Multi-Agency Attention

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First I shall discuss what professional power is and how it can be abused. I will then look at how motherhood makes women in Jenny’s situation vulnerable to the power of professional workers, how motherhood changes lives and affects vulnerability. Then I will explore the benefits and complications of involving multiple agencies in Jenny’s case and how it may affect her and her family. Service Providers have a certain level of responsibility and control when they accept their position.

It may be as a carer providing personal care for a service user whose physical or learning disabilities make them more vulnerable, or it could be as a doctor who has the power to detain under the mental health act. The service user / service provider relationship is unequal in its division of power. In Jenny’s case whether visits from professionals continue, up to even having Abby taken away is out of Jenny’s control. She did not ask for help, yet has many visits made to her home, interrupting her life.

Also Jenny is already vulnerable and feeling low, she could be easily led into unsafe or inappropriate situations, for example the late evening visits from Jack, the community psychiatric nurse. The visits from multiple agencies may also leave Jenny feeling less able, as they highlight to her, her inability to cope. Jenny fell pregnant unexpectedly, just as she was finishing a study course to become a quantity surveyor. The family then had to move for Geoff’s career. This may have left Jenny feeling very low. She has now had to put her career on hold, whilst moving house to cater for her husbands’ career.

Jenny is no longer a working women, making her way up the employment ladder. She is a mother. This change of status may have been difficult for Jenny to accept and affected her feeling of self worth. There are still views within society that to be a full time mother and house keeper is some how not as respected as holding a full time job. It could be that this is Jenny’s own view, which would make it particularly devastating, if she then felt she couldn’t cope with a role that she portrays as belittling. There is an association between the changes in hormones, which women experience after giving birth, and postnatal depression.

However there is no strong link between the two. The Royal college of psychiatrists state “Levels of oestrogen, progesterone (and other hormones to do with conception and birth) drop suddenly after the baby is born. How exactly they affect your mood and emotions is not clear… research does not suggest that this is a major reason for depression. ” A lot of the recent actions of the family have been for Geoff’s benefit, or for the benefit of their unborn child.

Now that Abby had arrived, the visits from the health visitor, initially, only briefly touch on Jenny and Geoff’s history together; they focus mainly on the physical health of the baby. Again Jenny is put to one side while others needs are tended. Now Jenny may feel her needs are not as important, her career is on hold, her husband works, leaving her at home in an area she doesn’t know. There is no talk of family in this fictional case study; this leads me to believe that may be they have moved away from them, again leaving Jenny to cope alone.

These feelings lead to Jenny not leaving the house, which stops her from meeting any one, and the downward spiral of loneliness begins. Jenny also now has the added concern of being labelled as someone with a mental health problem. Society attaches a certain level of stigma to mental health and Jenny may now be either worrying that that is how she will be viewed or she could believe that she is some how ‘crazy’ or a ‘mad-woman’. Jenny’s social isolation and feelings of depression will naturally be affecting the whole family. The health visitor describes Jenny’s interactions with Abby as “distracted” (p151, Unit 20, Block 5).

She also does “more or less the minimum care for Abby” (p143, Unit 20, Block 5) necessary for Abby’s care. This will have an affect on the relationship she has with her daughter and, possibly, on the future mental and emotional health of her child. Geoff also needs considering, he has also been under an increasing level of stress. He has a new baby “who often wakes several times in the night” (p143, Unit 20, Block 5). He has a stressful new job, which exhausts him, he finds it difficult to communicate with Jenny and may harbour some guilt about the need to move house.

Geoff must also be concerned about his wife’s mental health and her ability to care for Abby, especially after hearing her shout and observing her being rough with Abby. Many different professionals being involved with Jenny may leave Geoff feeling even more isolated, now people are worrying about Jenny and Abby whilst Geoff is left to work all day, then become the primary carer in the evenings. He may also be confused about who it is appropriate to talk to, about what. With so many professionals involved it would be easy to be confused about each ones role.

It could be that the concerns that he felt for Jenny have now been confirm, in his mind, by the sudden interest of so many people, therefore giving him a reason to worry. On the other hand Geoff may feel that he can relax a little as the professionals getting involved may lighten the load. Jenny may be ‘one less thing to worry about’ as she is being dealt with. A multi agency approach may also help Geoff, as he sees a lot going on, so in his mind things are on the way to getting better. Geoff’s sister, Gwen also displays some power over Jenny, by alerting the professionals to her situation without first consulting her.

The community district psychiatric nurse, social worker and health visitor all get involved in Jenny’s case and begin their own methods of treatment. The community psychiatric nurse uses the medical model and tries to introduce the idea of medication and visiting a mental health day center. The social worker adopts a psychodynamic approach, looking at Jenny’s past experiences and how they affect Jenny’s mental health now. The health visitor attempts another strategy, focussing on Jenny’s relationship with Abby, encouraging play between mother and baby.

With all these different approaches, Jenny may read them as attacks. She has gone from feeling very alone, to suddenly having her house ‘invaded’. The social worker is spending at least an hour a week, the health visitor is spending two hours a week and the nurse is also making regular visits. The different treatments may also confuse Jenny, and if one does begin to work how do they know which that is? There are benefits to a multi agency approach. Each professional will form a different relationship with Jenny and she may divulge different information to different people.

This could benefit all involved as long as the information is shared. This though causes it’s own problems, how do you ensure that all relevant information is shared whilst still complying with the Caldecott principles and company’s own confidentiality policies and procedures. A combination of treatments may also be beneficial, as long as the professionals are working together to ensure a complementary treatment programme is decided upon. Each agency will also have different resources available to them and can ensure that the other agencies are doing all they can, and should, to help the family.

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