All life is an experiment – I am not vulnerable!

friendship

I once worked with a young woman called Emma (not her real name) who had a mental impairment and would sometimes go into town alone, whereupon two young women would sometimes meet up with her. Emma would withdraw £200 from the ATM which she would share with these people. After an hour or so, the two women would desert her. The care home staff where Emma lived wanted to prevent Emma from going out on her own, they said it was ‘mate crime’ and that Emma was being financially abused.

I met with Emma and put this to her. She said, “I know they are not my real friends, they only want my money. I’m not daft.” I asked what would she do if it happened again? She said, “The same probably. It’s worth £200 to me because it feels like I have friends, I can pretend to have friends even if it’s just for an hour.”

Emma’s story made us feel sad and angry that people would take advantage of her and we wanted to protect her. But she did not want us to do that. She had the mental capacity to make the decision and, putting it bluntly, she did not care how we felt.

I also worked with a man who was nursed in bed at home but his son – frustrated with his dad’s deteriorating health – would shout at him. We wanted to stop the son from shouting at the older man, possibly apply to the court to prevent him from visiting altogether, but the man told us and the police to do nothing. He acknowledged it upset him when his son lost his temper but he loved him and wanted him to be around. In time, he died at home with his son visiting him to the end. As social workers with both children and adults know well, from the perspective of the person a not-very-good family is usually better than no family.

Had the legislation been available, we could have over-ridden their decisions to protect them. They would have been protected from abuse, so we would feel better, but would Emma or the older man feel better? If a capacitous person wants our support then we give it; if they don’t, we must walk away, no matter how upset or concerned we are.

I am reminded of that much quoted speech by Sir James Munby (‘When is Safeguarding Abuse?”) in which he says that if local authorities are to justify intervention then what follows must be better than what went before. I have no doubt the intention of the Vulnerable Adults Bill is not to wrap all people in cotton wool, but to take what Sir James calls a proper balance in supporting those “less well equipped” to deal with risk than others.  If you want to find out more try the brilliant Lucy Series @thesmallplaces – https://thesmallplaces.wordpress.com/2014/11/14/what-good-is-it-making-someone-safer-if-it-merely-makes-them-miserable/

However the proposals for a Vulnerable Adults Bill concern me because, although I have little doubt that while the courts would continue to respect the right of an individual to make an unwise decision, where such is to be over-ridden that must be by a higher authority than a council employee. Indeed, I don’t see why the inherent jurisdiction of a judge sitting in the High Court does not already meet this need. And as I see it, treating people who are vulnerable because of their disabilities differently from all other people is discriminatory.

In practice then I fear such an Act would be used against people, not to support people, and there would be little consistency in its application by health and social care workers. The culture of paternalism and protection is still deeply embedded in some quarters. For example, I have been challenged many times about the outcome of a capacity assessment I have completed, but not once when I said the person lacked capacity to make the decision, only when I said the person had capacity. That is absurd; the assumption of capacity unless proven otherwise should be well established but it is not, even ten years on.

I doubt those drafting the Bill would want this to happen but in practice many people with dementia (or not!) in hospital making the natural decision to return to their home would be deemed ‘vulnerable’ by ‘concerned others’ and needing protection. The ward staff would want this because they would not want to be held responsible in the event something bad happens to the person. This paternalism exists now in spite of the law preventing it. In my experience some professionals are not afraid so much of something bad happening to the person, they are afraid of something bad happening to them as a consequence of something bad happening to the person!

I tell social workers all the time that if they do what the MCA says then Section 5 of the Act will protect them from liability. But how could a social worker trying to defend the right of a person to make an unwise decision deal with such ward staff or police officers or concerned neighbours telling them that they must do something and citing the new law? Who among us wouldn’t be more worried about their job than the rights of the relevant person? The MCA is already intentionally used against people so what then would be the chances of a person unfortunate enough to be objectively considered ‘vulnerable’ appearing on the radar of health and social care retaining their autonomy?  See the case of Fluffy the Cat if you don’t believe this to be the case – https://ukhumanrightsblog.com/2015/01/29/what-price-liberty-damages-dols-and-a-cat-named-fluffy/

By the way, in time Emma found a real friend and moved out of the care home and into a shared flat and those two women lost their free money. What she had needed was support from her social workers, not for her social workers to decide what was best for her.

Ian Burgess, BIA and MCA Professional Practice Lead, on behalf of the Adult Principal Social Worker Network in England

 

Lymbery, M (1998). Care Management and Professional Autonomy: The Impact of Community Care Legislation on Social Work with Older People. The British Journal of Social Work 28, 836-878.

Munby, Lord Justice (2011). Safeguarding and Dignity: When is Safeguarding Abuse: Keynote address by Lord Justice Munby to the Rotherham, Doncaster and South Humber Mental Health NSH Foundation Trust’s AMPH and Social Care Conference.

 

 

​Stayin’ Alive While Getting Your First Job In Social Work

  • Do you remember your first interview for a qualified social work post? My guess is that you probably do. Having asked me my very first question on my very first interview for a social work post on the subject of why I had applied for the post, the chair of the recruitment panel inexplicably decided not to make eye contact with me but instead positioned his body so he could look out of the window to my left. I then remember him pulling the most bored expression I have ever seen from a non-teenager. I remember thinking, ‘at least give me a chance to bore you first before you look desperately disappointed in me, I promise I won’t let you down’.  By this point I was so purple in colour from neck to the top of my head that my cheeks hurt. The Matalan suit jacket that I had bought for my grandads funeral, doubling up for this momentous event, was glued to my shirt that was glued to my back. I spoke. Immediately all I could hear was my new voice, which reminded me of Barry Gibb doing the ‘ah, ah, ah, ahh’ bit on Stayin’ Alive from Saturday Night Fever. Where did that come from? It was high pitched enough to have brought all the dogs in the vicinity to the front door of the local social services office that I was holed up in. And the speed in which I spoke?! It broke the speed of sound! I described my journey into social work training and the need for this particular post in a way that would have rivalled legendary horse racing commentator Peter O’Sullivan articulate the last furlong of a particularly close Grand National. Anti-oppressive and anti-discriminatory practice, both thoroughbreds, were clearly neck and neck and could only be separated by a photo finish at the end. 

I was exceptionally lucky at the interview. On the right of the panel I found a really kind pair of eyes. I focused on them. They seemed encouraging, they seemed to get my predicament. I focused all my answers on them. Every time I seemingly said the right thing the kind eyes lit up and then the person nodded their approval. This was soon to become my first ever social work manager and had the most profound effect on my career ever. As I say, I was very lucky. 

It was clear working alongside other social workers that our experiences were similar. I heard horror stories of people that I had studied with unable to get a social work post due to poor interview experiences for some considerable time. I remember one friend I had studied with getting some feedback from an interview where she had failed miserably which said ‘the candidate should have focused on relevant legislation and not just The Childrens Act 1989… Could have mentioned Social Services Act 1970’. It was 2001. Social workers applying for posts can only do so much, we as interview panels and more experienced social workers and now managers will also need to step up our game.

So working with two brilliant social work managers who had similar experiences to me and having canvassed the opinions of social workers via twitter, we have tried to provide some top tips for our social work students in applying for social work posts. We think the tips are as relevant for interview panels as they are the candidates. Here’s just a selection of them;8

The Application Form – Well, firstly, there is a trade secret here which is really obvious if you know it but if you don’t you won’t even get an interview. You have to meet all the bits on the person spec, particularly those that are described as ‘essential’. So you have to write about how you meet these requirements. Sorry if you already know this and it seems patronising even mentioning it but its amazing how many exceptional candidates that will miss out on jobs because no-one has ever told them this!

Prior to the interview. If it says that you can speak to the Team Manager or arrange a visit then do so. Do some research into the job, the organisation and remember to take that knowledge with you. Recruitment panels are flattered by candidates who really know the job they’ve applied for and what the team/service is doing well. 

Prior to the interview. Make sure you are really clear where the interview is. Social work interviews can take place anyway! Check out the venue, parking, walking distance if its raining etc. On the day we advise getting to the interview venue at least a good 10/15 minutes before the interview is due to start so you can compose yourself.

Prior to the interview. Have examples of your practice ready. Panels love to hear you talk about what you have done and learnt as a social work student. Have a least 3 or 4 examples of people that you have worked with that demonstrate you at your best and show your social work values shining through.

At the interview. Your unique selling point is that you are new and enthusiastic and have strong values.  You aren’t expected to be the finished product (no-one in social work should ever think they are). But you are adaptable, willing to learn and you have examples of your practice to date which shows you put the person at the heart of your practice.

At the interview. Be as positive as you can be (without telling lies!). We can all have moments on the social work course when things don’t go well or placements may be difficult or the academic work is tricky. Try and reflect well on the positives where possible. When we are nervous we can often focus on the negatives. Try hard not to.

At the interview. This is a tough one. Because its an interview we can often find ourselves just talking about ourselves and our learning. However don’t lose focus in terms of actual social work. It’s all about the values. Bring the people we are here to serve to the forefront of your answers. How person centred are you? What did the person say about you? If you helped as a social worker what benefit did the person have?

At the interview. Have some legislation and theory ready and relate it to examples of your practice to date. 

At the interview. Know the 5 principles of the Mental Capacity Act!

At the interview. If the interview is going well the panel tend to write a lot of information down. If after answering a question for 20 minutes non-stop you look up and the panel are staring back at you and have all out their pens down and have stopped writing then it’s probably time to stop talking. Don’t worry, we all do it, but try and keep things concise.

At the interview. Having some good questions at the end for the panel is important. Surely as NQSWs you will want to know about the ASYE offer etc? Even if you only have one question for the panel at the end of the interview try and ensure that it isn’t just ‘when will I find out if I have got the job?’

Good luck to all the social work students who will find themselves applying form posts over the next few months. From one social worker to another, thank you sincerely for choosing to the join the profession. You have made a brilliant decision and this is truly the best job in the world. 

Prepare yourself. Take a deep breath. And then come and knock our socks off. We promise we will give you every bit of encouragement and we know that the Barry Gibb falsetto voice doesn’t really belong to you. 

 The Liberty Safeguards – the door is open for better social work

liberty or death.png

On the 13th March 2017, the Law Commission published their report on Mental Capacity and the Deprivation of Liberty Safeguards.  The overdue report finally arrived a week after news broke of the death of Rusi Stanev, aged 61.  The ruling on Stanev v Bulgaria by the European Court of Human Rights in 2012 was a catalyst for change.  Just two years later Lady Hale referenced his case in setting the acid test for determination of what constituted a deprivation of liberty in her summary of the landmark Supreme Court ruling which has come to be known as Cheshire West.

The Cheshire West ruling was a large boulder thrown into the relatively tranquil sea of adult social work.  The waves which it has generated continue to disperse and rebound across the profession, disrupting the comfortable care management function which has defined adult social work since the Community Care reforms of the 1990s.  Cheshire West was a wake up a call to adult social work, reminding the profession of its roots as an academic discipline that promotes social change and development, social cohesion, and the empowerment and liberation of people based on principles of social justice and human rights.  The role of Best Interest Assessor became a hugely desirable qualification for adult social workers who saw the opportunity to reconnect with their values as the person whose professional role was to uphold people’s human rights.

The widened the definition of deprivation of liberty in 2014 has, however, triggered unprecedented demand on Local Authorities. Almost overnight we experienced a 10 fold increase in the number of requests for the Safeguards to be authorised from hospitals and care homes where a deprivation of liberty was taking place.  In the last 18 months further pressure has mounted on adult social work services as deprivations of liberty are also being identified in supported living settings for adults with learning disabilities.   As social workers we are relearning report writing skills as we prepare to present cases to the courts, increasing our legal literacy with case law that references the UN Convention on the Rights of Persons with Disabilities and reclaiming our sense of professional identity and pride in our profession.

So, we have approached the Law Commission Report with optimism and a sense of hope.  The report (which includes draft legislation) reflects 3 years of work on the part of the Law Commission to review how fit for purpose the current Deprivation of Liberty Safeguards scheme in light of the clarity given by the Supreme Court in 2014 on what constitutes a deprivation.  Their finding is that there is a compelling case for reform of what has become an overtly technical process which is subject to increasing managerial concerns about levels of demand and the cost which Local Government is baring in administrating the scheme.  They observe that the numbers of requests for authorisation have reached levels which make it impossible for Councils not to routinely breach statutory timescales for completing assessments and putting the safeguards into place. Their solution is to replace the DoLS with a new scheme which they are proposing is called the Liberty Protection Safeguards.

Here is where a first pause is required. As a proposed response to reduce the level of technical fog around the current DoLS – already the name of the new scheme is causing confusion with parent and carer groups questioning what the difference is between a protection and a safeguard.  Our view is that names matter hugely.  As symbols of intent which send signals across the system a name is a powerful object.  Our preference would be to simplify the name and set out as we intend from the start.  Let’s drop the protection bit and simply call the new scheme the Liberty Safeguards because that is what they are. We know what images the word protection conjures up in the post Care Act world of health and social care; where we challenge those who self-neglect, ignore the spirit of making safeguarding personal or give barely a passing nod to our responsibilities under Article 8. If we call anything in adult care ‘protection’, then really do expect the worst because there is a swathe of the public sector that think that protection means good old fashioned, ‘lock em up and love em as best you can’ care. The best protection is self protection or sponsored protection where people’s rights are upheld with the same vigour and singular desire as we ourselves feel when it comes to protecting ourselves and our loved ones. If public protection is genuinely such a concern that the word protection must explicitly feature in there (and having read the first few bars of the heart-sinking entitled proposed Vulnerable Adult Bill) let’s at least try and agree on what it is we are trying to protect.  Our role as social workers is to protect people’s right to liberty.  So if we can’t drop the word, let’s at least move it to call them the Protection of Liberty Safeguards.

Going back to the detail of the scheme, our Liberty Safeguards would apply in much wider contexts including hospitals, care homes, supported living, shared lives and private and domestic settings. The new scheme will cover any situation where Article 5(1)(e) is potentially engaged. The specific arrangements that may be authorised are:

  • arrangements that a person is to reside in one or more particular places;
  • arrangements that a person is to receive care or treatment at one or more particular places; and
  • arrangements about the means by which and the manner in which a person can be transported to a particular place or between particular places.

Interestingly, the Law Commission also propose that whereas the DoLS scheme only applied to adults over the age of 18, the new Liberty Safeguards would apply for 16 and 17 years olds. This is a sensible change which reflects best social work practice in preparing young people for their transition into adulthood.

It is also proposed that the role of Local Authorities as the Supervisory Body be revised and replaced with a new Responsible Body requirement.  In a pragmatic nod to the drive towards integration the Responsible Body duties would be shared across health and social care depending on where the deprivation of liberty is taking place with hospital trusts and CCGs taking responsibility for their cases.

There are other significant changes which it is worth finding out more about from the various commentators who have written about the report.  However, our personal favourite is the blog written by Mark Neary.  The ruling on the unlawfulness of his son Steven Neary’s deprivation of liberty in 2011 is one of the most significant cases in adult social work in that it made the connection between Article 5 and Article 8 ECHR, the right to a private and family life.  If Article 5 is the technical aspect of the current DoLS scheme, Article 8 is the heart and soul made manifest in Mark and Steven’s relationship. If you ever get chance to hear Mark speak, please take the opportunity.

Whilst, we recognise and welcome the requirement to make explicit the relationship between the proposed Liberty Safeguards and the UN Convention on the Rights of Persons with Disabilities by upholding people’s wishes, feelings and beliefs when authorising the Safeguards, we are underwhelmed by the missed opportunity to emphasise the significance of Article 8 rights.  It makes us wonder whether the current obsession with interference with Article 8 rights to justify disproportionate responses to so called self-neglect has leaked into the thinking of those working on the report.

The Law Commission also recommend that the role of Approved Mental Capacity Professional be introduced building on the current Best Interest Assessor role.  As a long term advocate of the AMCP role we remain convinced that role is a lifeline being thrown to the adult social work profession and it should be grabbed with both hands. It is a role most naturally suited to social workers with adults because since 2014 we have rapidly embraced and consolidated our expertise, knowledge of and passion for human rights and the Mental Capacity Act (2005). AMCPs as the safeguard of people’s rights and well being. What greater opportunity can there be for all those social workers who came into the profession saying at their interview to get on the course that they wanted to make a difference?

So do the Liberty Safeguards provide a last chance saloon challenge to adult social workers?  We think they do.  But we also think that if better social work is to become our reality, social workers will need to be really brave. In embracing the social work role as the Law Commission envisage it, and making the most of the potential to elevate our professional by leading on human rights through social work, we may need to be prepared to cast off other roles that we have had bestowed on to us that don’t suit us, or that we don’t do well or moreover where the person themselves needs to be the only voices heard.  At the beginning of the Law Commissions consultation process we asked ‘Are We Human or Are We Care Manager?’ and questioned where social work sits, nearly 30 years on from NHS & Community Care Act. By the end of the consultation we think that yes, we can see the door which is open to us.  This 3 year process has generated overwhelming evidence that the answer to the question is that social work is human rights and that it is ready for the challenges of ensure that Article 5 loophole is dealt with. However, social work is not the answer on its own and can only wish to be a small part of the solution. As Mark Harvey said in his blog describing a new Bohemian social work movement:

 ‘we are not the custodians of society, we need to learn to be part of it, in fact we need to ask humbly if we can come and play again. Then and only then on an equal footing can we work alongside people and create opportunity, not risk averse application that does unto’.

To truly step up to the plate and play the role the new proposals need us to, we need to really ask ourselves – what sort of social worker are we?  Are we really ready to step away from the trappings of care management, which was a role no one else wanted but we ended up with in the post Community Care scramble of 1990. Our role as all things to everyone, assessor, support planner, broker, discharge facilitator are perhaps best rested with the individuals we support, the communities that they come from and families that are best suited to help deliver real meaningful outcomes because of their love for the person. Social workers, put down your RASs (they never worked anyway), step up to the challenge of the Liberty Safeguards and deliver human rights based social work and maybe not all the other things between.

The milkmen of human kindness

nsw

Firstly, if you haven’t read Mark Nearys fantastic book ‘Where Have All the Milkmen Gone’ then we think that’s a good place to start. Mark totally gets it when it comes to social work for Steven. He doesn’t want someone who thinks they know Steven and Mark better than Steven and Mark know themselves. He doesn’t want an admin officer for a social worker or someone who can broker care (although he does want the awful bureaucracy removing!). Mark doesn’t want someone who can interpret other professionals jargon. Mark isn’t looking for a mate for him or Steven. Nor is he looking for someone to relay decisions made by the great and good at panels in locked away towers. Mark wants someone alongside Steven. Someone batting for him. Someone who when Mark isn’t there is absolutely going to advocate for his sons wishes, feelings values and beliefs in a way Mark knows Steven wants. Crucially, Mark and others, want someone on behalf of the state (Local Authorities  or NHS – it shouldn’t matter) who totally get and love the fact that Mark and Steven love each other. The thought of standing in the way of their relationship should be as abhorrent as the feelings generated when you hear Mark talk about those who separated Steven from his dad. Whether it’s the principles of the MCA, the Articles in the UNCRPD or the Well Being principle in the Care Act, the overriding ethos is that the state should not interfere with the family life. Our role is to promote it, protect it and if possible to enhance it… And then get out of the way very quickly!

However it still looks like we are a million miles away. More evidence is coming to light of the routinised institutional nature of human rights abuses which are taking place in the name of so called care and treatment.  #underlockandkey was the latest in a series of reports on what is becoming an all too familiar story of families heart breaking distress.  There is an ever expanding list which is compelling and which identifies consistent themes including:

So, we change the size of our institutions from big asylum to small group home, and the uniforms are all but gone but the practice is frozen in time.  We continue to debate about how it isn’t enough to just build new types of institutions  – and we agree that a bigger shift is needed in mindsets if learning disabled people are to genuinely experience their full range of their human rights. Medical training still appears to over emphasise that clinical autonomy is the more important in decision making than the views of the person.  This has to change. Social Work training is grounded in human rights and individual autonomySocoal Work could potentially be the challenge needed. Since the early 1980s we’ve been talking about Social Workers becoming a named person providing advice and advocacy for people.

So many people have a named social worker and have done for years. But what’s changed?

Whether we are named Social Workers or not we are in the heart of a culture which families who are brave enough to speak to the press about their experiences are telling us is immersed in the ways of the old institutions. We no longer chase the doctors coattails, walk along wards or dormitories in large Victorian buildings but are we still effectively perceived by people and their families as still prowling the corridors, ensuring compliance and often crushing the hope they have of a loving family life.

The  Department of Health’s vision for adult social work  is the most recent attempt t0 define a role for a Named Social Worker. 6 Local Authorities are piloting the role as describe here – https://lynromeo.blog.gov.uk/tag/named-social-workers/

Social Care Institute for Excellence are reporting here on the outcomes so far from the pilot http://www.scie.org.uk/social-work/named-social-worker.  It is still early days,  but from our involvement this feels like something important is being tested.

Social work is at a crossroads. What do we want the Named Social Worker to be? More importantly, what do people with a learning disability and their families and supporters want their Named Social Worker to be?

Self-advocates have told us that they want their Named Social Worker to be there for them. They didn’t see the social workers in the heroic role of fighting medics to prevent admission to an ATU. People with a learning disability that we support don’t know what an ATU is right up until the point where the options have been exhausted, the ‘risks’ seemingly too great and the door locks behind them. The people we spoke to wanted a social worker to be, well, a social worker. The kind of social workers we think social workers want to be; a really good one. One who can speak about love without feeling embarrassed.

For ‘Named Social Workers’ read ‘good Social Workers’ or moreover,  Social Workers who are legitimised to be exactly what they have trained to be compassionate, kind and on the person’s side. Social Work has a unique role and position within the system and it is designed to be the safeguard against people being marginalised. Social work is steeped in an education of social justice, empowerment, human rights and an unequivocal and unashamed approach to helping people to remain as independent as possible and close to the loving support of their families and friends. Ensuring that is our unique role. The only safeguard that is needed is to keep people safe from the system intervening into family life. Whether social workers are ‘named’ or not, they need to be really good social workers regardless.

ethics-and-justice

“Oh No Love, He Can’t Vote”

Saturday 10th December 2016 is World Human Rights Day a day when the ideals behind the 1948 UN Declaration of Human Rights, and the subsequent Convention on the Rights of the Child and the Convention on the Rights of Persons with Disabilities, which provide a “common standard of achievement for all peoples and all nations”, towards which individuals and societies should “strive by progressive measures, national and international, to secure their universal and effective recognition and observance” are commemorated.

On a day like today social workers find themselves drawn to the observations of those who  argue that the most powerful human rights are not loud and shouty, but are almost mundane in their quiet nature.  To quote Eleanor Roosevelt:

“Where, after all, do universal human rights begin? In small places, close to home – so close and so small that they cannot be seen on any maps of the world…  Unless these rights have meaning there, they have little meaning anywhere. Without concerted citizen action to uphold them close to home, we shall look in vain for progress in the larger world.”

What does this mean for social work practice?  Well, for starters it means that human rights are universal in nature – rights are for all.  No exceptions.  No qualifiers.  The only test to have human rights is to be human.  Secondly,  however is the observation that without concerted citizen action to uphold people’s rights, the inherent dignity and equal and inalienable nature of human rights is placed at risk.  Social workers know that in practice, on a day to day basis, people’s dignity is not respected and as a result their rights are breached. 

An example of this is the impact on people’s right to be a part of democratic life in their country.  During the 2015 General Election social workers worked to support people to get involved and register as a voter, which is a right protected by Article 29 CRPD – the  right to participate in political and public life.  They found that for adults with a learning disability, however this right was not a given.  Every day decisions were being made, mundane/ordinary in nature, by managers and support workers that prevented people from having their Article 29 rights upheld.  Decisions based on assumptions that people with a learning disability are not fully human and therefor their rights aren’t the same as other people’s.  As observed by a social worker colleague – we have a long way to go before inherent dignity is’ a universally lived experience.

The full paper is here – http://yorkpolicyreview.co.uk/journalsite/volume-three/participation-of-adults-with-intellectual-disabilities-in-the-uk-2015-general-election/

So what can you do as a social worker?  Well, you can think about is this something you want to get involved with, you can ask yourself, do you want to shape your practice in terms of social justice?  Do you want promote citizenship, uphold the inherent dignity of the people you are priviledged to serve and protect their right to be human?  Are you willing, on World Human Rights Day to take the Eleanor Roosevelt’s challenge and think about how you can influence human rights in the small places?

To AMHP or Not To AMHP

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Image is Knitting a Justice Quilt by Mary O’Toole

Guest contribution coauthors 2 Approved Mental Health Professionals (AMHPs) working in a social work team supporting people with a learning disability.

This blog is in support of the second week of #7daysofaction in October 2016 – see https://www.sevendaysofaction.net/

We decided to become Approved Mental Health Professionals as we felt an anger deep inside which just wouldn’t go away.  Faced with daily experiences of people’s human rights being ignored and in some instances abused we felt that we had to do something. We are social workers who are working with people with a learning disability and these are the things that made us angry:

If you think we must be exaggerating, just take a look at this summary of findings reported in the Lancaster University Centre for Disability Research Briefing Paper about the first #7daysofaction in April 2016 – http://wp.lancs.ac.uk/cedr/publications/7daysofaction-2/

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Here is an example of where you might see some of these issues in your practice as a social worker. Imagine that you have been asked to support a person who has been detained under a Section of the Mental Health Act in a hospital 100 miles from their family.  The person is described to you by the doctor who makes the referral as having a ‘mild learning disability’ (what does this actually mean?).  When you make contact with the person, you find out that they have been locked up in a hospital for  over 10 years.  As you ask more questions you start to find out more things which at first worry you and eventually start to make you angry about their rights.  You find out that had they been convicted of a minor offence for the reason which they are detained under the Mental Health Act for, the conviction would have been spent by now. They have had regular MDT reviews and Tribunals, yet despite all this professional intevention nothing has changed since they were first detained. They are on a concoction of psychiatric medication to stop any natural behaviours, feelings or emotions sneaking out. They are deemed to be a continuing high risk by the clinical team and they recommend a lot more work before they are ready for release. In practice, this means they attend a course 1 day a week which involves taking a walk around the grounds. When you meet the person face to face you find that this person who the forms describe as being highly risky is intelligent, articulate, shows insight into what had happened and why.  They ask you why they can’t go out more, be closer to their family and prepare for leaving the hospital and moving on. They sum up their circumstances better than any of the ‘professionals’ involved – ‘I’m 30 and I’m spending the best years of my life in here with people I don’t want to be with, away from my family, for what reason?’

Sometimes visiting people in an ATU feels like we are back in a school classroom, sat in the science lab, watching experiments in action with the staff in the units waiting for a eureka moment before they will let the person go.  But these aren’t experiments, these are real people living real lives.

We decided that to try and combat some of what we found.  So that we could work to promote people’s rights we decided that we would go back to University and train to become AMHPs. Lots of people have told us along the way that they couldn’t see us as AMHPs.  They thought that we would struggle with the potentially oppressive powers which we would hold as an AMHP interpreting caveats to human rights which for over 200 years have been dominated by the views of doctors applying a clinical/medical lens to people (Kinney 2009).  They thought that being an AMHP would feel to be too far from what social work values stand for as they thought that AMHPs were about making compulsory detentions and admissions to hospital happen to manage perceived risks (Buckland 2014). We don’t agree. We think that being right in the heart of decisions, challenging the medical view of people being a risk to themselves and others, gives us the perfect starting place to prevent significant injustice by advocating for and upholding people’s rights, challenging assumptions, oppressive and risk adverse practices.  It means we can get involved in looking for alternatives to give people a chance at living the life they want to live.

Our experience is that people really struggle to understand the legislation.  The Mental Health Act Code of Practice is explicit in stating that all decisions must be compliant with human rights legislation.  Understanding is particularly poor of the Mental Health Act (1983) (amended 2007) and its interface with Mental Capacity Act (2005) when someone lacks capacity but doesn’t actively object to the detention (or where because the person has a learning disability professionals assume they lack capacity to make a decision that professionals deem to be ‘wise‘). The Act wasn’t designed to control people (who knew!) and the guiding principles should always be the starting point, for both the MCA and MHA and these aren’t hard to grasp. Whilst many AMHPs rightly highlight the practical problems that go with being an AMHP, we were more concerned with where people’s rights are within this process.

Challenging this system isn’t easy, it’s powerful.  But whilst detention is the ultimate infringement of someone’s liberty, it shouldn’t mean their rights, wishes and feelings are pushed aside. So with that in mind, we are more determined than ever to bring a right’s based approach to mental health, learning disabilities social work and any other social work we get near!

Training as AMHP’s is one of the best decisions we’ve made and we want more people to join us.  We need a rights based approach which upholds human rights, and being an AMHP is central to upholding this.

 

James, E, Neary, M & Hatton, C (2016) ‘Report on the First 7 Days of Action’ CeDR Briefing Paper 2016:1 Lancaster: Centre for Disability Research

Kinney, M (2009) ‘Being Assessed under the 1983 Mental Health Act- Can it Ever be Ethical?’ Ethics and Social Welfare vol. 3:3, p.329-336

Buckland, R (2014) ‘The Decision by Approved Mental Health Professionals to Use Compulsory Powers under the Mental Health Act 1983: A Foucauldian Discourse Analysis’ British Journal of Social Work p.1-17

Winter – Part 3

Each year the headlines going into the NHS winter seem to forecast a bleaker outlook.  

Whilst the 1st October still feels very autumnal, the build up to this years NHS winter is underway.

Which is worrying if you are responsible for arranging services for people who will need some extra support from adult social care to help them home from hospital.  In adult social care we rely on so called winter monies to fund out of hours, home care, intermediate care and transitional beds, all of which get people out of hospital and back to their communities so they can complete their convalescence and recovery.  This winter however the signs are that these funds won’t reach social care.  The NHS winter is biting and hospitals are needing every penny health commissioners can find.

This is further destabilising fragile social care providers, many of which are small local businesses who are really struggling to make things stack up.  As reported by the Kings Fund & Nuffield Trust social care providers face huges pressures in terms of retaining staff, maintaining quality and staying in business.

social-care-for-older-people        Social Care for Older People (home truths)

Our experience is that small, local providers are full of caring, passionate people who are trying to make social care work despite the challenges.  People like Mark, whose story from 5.05 minutes into this video about what happened on Boxing Day 2015 when the River Calder broke its banks left me speachless when I first heard it.

Mark and his team faced the worst that winter could throw at them.   But driven by deeply held convictions that it was their job to care, they are made social care work in the most challenging of circumstances.

Going into this winter we are anxious, but we haven’t lost hope.  People have an incredible capacity for caring and to find humour and happiness in the bleakest of circumstances.

winter-okie-aged-80

So going into the social care winter 2016 here are our suggestions:

1.  Remember why you work in the social care sector.  You care.  If you didn’t you could earn more somewhere else.

2. Nevet forget you are a guest in people’s lives and this is a huge privilege.  The minute it stops feeling that way it is time to move on.

3. Create space with your friends and coworkers to talk about the people you are here to serve and support.  Every person is a bright spark of colour in your life.  Sharing those sparks might catch a fire to keep you and your colleagues warm during the darkest of days when the pressure is on.