifications were recognized in England and there were plenty of social work openings for me. But, plans change and relationships bomb, and I happily returned to Australia, moved state, and was employed as the senior counselor for the Alzheimer’s Association, responsible for counseling services for two-thirds of the state. In addition to offering counseling to family members of people with dementia, I developed and provided training in dementia care to staff in nursing homes and community health centers, and oversaw the work of counselors in regional towns in the state. Often, I would jump in a car and drive a 500kms roundtrip to visit a farmer caring for his wife on an isolated property – with the goal to set up daily support for them both, often as phone calls, respite care, or a monthly meeting in the nearest town.

The organization agreed to send me on a 6-month research project that would collect information on dementia programs in New York, Toronto, Chicago, Helsinki, and the Netherlands. I attended international conferences and caught up with the specialists I had worked with in Australia. I met the experts in each country I visited and saw firsthand how different programs had been implemented for people with dementia. I had an office available to me above Grand Central Station in NYC, where the local chapter of the organization was located. This research project was invaluable in the information it provided to me, which was then documented and sent back to Australia, with the hope that it would be used to improve and direct future dementia care.

Secure units add to the distress of dementia

Soon after completing the project, my personal life kicked in. I married and we moved overseas. I was not to return to work for 5 years, after the birth of my third child. We had lived in 4 cities, meaning that my professional network had dissolved. I was happy to find a position in another older adult mental health unit on the west coast of Australia, that again involved a mix of inpatient, outpatient, and community outreach services. The chance to work with people with dementia, meeting with them daily in a locked unit, hoping to be with them for that brief period when they were able to express their thoughts or recount a memory, reignited my fascination for working with people with misfiring brains.

It is tragic to see someone who is a husband, wife, parent, grandparent or good friend, reduced to wandering the corridors of a secure dementia unit, generally awaiting a move into residential care. I can confirm that a quiet moment, music, walk in the sunshine, or gentle physical contact like a hand rub or brushing someone’s hair – will make a world of difference to a person with dementia. I have also become a strong advocate of euthanasia, and the need for healthcare workers to respect advanced care directives.

Community education and raising mental health awareness

I eventually moved to a hospital with less travel time, taking up first a position in the aged care assessment team and then successfully applying for the senior social work position in the older adult mental health unit. By this stage in my career, I wanted to extend mental health awareness in the general community, to make it easier for caregivers to seek the help they need, and to raise pressure on the government to increase services and improve the existing services.

As a team, we presented community education sessions on topics like recognizing depression, maintaining good mental and physical health in aging, medication use and abuse, caring for someone with dementia. I was able to secure funding for what was to become an annual festival, called “Music to Move Your Mind” – which raised awareness about mental health in the format of a community-based afternoon of markets and music. I reluctantly left this position to move to Singapore.

By this stage, my own father was showing signs of vascular dementia. We were very close and I could see the changes during our Skype calls.

Singapore – scratching at the shine, teaching human development, and adoption

In Singapore, I completed my master’s degree in social work while waiting to adopt our fourth child. This family extension came about from voluntary work I had been involved in that basically matched expats to charities, where they could give their time to helping others. Singapore is much more than glitzy shopping centers. It doesn’t take much digging, or many stops on the subway to discover poverty, discrimination, mental illness, and people isolated and unwell in tiny flats or homeless. I agreed to teach a social work course on human development for the local campus of an Australian university. All students worked full time and attended the course in the evenings. Issues of race, culture, and religion guided how they felt about many issues, which was something I had not been fully aware of previously. For example, one student told me he couldn’t work with a gay person because his religion didn’t accept homosexuality. On a similar note, when we applied to adopt a child from local child protection services, I became aware of a system of private adoption agencies that catered to people seeking babies without connections to local people, yet wanted a child of specific race origins. Naturally, this is only one side of the story. I was happy to meet many adopting parents who were delighted to be allocated any child who needed a family. As such, I helped run support groups for adoptive parents that focused on issues related to developing attachments with their children, something that can be problematic but is definitely treatable.

After a few years, we moved to the Netherlands. By this stage, my own father was showing signs of vascular dementia. We were very close and I could see the changes during our Skype calls. With a young family, I was restricted in my ability to travel to Australia to spend time with him in person. I did arrive a few days after he sustained a massive stroke that left him in the hospital where he died 6 months later. During the years of his decline before the final stroke, I wrote a book “Parental Guidance – Long Distance Care for Aging Parents” – that was a culmination of all my knowledge and experience of the healthcare system, and that offered some guidelines to remaining engaged in the care of a declining parent when you don’t live close to them. My goal was to give family members the skills to connect with the doctors and healthcare staff in hospitals, residential and community health workers, and other family members – to advocate for their parents when they are unable to do this for themselves. As it turns out, COVID-19 has extended the need for these skills.

Finally, I now live in Prague. I no longer work as a social worker but continue to feel enraged by inequality, racially-based discrimination, underfunded healthcare services for the elderly, and the lack of a cure for all mental illnesses especially dementia. I miss making a difference. What I have taken away from my time as a social worker is a strong understanding of systems, forced patience completing government forms and dealing with public servants, a solution-focused approach to life problems, and a love of unraveling the thoughts of people working with misfunctioning brains.

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