Updating the parable

Mental Health Nursing,  Jul/Aug 2000  by Armson, Simon

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The Samaritans are a household name offering a listening ear, day and night, to people in distress. But mental health issues loom much larger than they did 50 years ago. Lawrence Pollock talked to national director Simon Armson about facing up to these trends

The sensational death of Diana, Princess of Wales and the week of mourning preceding her funeral, was a unique and unfathomable event in modern British society.

Millions were moved to grief for the loss of a very semi-detached royal and flawed heroine.

The psyche of Britain seemed to be turned inside out. The Samaritans geared up for a surge of demand around her funeral. To their surprise there was a significant drop in calls.

Simon Armson, UK director of the Samaritans, believes the events of that week discharged emotions which individuals, previously, had not been able to deal with.

"People were weeping in the streets, hugging each other, comforting. The event gave permission to society to express feelings that had been locked up for a long time."

Mental health professionals will have their own recollections of that period and form personal views on whether Britain engaged in a week of catharsis or opiate ingestion.

For the Samaritans, however, like CPNs, social workers and professional carers, the moment passed. A bleaker, more familiar social terrain reappeared requiring the development of long-term strategies.

In a society where mental illness and psychological distress have drawn forth a large statutory infrastructure, the Samaritans remain a very British charity.

They were founded by maverick clergyman Chad Varah in 1953. Early in his ministry, he was traumatised by the story of a teenager who committed suicide because no one had explained to her, the onset of menstruation.

The essence of the Samaritans was set in the early days, at the counselling centre Varah opened in his London church's crypt. 'Clients' waiting to see tim were leaving, comforted, after confiding to church volunteers who served tea. Varah realised that the specialist help he was offering was unnecessary or superfluous.

The result was a spread in the 60s and 70s of Samaritan branches based on both anonymous telephone contact and personal befriending. Nonspecialist, non-judgemental, nonprescriptive and absolutely confidential were the watchwords.

There are now more than 200 branches in the UK and Republic of Ireland-with nearly 20,000 volunteers. The volunteer-staff ratio of 500:1 is one of the best in the voluntary sector. Last year they fielded 4.6 million contacts by phone, e mail and in person, in the UK

It is a success story, certainly But the organisation finds itself, approaching its 50th anniversary in a rapidly changing world. Can it maintain a recognisable commitment to what Armson calls `emotional support that helps people to go on living?'

Mental illness has emerged in the past 20 years from the shadowlands of mainstream consciousness and the physical invisibility of the long-stay psychiatric hospital. It is an issue both objectively and because of the perceptions the public, and the tabloid media have.

For the Samaritans, there is an inevitable challenge to their methods.

Training has always been rigorous, designed particularly to test selfknowledge and probe judgemental attitudes. But Armson is conscious of the balance that needs to be struck in handling mental illness.

"We do become experienced in recognising and reacting to mental health difficulties. But we have to be careful we do not not run the risk of attempting to create disgnosticians."

It was important, he said, to avoid technical expressions which could be meaningless.

Again, the Samaritans are not counselling but their role will extend to exploring with a caller what the possible range of interventions might be - though Armson admits the potential difficulty of dealing with someone experiencing hallucinatory episodes.

These careful rules of engagement allow for enquiries into whether medication is being taken without being directive about the issue. Yet mental illness is a condition which permits little scope for neutrality and presents a generalist, nonprofessionalist organisation like the Samaritans, with particular dilemmas.

"We would not expect a volunteer to take a view about whether the way a caller presents, represented indications of a psychosis," comments Armson.

"That would be getting far too close to a diagnostic application.

"We hope volunteers will recognise what appears to be, what one might loosely call, a `mental disturbance', where the reality of the caller does not coincide with their own, where there are marked indications of someone being very down or depressed.

"In those cases, we would often be exploring with the caller who else might be involved - whether they have been talking to their doctor, seeing a psychotherapist or if there is a CPN looking after them."

At a more practical level, Samaritans have to consider how they handle a disturbed woman or ill man wliO persistently visits the centre simply as a place to go.