Sticking to the Rules: Safe for Who?

As I sit here writing this blog, there is a repairman working to secure the front door of my flat. Yet again, a welfare check was called on me by an organisation I was involved with, and the police and ambulance came smashing my door down. I wasn’t at home, and returned some time later to an unsecured front door. Did I request this welfare check? No. Did this welfare check help me? No. Did it add to the shame, guilt and other difficult feelings I am already struggling with? Yes. Did it cause me even more trauma? Yes.

The person who called the welfare check likely thought they were ‘doing the right thing’ by following their organisation’s procedures, because I said I was suicidal. Often, saying these things kicks off a process which is supposed to keep me safe, but is the opposite of the help I need, and ends up causing me extra harm. And once the crisis passes, I am left alone to add something new to my growing list of traumatic things to resolve, on top of the original unresolved problem that prompted the welfare check in the first place. And because the organisation has followed their procedures, they also feel absolved from any further responsibility to help, despite leaving me in a more unsafe situation than before.

Services connected to mental health often make decisions such as these, using processes designed to keep service users safe. However, this can inadvertently cause harm, particularly for people with lived experience of mental distress and trauma – and even more so for those of us who face life through the lens of neurodiversity. Instead of using a one-size-fits-all approach, services must recognise that lived experiences vary, and people need different things to feel safe. Services must work reflexively with people to be truly ‘trauma-informed’. Sticking to strict procedures prevents them tailoring their approach to create the safety and care people really need, causing extra harm instead of the help they promise.

The nature of trauma (and neurodiversity) means people’s needs can be completely opposing. What might seem like a logical and necessary response for one person, is the opposite to what another individual needs. For some, a welfare check might have been appropriate and welcomed in the above scenario. For me, it was completely inappropriate. It’s important to address issues such as these before a crisis happens, and have individual plans in place, so actions designed to help don’t end up making things worse. And it’s even more important that when I am able to say what is helpful and what is not helpful, I am listened to.

Last time I experienced a similar welfare check, I went in person to the police station – in extreme distress – to tell them that this course of action was never appropriate or helpful to me, no matter what the circumstance, and I needed to make sure it would not happen again; giving me that assurance would be more helpful than smashing down my door again! The first officer I spoke to said they can’t change their rules around this. I insisted on speaking to a supervisor, who understood a little more, and tried to implement an alternative plan. But somewhere in the system, that plan was lost. Yet again I had to endure another distressing welfare check. If they really want to help me, why can’t they listen to what I’m asking for?

Interpersonal communication is one of the big things I struggle with, so when I manage to ask for what I need, only for it to be ignored, it hurts me twice as much.

I was once under the care of a community mental health team who refused to communicate via email. Instead, they would only contact me via phone – which I am often unable to answer – or via postal letter, which was not appropriate at all because I was homeless without an address. Struggling to meet my communication needs, the service asked if I wanted to be discharged. I explicitly told them I did not want to be discharged, I wanted to receive the right help. In response, I received an email with a letter attached, discharging me. This was extremely distressing for me – not only were they ignoring the needs I clearly stated, but their rules were one-sided, dictating that I was not allowed to email them, yet they were allowed to email me.

Situations like these put me at the losing end of a power imbalance. Given the nature of my early childhood trauma, this is a particularly triggering and re-traumatising scenario to find myself in. It also makes me less and less likely to reach out for help when I do need it, ultimately leaving me in a more unsafe situation.

Organisational processes make it easy for staff to turn around and say ‘we’re just following the rules’, losing sight of how their actions can bring further distress. I’ve experienced this so many times, including present day interactions with services, and it continues to cause me great harm. I wanted to write this blog post to highlight this harm and the changes needed to create real safety and care in health settings. This is particularly relevant today, as health services implement trauma-informed policies without this deeper awareness of how they could inadvertently cause harm.

I don’t think the harm I’ve experienced is intentional. It seems there is a lack of understanding of how trauma and distress present, especially in neurodiverse women, and how it varies between individuals, creating very different needs. I also think that many workers in these services are out of their depth, not given the right support to work effectively within organisations which are often limited in what they can offer, similarly restricting the staff working within them. In these instances, rules can end up being more beneficial to the organisations and their staff, to the detriment of the service users they are supposed to be helping. But I also believe it’s possible to work together and create something safe for both staff, and service users – if only the services are open to it.

It’s so important health services understand this. It’s also relevant to other settings linked to mental health, accessed by people with lived experience distress and trauma. I’ve had similar situations with my housing workers, PIP benefits, university, and other organisations that should know better – there are many more examples I could give. This is something that needs to be discussed more, and it means a lot to me to share my experiences on the NSUN blog.

In the meantime, it’s hard not to feel like I’m swimming against a tide that never turns. Life seems to be one step forward, two steps backwards. And now, it’s time to go and check out my temporarily repaired front door. I’ll still be reminded of the awful welfare check crisis every time I look at it, and I’m still waiting for a proper replacement, but at least it’s secure again… for now.

About Eleanor

Hello! I’m Eleanor. I’ve always lived life outside the box, and recently it has begun to make sense why. I have lived experience of complex trauma and mental distress, beginning in very early childhood and continuing up until this day. I also have the challenges of late-diagnosed autism and ADHD (although I do not like these labels), which give me both superpowers and explosive meltdowns. Many of the systems and services which are supposed to help me have instead added to my distress, and I’m passionate about trying to change things.

This blog is part of our series on safety and care in healthcare settings. You can find the other pieces in the series here.