Someone to Safeguard

The referral was pretty bog standard these days. The neighbours didn’t get Elsie’s permission for any of her details to be referred to Social Services. In truth it had never crossed their minds they’d be asked for this. When pushed by the call centre about the issue of consent they said that they didn’t think they needed her consent and that this was a matter that ‘the Council must take seriously for everyone’s sake’. And then behind the thinly veiled threat to act the neighbour stumbled upon four little words. Magic words. Words that suddenly change the meaning of everything and words that seemingly come with their own legislation, procedures, judges and juries. ‘It’s a safeguarding issue’. And boom, there it is. Elsie, aged 87, never known to the Council, never having failed to pay for council services or any other tax that propped up with welfare state that she didn’t really partake in, was known. Consent overridden. Case opened. Within moments Elsie had an electronic file. Elsie had a Reference Number. And Elsie would receive an automated letter thanking her for contacting the Council and she would receive a call within the next seven days. All done within five short minutes from the start of the phone conversation. Within ten minutes Elsie was on waiting list of other Reference numbers waiting to be allocated to a Social Worker and sat on the computer screen of the Manager. Whether Elsie used services or not, from that moment on to the day of her death, nothing was clearer – Elsie was a Service User and there was a record to prove it. There was, as far as everyone was concerned, someone to safeguard.

The social workers went in twos to the address. No-one was quite sure why. The referral mentioned that Elsie had got cats but there wasn’t any belief that the cats were dangerous. Perhaps the second social worker was there because social workers love cats. The referral said the house was ‘dirty’, ‘things everywhere’, ‘cluttered’, ‘soiled pads in the garden’ and Elsie, although not seen for some weeks, was wholeheartedly felt by the neighbours to be dirty herself. ‘She’s self neglecting’.

Having knocked at the door and getting no response the social workers pushed slightly at it and the door opened. A cat ran out and then back in again. No sign of Elsie in the hallway. The social workers called her name, walking gingerly through the hallway, past a sideboard with some framed pictures of a moustachioed man with the ‘Geraldo, King of Swing’ emblazoned on them. Calling out her name and holding out their ID badges the social workers continued inward.

Elsie was in the kitchen. She smiled when she saw the social workers and beckoned them in still further. The social workers introduced themselves and whilst doing so Elsie kept on smiling before raising her hand as if to stop the second social worker saying their name. Elsie bent forward and placed her right ear up against what looked like a radiogram from footage used to show listening to the broadcasts of Prime Minster Churchill telling them they wouldn’t surrender. Almost trance like Elsie’s smile remained fixed as she listened to the radio. Elsie probably listened to the radio for a full three minutes, to the social workers, observing the cats, the newspapers (one from May 1991 with a picture of Paul Gascoigne on) and moving their feet on the sticky floor tiles, the three minutes felt like a lifetime.

When Elsie moved away from the radio she asked the social workers ‘who are you again, love?’. The social workers explained who they were and said that they were there to see if ‘she was alright, you know, see how things are’. Elsie said she was fine and asked if the neighbour had asked for them to visit. ‘She’s lovely, like that. Looks out for me’. Elsie explained that she had lived in the house all her life. Her parents, who she said ‘died recently, in 1971 and 1975’ had left the house to her. The social workers listened. They wanted to be respectful, they had questions of course (and they had lots of boxes to tick) and had already decided that things ‘weren’t right’ but they listened nevertheless. Half way through talking Elsie’s eyes suddenly lit up. ‘John!’ she said. Within moments Elsie was back to the other side of the kitchen, head propped up against the radio, same expression on her face, which now to the social workers seemed almost rapturous. This time a longer a wait. Five minutes. Elsie broke her concentration just once, to beckon the social workers to sit down. Neither did. Elsie didn’t notice or care.

Elsie said that John worked for the radio. He was in his late forties and his job was a ‘broadcaster’ and that each day John ‘either announced the news or introduced big bands… sometimes both’. Elsie said that John was based in London and he still lived there. She said John sometimes slept in the radio station and sometimes broadcast during the night, but not usually. The social workers continued to listen but really wanted to talk about the cats and Elsie’s ‘daily routine and keeping clean’. More in an effort to wrap the conversation up about John and move on to the matters at hand, the self neglect, one of the social workers asked a question. ‘John sounds lovely. Is he someone you have actually met and know’? And with that the tone of the conversation changed. Elsie explained that John had spoken to her on the radio for over 60 years. He was her man friend and he was engaged to marry her. Her betrothed. John had promised Elsie that one day he would drive up from London in a white Bentley car and marry her. Their plan was to live in London and take Elsie away from all this, including the cats. Elsie said the social workers could have the cats if they wanted them.

On walking to the door with the social workers Elsie thanked them for coming but they had to go now as John liked to ‘talk to her alone’. Elsie smiled as she shut the door behind them. The last thing the social workers heard Elsie say as the door closed was that John was her man and ‘was not for sharing, goodbye’.

The social workers weren’t inexperienced. One had just become an Approved Mental Health Professional and the other had worked with older people for years. But as they walked to their cars and drove back to the office the silence between them spoke more than any words of completed boxes on the safeguarding form. ‘What was all that about?’
Safeguarding referrals can be complex. The social workers knew that. They also knew that to ‘help’ Elsie they had to get to know her, build up trust etc. So the visits continued throughout the next week. On each occasion Elsie spoke to the social workers but continued to ignore any questions about her health, her wellbeing, her cats and the state of her house. Most questions were met with ‘I know love. John’ll see to it’. All conversations were interspersed with long periods of Elsie listening to the radio and smiling with occasional, knowing nods and some ‘ah’s’ aimed at the social workers as if ‘John’ was further confirming plans that would need to be relayed to the social workers. For the most part the social workers just heard the hiss of the untuned radio. For them there was no voice, no programme and without doubt there was no John. However what bothered the social workers more than this was that there was no progress. No getting Elsie to see what state she was in. No getting Elsie to consent to sorting the house. No getting Elsie to realise the safeguarding issue. The self neglect. The abuse.

Safeguarding doesn’t allow for stalemate or for someone to continue to be abused. It identifies the abuse and through a list of ‘outcomes’ it makes the social workers do something. For the social workers things needed fixing for Elsie. She had a choice. Either Elsie worked with them to ‘improve the situation’ or they would ‘Refer to other agencies’. The case notes were clear. Elsie wouldn’t engage. She lacked capacity to make the decision. It was all in her best interests. The risks were unmanageable. The hoarding was a fire risk. The cats were underfed and the RSPCA would be cross. She needed safeguarding. If only she could see it! She was a problem. The problem needed fixing.

The social workers didn’t seek Elsie’s consent to refer to other agencies. In Elsie’s case the ‘other agencies’ was the Mental Health Team. Elsie was visited by a Community Psychiatric Nurse, who within hours visited again but this time with the Psychiatrist. The social workers received a call ‘How has this gone on so long? and ‘she’s in a terrible way, totally delusional, paranoid ideation’ and is ‘refusing all treatment because of this bloody John thing’. The next call was to the AMHP. Pink papers in the bag, the Mental Health Act Assessment was to take place that evening.

The Ambulance couldn’t stay and eventually the police were called. 87 year old Elsie was escorted out of her property by two young police officers. One of the police officers had to switch the radio off during ‘the incident’ in the house. He at least had the foresight to give the radio to Elsie and reassured her that she ‘could hold it’ in the back of the car. It was the only bit of humanity Elsie ever witnessed either that evening or throughout her entire dealings with the ‘support’ agencies.  Section 2 completed. Safeguarding outcome achieved. No more self neglect. Someone had been safeguarded.

The first thing Elsie did on the ward was to find a plug for the radio. John was there. Reassuring her and helping her to stop crying. And that’s how things stayed for a number of weeks. The medication was taken, Elsie complied. The nurses moved on to the next person, Elsie listened to John. There was no more worry about Elsie from the neighbours, the problem had been fixed. No more self neglect, no more self to neglect. Elsie’s care plan said ‘needs all cares’. And that’s what she had. All cares attended to and a continued love affair with John.

The discharge planning never once considered home. Home was where the ‘multi-disciplinary team’ had felt that the bad thing happened. Home was where the cats had had to be removed and where the social workers had found Elsie’s love letters to John, which had ensured merriment on the ward due to the details that she went into about her feelings for him. The self-neglect would re-start at home and why risk things? Elsie was happy enough. Everything was fixed, apart from the John thing.

The Care Home never fully read the care plan about Elsie and the new social worker had not really written much up about John and what had happened at home. The radio didn’t go with Elsie to the Care Home. Elsie noticed this on her first day at the home. However instead of asking for the radio Elsie screamed for 8 hours. In the end she was given medication. The Care Home didn’t call the hospital or speak to the psychiatrist about how distressed Elsie was. They made one phone call that day, which was to the social worker requesting more funding ‘due to the screaming’ and the impact this was having on other patients and staff.

Over the next 3 months Elsie moved into two different care homes and was returned to hospital following a fall. The radio was never switched back on.

Elsie died in a care home. It was four months, five days and 6 hours after the phone call from the neighbour.

Lord Justice Munby stated ‘what is the point in making someone safe if it merely makes them miserable’. In ensuring Elsie was miserable, we were unfit to even ensure her safety. John did exist for Elsie and we never saw that. John was the risk management plan. John stopped Elsie self neglecting, not the other way around. Elsie was the expert in her own situation and had an 87 year start on the rest of us who tried to study her and fix her within weeks. John was her flickering light of hope which we extinguished in the name of safeguarding people from themselves. I hope she saw John again somehow.

Happiness

Where do you start in the search to define happiness?  Why would you even try?  How arrogant must you be to think you could make a determination as to what constitutes the basis on which another person would be happy?

The World Health Organisation has been exploring ideas about social and economic progress being measured in terms of nations “happiness” levels for some time –  see the report of the Commission on the Measurement of Economic Performance and Social Progress which proposed that states should shift from measuring economic production to measuring the well being of citizens as the key measure of how sustainable their economic and social policies were.  Recommendation 2 in the report is that social policy should emphasise “the household perspective”.  The UK benchmarks above average for most well being measures, however performance is below average for mental well being (20th of 27) and child self-reported health (24th of 38).

Happiness

Reading about the search for a sustainable home for his son Steven from @MarkNeary1 this last month has emphasised just how important that household perspective is.  Reading a day in the life of Mr Neary however is more than that, it is also a reminder that happiness and mental well being are found in the small things, the stuff that you often take for granted.  That being able to go to the pub and have a pint is definitely in Mark’s best interest and therefore in the best interests of his son Steven.

Which takes us to the question, if social care policy and law is about well being and happiness, is social care in the happiness business?  See this from digital story teller @JohnPopham who visited an older people’s care home earlier this week.

 

Improving subjective well being has been a focus for UK social care policy leading up to the Care Act (2014) which introduced the legal duty that Local Authorities are responsible for promoting well being, that people being happy is in their best interest:

“The general duty of a local authority, … in the case of an individual, is to promote that individual’s wellbeing”.

The first legal challenge to how well Council’s are meeting this new general duty is due in Court this autumn, following Luke Davey and his mother having won the right to bring a judicial review of changes made by Oxfordshire Council to his support.  Luke defines well being in terms of being able to get a drink and go to the toilet without the need of his mum having to assist.  What is striking is how far away such ambitions are from the lofty, ambitions of those who believe that they can at scale and pace transform the system of health and social care.

When we forget that it’s the small things define happiness and mental well being, do we start the slide that leads us away from seeing people as being fully human, is it that moment of loosing sight on what constitutes happiness which leads to unhappiness, captured so distressingly in extract from Tony Osgood writing about “serviceland” that strange place where commissioners think they know better than people about what they want and need in their lives:

jane isn't happy

Service land makes for uncomfortable reading.  It leaves commissioners of “care and support” facing a series of uncomfortable questions.  Do we sometimes get confused in social care about the limitations of our legal powers? Do we confuse the role of Social Workers as being a form of “soft police”, dressing up interference in people’s lives as being a form of safeguarding of people’s well being.  Do we focus on physical aspects of safety to the detriment of mental well being?  And in doing so, do we create the conditions which lead to unhappiness, which lead in a self-perpetuating cycle to more “challenging behaviour” which leads to us thinking we need to commission yet more services to meet the very needs we have created? Service land is a place of unhappiness. How typical is it of people’s experience?

LJ Munby in the case Local Authority X v MM & Anor (No. 1) [2007] EWHC 2003 (Fam) reminded us that in keeping with our positive obligations to uphold the UN Convention on the Rights of Persons with Disabilities, people’s wishes, feelings and beliefs must be taken into account when determining what is in their best interests (para 121).

“The fact is that all life involves risk, and the young, the elderly and the vulnerable, are exposed to additional risks and to risks they are less well equipped than others to cope with. But just as wise parents resist the temptation to keep their children metaphorically wrapped up in cotton wool, so too we must avoid the temptation always to put the physical health and safety of the elderly and the vulnerable before everything else. Often it will be appropriate to do so, but not always. Physical health and safety can sometimes be bought at too high a price in happiness and emotional welfare. The emphasis must be on sensible risk appraisal, not striving to avoid all risk, whatever the price, but instead seeking a proper balance and being willing to tolerate manageable or acceptable risks as the price appropriately to be paid in order to achieve some other good – in particular to achieve the vital good of the elderly or vulnerable person’s happiness.

What good is it making someone safer if it merely makes them miserable?”

The #7DaysofAction campaign is exposing that unhappiness is the experience of many within the health and social care “system”.   36 families have now come forwards to tell their story.  The campaign will be telling these stories in October, and as social care professionals we will be listening.  There is a social care commissioner and social worker involved in each and every story, but crucially, will we be able to detect the social work or will we be hearing something else?

We will be supporting the campaign.  Please join us.

Picture is “Things that make me laugh”. Artist Will Turner aged 9.

The elephant in the room in adult social work is often a cat

elephant in the room

Firstly, thanks to @Harr_Ferguson for the title which was inspired by this tweet:

I remembered this tweet today whilst driving home and reflecting on having heard several stories this week from amazing social work colleagues where pets featured in a critical role.  The colleague who, having tried to engage with someone through their letter box had the dog set on them.  The parents who were walking the dog every night past their son with a learning disability who was living independently in his new home to reassure them that he was OK.  The mum and son with very complex communication needs whose face lights up when he sees the family dog come into the room.  And finally, the amazing colleague who was planning to finish for the weekend only after they had sorted out 11 cats and 3 dogs so that the person they were supporting could feel safe enough that their pets were cared for to accept a period of convalescence and recovery from a period of acute ill health.

Social care is full of evidence to suggest that pets are associated with psychological and emotional well being.  Something that we could perhaps pay more attention to in adult social work.  Dr Sara Ryan (yes Connor’s mum) has written a really thoughtful paper on how pets are important members of the families they belong to and yet how often they are unseen by the “professional” in the room – it’s here if you want a read:

http://onlinelibrary.wiley.com/doi/10.1111/1467-9566.12176/abstract

Sara’s paper reminds us that as social work practitioners, it is far too easy for important family member to become invisible when they are sat right in front of us – an observation which Harry Ferguson has written about in his brilliant piece about the unbearable complexity of social work decision making in the British Journal of Social Work.  See here:

http://bjsw.oxfordjournals.org/content/early/2016/06/29/bjsw.bcw065.abstract

In our induction for Newly Qualified Social Workers, we often talk about a real case which we got very wrong.  The lady had 20 cats.  We thought we knew best.  We thought we could see something as professionals that she couldn’t about her life and experience.  We took her away from everything she knew, everything that was important to her in her life.  The result was that she deteriorated very quickly.  It is telling, that when we talk about the lady with the cats, we only talk about her cats as a passing, almost jokey remark at the start of the story.

And if you want to know just how wrong we can get it in social care – see the case of Fluffy the Cat https://ukhumanrightsblog.com/2015/01/29/what-price-liberty-damages-dols-and-a-cat-named-fluffy/ whose 91 year old owner was removed from his home and unlawfully deprived of his liberty in a care home leaving his beloved cat behind.

Today, pets have featured heavily as we have reflected on this week, appearing in several of the stories which I have heard being told as part of the end of week come down.  All social workers will recognise the end of week come down.  It is the really important bit of the week when social workers take care of each other and the complexity of the decisions they have supported people to take.  It is the moment where social workers use story telling to reflect about the week which has past and as the social work office winds down, it is the process which enables practitioners to go home without carrying the weight of every potential risk with them into the weekend.  Without that moment of story telling, social workers, the best social workers, the ones who will be back fighting for people’s human rights once they have rested and recovered, will often spot the small things they have missed during the heat of the busy week.  That is the time when the pets emerge.

Today, as we told our end of week stories, we heard of that we had seen 11 cats and 5 dogs.  We spotted something we didn’t know before, something we didn’t previously notice about what is important to the people we are supporting.  And when we next speak to them, because of that moment of insight, we will be able to include in our conversations with them that they have another member of their family that we are interested in.

And crucially, we had a moment of laughter and mutual support which came out of that recognition – because we are pet owners too and we know what our pets mean to us. In that moment you become less professional and more human and you are closer to the person you are there to support.  Which is a really good thing.

This week, however, I am left with unanswered questions which I leave me unsettled – what happened to the lady’s cats?  What if we got it wrong?  What if it was being removed from her beloved cats that was the tipping Point?

Honestly, I will never know what happened to the cats.  But we do know what happened to the lady with the cats, we moved her, leaving her cats behind, she became very distressed and after a long and lonely 6 months on various hospital wards she died.  It was traumatic for all concerned.  Including the social worker who has never forgotten her.   To quote Professor Ferguson “The powerful impact of unbearable levels of complexity and anxiety on social workers requires much greater recognition.”

Have a safe weekend to all our EDT and hospital weekend colleagues working this weekend.

 

 

 

 

 

 

#SWisHumanRights

On Friday 200 of us came together in York from across the country to talk about social work, social justice and working together to to uphold the universal character of human rights as enshrined within the UN Convention on the Rights of the Child and the UN Convention on the Rights of Persons with Disabilities.

We would like to invite you to join us here – https://storify.com/ElaineLJames/swishumanrights

and here #SWisHumanRights – highlights video

My Kingdom for an AMHP

AMHP

Guest Blog from @asifamhp

I have been an AMHP now for a number of years. The job has changed, the organisations that I work with have been restructured several times. The politicians have come gone. Through it all the cases keep coming.

AMHPs inhabit a twilight zone in the gap between the NHS and Social Care. We fill the gap between H&SC and the Police.  Too often AMHPs are stuck in the middle of interagency partnership working not actually working very well. AMHPs have lots of responsibilities and duties.  Ultimately as AMHPs we exercise legal powers to remove a person’s liberty (it’s the AMHP that make the application to detain (“section”) people not the doctor).

This is a lot of power; remember the person has usually has done nothing wrong.

An AMHP can go to a Magistrates Court to get a warrant that allows the State to enter homes uninvited (using the big red police key if required) and if necessary use force to remove a person to a Place of Safety. But an AMHP cannot direct or instruct a medic or police officer to turn up.  AMHPs also can not require an ambulance to be dispatched to convey someone from their home to the now almost mythical hospital bed.

In my current role as dispatcher of AMHPs, I have become acutely aware of the difficulties faced by my colleagues and I am concerned that our voices and opinions are not often heard or valued. The role of the AMHP is a vital one but I fear that it is one that is almost invisible.

Coordinating a Mental Health Act Assessment is all too often a problem solving exercise in terms of sorting a hospital bed that does not exist. I worry about working with partner agencies that are unwilling or unable to help. These are practical problems that present AMHPs, in often very challenging and sometimes risky situations, with a huge amount of heart and head ache.

The difficult bit should be the engaging with the person and their family,making the decision to detain or not, however all too often it’s the other stuff that is the difficult bit. The stuff that everyone else assumes and takes for granted will be there.

BTW if required, a hospital bed is the doctors job to sort – honestly it is!

Countless policy initiatives try to sort out Mental Health.  There has been a Mental Health Task Force, a Crisis Care Concordat, a 5 Year Forward View, most weeks another report is published highlighting system failure. But acheiving Parity of Esteem for mental health with physical health still feels some way off yet.

The lack of value given to mental health becomes acute when I am coordinating Mental Health Act Assessments. I often find that I have to find a Section 12 medic whilst also trying to do the assessment. That’s a bit like an ambulance having to find a paramedic on route to a Road Traffic Accident.  And that’s before we even talk about hospital beds for someone who is really ill and needs one.

I invite you to contact your local CCG ask them about the arrangements/contract they have with your local Ambulance Trust in relation to the conveying of patients that require admission to hospital? Better still ask them about the arrangements they have in place for the conveying of someone who is detained and in legal custody, but resistant and objecting? Ask the CCG about how much they are spending on placing people out of area in private (for profit) provision and then ask them if they have read the MHA or Code of Practice? Ask them and your local NHS MH Trust if they are familiar and complying with the duty imposed on them by Section 140 of the Mental Health Act? While you are at it, ask your local Acute Trust if it’s Emergency Department is a Place of Safety? There are lots of other questions worth asking if you are interested.

A Mental Health Act Assessment is many things, all bundled up into a big fat mess sometimes. But people tend to forget that it is also a legal process and AMHPs are at the heart of that. The starting point should be the Mental Health Act itself (Guiding Principles and all) and the Code of Practice. I wish more people involved in all this would actually read them and adhere to the Code of Practice in particular.

I fear that Psychiatry is overly reliant on coercion and has developed an erroneous understanding of risk assessment and risk management that reflects and reinforces stigma.  I also worry about big Pharma and its link with psychiatry – but for another time/blog.

The role of the AMHP is to reduce risk.  This is not an exact science, no one wants to be blamed when things go wrong and they do go wrong.  However we must guard against moral outrage and panic when things go wrong.  We need to think about evidenced based practice. We also need to remember what we do impacts on the people, sometimes in negative and damaging ways. We need to be given the time to think about our decisions as AMHPs properly and to be supported to do this in the least restrictive manner possible. Far too often a mental health act assessment is seen as a solution to a problem, when perhaps the solutions  is something else.

Medics are too quick to reach for the MHA and are completing too many Medical Recommendations. They are then exiting stage left and all too often have no idea where the bed is. I can think of no other branch of medicine where the highly trained and very well remunerated expert is allowed to leave others to get on with it. I also believe that AMHPs are making too many Applications to detain people and again that this is multi layered issue that needs to be properly analysed.

Conversely I see people who should remain in hospital being discharged too early to “unblock a bed” and then being assessed and readmitted very quickly. At the heart of this is the lack of sufficient, appropriate inpatient bed provision and lack of investment in community services.  The commissioning arrangements for mental health are not good enough leaving children and adults too often being placed often 100s of miles away from home, in private (for profit) provision.

For the most part my AMHP colleagues, up and down the county, are extraordinarily committed and skilled individuals.  It is an absolute privilege to witness how many of them go about an extremely challenging and at times risky task with humility and humour. Many go way beyond what could or indeed should be reasonable expected of them.

Do we always get it right? No we don’t.

The MHA is a very complex piece of legislation requiring AMHPs to make often very complex decisions, in difficult circumstances, without necessarily being in possession of all the facts and under pressure from various interested parties. Being an AMHP is not an exact science. It takes a fine/funny blend of skill, knowledge, experience, values, support and luck to develop an AMHP who is able to successfully and safely undertake the task. Please don’t take the invisible AMHP for granted. Throw in the MCA interface and it is an almost an impossibly complex job to do.

I have been unlucky/privileged enough, depending on your view of the world, to have assessed three generations of one family. That really was a moment for me to take stock and to wonder about the broader issues in terms of inequality of opportunity, substance misuse, nature V nurture and the whole medical V social model.  Working with that family I really wondered about the role and purpose of psychiatry and my part in that as an AMHP.  AMHPs see often very real and often harsh realities of everyday life and the impact of multiple layers of economic disadvantage, oppression and inequality of opportunity.

AMHPs, as people, are also shaped by our own history and experience of life.  AMHPs like everyone else have personal experience, either directly or indirectly, within their family or friendship groups, of mental health issues. I really like the “those of us” inclusive statements when I hear people talk about experiencing mental health difficulties/distress/illness. AMHPs have to be able to be firm and keep positive. Like other AMHPS, I have over the years had to coordinated some very challenging and difficult MHA Assessments. I have been out with the armed response unit, been on rooftops, been assaulted and called all sorts of names.

As an individual I am reasonably robust and have a well developed sense of humour. I have also managed (I hope) to hang on to “the what” initially motivated me to become a Social Worker and this helps me deal with and manage some of the challenges that I face. I have also been lucky enough during my career to date, to have had some very motivated and skilled colleagues who have supported and encouraged me. I think of them warmly and I am in their debt. I have met some very lovely people and families on my travels.

As AMHPs we are often asked to do “something”  when appropriate we use the MHA to detain an individual or in the case of a Community Treatment Order to place restrictions on their choice/liberty. Equally importantly we decide not to detain or restrict.

We often meet people at a low point in their lives and when they are in crisis and distressed. This can be very difficult for them and us; at times it can be very stressful or just plain ugly. It can also, over time, have an impact on you as an individual. I am not sure that that is fully appreciated by our employers, but I am grateful that I have colleagues who understand this.

Moving forward I think AMHPs might be exceptionally well placed to be in demand. However there are fewer of us and we are getting older together as a group.  I wonder who is planning for and thinking about the next batch of invisible AMHPs. Most people have no idea what an AMHP is or what an AMHP does and unfortunately that includes some who should.

With that increasing popularity/demand for AMHPs, I hope comes some recognition and interest in all things AMHP and with that, a voice that might be heard. I hope that voice echoes and advocates for the people and families we work with. Because what really concerns me about being invisible is that the cloak of invisibility is also wrapped around the people and families we work with/for. Very often at the point of crisis in mental health, it is an AMHP that is required & sent for.

Now is the winter of our discontent

Made glorious summer by this sun of York;

And all the clouds that lour’d upon our house

In the deep bosom of the ocean buried……………. An AMHP an AMHP, my kingdom for an AMHP!

Hold the front page

Mary PoppinsThere is a scene at the end of Mary Poppins where the Banks Family go to fly kites together.  It is a joyous scene, celebrating a family with a renewed identity, purpose and open to possibilities about many exciting futures.  But it’s also really quite sad as it marks the moment where Mary Poppins realises how much she cares about the Banks Family just at the point when they don’t need her any more.  She gathers up her bag and quietly floats away presumably to another family in need.  The mix of emotions on display are really familiar to social workers.  As is the decision to walk quietly away from a successful intervention, leaving the family or the person to determine how they frame telling their story to the world.

For several weeks now there has been a lively debate taking place about the media image of social work following an episode of Dispatches featuring a Social Worker calling themselves Vicky. There are concerns within the profession that the constant barrage of negative media images about social work is resulting in people leaving the profession.  Some voices argue that we must step up and that individual social workers should tell their story about why they entered the profession and what it is that drives them.  The thing about Mary Poppins though, is that you never find out her back story, and crucially, that never detracts from the movie.  You never stop and think, oh if only there had been a bit all about Mary.  As deeply frustrating as it is that the media continue to only tell negative stories about social work, that doesn’t mean that individual social workers should be rushing to fill the press with their story.

There are lots of factor which influence retention within the profession, level of professional autonomy, access to resources and CPD, the professional relationships between agencies in the sphere of practice that social workers operate and most importantly alignment of the values of the employing organisation with social work values.  Media image however, there isn’t much evidence that negative media has quite the effect many appear to be assuming it does.  Given the extent of media coverage of the role of social workers in the cases of Victoria Climbie, Baby Peter, Winterbourne View, Stephen Neary, Connor Sparrowhawk and in the most recent of tragedies Liam Fee, it would surely be hard to find any social worker who has qualified in the last 10 years who wasn’t aware of the media image of the profession when they joined.

The thing that Mary Poppins reminds us, is that it isn’t our story to tell, it belongs to the person we are there to support.  If they choose to include in how they want their story telling that a social worker was involved, then we should be honoured to respect their decision.  However, the really hard thing about social work is that in most cases, the real test of the success of the social work intervention is that the person no longer wants or needs to acknowledge the social work. Good social workers get that.

A while ago a script writer made contact who was looking at making a six part TV drama ‘about social work’. The conversation with the writer was fascinating.  She wanted to know stories ‘about social workers doing social work’ and the impact it had on them. We decided that we couldn’t help her.  Our ‘best’ social work stories were essentially not ours to tell. Social work stories include the family in absolute crisis following a ‘honour killing’ which claimed the death of one family member and the incarceration of many others; a young mother admitted to hospital under a section following the death of her baby; a man ‘escaping from a care home’. These were stories and experiences that were vivid, powerful influences shaping our practice.  But they weren’t what the writer wanted. She wanted to know the impact on us of being involved in complex case work, what we felt and our role in ‘dealing’ with the pressure. Whether its part of social work training or our particular approach to practice, this isn’t something that we could articulate. It wasn’t important.  The effect of experiencing other people’s lives genuinely didn’t feel like a story we could tell.  Only the people we have worked with know if their lives were any better as a result and only they have the right to tell their story however they chose to frame it. People who experience social work are the ones who should be telling the media what social work is, both good and bad.

A palliative care social worker told us that good social workers are like chameleons. They blend in. You don’t often see them its enough for people who need social work to know they’re there and that’s enough recognition for the social worker too.  Thinking about it, Mary Poppins had chameleon like qualities, her carpet bag of social work having moved on from the traditional contents (day care, home care, respite, supported living) to a more exciting range of  modern options (Direct Payments, Individual Service Funds, Personal Health Budgets, Integrated Personal Commissioning).  You can still find if you look deep enough into the bag her spoon full of sugar.

But social work isn’t about looking down a deep hole at someone, turning on a blue light  and inviting the paparazzi around to film the drama unfold.  Social work is about getting into the hole with the person to give them the leg up so they can wherever possible scramble out of it clinging onto whatever dignity remains. If the person tells someone of the great work of the social worker then that’s great, if they don’t then that’s great too. It doesn’t lessen what the social worker did.  Social workers have their moments of fame. They know their worth. They are honoured at least one night every year when they have an award ceremony. The Queens honours list regularly includes social workers. But for the rest of the time they are OK going under the radar acknowledging that ‘their story’ was never really theirs in the first place.

If we are really critically reflective, is the desire to sell positive social work through the press really about us trying to get a message out that ‘we are here, please fund us?’. If it is then lets be honest. In times when food banks are reporting increased usage, records of people are requiring mental health care & the numbers of safeguarding referrals are reaching epic proportions we need to rejoice and celebrate social work. Our unseen, unheralded social work, is keeping more children and adults safe and alive. But hold the front page, we don’t want it.

Mary Poppins intervention in the lives of the Banks was mesmeric. But in the end, only the Banks knew about the magic she brought into their lives.  Having made that difference, she blended into the background and floated off.   No headline required.