Final post

Well, thank you for making it this far with me. I have decided after a fair bit of thought to officially ‘retire’ this blog and I won’t be updating it anymore. I’ve moved on  and am doing different things now. That isn’t to say I won’t be writing in other places and doing other things but not here.

I am going to leave the blog archives open and hope you find it useful. I started this blog back in 2008 and it’s helped me through a lot of difficult times, professionally and personally. Through foster caring, bereavement, moving houses, moving jobs and much growth and happiness.

I’ll still be around and pop in but I wanted to leave a final post to explain.

Whatever I end up doing, I’m incredibly proud of being a social worker and that’s not going to be changing any time soon.

Be good.

Empowerment

Since I started my social work training in 1998, I have spent a lot of time thinking about power and my relationship with it. When I was a student, I didn’t feel that I had ‘power’. It felt like it was being at the bottom of a professional hierarchy. Yet we learnt about ‘empowerment’ and how we, as students and (eventually) as social workers advocate and ‘empower’ other people.

It was a tired old adage. Social work is about ‘empowerment’ but it always sat a little bit uncomfortably. By saying that I empower someone else, that makes a number of assumptions. Firstly that somehow I have more knowledge and authority than the person that I am ‘empowering’. It is a patriarchal approach at best. I ‘empower’ you. What does that say about me – and about you and our views of the world? Secondly, I didn’t think – and we weren’t taught about empowering ourselves. It was about different ‘client groups’ we worked with. We learnt about oppression, prejudice and all those structural issues that exist in society but we weren’t, as students in a setting where we were very much amid and victim to massive issues of power differentials – with lecturers and tutors and with practice teachers – of empowering ourselves in relation to the course and the university. So all that theoretical teaching begins to take a hint of vague hypocrisy.

Sometimes I still see tutors talking about how they teach their students to ‘empower’ others. Is that what they are doing themselves? Are they empowering their students or encouraging their students to challenge them? I had a particular experience at university (when I was studying my social work MA) which colours my view. The leader of the MA programme was a bully. He enjoyed his power relationship with students. We didn’t see it at the time, but saw it for what it was fairly rapidly afterwards.  He would talk about ‘empowerment’ while demeaning students and emphasising his own power within the context of teaching social work. It was the kind of thing that made me terrified of the thought that he had ever practised social work.

Then, when I was on my first placement, with my fantastic practice teacher – she said to me to remember my own power in the relationships with the people I saw on placement. I felt like a ‘little student’ – we had been disempowered as students as a part of the course by the attitude of this tutor and she told me that I had enormous power in respect to people who used the service we were providing. It helped me feel a lot less sorry for myself and helped me to understand power and empowerment much more clearly than anyone in the university was able to. You see, I hadn’t recognised my own power while I had been caught up in other people’s power games over me. We rarely recognise our own power. If I “empower” someone else, I am immediately putting myself in a position where the balance is skewed.

 

I have power. I can give you power. I empower you. No. I think that’s the wrong way of looking at the process. I can, perhaps, help you to recognise your own power so that you can empower yourself but I maintain that it isn’t possible for me to empower you. If I empower you, I immediately remove some of the ‘power’ from you because I am in the position of gifting it. I may be able to create conditions for you to recognise where and how power fits in between us. I can, perhaps, create an environment that allows people to seize power and challenge me. I hope they do. But I can’t ‘empower’ you as it isn’t within my gift to change the way you think.

That’s the way I see it. I struggle still with my relationship with power. It was a large focus of the ASW training when I did it. I was in a supremely powerful position where I was able to remove someone’s liberty without a court judgement. I could make a decision to detain another person in a hospital. That is immense power. Yet in my own organisation, in the NHS trust I worked in, I wasn’t trusted to give feedback to a woolly ‘consultation’ about the services we ran. My voice wasn’t heard when I did raise concerns about cuts in services or even, when we aren’t talking about money, about poor services that didn’t respect the rights of individuals. The shouting wasn’t always about cuts – sometimes it was about quality. I felt disempowered and yet I was in one of the most powerful positions it is possible to have – to make a decision to detain someone.

It made me think a lot about ‘empowerment’. As an AMHP, I had power. I had immense power. I couldn’t give that power away. I couldn’t empower people. I could discuss and consult. I had a duty to. But the power was mine and it was not mine to give away. In order to talk about power and empowerment, we have to confront our own power – even when we, as professionals don’t feel powerful within the organisations or systems in which we work. If we underplay our power, we do everyone a disservice, especially those who rely on us to use our power well and ethically.

I’m a in position now where I have power. Sometimes I feel disempowered but it is my responsibility to work on that. I don’t and can’t ask other people to ‘empower’ me. Can I ‘empower’ anyone else? I don’t think so. I can recognise – indeed, I have to recognise my own power. If I deny my power, I am denying the positive changes which I, personally, can effect. If I tell someone else, I will empower you, I am possibly taking power away from them.

Should we be teaching ‘empowerment’ on social work training? I don’t think so  but if we don’t teach about power and our honest relationship with it – for good as well as bad – we do everyone who comes across us a massive disservice. We shouldn’t be afraid of the power we have. We need to recognise and learn to understand it so we can spread it and hope that it becomes contagious.

Awareness

. [insert condition of choice] awareness day/week/month. I’ve been pondering what we mean by ‘awareness’ and what these events achieve. I don’t want to be naturally cynical. They can be a good focus for fundraising which is never a bad thing. It does make me question what ‘awareness’ itself actually means and whether we need to rebrand and rethink how we share and spread information about specific conditions and illnesses.

Last week, for example, was dementia awareness week, which I’m going to use as an example, but the same points follow in a similar way for Mental Health awareness week, or epilepsy awareness week or breast cancer awareness week. I am by no means saying that these are ‘bad’ things. They aren’t. People need to have a good understanding of the range of issues that are faced by people who have these conditions. For example, concerning dementias, I think it’s really useful to present information about dementias and the way they affect people as well as  how we can be moving forward in promoting good dementia care. I have worked in this area for many years and think I’m sensitive to the need to break down attitudes that marginalise people who have dementia. Does an ‘awareness’ week do this? Perhaps.  I am of the mind though, that when we advocate ‘awareness’ we are selling ourselves short. Awareness is the easy part. Let’s roll out a few adverts then we’ll have an ‘aware’ population. Or will we? Are we selling ourselves or our issues short when we target these weeks/days/months? Does an awareness week change the minds of anyone who had a prejudicial attitude previously? Or – like ‘NHS change day’ are we pledging to do things we would be doing anyway? And even if we are doing what we would be doing anyway, perhaps doing them en masse or with a public pledge, it focuses our collective minds because that’s part of human nature.  Does it allow us to place conditions into boxes and exacerbate stigma – and this is a week for mental health, next week is a week for dementia and then we have a week for asthma without needing to consider the complexities of multiple needs which do not fit into boxes and people who don’t want to be defined or understood on the basis of diagnoses? I don’t have any answers to these questions but that are ones that I ask myself frequently.

I also ask  myself what do we want to achieve through awareness? If it’s breaking stigmas, should we direct our efforts in different ways? Will adverts target and highlight issues to people who have prejudices against illnesses they don’t understand? Maybe. Or maybe awareness weeks/days/months are about actually bolstering support, identification and a sense of community for those who are affected by the issue of the day/week/month. Thinking of dementia awareness week, for example, does it, perhaps provide in itself,  support and understanding to people who have dementias and their families? A focus on the services provided and some more opportunities to join together and form peer support networks and carer support networks? I didn’t see much of this although, to be frank, I wouldn’t be the person that would be targeted, having neither a diagnosis of dementia myself nor caring for someone with dementia.

I found myself thinking, last week, what difference does ‘awareness’ make? Even if it’s just internal thought processes of one or two people, it’s useful but my concern is that sometimes it can be easy to be complacent and fit conditions into ‘events’ that then drift into the background for the rest of the year. Or we can get ‘awareness’ fatigue. Perhaps we need more awareness of what awareness actually means. I think what I’d like to see is more discussion about what ‘awareness’ means and what outcomes we want to achieve with awareness. Awareness is good. Awareness is useful. Action leading from awareness is, perhaps, better though. Even if the actions are small steps. My fear is that we want to compartmentalise and attach labels.  I don’t think there’s any harm in awareness weeks but sometimes I like to think what is the actual aim? Is it awareness or should we be a little more ambitious and have more ‘action’ weeks?

Dementia, Social Work and Awareness

Dementia awareness week starts tomorrow on 19th May. When I think about ‘dementia’, I don’t think about government initiatives and new exciting ways to ‘raise awareness’. Raising awareness is good but only if we are raising awareness with a reason. Awareness isn’t enough. I’m an avowed cynic of the government’s ‘Dementia Challenge’ for many reasons but not least, the name. Dementia is not and shouldn’t be a ‘challenge’ any more than we need a ‘broken leg’ challenge or, to put it perhaps more honestly, an ‘age’ challenge. Fundamentally the language of ‘fighting’ dementia is embedded in an ageism that doesn’t recognise that dementia is a process and a range of symptoms that can look very different from person to person, family to family and society to society.

When I think about ‘dementia’, I think about the people I’ve had the privilege to work alongside as they experienced challenges of the systems that we have created to make experiencing illness more of a challenge. The ‘challenge’ isn’t dementia. The ‘challenge’ isn’t age. The ‘challenge’ if we want to use that language, is one of a health and social care system that stigmatises and isolates. That creates language and rhetoric around ‘choice’ and ‘involvement’ but rarely delivers or delivers in inequitable manners which further increase the challenges to those who have to navigate systems.

I think about Rose and Maisie. George and Bill. I think of Dorothy and Lily. I think their families and those of them who didn’t have families. I think of the different types of dementias and memory impairments that have affected the people I  have met and their famillies. Alzheimer’s, most commonly, but also vascular, Lewy Bodies, Korsakoff’s, Picks and the many that have names I can’t remember. I also think about the calls for more dementia nurses, more Admiral nurses, which I am sure is a good thing. But I want to draw out a call for more dementia social workers because I think, if there’s a role that can be played, it has to move into the territory that social work  has, in the crux between medical and social systems.

I worked in an older adults mental health team before ‘memory clinics’ came into being. Memory clinics are good. They are good for diagnosis. I argued for a social worker or two in our memory clinic but there was no funding for it. It wasn’t seen to be ‘necessary’. No, we need nurses because nurses can follow up the clinics. Nurses can monitor the medication. We don’t want to pick up care management responsibility for the group of people who would come into memory services because that is the local authority’s job. These were the responses I had. And there’s the rub. There was and perhaps, still is, the opportunity for single care coordinators to link between health and social care and if any are best placed for straddling that divide, it is the mental health social worker who specialises in dementia.

While I worked in a mental health trust, I had good working relationships with the multidisciplinary team but my social work background gave me an additional role in terms of managing, developing and advocating for those who needed social care support as well. Amid all the calls for more support and research in dementia, we see little call for more social workers who specialise in dementia care, and I think we are missing a trick. Of course, I’m biased. It was an area I loved with a passion. I do think that if there’s one area in mental health services that we can, and should, push against the removal of social workers, it is in the older adults services and dementia particularly.

Working in dementia services, I worked a lot with families, sometimes at great distances because they did not live near their loved ones. We ensured that the information was there to guide people through the systems – when we had it anyway. We worked particularly with people who ‘didn’t engage’ with services (I hate that term) because they didn’t understand or acknowledge their diagnoses and often the work we did would be very slow at first. A knock on the door. A few words and a smile. We kept going, kept going, until our faces became familiar. We had the opportunity to work in different ways and to build up relationships. I was lucky with my managers. We had different criteria for admission into our services than the adult teams. When I visited some people, two/three times a week – or undertook visits to family members to offer an ear to listen – even if there was little practical support I could give, it felt like time well-spent but it might not have been exactly ‘working to the service model’.

If I could design a model for dementia care, it would have social workers at the heart of it. There would be multi-disciplinary teams of course,  but they would include district nurses as well as community psychiatric nurses. We’d have some specialist OTs, medical covers and social workers would be the care coordinators – straddling the balance between health and social care systems. The support would be there for families and friends as well as those with none. We would have time to put together support plans which were able to ensure that people’s wishes were captured as soon as possible and work on advance directives and lasting powers of attorney from the first point of contact. But if people didn’t want to discuss those things and just wanted to ‘be’ – we can do that too.

Social work could be a key to unlocking integrated dementia support systems and as a profession, we have to ensure that our voice is not lost. The desire to medicalise dementia is a result of a nonsensical funding system where health is funded through the NHS as free at the point of delivery whereas social care is means-tested. This means there are many interests regarding freezing social care and social work out of dementia services. People don’t want to pay for services when they could be delivered free. This shouldn’t though, drive policy in the future and without social care sitting alongside nursing, we risk losing the heart of support systems which need to reflect social situations as much as medical needs. It’s imperative that the voice of social care remains at the heart of dementia care and dementia services.

Maybe we need some ‘Admiral’ type Social Workers out there.  Meanwhile, for dementia awareness week, we should examine what we want dementia services to look like and ask people who have dementia to tell us what they want from services rather than making decisions around what we think is best. I think social work and social work values are particularly well-positioned to seek and respond to those voices.  As for awareness, it’s better than lack of awareness but as we move into an ‘awareness’ week, it’s worth thinking – why do we want to become aware and what are we going to do when we are aware. Awareness without action or change, well, it’s not much better than a lack of awareness.

Think Ahead – Why the Fast Track Mental Health Social Work Scheme is confused and poor

Last week, I read an article about the proposed government attempts to bolt a ‘Frontline’ scheme on to Mental Health Social Work. I was angry and I raged. Thanks to a comment (and I genuinely mean that) I wondered if I’d prejudged the process by some ill-considered quotes from the so-called ‘senior researcher’ and a government minister. Then I read the report itself and realised that while I hadn’t known all the detail, none of the concerns which I raised had been addressed.

People who have far more skill and knowledge than I do have written about this scheme – and people who actually know and understand the sector, unlike a think tank researcher who, on his own Twitter bio, claims to have expertise in education policy. I’d recommend the following pieces to learn more about the response to the scheme. This piece by Dr Martin Webber – a social work academic who has a particular interest in mental health social work (and more importantly, actually knows what it is) and this piece by Matt Graham, again, a social work academic who has worked in and knows mental health social work. Then there’s the sector commentary, from Community Care (an incredibly disingenuous interview with Norman Lamb which actually makes him into a bit of a laughing stock as he clearly demonstrates his lack of understanding of mental health social work – when he says, for example, that ‘only 8% of social work students choose a mental health placement’. Seriously – I feel a little sorry for him having been fed this by IPPR because anyone who knows social work and social work education will understand what that figure is really about and it isn’t about students not choosing mental health) and Mental Health Today.

 

I want to look at the report itself and while I don’t want to repeat some of the issues raised above, I am going to relate the cognitive dissonance between what the report says and my understanding and knowledge of mental health social work and why I think it’s based on flawed assumptions.

 

Starting with a solution and then ‘consulting’

This is something that is raised in the above pieces. It is blindingly obvious the government agenda was to take the ‘Teach First’ or ‘Frontline’ agenda and impose it on mental  health social work. Regardless of any consultation or discussion. This was a development that started with a solution and then went in search of a problem. Is the problem in mental health social work that there aren’t enough high calibre graduates coming into the profession? I’d say not but then, I’m biased and I know the excellence of my peers. I’m actually not opposed to new routes into social work for different groups of people. Our profession is strengthened by diversity. However, my worry is that this obsessive inferiority complex that social work, as a profession, has is going to stifle rather than extend diversity in social work. I see a professional voice that is growing and becoming more secure in itself and then we are told there’s a problem with image.

Having worked in and around mental health social work, I have never felt anything other than highly respected and valued as a member of a multidisciplinary team. Certainly, the consultant psychiatrists I’ve worked alongside have told me that they greatly value the social work profession and what it adds to multidisciplinary teams. So where is the problem? Not enough people who can’t get into clinical psychology considering social work as an option? Because that’s what seems to be presented in this document.  The document calls for an ‘improvement in the status of social work’ but certainly, within mental health (perhaps, unlike adult social work where professionals really have been deskilled and I’ll come back to that) I don’t see any concerns about the status within those who work in the profession. I was far more valued as a mental health social worker than as an adult social worker. But our job shouldn’t be about what status we have as professionals. It’s about doing a good job well, in a ethically sound context.

 

I’m going to look at the report in chunks – particularly where I feel the evidence is flawed and consider the report in detail.  I’m going to use the report headings themselves for ease of cross-referencing.

 

The challenges facing mental health social work

This is the place where we see how poor the research and consultation was, in the first chapter. We see evidence presented of the need for robust mental health services due to a rise in need. It’s hard to relate this to the destruction with which this government has unleashed on the health sector in general and mental health services in particular and not wonder what on earth the report is trying to prove. I hope the government didn’t pay a lot for this research as it’s pretty clear that the mental health sector is underfunded and working dangerously. However, the attempt to link this to a lack of the supply of good mental health social workers is flawed in the extreme as the problem isn’t a lack of supply or potential supply but a lack of actual posts available.  Here’s a nugget which evidences poor understanding

“Some local authorities have found it so difficult to implement integrated
working with the NHS that they are now choosing to bring their staff
and services back in house. It is important to find ways to deliver holistic
and integrated services in a more effective way”.

I’d say to the author that the reasons for pulling social workers out of mental health teams was related to Eric Pickles’ decimation of local government budgets rather than any decisions about ‘integration’ wasn’t working. Local authorities have different targets and sometimes social workers in mental health teams are pulled in different ways but I have spoken to many social workers who have been pulled out of mental health services and I’ve spoken with mental health teams who have had social workers pulled out.  The choices made were due to budgets not an ‘integration isn’t working’ agenda.

The integration agenda

The report then kindly explains to us what a ‘CMHT’ (Community Mental Health Team) is. I hope some of the directors of adult social services who are quoted in the article read this bit because my experience is that they rarely have a clue themselves.

The report says

Some {social workers] have reported benefitting from
greater levels of cooperation with other professionals, enabling them to
deliver a high-quality service to those with mental health needs. Those
that have reported negative experiences, however, have usually done so
due to a perception that they are unable to use their social work training
to deliver the social element of assessment and treatment. These mental
health social workers report either a situation in which their contributions
are undervalued and overridden by medical colleagues, or that their roles
as ‘care coordinators’ (see box 3.2) have caused the nature of their work
to become that of a generic health professional, requiring very little, if
any, social work expertise

So we can see what the researcher is doing by choosing the information that suits him. He discards the ‘some’ with positive experiences and picks up ‘those who have reported negative experiences’ and runs with it. He then goes on to pull apart ‘care coordination’ which he helpfully explains in a little box. This is my explanation of ‘care coordination’. Concerns about generic roles within CMHTs are not exclusive to social workers. I’ve heard nurses and CPNs describe the same. The issue isn’t solved by looking at social work in isolation. I have to say my experience was never one of disrespect or ‘being overridden’ by medical colleagues but maybe that says far more about a working culture and environment  and the leadership of the team than it does about social work specifically. If there is a problem, is it not one which is dependent on what profession you are but of general professional respect and hierarchies within teams. I would also absolutely refute that a generic role doesn’t require social work expertise. The point is that we, even when we work generically (and I did) contribute according to our professional backgrounds and work in multi-disciplinary teams to contribute our learning, values and positions.

I’ve found a bit I agree with

There are also significant concerns about the management of social
workers in integrated teams. Research suggests that social workers can
feel abandoned by the local authority

I certainly ‘felt abandoned by the local authority’ BUT why does the author then go on to completely confuse things by asking directors of adult social services for their input when they haven’t really proved that they know, understand or engage with mental health social work. I can live with feelings of abandonment from my employers to be honest, as long as I’m allowed to do the job I feel it is ethically right to pursue and a different training route does not solve this issue.  Then we get a really odd logical leap which evidences the need to find a solution and look for a problem. The author (I’m not going to call him a researcher anymore because he is using fiction), moves from a paper which talks about integration to a conclusion that we need

a cadre of highly trained social work
professionals with a commitment to integrated working will be required
to make multidisciplinary teams a success. A need therefore exists to
foster a new generation of mental health social workers, who have the
capabilities and confidence to work effectively with other professionals
in integrated teams.

So let’s get this unpicked a bit. He is blaming a lack of integrated working, entirely on the ‘cadre’ of social workers in integrated teams. Wow. We need a ‘new generation’ of mental health social workers. Need? Really? This is where we start seeing the arguments fall to pieces because what we actually need to make integration work are confident social workers who are able to challenge within teams. Sure, let’s bring some more in but this suggests we NEED new people in. Let’s have the new blood in because the current ones don’t have the skills. I see we move from fuzzy arguments to pre-defined solutions in a whirl. Funny that Lamb says this isn’t about denigrating current mental health social workers but it seems quite clear in that sentence.  You see, it’s OUR fault that integration isn’t and hasn’t worked. Our fault as mental health social workers. Not the local authorities who are desperate for money and need to bring their social workers back in house to pick up the local authority targets. No, it’s the fault of the social work profession.

And the conclusion

the first problem that a fast-track recruitment
programme in mental health social work will help to address – protecting
both the integration agenda in mental health and the role and status of
mental health social workers

And there we have it. This is going to ‘save’ the integration agenda. Unfortunately, the author has completely misunderstood (actually, I’ll give him some credit) or misinterpreted intentionally the reasons that integration has been struggling in mental health. Clue: It isn’t solely the fault of the social workers in the teams.

 

Recruitment

The next issue the ‘problem’ with recruitment. This is where the report gets very confused about the links and differences between adult social work and mental health social work. The author starts by saying

A situation has therefore arisen in which an increasing number of newly
qualified social workers are competing for a decreasing number of social
work positions. As a result, the vacancy rates in adult social work have
declined steadily from 9 per cent in 2011 to 6.7 per cent in 2013

Ok, what springs to mind immediately isn’t ‘What we need is a fast track scheme’. There are very different concerns and sensibilities than exist in childrens services. in fact the report talks about an ‘oversupply’ of newly qualified social workers.  There’s an odd little sentence about recruitment being a particular problem in adult mental health services. I travel around the country a fair bit in my current role and I speak to a lot of people in a lot of community mental health teams – both at work and outside of work – and problems recruiting to mental  health social work posts is never something I’ve come across. Of course, there may be parts of the country where that isn’t the case, but for London, where I am very well embedded, it’s not an issue I’ve ever heard raised. So where does the author go?

The most acute recruitment and retention problems concern
the role of approved mental health professionals (AMHPs). AMHPs
exercise functions provided for under the Mental Health Act 1983,
including making decisions about compulsory admissions to hospital.
Local authorities have a statutory duty to ensure that they have a
sufficient number of AMHPs to carry out the roles required of them
under the Act.

I sniggered at this. Yes, it is true there aren’t enough AMHPs but does he know the reason the change in the Mental Health Act 1983 – as amended 2007 – as made? It was to deal with this problem entirely. Now, it hasn’t been particularly successful but there are certainly a fair number of nurse AMHPs knocking around and the issue now isn’t so much the lack of availability of nurses (or social workers) to train as AMHPs so much as the lack of willingness for mental health trusts to pay for their training as the responsibility to provide AMHPs is the local authority’s. So having more social workers through a fast track route won’t ‘solve’ this problem. That’s the reason the number of social work AMHPs remains high – it’s due to the cost of training rather than the lack of supply of people who want to do the training. And then there’s a little box explaining why fast-track recruits can’t do AMHP training. Seriously what a clue has this author got about what the AMHP role is that he condescends to actually explain this. I would not want anyone without considerable work experience in a mental health setting (and 2 years training doesn’t come close) to take such a role and he insults our intelligence with  his little ‘explanation’ box. Mind, insulting the intelligence of social workers doesn’t seem to be a particular concern of his.

Then we have the little survey of directors of adult social services where no distinction is made in the questions between adult social work and mental health social work. So let’s look at some of the questions asked by the author and see if they are leading.

90 per cent of respondents either agreed or
strongly agreed with the statement that ‘more needs to be done to attract
the highest possible quality candidates in to the social work profession]

Firstly, this doesn’t specify adults, children or mental health social work and secondly, isn’t that about asking people if they like chocolate? Wouldn’t people say ‘yes’ to that question asked in relation to any profession? Should we do more to attract the highest possible quality candidates into teaching/nursing/law/journalism/banking – hard not to say ‘yes’ to any of this. And this is the ‘research evidence’ that this study is build on. A joke.

And he goes on

Our survey found that
47 per cent of respondents either agreed or strongly agreed with the
statement, ‘My local authority experiences a problem recruiting high
quality social workers in to adult settings’. While the response was
by no means unanimous, it does highlight ongoing concerns over the
quality of social workers.

47% is under half – there is no distinction between adult and mental health social work. This does not, to me, explain a specific concern about mental health social work and I’d ask the author why they put ‘adult social work’ in this question and not ‘mental health social work’. Remember, this is directors he is asking. Who probably haven’t got a clue about the quality of work done in the mental health trusts where they second their employees to. I’m not sure this is a fair reflection on the quality of social workers but what I’d say it is evidence of is asking questions and leading questions to evidence a solution which has already been proposed.

Let’s go on and please remember, these questions do not specify mental health social work.

Our survey of local
authorities found that the five skills deemed to be most lacking among
job applicants were:
• analytical ability/critical-thinking skills/intellectual capacity (56 per cent)
• awareness of evidence and its impact on practice (44 per cent)
• practical experience of social work (39 per cent)
• leadership skills (35 per cent)
• knowledge of integration and partnership working (32 per cent).
It is therefore clear that more needs to be done to attract talented
individuals into the profession, particularly those that can bring these
particular skills with them.

So remember how these questions are asked – they are not asking if applicants lack these skills but rather, if they have to choose skills which applicants lack, which would be their top five – so we are starting from a point of identifying deficits which are assumed to exist – and remember only 47% of respondents said they ‘agreed’ or ‘strongly agreed’ with their LA having difficulties recruiting high quality social workers. Surely it would have made more sense to ask these questions within mental health trusts where social workers actually work and where their job and the quality of their performance is known rather than directors of adult services who base their experiences on the far higher numbers of adult social workers that they would have contact with. This is why I say this evidence is flawed.

So what makes a ‘good’ graduate entrant into social work. Let’s see

Despite recent recruitment initiatives, social work is still not seen as a
career of choice for many graduates from highly selective universities.
In 2011/12, 2,840 people started social work master’s degree courses,
but of these only 270 had completed their undergraduate degree
at a Russell Group university, and only 10 had attended Oxford or
Cambridge. This means that only 9.7 per cent of people who started
training to be a social worker through the master’s route in 2011/12
came from a selective university

Now, before I get told off for hypocrisy myself, I have no issue with more graduate recruitment into social work from ‘selective’ universities but I don’t see the lack of recruits from ‘selective’ universities as a problem with social work recruitment. People want to join the profession – great – but why is which university you go to seen as a determiner of the quality or attractiveness of the profession. Is it a problem for social work that the profession doesn’t ‘compete’ with law, medicine and finance? Maybe we should rather, compare to nursing. Or better not compare with any other profession because, you know, we aren’t any other profession. I was lucky enough to get a grant when I went to university. I didn’t pay for my university fees (yes, that ages me!). I could choose any university that would take me – I was lucky to be able to choose a university with a good reputation. However, were I going to university and needing to pay for it without a grant, I would choose the cheapest, nearest one. That doesn’t make me less able than someone who happens to live in a town with a ‘selective’ university.  There is a route into social work for all graduates – which is the masters route – and it’s the route I took. It still exists.  Then he comes on to his great ‘let’s attract people who can’t make it onto clinical psychology courses’ argument. Um. I’d rather have people who actively choose social work to be honest. This is the argument for a specialist ‘mental health’ route but I don’t see any comparison (which makes far more sense to m e) with mental health nursing which is a different route to a mental health specific profession. I’ve often written of the need for generic training in social work because it preserves the integrity of social work – separating the routes out weakens the profession at a whole. If we have one ‘fast track’ route for ‘high flying’ graduates into childrens social work (Frontline) and one for Mental Health (Think Ahead) – where does that leave adult social work – working with people with physical disabilities, learning disabilities, older adults (which is my particular area of interest) – are we saying that doesn’t need ‘high flying’ graduates. I think we need one coherent path which allows for higher level specialism after qualifying and a more coherent post qualifying framework at a higher level – rather than fragmenting entry routes but that doesn’t exclude ‘high flying’ graduates. I’m very happy for them to join us. Delighted.

 

Education and practice learning

The author moves on to a critique of current training. I was a practice educator in a mental health team so was particularly interested in this. The author picks up general criticisms of social work education however Croisdale-Appleby and Nearey reports are considering these issues and will, hopefully, look at the whole education setting. It isn’t an argument for a completely new route in. He conducted a ‘focus group’ with students

All of the students felt
that the practical element of the course was important, particularly
for those who had come straight out of an undergraduate degree
that contained few practical elements

Did that need a focus group? I guess it did if you  have no idea about the sector but maybe it would be useful to take more students who have practical experience in social care settings rather than relying on the degree to do it all. I am not saying everyone needs years of experience of work in social care to enter the course but it seems like the solution could be ‘get the experience yourself’ rather than rely on a course to turf out a perfectly functioning social worker. I worked in social care for years before I did my social work training and it embedded a culture and understanding of the sector that could not have been replicated in a two year Masters degree. That’s my experience. Maybe the answer is to demand experience before admission to training courses rather than trying to ‘do it all’. It would display a commitment to the sector too –and I include experience as a user or carer of someone who uses social work services – it doesn’t have to be paid employment but it seems like the obvious answer.

We have Lamb rabbiting on about social work students not ‘choosing’ mental health placements but here’s the evidence he uses

A particular problem appears to be that fewer social work students are
qualifying with experience of mental health work. Placements in mental
health and other NHS services account for between 0 and 8 per cent of
all social work placements

So do we see the problem here? I don’t see the word ‘choice’ anywhere. As someone who offered a mental health NHS placement to students, we were massively oversubscribed in terms of students wanting placements. Mental Health placements in statutory services were seen as ‘gold dust’ in my experience. This is absolutely not about choice. My concern is that we are seeking the wrong solution. Think Ahead will deprive all students who come into social work from other routes from mental health placements as there are so few around and they will be able to ‘cherry pick’ for their own students and offer money to organisations for their own students to have placements. This means there will be fewer opportunities for those who use other routes into social work to have mental health placements with the risk that the diversity of students coming into mental health social work will decrease.

The author then goes on to waffle about bureaucracy in social work and how social workers should be able to ‘deliver effective interventions’ in mental health social work. I’m not going to waste my time on this simply because his paper doesn’t address a solution which is exclusive to graduates of a Think First type scheme. I think the idea is that these ‘effective interventions’ will be somehow ‘taught’ on the course but that replicates my concern about the Frontline scheme. Social work qualification courses aren’t about ‘teaching’ interventions – that comes with the job and the specific role as mental health social work varies and the tools you learn to use in a specialist dementia setting would be significantly different to those used in CAMHS – not least, the interventions change. The requirement of the job is not to train social workers to deliver specific interventions but to have an understanding of a framework to fit different interventions into different settings. So he shows no understanding of the needs of community mental health teams. Again.

 

Design Debates

Now the paper looks at how a course might actually look – The paper looks at Frontline as an exemplar – of course, because Frontline was developed by IPPR and has a similar type agenda as Think Ahead  which is quite open. And what of Frontline – remember, this is what Think Ahead is striving towards.

Frontline has completed recruitment for its first cohort of
participants, who will start the programme in the autumn of
2014. It received 2,684 applications, representing a ratio of 25
applicants for every one available place on the programme. Of
these, 1,272 applicants had completed an undergraduate degree
at a Russell Group university, and 184 were Oxbridge graduates.
This compares to the 270 Russell Group graduates who started
a master’s degree in social work in 2011/12, only 10 of whom
graduated from Oxbridge. Frontline has also attracted a larger
share of men than other to social work training routes

Russell Group/Oxbridge as determiners of quality, oh and more men. That’s good then. That’s always a plus. Seriously though, I don’t have any issue with Oxbridge/Russell group grads (or even men (!!)) choosing social work  but lets have some honesty with this debate. Yes, they had more applicants  but nowhere do they mention the £20,000 pay for people to take this qualification route. Now, who WOULDN’T choose to apply via that route rather than a Masters. Doesn’t matter if you want to work with children or not. If you have the option of choosing to apply for a bursary which is significantly lower or a course which pays decently and where you’ll be guaranteed placements – even if you weren’t bowled away with the programme, of course you’d choose the option with more money attached. So I think we have to take those figures with  pinch of salt. What I don’t understand and what’s written nowhere is how the outcomes of these students will be measured. There is no thought of seeing how Frontline cohorts perform BEFORE rolling out to other sectors or seeing if there is an evidence base to prove they are improving social work practice. No, that would take too long because the government has an agenda.

 

The little box about Frontline also doesn’t mention that the Frontline programme fell pretty steeply at the HCPC hurdle which monitored and regulated the quality of social work education. Oops.

 

The paper mentions recruiting for values but every single social work programme in the country should be doing this. This is not specific to a fast track scheme but they we get on to the real nub

The graduate recruitment market is extremely competitive, with many
corporations offering handsome rewards and training packages to
attract the most talented individuals. The programme must therefore be
designed to be attractive to graduates

AKA let’s pay people more to do social work courses. Actually, if they just stuck to that bit and threw away all the rest of the document, we’d probably recruit people into the profession but something that they should be aware of is that in some parts of the country, social workers won’t be early much more than the training salary when they qualify. This is not the equivalent of a medical degree where you train but in return get a higher salary on qualification. Or lawyers. It is much more akin to  nursing in terms of salary levels – except in nursing there are far more routes to management and leadership than there are in social work.  Funnily, this is their evidence that retention would not be an issue

Two-thirds of Teach First participants remain employed in teaching for
at least one year beyond their completion of the two-year programme

Er, guys, you know measuring retention after a two year programme and one year employment isn’t really much of an indication of long term retention rates.. guys.. guys. Seriously, one year out they have measured retention rates – oh and a 33% dropping off is seen as ‘good’. That’s even worse than social work. How about a comparison with regular retention rates in social work rather than pulling teaching in because you know, they are actually different professions. Oh, then the figures might not prove what the author wants them to prove (remember, starting from the solution and working backwards way of working). The paper then wiggles a bit and says, well, it doesn’t matter anyway because the programme actually isn’t about providing ‘frontline’ mental health social workers anyway, see –

What’s more, even if the proposed fast-track programme did have
a lower retention rate than existing, traditional training routes, there
is in any case considerable value in having a set of ‘high-calibre’
professionals who are trained in social work but who go on to forge
careers elsewhere in society

Which is completely counter to their argument about needing these high calibre graduates to embed and lead integration within social work settings and as social workers within mental health teams. And oh, the knowledge of interventions they will waste. No, this is about giving graduates a two year course in ‘leadership’ (what on earth.. ) and ‘mental health interventions’ (which they might need in some board rooms but probably not the way the programme was planned) as they flit through actually speaking to people with mental health needs really quickly on their route ‘to the top’.

If I were advising someone who wanted a leadership role in mental health, I would advise them to take mental health  nursing as a route to leadership and management as there are far more opportunities there. Every board of every trust is required to have a lead nurse. So where will these ‘leaders’ go? Oh, I shouldn’t say that, I’ll probably have one managing me in about five years time! So Lamb’s bleating about this programme improving the status of mental health social work is actually about this

Participants on the programme will develop an insight
into the problems that mental health social workers help to address,
and take that knowledge with them if they move into other leadership
positions in fields such as law, government and business

It’s a little game for a leadership class to play at mental health social work for a couple of years before passing on to private sector positions or better paying jobs. It isn’t even about leadership within the mental health sector. Is that what the government really wants to create a leadership ‘class’ and it is using social work as a tool. It has no interest in the profession itself. But we knew that, didn’t we?  There is a feel of ‘go, my bright young stars, try to see what ‘common people’ do for two years and then we’ll take you back into our law/govt/business embrace”.  This programme,in the words of the author “

it could help elite groups in society to gain a better understanding of the society that they serve

even if they don’t stick around for more than two years. I wonder if the author (I know nothing about him – wonder if he’s an elite) realises how incredibly insulting and patronising that sounds. It feels a bit like a person who is privileged staring into the lives of ‘poor people’ as if it’s some kind of sociological experiment without an understanding of the deep affect that relationships have in mental health social work. This is not an area to experiment. These are people’s lives and realities and it is not a testing ground for elite groups in society to play around with other people’s lives. I feel very strongly about that and was actually both shocked and sickened by these phrases. There is someone who doesn’t understand social work at all. I did ask the author if any service user groups had been consulted about this programme. I haven’t had a response. I hope he drops these phrases into the service user consultations – because there will be service user consultations, right? I mean I hope there already have been because as far as I’m concerned, that’s where I’d start.

So the course is a proposed two year programme but you know, the responsibility needs to come early because

In a national High Fliers survey, graduates ranked ‘having
responsibility from day one’ as one of the most important motivations
for applying for a job

I’m  confused as to whether this is a job or a training opportunity. Starting a masters course doesn’t sound like a ‘job’ to me but then, I stuck around for too long to fast track into govt, law or business so clearly I’m not as clear minded as the group that will be attracted by this route.  So what about a fast track then – well, let’s look at the evidence, says the author

While social work lecturers expressed concern about compressing
course length, those behind Step Up to Social Work and Frontline
believed that a carefully designed programme targeted at exceptional
candidates could be delivered in a shorter space of time

And let’s discard what the lecturers say and use the words of those who have no vested interest and are running condensed programmes say. Oh. Now, there’s choosing your evidence to suit your outcomes. We don’t have any clear outcome measures over the long term of the effectiveness of fast track routes. Frontline hasn’t even started running yet but the author thinks it is appropriate to take ‘what they say’ as evidence to show that fast tracking can work. That’s is the candidates are exceptional. Ah, maybe that’s the difference. It would be nice to have evidence though but that’s never troubled any politician or think tank. The programme will be located where the recruitment difficulties are. Ha ha. Good luck with developing that, Think Ahead. They say

The proposed programme must
be designed to address this issue by targeting areas and individual
NHS mental health trusts that have particular recruitment difficulties.

Do they know that few mental health trusts recruit social workers directly and those that do recruit them as ‘mental health professionals’ rather than as social workers? Why would a Trust choose to train a social worker rather than a nurse? Possibly because Think Ahead will pay them to take people on but this won’t develop models for sustained retention over the years – but then, that isn’t really Think Ahead’s purpose either. It’s about fast tracking people into professions that pay more and using this merely as a developmental tool along their journey – the cost being, people’s lives who are affected by short term relationships and people who have little interest in developing in practice. Again, we see evidence of a lack of understanding of the sector.  Their muddled thinking is evidenced by putting in the same sentence

Even so, the
programme should still aim to work with local authorities that are facing
particular problems in recruitment and retention as much as possible.

So wait, are they going to be working with mental health trusts or local authorities because they seem to be confused themselves. And I may not know everything (quite!) but I do know the mental health sector in London pretty well and wonder where they are going to find these vacancies. My suspicion is that the programme will bribe LAs and NHS trusts to provide placements so the scheme can get up and running – because honestly, the posts don’t exist anymore. The flit across the need for generic training but what hasn’t come across to me at all, is that there is any understanding that ‘mental health’ is not one speciality. Let me give my own experience. I worked in adult services in an older adults team and then moved into older adults mental health. My understanding from working in a social work team and doing care planning and care management was a key skill to take with me into older adults mental health services. If I’d done a generic ‘mental health’ social work course, I would have learnt different skills. I think we need a longer rather than a shorter course. My own solution would be to pick up on the AYSE and post-qualifying routes and firming up the routes into specialisms at that point – not at the entry level to the profession. That doesn’t exclude anyone and any ‘elites’ who want to join are more than welcome but it doesn’t create a separate route for ‘elites’.

And they argue that this training needs to be delivered by a social enterprise. And there’s the rub. This is a push to privatise social work recruitment and education. Remember, Frontline haven’t made it through the HCPC accreditation process yet but this is an attempt to split the profession and turn the training into a profit-making ‘social enterprise’ that will be a platform for division rather than unity. What will make social work stronger is unity rather than division. Fine, lets have new routes in but isn’t that what Narey and Croisdale-Appleby were looking at anyway. How about we stop, and assess the research and evidence before charging down a new path, especially when the evidence is based on so many fallacies.

 

How the programme will operate

If we need more evidence of the lack of understanding that this report is based on we need look no further than this section which explains in more detail how they propose to run the programme.

Let’s look at the avowed aims of the programme

The programme will be designed to attract high-calibre individuals
into employment as mental health social workers within integrated
community mental health teams. It will develop participants’ practice
capabilities and leadership skills, emphasising the inherent role of
leadership within social work practice (bringing together a range of
actors to solve complex problems). It will be designed to develop a
cadre of social workers who are able to lead the integration agenda,
as well as address issues concerning recruitment and progression of
social workers in the area of mental health.

FACT – integrated community mental health teams are rapidly disappearing because the government has driven enormous cuts to LA budgets.

FACT – if there’s one thing which is no missing in mental health social work it is professional leadership. In fact, mental health social workers are highly respected in the field and as AMHPs are often asked to contribute advise to the teams.

FACT – it isn’t a lack of the ability of social workers which is not pushing the integration agenda. To suggest this is frankly, laughable, and makes the whole document a joke.

FACT – there aren’t any issues around recruitment of mental health social workers. The document muddles adult and mental health social work in its survey and admits that there is an oversupply of social workers

FACT – The lack of progression of social workers in mental health is related to the way that NHS trusts operate and this is not going to reconfigure the entire NHS

So there we have it. The whole project is based on poor assumptions.

It’s even worse when it goes on to explain the problems it will solve, including the  lack of supply of AMHPs. Seriously, they just don’t get it. Especially if these elites are off being lawyers, politicians and businessmen because the one saving grace of being an AMHP is, you need actual, real experience. The issue about the lack of practice placements is not due to lack of choice but lack of supply. I suspect this programme will buy placements but that will affect supply of placements to those taking other routes which is a problem for the profession as a whole although it won’t be a problem for Think First ‘graduates’.

Ah ha, I see the first use of the word, service user to indicate involvement

As with all social
work courses, it is also important that service users and employers are
engaged in the design of the programme and in recruiting participants

I wonder how many service users were involved in the development of this paper. I asked that question.  It hasn’t been answered. And where will the placements be?

Community mental health teams are therefore strong contenders
to become the teams in which the Think Ahead programme is primarily
based. They are the ‘hub’ for the majority of mental health work carried
out in the community, and have strong links to other parts of the system
such as inpatient hospitals and children and adolescent mental health
services.

Oh, and they’ll dabble a bit in forensic mental health. I don’t see any attention paid to older adults services or dementia. Maybe they forgot that that falls into mental health services too. Oh, maybe they’ll be a problem with access to CMHTs which don’t have social workers in them anymore. But Think Ahead have a solution – they are going to be responsible for re-integrating mental health services personally – cos the programme is THAT attractive.

The NHS
mental health trusts that are selected to partner the programme and
provide the practice settings for participants will therefore need to be
committed to making integration work and promoting the role of social
workers within integrated mental health teams. In some cases, the
programme will have to actively rectify the structural and organisational
weaknesses that in the past have created difficulties for social workers
in integrated teams. This means that, in return for taking part in the
programme, trusts may have to improve their structures and systems
for supporting social worker

Er, I see a bit of delusional thinking here. Firstly, it wasn’t the Trusts that chose to remove social workers but the LAs who removed them due to financial costs so this just shows pure ignorance. And they really think that as a training programme they can demand integration of social workers into CMHTs? That’ll be interesting. I’m sure they’ll have money to do that but wow, the incredible lack of insight and arrogance is phenomenal. Do they think their programme will be so attractive that trusts will reconfigure to suit them? My experience of mental health trusts is they won’t deal with the hassle and will just employ more nurses instead. THis is just an incredible claim. Think Ahead is going to be able to demand integrated services.

As for the details, the graduates will have a DipSW after year one, and year two will see them employed in CMHTs on a year’s training contract to develop skills in the field. Seriously so despite them waffling about generic qualifications, they are condensing a two year social work programme into one. I have an idea. Why not extend the training to two years and call it a postgraduate programme – then, choose the very best social work graduates, from whatever route they choose and give them an extensive placement and support within a mental health setting. Oh, because that doesn’t ensure that only the elite can access this route. And it doesn’t allow a social enterprise to profit. Silly me.

After this two year programme

Given the amount that the NHS mental health trust and local authority
will have invested in the programme up to this point, it is likely that they
would offer participants a permanent job at the end of the programme
(although they would be under no obligation to do so). The programme
should therefore provide a more direct link between the supply and
demand for newly qualified social workers.

 

Invest? Do they understand the financial situation at the moment? Do they actually know what the demand is for mental health social workers at the moment? I can’t really see a geniune cohort existing. They are looking in the wrong places, at the wrong issues.

 

Conclusion

Well, I took the challenge and read the document. Much of it made me laugh but it also made me sad that this has been presented as an answer when the problems have not been clearly defined or identified. We, as a profession, have to consider what this will  mean as a whole if we allow these schemes to develop in the way that they have been presented. This isn’t about broadening entry. This is about removing social work education from the public sector. This shows incredible lack of insight and understanding into mental health social work.  As for the people who were consulted – they were as follows:-

 

Baroness Claire Tyler, chair, CAFCASS (chair)
Joan Beck, chair, Association of Directors of Adult
Social Services
Steve Bridge, social care workforce strategy manager,
Department of Health
Karen Dolton, head of care, Manchester City Council
Annie Hudson, chief executive, the College of Social Work
Dee Kemp, director, Topaz
Professor Julian Le Grand, professor of social policy, LSE
Doctor Glen Mason, director of communities and local
government, Department of Health
Josh MacAlister, chief executive, Frontline
Bridget Robb, chief executive, British Association of
Social Workers
Lyn Romeo, Chief Social Worker for Adults
Professor Hilary Tompsett, chair, Joint University Council
Social Work Education Committee
Frances Turner, social worker, Central and North West
London Mental Health Trust, Milton Keynes
Professor Aidan Worsley, chair, Association of Professors
of Social Work

I see one currently practising mental health social worker. I see no mental health trust management representation. Most tellingly, I see no service user representation at all. Is this the way we are allowing our profession to be defined. Read the report and weep. It is based on fallacy and factoids. It is based on leading questions and little knowledge.

We should look at where demand actually is, if there is demand and focus on that. We should develop stronger post-qualification frameworks and ensure that the social workers we have, stay and lead. We should fight for our profession as one and not look at mental health, adult and childrens and family social work as separate strands. Otherwise we don’t know what we’ve lost until it’s gone.

 

And I am waiting for the response about which service user groups were involved in this consultation still. Waiting.

Fast tracking Mental Health Social Work

First they came for the children and families social workers..

Last year, the government announced the shiny ‘Frontline’ scheme which was designed to fast-track ‘elite’ graduates into child protection jobs in ‘tough’ areas and push these sparkly bright graduates into ‘leadership’ roles. At the time, I moved this blog out of retirement specifically to challenge the processes, thinking and mostly the lack of consultation and involvement of children and families social workers – or indeed any social workers – when this scheme was developed. I’ve written about it here.

I spoke out and spoke up as best I could because I think these ‘fast track’ schemes are a folly and are attempts at solving the wrong problems. I lost that battle because it was the government doing what the government wanted to do. Yes, those in favour say, this is just about another route in to social work – perhaps I’m simple-minded, not being an Oxbridge graduate and all, but I thought we already  had the post-graduate route in to social work training (Masters qualification route). We even had a specialist child-focused route in to social work (Step Up to Social Work – which I’m also not a massive fan of, incidentally) but no, this would be different because this would fast-track even more and focus even more. So it would take all the worst parts and combine them.

This morning, the Independent reports that the IPPR (the same think tank of policy bods who haven’t got a clue about what social work actually looks like) are presenting a lovely report to Norman Lamb about encouraging graduates to move into mental health social work and this week ‘Think Ahead’ will be launched. Actually just typing that causes a deep nausea in my stomach and makes me shake with rage. ‘Think Ahead’ – that’s nice.

This is what the Independent says

Just 10 Oxbridge graduates studied for a social work master’s degree in 2011-12, compared with 10 per cent of the entire cohort applying for Teach First, the successful graduate teacher training programme. Despite the high skills required and difficulty of adult social work, very few top-flight students regard it as a prestigious job, the IPPR report says.

So that’s it, guys. Quality is judged by whether you are an Oxbridge graduate or not. Apart from the nausea, I have to say the tears are coming now. There are fantastic mental health social workers out there. There are fantastic mental health social workers coming through. This is a kick in the teeth of the highest degree. If we didn’t go to Oxbridge, clearly we aren’t good enough. Is there so little understanding that the issue is not about new entrants into mental health social work but the pulling apart of mental health social work so that there aren’t any jobs anymore. Surely we should be focussing on THAT. There is no shortage of newly qualified social workers who are very skilled who want to work in mental health. Maybe pushing some of the money and support into building strong post qualification frameworks to support them might be a better idea than pulling in people who don’t really have a clue what social work actually is.

 

Government endorsed ageism

I worked in an older adults mental health team. It is vital that I had a good understanding of adult social work as well as mental health social work. Lamb’s comment sticks in my stomach.

Mr Lamb said last night he was “very enthusiastic” about Think Ahead. “We are looking for people who can commit to do something to make a difference to young people with mental health problems, particularly people in their late teens and early twenties,” he said.

See, as far as Lamb is concerned, his focus is on making a different to YOUNG PEOPLE. Does he even know what mental health social work is or is he trying to develop a programme which is a mix between Frontline and Think First because, you know, Frontline blatantly isn’t focusing on anything other than child protection social work. This is evidence of the clear folly of building social work into specialist silos. This pot is where Mental Health goes. This pot is where Child Protection goes. We’ll train you as a ‘specialist’ social worker – whoops, what do we do if a child has mental health needs? Heaven forbid someone has dementia and that needs specialist social work input. Has there been ANY thought about it because it doesn’t look like it. I’d like to know from Lamb how many practising social workers they spoke to and where those people work – as well as their names – as they clearly don’t have a clue what happens in mental health social work nor what is happening now as local authorities pull their social workers out of mental health trusts. And that is happening all over the country.

What is social work?

According to the Independent article

The IPPR research shows that nearly 50 per cent of local authorities have problems recruiting high-quality adult social workers.

Well, I, for one, can’t wait to see the figures behind that research and there seems to be some confusion between adult social work and mental health social work which are not actually the same thing but I doubt the IPPR Oxbridge PPE graduates realise that. We are increasingly seeing a fragmentation of social work into discrete areas – you are a child protection social work or a mental health social worker etc. This is not helpful as the thing that makes the profession cohesive is our broad generic base. If we look at what social work is, it’s about a value base, an emphasis on reflection and social justice, a key understanding of how pieces fit together which are beyond labelling definitions and a focus on strengths-based models of working with people using specific approaches. This is beyond child protection processes or care management processes and it is what makes the profession one. I was disappointed to see one of the Chief Social Workers (for children and families) ask why genericism was important on twitter this morning when nurses had specialist training. What an utter heart-sink moment that was. If we have to explain why genericism is important to the fundamental definitions of social work to someone who defines themselves as a government appointment social work ‘leader’, I’m afraid we, as social workers are losing the battle. It is important that as social workers – social work practitioners, students, academics and social workers internationally, pull these definitions back from our government which is trying to define us by the processes that they ask us to do. We are far, far more than our tasks and that is why generic qualification is necessary and important. We need the space to understand beyond our specialisms and to grow and explore our values – because it is social work values that make social workers, not knowledge of specific child protection processes.

 

Choosing your team

Then the Independent goes on to say

The Think Ahead scheme will run as a social enterprise and operate rigorous two-year courses, starting in September 2015, for the “best and brightest” who could bring leadership to the profession. The board of the social enterprise will include Paul Farmer, the chief executive of Mind, and Dame Carol Black, the chairman of the Nuffield Trust and an adviser to the Government on health and social work. Mr Lamb also consulted Alastair Campbell, who has written extensively about his personal struggle with depression, on creating the programme.

And we get to the point. These are going to be the leaders and not the practitioners. They are not remotely interested in promoting good practice in mental health social work but producing a fast track leadership programme for privileged people who wouldn’t want to dirty their hands with actual social work. None of those people mentioned, the so-called ‘great and the good’ who are going to be on the board of this social enterprise are social workers. NONE OF THEM. Can we stop and think about that. Can we think about another profession that the government would treat with so little respect? We saw Ed Balls consult an agony aunt from the Sun to decide where social work should go after Peter Connolly’s tragic death. Now Lamb is no better in asking Campbell. This is a mess and it’s a government promoted mess. But he doesn’t need to bring social workers along with him because he is going to grow his own social work leaders who look like him, went to Oxbridge and don’t need to have any understanding of mental health social work. It makes me sick to my stomach and it’s difficult for me to even read but I’ll go on.

 

Kicking the profession while you’re at it

Now this bit made me laugh.

The new IPPR report says that “more than 90 per cent of directors of adult social services believe more needs to be done to attract the highest possible quality candidates into the social work profession”. Directors believe many job applicants lack analytical ability and intellectual capacity, awareness of evidence, practical experience of social work, and leadership skills.

The Director of Adult Services in the local authority I worked in didn’t actually realise that we, the mental health social workers which he had seconded into our mental health trust, were employed by him. He certainly wouldn’t have a clue what we did on a day to day basis or how skilled we were. And if he had said we lacked analytical ability and intellectual capacity, well, I’d have asked him (but he wasn’t remotely interested in what we did) to come out on a Mental Health Act Assessment with me. Does the government realise how insulting all this is? I think it does. They want to divide and rule and tell us how rubbish we are so we need to fling some Oxbridge graduates into the mix. Does Lamb or the IPPR even KNOW the difference between adult social work and mental health social work? Do they know that most Directors of Adult Social Services don’t know who their mental health social workers are because they are mostly seconded out? It sounds like pure ignorance of the sector to me. It seems like the government have built a solution without actually knowing or analysing the problem and certainly without an understanding of mental health social work.

And then the article says

Demand for adult social workers is high: a third of all families includes someone who is mentally ill, while one in four people will experience a mental health problem during their lifetime. In 2010, more than 1.25 million people used specialist NHS mental health services.

Ha ha. Ha ha. Seriously. Does the writer of this article actually know that these services have been slashed to pieces. Yes, more people need mental health social work  but there is less money and far, far fewer social workers delivering social work in Mental Health Trusts than there was in 2010. This makes a mockery of those of us who know how hard the cuts have hit.

 

Then we have the final kick in the teeth

Jonathan Clifton, senior research fellow at IPPR, said: “As the number of people diagnosed with mental ill-health increases, there is a moral imperative to develop effective services that can support each of them.

“Too many people can be let down when things go wrong, causing distress and putting vulnerable people at risk. A fast-track programme like Think Ahead could be one step on the journey towards changing this.”

Oh, dear, Jonathan Clifton, you really are a bit thick and haven’t done your research very well if you are the best they can do with a ‘senior research fellow’. The issue isn’t the quality of support and the fast track programmes. The issue is mental health services have been utterly decimated by this government and there isn’t money left to pay those who did the job well. I know because I left when we went through cuts which actively harmed people who used the service. Yes, vulnerable people are at risk but they are at risk because of people like Lamb cutting mental health services and support  – not because there aren’t people coming into the profession.

 

Rage, rage against the dying of the light

This scheme is ill-thought out, ignorant and insulting. It shows no understanding or insight into mental health services or social work services. The quotations are muddled, the thinking is illogical. As social workers who are committed to driving the profession and most importantly supporting and advocating for people who use social work services, we need to shout out and long about these destructive programmes and the lack of input that social workers have had into them.

If we want to look at what will ‘save’ mental health social work – I’ll  happily tell Lamb but then, as a social worker, I’m not the kind of person he’d want to consult with – especially as I guess he’d say I lack intellectual and critical rigour and analysis (although I’d like to see him say that to my face). You see, Lamb needs cleverer people than social workers to decide where social work needs to go – clearly. We are too thick and too many of us are plebs for us to be properly informed and consulted. No, it needs a think tank and other professionals to tell us. But if he were to ask me, this is what I’d tell him.

1. Fast track isn’t the answer. Longer, slower track is.

Keep the generic qualifying routes we have. We have postgraduate qualifying routes. What’s wrong with them? THEN, then, we have a robust, compulsory one year additional course supported by employers to get the specialist skills embedded but where this ‘let’s focus on young people’ thing comes from I don’t know. If we are going to build specialisms, please lets have an older adults one too which combines specialist mental health (particularly around dementia and late onset functional mental health needs) and physical disability which often affects older people.

We need more time not less time.

 

2. Consult social workers who are actually doing social work

I know, this is blue sky thinking. Who would think they could change the profession and actually ask the professionals working in the field. What would we know? But it would be nice, wouldn’t it.

3. Listen to people who rely on social work services.

Quick, let’s find ‘one of us’ who has had a mental health difficulty and shove them in the consultation. Ergo Alistair Campbell. No, Mr Lamb. Find someone who is currently using a mental health social workers’ services. Someone who has been detained by one of us. Find someone who is living in poverty and is being supported by a social worker because they don’t have any other support. Of course, have Mr Campbell as well but he may not be representative of all people who use social work services. Show a bit of respect to those who are reliant on these social workers coming through.

4. Drop the leadership strand.

You can’t train new graduates to be leaders without actually doing the job. We would be creating the wrong leaders. Look what the NHS graduate leadership programme does when leaders grow who haven’t had any clinical experience. The focus is on providing good quality social workers so why push them into leadership roles immediately. Leadership has to be earnt.

5. Genericism is important.

I won’t repeat myself but it is what makes social work, social work. We can’t allow others to define it for us. Let’s focus on post qualification training and make that more robust. Let’s push the focus into retaining and supporting good social workers. Let’s emphasis time to reflect and grow rather than jump on fast track scheme. That will improve mental health social work.

Death and Bereavement

I’ve been thinking about death this week. There isn’t anything particular that’s triggered it. I think about death a lot actually. Does that make me a morbid person? I don’t think so. Death is, after all, a key part of life. I think we should all think and talk about death far more than we do and I’ve never really understood the reluctance to do so. Talking about death when you are dying is a natural thing to do, I think. I’ve never been aware of dying. Talking about death when it isn’t provoked – when you haven’t experienced a recent bereavement or when you haven’t been told that it is something that is more imminent, is something that is less common. But it’s something I believe we should all do more of.

I remember when my father was dying how difficult it was to have conversations with him about his funeral preferences when he was in a hospice. It made me think, as I considered with my siblings, how much easier it would have been to have had those conversations earlier, when there wasn’t a death sentence over his head. My parents both had ‘planned’ deaths in a sense. In that illness precipitated their respective deaths. Sudden death though, is a completely different experience and planning, thinking and talking about it may help those who survive beyond us.

I’ve found it difficult to talk with my partner about our respective deaths. I have thought a lot why that might be. Perhaps there’s a thought that talking about it might make it come sooner, that innate superstition that resides in many of us. I think there’s probably something to it. I think it’s also the difficulty in conceiving of what life might be like when someone you love is no longer around. When my father was dying, I remember trying to think about life without him. I couldn’t really manage it very well. I was worried about how I would cope. What the world would look like without being able to talk to him about it. The imaginings I had didn’t reflect reality because when you are bereaved you don’t have the choice that imagination gives you. Sometimes, as a thought experiment, I try to imagine living without various people that I have become accustomed to in my world but I know it’s not a ‘real’ belief. Because, in my fortunately limited experience, nothing can really prepare you for a death of someone who you love, need or who affects you.

We talk about pathways of bereavement but I don’t think there really is. I’m not sure that Kubler Ross has helped me very much with stages of bereavement or however that’s interpreted now. The theories seem to indicate that there’s a prescribed path to take. You go through one stage, then you pass to another, then you pass another until you deal with it or ‘get over’ it or ‘accept’ it or whatever the most sensitive language says. Of course, I’m being a bit flippant. Thinking of my mother’s death which is now over thirty years ago, I haven’t accepted it and I know I still get angry sometimes,  just as I did as a ten year old, at the sheer injustice of it. Now though, I am less likely to blame her personally but it’s an interesting thing because I do ponder who or what I’m actually angry with. Not ‘accepting’ doesn’t mean it affects my day to day life but it means that wherever we are at in life, we are touched by those who came before us, affected us, loved and hated us (because it’s not just a relationship of love that triggers senses of loss) we are the sum of those who passed us on the way.

I think about people I have actively disliked who have died too, and what my bereavement process has been for them. I won’t name them or go into too  many details, but it is a part of who I am in the same way. Yes, there’s someone I should, perhaps, have ‘made peace with’ in the normal parlance before they died. But then, I think ‘why’ and for whose benefit. I didn’t really ever forgive them for what they did so why would I pretend to when they were dying. Would it be for their benefit or for mine? Possibly neither as it wouldn’t have been an honest apology and we’d both have known that. Does that mean hate and resentment are now burning up inside of me? No, not really, because the way we treated each other was honest based on the experiences we  had.

I’m not sure what I’m trying to say anymore except that there is no path that tracks the way bereavements happen. There is no ‘right’ way and no ‘wrong’ way of dealing with loss. Some people need to talk and some prefer not to. Some are eaten by regrets and others aren’t but it doesn’t mean that one person is ‘further down the path’ than the other. One of the things I found most helpful was people acknowledging that I’d experienced a loss. I didn’t want other people not to realise that my world had changed, even though I didn’t expect them change any of their actions as a result of that.

Although we don’t talk about it very much, particularly when we are healthy, I think talking about death is enormously useful. Telling people what we want when we die or if/when we are dying. Trying to think about it because we will all die and be affected by death. It isn’t always easy but it is useful.  We will all die with regrets. That’s humanity. It doesn’t mean forgiving people who you don’t feel you can or being less the genuine or honest when people do die. We try to remember the good but sometimes we need to remember the bad too.

In the end (pun intended), I think talking about death is what helps us to live and establish our own priorities – about what and who is important to us and what and if we want to leave a legacy behind. In order to live honestly, we need to bring death into our lives.