The risk of endings and falling through the cracks
Transition and endings are a particularly challenging time for people facing multiple disadvantage. It is also when they are most likely to fall through the cracks in the system. In this blog, Cassandra*, a consultant with lived experience and member of Independent Futures, shares their personal experience of endings and their suggestions for minimising the risk of re-traumatisation.
I’ve had many ‘endings’ during my journey through services. Not all of them have been damaging, but a lot of them have. The problem is that the system is often not set up to help those who have a lot going on. Most of the endings I have experienced have been ‘done to’ me.
On numerous occasions I have just received a cold and procedural letter through the post or an ending out of nowhere in a face-to-face meeting where the decision has very much already been made. There was no attempt made for the service and client to collaborate to finish the piece of work. I think this is due to a number of reasons:
Operational pressures meaning a sudden decision is made to discharge people because there are too many people on the books
An escalation of risk or ‘complexity’
An improvement in someone’s situation which means they are now not risky/complex enough
A lack, or perceived lack, of engagement
I have been discharged from services for all of these reasons or had restrictions placed on how I am allowed to engage with services.
When there are operational pressures, often the most tenuous reasons are found for discharge. In some ways these are the endings that I find most dishonest and frustrating. Instead of being transparent about what the service can or cannot provide due to funding restrictions or capacity, the reasons given all centre around the individual. I’ve been told in the past that I’ve ‘learnt a lot’ or ‘improved a lot’ or that I ‘have enough support’. There’s never a conversation as to whether you agree, or if you are asked and you disagree, the professionals seem to ignore that opinion and carry on regardless. The decision is made by the system and you have no say whatsoever. It is an extremely disempowering situation to be in.
When there is a perceived escalation in risk or complexity, you can again be made to feel like the problem. I’ve been told that I need to be discharged because I’m ‘too risky’ or I’m too complex’ for that particular service, or that they cannot manage my ‘challenging behaviour’. The problem in this instance is that you walk away feeling like people are rejecting you for who you are, that you are something that people want to shift off their case load because you are ‘difficult’. The other issue is that there is very rarely an alternative offered, or any partnership working to identify what service might be better placed to meet the person’s needs. It can be so damaging to be rejected by services in this way. Particularly services that are apparently designed to manage a certain amount of risk. If I’m ‘too risky’ for that service, what kind of narrative does that send to me about my worth, about how I should feel in comparison to the rest of society? You end up feeling even more marginalised and worse off than before.
If you find you are working well with a service, it’s all too common for support to be suddenly withdrawn. The service perceives that you are ‘better’ and therefore discharges you. In reality, the improvements made are often really hard won and still in the very early stages, meaning that without support you crumble and hit crisis again. You are either ‘too complex’ or ‘not complex enough’. You end up constantly falling through the cracks.
In terms of being discharged due to lack of engagement, I think what people really mean is ‘you are not working with us in the way we think you should’. You don’t respond to our rigid way of doing things.
So how can things be done differently? How can things be done better? The few positive endings I have had, have been discussed really early on in the working relationship. For this reason, they feel like something that I have had a say in, something that I have worked on together with that worker and any fears, concerns and worries around the ending have been voiced, heard and held in a safe way. I know that I find endings difficult but it is possible with the right support to finish things in a positive way. I have now learnt that sometimes my protective mechanism is to end and leave a service before they chuck me out. I want to jump before I am pushed. If I feel I have a constructive relationship with a service or worker I can express that and work out what to do collaboratively if I were to just leave and stop turning up to things. Unplanned endings do happen, but if the service is planning the ending, then the client should be involved in that process as soon as possible. Re-traumatisation doesn’t have to be a feature of all discharges from services.
*Name changed to protect their identity.