Naomi, @doricgirl #MadCovidDiaries – 27.5.2020
I don’t know why it’s taken a pandemic to get me to the peak of my frustration and anger with the widespread mental health ‘intervention’ that is known as signposting, but I suppose we all respond differently to crisis – apparently my reaction of choice is rage against the practice of information giving that sometimes compares in methodology to Dominic Cummings’ approach to sight tests – at best not well thought through and potentially extremely dangerous.
It probably seems like a trivial thing to get annoyed about at a time like this. But to me the fact that this widespread practice of giving or sending under-researched and often inaccurate information to people seeking mental health support at times of crisis continues, even when there is so much change to services that checking accuracy should be at top of everyone’s list. It shows just how little consideration is given to the hornet’s nest that is signposting.
I both work in the voluntary sector in a small specialist charity and use local mental health services. In both roles I frequently see or hear about ‘signposting’ as a key part of support on offer. The more I hear about this, the more I wonder who it is for?
On a personal level, I think what has tipped me over the edge was a letter I received myself about a month ago in response to a referral to a CMHT. Over my entire life I have struggled with an ever expanding range of fun mental health symptoms, most recently impressive depersonalisation which has left me so disorientated and confused I couldn’t leave the house alone for fear of being run over, not being able to work out where I was, or losing my toddler if she chose to leg it. I know this is a less well understood issue for many working in mental health, so I don’t generally expect an informed response. This contact, due to my fears the depersonalisation was again threatening to take over my life, resulted in a lovely signposting list in the post.
Of the four organisations it was suggested I contact, the information was not correct for a single one of them. Inaccuracies ranged from opening times, contact details, what the service does and who it’s for and the actual existence of the service (and not a tiny, local one!). Fair enough, things are changing quickly at the moment – but some of the incorrect information was at least 2 years out of date. There was also no attempt to update any of the service information in light of the current lockdown situation, and several of the services suggested usually operate as face to face service. To support this a number of website links were printed in the letter from useful health-related sources such as the BBC and the Guardian.
It has taken me more than a month to be less furious about this whole process. As I work in this area, I could see immediately that much of the information was incorrect. But what about people who don’t know this and are chasing up services for support through incorrect information or left thinking (as I did) that if all the information I needed was on the BBC website then I must have been imagining how much I was struggling.
In the organisation I work for we have gone back and forth on the topic of signposting to other services over the years and come to conclusion that it is very hard to make it compatible with offering direct support, as it can feel very much like we are fobbing people off to another service.
Additionally, on an almost weekly basis we have to respond to contacts from people who have been signposted to us with inaccurate information about what we do. It’s excruciating for both us and the person getting in touch to have to explain that despite them having the courage to reach out for help, be ‘signposted’ on to another service and then get up the courage to contact us, we don’t do all the things that have been promised. Often this is due to a lack of research or knowledge by statutory services about what the voluntary sector does or can do.
Signposting seems to assume there is limitless resource in the voluntary sector to respond to anything that the NHS can’t or won’t deal with; that it’s easy for people in distress to work through a list of ten random agencies to try and work out who would be best for them to contact; and that providing accurate information about what the services do, who they support, when they are open or even how to contact them is unnecessary. I raise this in countless meetings and am often met with the counter that the voluntary sector changes so much that it’s hard for the NHS to keep up – again showing a complete lack of knowledge about the precarious funding situation in the voluntary sector and why that might be.
So who is signposting for? Time and again I come to the conclusion that signposting is there to help individuals and organisations to feel less helpless, and like they have done ‘something’ in the face of their own limits and resources. It’s an understandable place to come from, but to frame it as supportive to those it’s aimed at, with no thought given at all to the accuracy and relevance of the information given out, to me makes it start to become a risky practice which can actually be harmful.
It seems so innocuous – give someone a leaflet and feel better about yourself – but that comes with a message that says you’re not my problem, and inaccurate, under-researched, blanket information also says ‘and I don’t really care enough to bother to check if this is actually useful’.
In a time of complete chaos and mixed messages on mental health support it matters more than ever that signposting information is accurate, is supported by an understanding of what other services in the voluntary sector actually do and is recognised as something which is neither neutral or harmless.
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