Naomi Mackett, Clinical Psychologist, No Wrong Door, Warrington
Naomi trained as a Clinical Associate in Applied Psychology (CAAP) at Edinburgh University, after which she worked in Fife as a CAAP across both CAMHS and looked after children services. She finished her doctorate in clinical psychology at Bath University, and then started in Warrington as part of the No Wrong Door service.
Reflecting on her journey to this point, Naomi picked out a role she had in Fife as the moment when her interest in working with children was sparked. She explained that it was a split post between CAMHS and looked after children services working with children in Fife therapeutic placements.
It has been this passion that has pushed her into more challenging roles where she feels she can make a big impact on the lives of children. Her current role in Warrington has been unlike anything she had experienced before.
“When I arrived there wasn’t much of a framework or structure to what was wanted from the role other than just come and do it and see what happens. I feel like I had never worked somewhere like this, everywhere else has always had quite clear structures of what they want from you. That has been very freeing and very scary at the same time, but it has been a really flexible way of working.”
Professionals need to understand each other
This flexible approach is very different to the ways of working Naomi experienced before starting at No Wrong Door. In her career journey to date, Naomi has seen how a lack of collaboration and understanding between organisations restricts their ability to work effectively to support children and young people. Too often organisations fall into working in silos as a direct result of their rigid boundaries and processes.
“One of the major issues I have seen everywhere I have worked is the lack of relationship between social services and CAMHS and I think that comes down to the different ways services are trained. What CAMHS think is a mental health problem and what social care think is a mental health problem are completely different things and I think half of the time of the people in those services is spent fighting over definitions of things and who should do what rather than actually doing things.”
Naomi gave the example of a particular young person she has worked with in the past. This young person had experienced extensive developmental trauma, he had diagnosed ADHD, high levels of communication needs, difficulties with learning, and had repeatedly been in trouble with the police. “When he became known to our service the conversation was very much CAMHS saying the issue was the environment and it’s his home, and social care saying they think its psychosis, and we were stuck in this situation where people on both sides were pulling in higher and higher people and the conversation never went anywhere.”
“There are huge cultures of what these different organisations expect from each other, but they don’t really understand each other’s work.”
Learning across organisations
This challenge of managing traditional organisational boundaries is something that No Wrong Door is actively trying to improve by co-locating professionals within residential hubs. Naomi works closely with the hub staff, social workers, the police, and a speech and language therapist.
Being co-located with other professionals has fostered a learning culture between them based upon trust and Naomi feels it has given her the space to bring her expertise to make a difference to children and young people. Importantly, this learning goes both ways and benefits all involved in the system.
“There is some really good stuff in terms of learning from both spaces and how I bring my knowledge into a social care context and then how I bring that knowledge from social care into child and adolescent mental health services. I think that learning from each setting has been really helpful in some ways.”
She feels that her insights as a clinical psychologist have supported her colleagues in their understanding of the challenges faced by the children and young people they work with, but her colleagues have also affected her own way of working. “I think psychologists can be quite cautious in what they say but this role has made me more direct in what I say and how I speak, which is much less an NHS way of speaking and is a more social care way of speaking.”
Relationships at the centre of collaboration
Naomi is convinced that greater collaboration between organisations is needed to improve how services are provided and outcomes for children and young people.
“A greater understanding between those services is one of the most important things to achieve and a project like this is getting somewhere to improving that relationship as it is so entrenched everywhere as it is a resources issue.”
For Naomi, Trusted relationships are the foundation of effective collaborative working where professionals develop ways of working together and they can approach challenges together with their collective expertise. This fuels the learning environment and supports the cross-pollination of ideas. It’s not as simple as attending more training but requires “professionals to actually work alongside each other and to be constantly having conversations.”
Naomi would like to see the No Wrong Door approach to co-locating professionals used more widely.
She feels that being co-located at the No Wrong Door Hub, “you get to know people so well and you can see their perspective when you trust their opinions and their intentions. I think a solution is for more co-locating of services and seeing how each other work.”