Thresholds: Bubbles and Lemon Washing-Up Liquid

When as a student I accompanied the Community Psychiatric Nurses on my first home visits (c.1980), I remember the extent to which the basics were highlighted:

• you do not enter until invited;
• you are a guest and may be asked to leave at any time -

(which was another way of saying you are not always welcome);

• listen, observe, accept - don't judge but do learn.
• don't take things personally and speaking personally look after yourself.
• what you see (just outside, hall, lounge) does not always reflect the true domestic picture -

(which is another way of saying what's in the fridge...?);

• you don't venture anywhere else without a clear clinical rationale -

(if in doubt seek advice, supervision, support)

• and so on...

This mix of guidance, good manners and common sense and a return to clinical practice these past months has prompted reflection on the threshold presented at people's doors and the fact that health, social care - life no less - is full of them.

Each may mean the turning of a page with no chance of going back....

I arrived to do a visit recently to find a bottle of apple washing-up liquid waving in my face. As I looked at the bottle one of the tiny bubbles floating inside without a care decided to burst.

"This isn't what I wanted! I wanted lemon!". I had crossed this particular threshold to try to persuade the vexed individual before me that perhaps they could not safely cope and manage there any longer, for reasons causing acute concern to several people and agencies.

"I wanted...." There was a stark contrast in the attempt of this person to exercise choice over the washing-up liquid in what was theIr home and the likely degree of autonomy in their next home: a nursing home.

Critical as it is from a legal perspective - it isn't just walking through the front door of people's homes that matters. There are of course other thresholds. As a clinician what is your purpose in visiting and what is the client's mental capacity to understand why you are there? In what may follow how much choice will there be beyond meal time menus, eating in the dining room.....?

I doubt that washing-up liquid will be one of them?