Carrying It
Carrying It explores what responsibility creates in people.
Through conversations with people who hold responsibility, and people who feel it, the podcast examines how pressure, behaviour and influence move through work, relationships and everyday life.
Because responsibility doesn't disappear. It shifts, and someone carries it.
Carrying It
What Get's Left Behind?
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In this episode of Carrying It, Phil Scott speaks with Marie Adams, a social prescriber, about what happens when responsibility reaches the limits of organisations, but people are still carrying the consequences.
Together they explore why so many problems can't be solved with a diagnosis or prescription alone, and how listening, trust and community support can help people move forward when there isn't a simple solution. The conversation examines trauma, loneliness, confidence, and the hidden emotional weight people often carry for years before anyone truly hears it.
They discuss social prescribing, prevention, the role of local communities, and why helping someone carry responsibility isn't always about finding a resolution.
If responsibility doesn't end where organisations stop, what does it really mean to help someone carry what's left?
Responsibility doesn't disappear. It shifts, and someone carries it.
That's true inside organisations, but it's also true in society. Every episode of Carrying It supports organisations working to improve how responsibility and mental health are understood and supported in real systems.
You can learn more about the organisations we're supporting through the links below.
https://www.mind.org.uk/information-support/local-minds/
http://www.mentalhealth.org.uk/
Responsibility is unavoidable in leadership and influence. In all kinds of roles, from firefighters to social prescribers to vets. What matters isn't whether it exists, but what it creates and where it travels. Responsibility creates emotional load. That load doesn't disappear, it shifts, and someone carries it. Welcome to carrying it when responsibility doesn't stop. That's what this podcast is interested in, not how hard leadership is, but what responsibility creates. This conversation is about limits. What happens when responsibility reaches the point where organizations can go no further, but people still need someone to help carry what's left. Today I'm joined by Marie Adams, a social prescriber, whose work sits between healthcare, community, and everyday life. Welcome Marie.
SPEAKER_01Hello.
SPEAKER_00Okay, let's dive straight in. There may be people listening to this that have never heard of social prescribing before and don't know what that entails and what it is. Let's start there and maybe you can introduce social prescribing and explain what it is.
SPEAKER_01Well, social prescribing has always been. It's not a new thing. It hasn't been invented by the NHS to be parachuted in 10 years ago to help people with non-health issues. It's what used to happen in the community with families listening, supporting, understanding, and working together to help people deal with their issues. But as we know, society has completely changed. And since the 60s, the change in the way we deal with issues, how we work, how we learn has all been disseminated and we've had to find new ways of working together to support each other. So social prescribing was founded on the base basis that people need to be heard, need to be listened to, and need to be supported to access different activities that they may not have even thought of to help them deal with the issues they're dealing with. It's also all about the social determinants of health, which sit alongside clinical health issues. Because people who are struggling with bereavement, people who are at risk of losing their jobs, have a huge amount to carry, and that stress has a huge impact on their mental health, on their physical health, and they go to the doctors. But actually, it's not something that is easily resolved with a diagnosis and medication. It's also about understanding what really is going on in someone's life to get them to that point. So that's why social prescribers listen. We hugely listen to our patients. We have to work out the real issues. And I've seen patients for over an hour, and then eventually they tell me what the issue is. And this can be way back as a child, trauma has a huge impact on an adult's life and what they're living with and how they deal with their situations. And it's situations that they put to the back of their mind, and then as an adult, and then as they've got families, or as a bad situation happens, it gets triggered and it comes all to the fore, and it has huge impact, and it can actually break down a person's life so much that they don't realise it's happening, and that's when they go to the doctors, because family members are saying, There's something wrong with you. Something wrong with you, Paul. Why don't you I think you need to go and speak to the doctor? Not really sure what it is. They can't even describe what their problem is. And then they get asked to see a social prescriber. And we talk about everything, and with our learning and our skills, we're able to pull out. We they go back to childhood to the issues that they've buried and actually identify what the issues are. It's not always the worst thing you can imagine. Some of this is their granddad died, and they weren't seen as old enough to be involved in the conversations when when people die and how you cope with grief, that it was just considered they're too young to deal with it, and that still is is still in them that they they lost somebody but they were never able to talk about it. But it just comes up so so um their parents die and they were able to deal with that because no, we're born, we die, we know that as a natural thing. But the thing which triggers the worst bit is the where they weren't able to deal with it when they were younger.
SPEAKER_00You mentioned there that the entry route into social prescribing is often through a referral from a GP. That's you know, people when there's something wrong with them, they go to their GP. But a lot of what you talked about there is very psychological. I'm sure you don't sit them down on a couch, but there's that sort of Hollywood impression of lying on a couch and having a psychologist or a psychotherapist. How do they interact? Does that come before or after? Is that in parallel?
SPEAKER_01Right. So a lot of people have bad experiences of what's known as NHS talking therapies. Also, the waiting lists are huge. I mean, we can wait a year. Do you do the initial assessment? You can be referred to the online sessions, and then you have to wait for a psychotherapist or a psychologist to see you if that's the specialist you need. There are community mental health teams as well. However, you refer to them for a different um with a different diagnosis from the GP, such as schizophrenia or bipodes or other things. So you might start going through the path of talking therapies, but then would be referred to community mental health teams. So you're not being missed, it's just different ways to get into it. But for me, as a social prescriber, a a patient would come to me and the best appointments are actually in the surgery because a patient sees it as a medical issue. So seeing me in their home or talking to me on the phone doesn't give it the gravitas of how they feel the situation is, and so I like to have them in the surgery, and we have up to an hour and a half to just talk. I um I try to bring humour into it. We do have a bit of a giggle. A lot of well, most of most people dealing with mental health cry. So I have my box of tissues, we sometimes have a cup of tea, so I have my own kettle in my room, to break down all the barriers. The men and women to come at this a different ways, and men like it very structured, and women like a nice cozy chat. But and in between, there's everything else. So I have to encourage them to talk, and they can be talking 20 minutes and still not tell me what the issue is, and then I have to keep opening up the layers and going back in time, going forward until they actually tell me, and they know that I'm trying to get it out of them, but they have to trust me, and that's the most important thing. They have to trust us to share what is to them is the worst thing. It's it's not always the worst thing I you can imagine, but to them, in their life, in their lifestyle and what they understand, it's the worst. So it could be being made un maybe being made redundant because the stigma of having to sign on and get job seekers, no one's in their family's ever done that. Or it could be they're going to be getting divorced, or they're living in the same home and the situation's really bad, but they don't want to share that because it's very embarrassing, isn't it? To open up and share your situation which you don't tell anybody else about, you just live in that moment and you're having to share it because that's the reason why you've had to come to the doctor's because you can't cope anymore. And the doctor can't cure them.
SPEAKER_00Do you find it's normally one problem that you can pinpoint when you peel back those layers, or is it an accumulation of multiple smaller problems over time?
SPEAKER_01You're right, it's more than one problem quite often. So I can get them back to where the problems start, and then I have to go forward to identify each other thing. An example is so had to leave home at 16 because the relationship with the step parent wasn't great, and they struggled, they survived, they struggled, got a job, career dropped job, and then they had they had then got married, got family. Some there's a health issue with somebody within the family. Work is becoming a struggle, it's more stressful, home life is stressful because the the a loved one is not very well, and then um they're really sleepy, they're really tired, they can't understand what's wrong with them, they're starting to get niggly, and then the relationship at home is breaking down. So it's quite a few things, but it stems from one thing. I'm a great believer that if you've experienced something, you can never forget it. However, you can draw a line, and it's up to you if you go back to the line and hit it like a bumper car, and then you go back again because you know it's safe because that can't hurt you again, but you've got to talk about it so that you can accept it. And through life, we have quite a lot of these lines, some are a bit dotted, some are very heavy, but you've got to accept that it is part of your life, and you can't change you, and you can't change what you've experienced, but you can move forward. Um, and hopefully, my role is then to refer them to the support they need. And there's lots of levels of support. So we have Mind, which deliver coping skills, we have talking therapies, which do online CBT, have also um counsellors, there's also private counselors they can access. They don't have to do everything through the NHS, just where do we start? And a lot of people, once they've opened up and shared, actually that that helps them move on. And it's very powerful, it's very powerful. I mean, the tears, the emotion, the emotion of the emotion, because they're getting very frustrated or they're I'm crying uncontrollably, but they've talked about it for the first time and could be 20 years. And that's just so powerful, isn't it? It's like and it's such an honour for us as social prescribers to have that permission for that person to tell us the real problems, what what it is. And then sometimes I just sit there and go, That's that's absolute shit, because I don't know what to say sometimes. I don't have the words, and I just it's silence and I just go, that's shit. And then we look at each other and it's uh they're like she understands, you know, or that person understands, and yeah, and then you then you build on from that, and I and sometimes that's all you need. And I don't think social prescribing is seen in this way in the terms that my colleagues experience social prescribing because if you look on the telly, it's all about referring to groups, and the last thing I do is see a person to refer them to a group.
SPEAKER_00You have to talk first. So, do you find then that people are coming to you for a solution, like they would go to a GP because they want to be diagnosed and they want to be given a remedy, or are they just looking for someone that understands what they're carrying?
SPEAKER_01A lot of people who come to social prescriber don't understand what we are about, they just haven't got a clue. I've been in my surgery nearly seven years, they don't even know I exist. I'm at the furthest point, so they don't even see my door sign. But what they think they're coming to see is someone who will listen to them. Because the way my surgery is, they refer to me because I'm a friendly ear, but I also can help this person by moving them forward because they've seen that happen, they've got the case studies for that. So they support them, they encourage them to come and see me because they know that I'll be able to help them. I mean, I I don't mean help them is just by listening to them. I don't always I don't always have answers, but sometimes that's all people need. They don't all turn up to see me because they're not all ready to face their their situation and whatever it is, because once you start opening up, you can't you can't go backwards. Because it's in your head then what you've got to deal with it, because you've said it then. Um so we've got to deal with it. So But I when they leave, I haven't left them, they've said all this, and then they're out the door. We close the box, we um we make I make sure they're okay, we have a bit of a laugh. So it's as much as a quarter of an hour closing down our conversation as it is how long it's taken to do the conversation.
SPEAKER_00So there's that element of the unknown, as you say, that they don't know why they're coming to see you, and then what you give them is normally I guess a mixture of practical advice and then just helping them feel, you know, like there's someone there, a little bit less alone. In in all of that, what surprises people most about the work that you do?
SPEAKER_01That I get it. I've had many people say, You've heard what I've said, you get well, yeah, yes, you get it. It's not that they don't think I'll understand, it's the fact that I've been able to articulate it back to them, what I understand they've said, and it's what they understand I've said. Do you know what I mean? So we are so I'm saying it back to them, they've kind of gone and I've gone, This is what I think you're trying to tell me has happened, and and they they love that, and that's what they don't because they don't get that from the doctor, because the doctor's here ten minutes. So it's very few people who actually got the time to listen. Yeah, I mean, it's tough. To get there, to to understand a patient's situation is is quite tough. So in all of this, you know, there's you never know what patient's going to walk through the door, they're not ex expecting anything from me, and I I don't know who I'm going to see to what I can give them as well.
SPEAKER_00You talked there about your surgery and and where you are at at the end of the corridor. Is there some symbolism in that that and maybe I'm reading too much into this, so tell me if this is a wrong conclusion, but you're at the end of a corridor of a GP's surgery, you're still in the building, so you're still part of that formal service, but you're about as far away from the formal service as you can get while still being part of it. Is there some intent, do you think, in that?
SPEAKER_01No, and no, yes, I know what you're saying. When I first started six years ago, I was upstairs and patients can't don't access upstairs, and I used to have to find a room and I used to meet people out for coffee. And then my supervisor, he recognised that I have value to my job, and so he's got me into the surgery, and he got me into the surgery two days a week, but now I'm three days he got me three days a week because I because he realizes that the impact and patients don't return to the GP if they're coming to see me. So I'm in the cupboard, I'm in the t smallest surgery room, which is under the stairs, uh the external stairs. Um and you're right, it I it is, you know, where do we put Marie? Yeah, no it's no bigger than the blood room really, but I'm in the surgery and I I have other colleagues in other areas who don't even have a room, you know, who just do everything by telephone. So the value of the service is not as professional as it should be, as should be seen. Well, you know, we're still young, aren't we? We say ten years we've been going, you know, how long has the NHS been in place? So uh, you know, we're gonna get in there. Also, social prescribe is going to be one of the things in neighbourhood health. It's got to be, because it's about prevention. And my role is all about prevention. So, how do we prevent people who are dealing with and living with long-term health conditions, move forward so they can live a healthier life? Because even if we're living with h health conditions, and we're going to be living to a 90, a hundred years old. We've still got to keep those people moving, looking after their health, considering all other uh aspects of their life, and not just focusing on what that is at that moment. All these things add up so we don't dwell on what's bad about our life because it's keeping us positive. But we don't we're not looking at it as a big picture thing, we're dealing with it as as it happens, and um that's quite scary, really.
SPEAKER_00What do you think the communities and the neighbourhood can do then that the big systems, the national services, struggle to do?
SPEAKER_01Well, within communities, we have got community centres and community buildings and community hubs mainly. And we also have leisure centres, but they're expensive and their exercise is very expensive to access at those places. If you're an elderly person on a basic pension and pension credit, it's difficult to access that. So what social prescribers do is we inform people about attendance allowance and we help them apply for attendance allowance, which is up to £100 a week. And that that money is to help people um be independent at home and they could they could cover the cost of the transport and going to these sessions. Yeah, we have to break down the barriers, you have to meet them. Social prescribers meet the sessions, we have to do the introduction session with them, you know. We're very good at going to these sessions and moving about with people. So we have to break down the barriers as well. We have to be um fully aware of what's going on in our communities, and then we promote them. A social prescriber is very good at selling, selling the benefits without them realizing they're missing it from them. So it's all the positives we we big up into this the positives and we'll meet them there and we'll we'll support them through the first couple of sessions and and stuff like that. And I phone them up after they've been to a session to get their feedback. It's not for everybody or any stuff, but you know, you you do the encouraging bit so that they're not on their own, because that's the fear. Going through a door of anything, if you're going to through a door of a new pub, for example, it's it's quite scary if everyone's going to look round at you. Well, uh from a female's point of view, I find that. But it's quite scary, isn't it? You know, when you go anywhere, if you're going to anything, apart from the supermarket, which is all big and open, most things are quite close to the door, so you're frightened of of what's going in. And so what social prescribers do is to reduce fear, and we are aware of what's going on in local communities so that we promote it. And and that it's not exercise, isn't just about going to armchair exercises, it's also about the local choir, it's also about um activities where people just come together. So the Silvercraft Group or Park Run, all these different things. We have to be aware so we can gauge what would be the most suitable activity for the person we're having a conversation with. Don't give them everything because they are shut down. They won't know everything. And if you've been with me for an hour and a half, my goodness, you're definitely shut down. So you have to give them the right information to take take away with them. I'm a great believer in printing out, so I show people websites which have helplines on. I show I print off information off the websites as well, because if you give people a website, they won't look at it because you they think you've told them what's on the website, and there's so much more information out there, so I find really good quality information that um I share with my patients so that they can go and find out more as well, and that's really important. So, but yeah, they do sometimes go away with the tree, it depends what we're talking about.
SPEAKER_00How much of the responsibility for this do you carry? I mean, printing off leaflets and things is one thing, but the way you talked there about it's not just making sure they go once or helping them get there the first time, right? This is continuous and there's a big responsibility there over an extended period of time. Does that sit with you personally or somewhere else?
SPEAKER_01No, I'm doing a job I'm paid to do. I'm very passionate about it, obviously, because I I've been doing it for so long, it's a tough job. But my job is to listen, understand, support, and share information. Not everybody's ready to do the next step to a group activity to get the support they need because it's quite where they are, if they've got really bad depression, that they can't hardly move, their brain's switched off, that they everything's tight and they're they're really uncomfortable. So I support people until they can open up a bit more, but they I can also just not answer my texts and we don't I don't ever see them again. It's that it's their choice. No one's forced. I'm I always say to my patients that what I say is just words. I don't prescribe and m make you do anything, it's all down to you. Uh but if you want help, then I can I can do that as well. So nothing's forced on them. It's it's all down to them, it's it's their responsibility. But I feel had somebody who went to inclusion in the last few months. She's now 76 days dry. So next time she sees me should be a hundred. And because I see her every month, that's her motivation to keep doing it. So I have that's that's a really good story. That makes me feel warm and cozy. There's there's lots of stuff like that. So they want my support because they first opened up to me and then I made the referral and she thought she was going to have to go into 12 week detox or whatever it's called. But she's been doing it at home because she's so focused. She'd made the decision that she wanted to um stop drinking and now she's been doing it for so long and she's gone and act with gets her sunflowers and shows her how much money she saved and she's been treating herself. But we have conversations to say well what what would happen if you felt like having a drink and stuff like that. So and we we we talk, even though she has a counsellor and she has a support worker and she goes to the groups they're important but it's because where she first started it's important to her as well. So I have quite a lot of pe patients like that who we we touch base every two months. Because see patients as long as we need to but it's you know for every 50 patients I would think three patients are like the person I just described and 20 patients see me and the the what I give them the information and they they just go and then the others I I'm I might speak to don't want to they don't want my involvement or they don't get back to me. So we're small percentages but we see um the four social prescribers in my team we see about two and a half thousand patients a year. So so we we're turning over quite a lot of patients but we don't run groups. So us our social prescribing team um the GP leads don't want us to run groups because they feel there's enough in the community and also it takes our priority away from dealing with the patient. Yeah. So we've we formed our own way of working really and each of us do it in our own ways because we're our own people.
SPEAKER_00What happens to those patients that fall through the cracks then that don't come back or don't respond to the text messages and may have taken some literature but haven't done anything with it or taken it any further?
SPEAKER_01So quite often those patients haven't realized the value of a social prescriber input and they go back to the GP. So the ones who keep coming back to me don't go back to the GP and I can talk to them and the GPs or any any health profession in our surgery they recognise that I've had a long chat it's recorded in the in the notes they will either um allocate whatever the work is to be done or they give the patient a call themselves or sometimes I just increase the medication because of the notes what's in the notes. So yeah it's we work together.
SPEAKER_00What kinds of people come and see a social prescriber?
SPEAKER_01I see children I I see all ages but I see children with ADHD I see um all these frailty people um I see m a lot of people with anxiety and depression I also see people who uh repeat refer us to one one um and you know well anything really anything which a doctor can't really diagnose there and then because the patient can't get it out. They can't explain enough they don't have the right words they don't have an understanding of what's really wrong so they're asked to see me. So that's what it feels like anyway. I'm sure a doctor sees it some as a different way and then I refer back what I find out if needed.
SPEAKER_00When do you know that you've genuinely helped someone when they've changed I see a change.
SPEAKER_01So the lady I spoke about being dry she's lost weight she's brighter she's respectable so quite loved to people when they first start seeing me struggle to have a shower before no I don't care how they come but there's a difference so they they struggle to uh look after themselves before they come and see me and then when it star when everything starts working there's a complete change they're bright they're sparkly they have enthusiasm they're motivated it's just it's it's a bit life changing really they feel different you can see they're different we're s we celebrate you know I'm always clapping and shouting at them because to celebrate because who else they're going to celebrate with because they've told me and we're sharing how far they've come so we we celebrate a lot I'm quite loud in my maybe that's why I'm the furthest set from the furthest end of the surgery because I'm quite loud with my patients. Yeah it's um celebration's great explaining how far they've come since they they first started seeing me um yeah and and just being chuffed for them really. And sometimes it won't be the thing which they think was the issue so um the fact that they've been able to go out at the weekend to meet friends when they haven't been able to go out on their own for a long time. They've um um what else they've gone down to the seafront on their own because the husband that's what they used to do with the husband but they they're struggling to be able to do that because of all the memories and they were able to do that because it they used to go to Cafe there and she wanted to get back because they had friends there but she found it difficult. But it's the smallest thing isn't it the smallest thing is the biggest thing. I do talk about the smallest steps we take to get them where they need to be and it's two or three small steps which isn't even a slab will move them down the road and do they feel a resolution or do they just feel that they're able to carry things a little bit better and a little bit easier? I don't think there's a resolution. I think it's the line I think they they done the line and so now they can bounce off the line then they can move forward. You have to live with this stuff. I think I make it a bit easier because we've made it real we make it real there's no judgment there's never a judgment learnt. It's a tough job but you learn not to not to show emotion when you're told stuff and then when you are told stuff you think oh is that it's what to somebody it's the it's the worst thing but actually I might have heard it a few times so it's normalized of me. So there's no emotion, no no effect that I I've got this judgment they carry things a lot better not a little better because they've learned to live moved from when they were feeling really anxious really worried like it was the end they've actually been able to live through that and it's got lighter alongside medication sometimes antidepressants they've realised that actually there is something going forward and that there is a purpose to keep going forward and yeah and and they always always can come back to me. So it kind of naturally filters peters away really because um then we don't have to talk about it again. So it's then is what are you doing then? So then we go forward well what have you been doing what are you going to do and so what is there to talk about once they've dealt with dealt with that so they always have the option to come back and I don't tend to go anywhere. I'm very happy in my my job and they could just do an e-consult and it comes straight to me. So they know that it's quite safe to leave me because I'm still I mean there's no guarantees I'll be there but it's at that moment in time they can leave me and they can come back if they want and they do sometimes as you just said there's a continuation.
SPEAKER_00Everything has its limits right they can't see you forever and eternity what is it about how you leave them and healthy responsibility for them what does that look like when there is no resolution, no finish line normally is they they're more confident so what I see is confidence and motivation.
SPEAKER_01So the weekend's coming they can't even plan what they're going to do at the weekend a lot of people like this they're dealing with the issues they don't know how to prioritise anything everything's all all encompassing and it's all a blur so I'm always saying you can only do one thing at a time so I help them prioritize so at the end they are dealing with one thing at a time they've dealt with all the rubbish that they were trying to cope with and have prioritized it and and dealing with it. So they might have access counselling they might have spoken to our mind ladies they might have just been coming to see me every fortnight. So we've been doing a lot of work before that it comes to the point of them being discharged and they're happy when they come to see me there are different there are different people you I mean we must all recognise this we see people who are very low, very flat and then we see them another time and they're bright and they're actually positive and they can have a conversation they're not running away from a group they they have slightly changed and this is what I see in people and it's not for them to tell me they've changed it's for me to feel because that I've listened I'm listening. When we first met I listened and I understood and I was able to see the situation and now I'm listening and able to see the situation's completely changed and they're on a different path. But they have a right to leave because they don't want to talk keep talking about no one wants to keep talking about something which has actually moved forward and and they're dealing with I mean we can't change everything and these issues they might still be living with an issue that but they're still going to be in a better place at the end of us having a conversation more than a conversation maybe four months conversation.
SPEAKER_00I think that's a very practical and positive way to draw this episode to a close Marie so thank you very much for spending the time with me today. I enjoyed and learned a lot from that thank you thank you each episode of Carrying It supports organizations working to improve how responsibility and mental health are handled in real systems. Links are in the show notes. This conversation was about limits and the reality that responsibility doesn't end where organizations stop because systems have limits but people don't