The Priority Game

One of the most difficult aspects of Julie's illnesses is the chaos.  Some of that chaos comes from the illness itself, but much of it comes from weaknesses and failures in the system: long queues, missing information, conflicts between staff. And some problems arise from well meant but flawed attempts to intervene in Julie’s life without finding out her priorities. At the moment, for example, there is no sign of an end to the waiting list for therapy – which probably would help – so staff have decided instead to devote their energies to helping her move into her own accommodation  – which probably won’t.

I struggle to get my head round the logic of helping her move out of the family home right now.  There’s no suggestion that living at home with her family is doing her any harm, and every evidence that broadly speaking it works.  She’s ill now, but she’s had a run of nearly two years since she last spent much time in hospital.  During that time she’s been successful at school, made plans for her future and a circle of good friends.  She has only six months left before she sits her A level exams, after which it would be easy for her to move out, either to study at university, or to get a job.  If she moves out now it will have to be into supported housing, a long way away from her school, without the support of friends or family.  Nobody could tell me who would support her financially.  It would make it hard to finish her A level courses, she would be very isolated, and would be heavily dependent on services that already fail to meet her needs.

I tried to explain this, but I could see that no one was listening to me.  People working with her distrusted my point of view because I was Julie’s mother.  As Julie’s mother I couldn’t be trusted to work in Julie’s best interests because I could not be emotionally neutral about her.  It doesn't matter that I have years of experience of dealing with her and her illness.

During a crisis it can be difficult to work out what Julie really wants, especially if, like many agencies that get involved at this point, you have never met her during the times when she is not in crisis.  Even I find it difficult to work my way through the cloud of doubt and confusion that surround her at these times. Did she really – as Jude, one of her support workers, kept insisting - feel that moving into her own place was suddenly so overwhelmingly important that she was willing to give up school and university for it?  Or was this just another manifestation of her current mood of despair? 

I was puzzled how to find out what Julie's priorities really were, and then communicate them to everyone else around.  That's when I hit on the idea of the priorities game.  It came to me one night and the next morning after breakfast I sat down at the table and drew it up.

I cut up a piece of paper into lots of small squares.  On each square I put a goal - most of them fairly non-specific.  There were things like:

Make lots of money

Be a good person

Work with people I like

Go to university

Get a place of my own

Some of them were similar but slightly different.  There were:

Get a job

Earn a good living

So the first priority was to get any job, but the second one was more choosy.  There were others that were mutually exclusive:

Live on my own

Live with flatmates 

The final square just said "ME".  We put this last square down in the middle of the carpet, and I set Julie the task of arranging the other squares around it.  The more important a priority was to her, the closer she put it to the ME square; the less important it was, the further away it went.  Obviously there is a limit to the number of squares you can fit around the central square.  Some squares ("Make lots of money") didn't even make it onto the carpet.  I stressed that there was no right way of arranging them, and that where you put them probably varied a bit from day to day.

To my surprise Julie spent all day doing this task, adding more squares where she thought there were priorities missing from the stack.  The picture above isn't the arrangement she actually made for herself in the end - I felt it was too personal to share - but it will give you the general idea. At the end of the day we talked it over and it was a wonderful conversation.  But best of all, Jude, the support worker who was so keen to help her move into supported accommodation, dropped by and we shared it with her too.

It proved to be a turning point. For the first time we could all see in front of us what Julie felt her priorities were. It was very visual and easy to grasp. There was no need for Jude and I to argue over who was acting in Julie's best interests.  Julie was leading the conversation.

It was obvious that many of Julie's underlying priorities were unchanged by the crisis: and what a relief it was to see that she was still the same person I thought I knew. But some of the more specific goals - the precise career she had been planning to follow - had become less important and perhaps a bit of a strait jacket.  Perhaps a good time to give herself the freedom to think about some other possibilities.

And as to moving out of the family home? Well that did make it onto the carpet, not particularly close to the ME square, somewhere alongside "Go to university". Yes, she admitted, she did long for her own place one day, but she didn't think it was worth leaving school to achieve. But having seen her priorities for myself I felt fairly confident that she could act in her own best interests.