A Gift

I’ve written before about receiving presents from service users and to be honest, it doesn’t happen very often anyway but yesterday it did.

I went to visit Mr F. I see him regularly as he has been having a pretty difficult time of things recently. When I visited him, I was expecting it to be a tough visit. He has a lot of anger about  a lot of things, including the service that my team provides. I am the last in a line of care coordinators from our team. He has made a lot of complaints about us as a team and a department. I haven’t been working with him for too long.

It was a sunny day and he was sitting outside. He grabbed a chair for me to join him and I imparted the updates that I had been wanting to tell him about. Then he went inside and came out with a dusty, slightly soiled picture of a cat. He said to me ‘I know you are a cat lover, so you can have this’.

He has cats, often his cats approach me. I don’t flinch. I even forgo that one cardinal rule a colleague once imparted to me when I first started working in the borough about ‘not touching the pets’. I can’t help it. I do love cats. On one occasion, we even managed to complete an Attendance Allowance form with a cat sitting on it – writing delicately around the cat wherever possible. Being subjected to the snarls when we needed to gently push cat bottom out of the way to fill in the form under it.

So presenting the picture to me, he added for effect ‘It even has cat hairs on it’. And indeed it did. His cats like sitting on things. Especially papers.

I took it, saying that there were lots of cat lovers in our office and I’m sure it would give pleasure to us.

Perhaps I shouldn’t have but my immediate determination of the value of said picture was around the pennies.

But the sentiment was worth so much more. Especially with the cat hairs.

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Shoesmith and the aftermath

Image by Getty Images via Daylife

Sharon Shoesmith’s appeal against her dismissal as ‘unlawful’ was rejected at the High Court yesterday but it wasn’t as straightforward as some headlines might suggest.

I haven’t a great deal of sympathy for Shoesmith necessarily. I think that there has to be an element of ‘the buck stops here’ where bad practice is concerned, particularly as it seems that the poor practice was related to atrocious staffing levels and poor supervision but I think that Ed Balls’ media play party with her and others in Haringey as the sacrifical lambs was incredibly uncomfortable.

It felt very much like a response to a media baying for blood rather than a considered investigation about what had gone wrong and how better outcomes could be achieved.

The judge though rejected this interpretation and has indicated that an employment tribunal may be a better place for Shoesmith to address her grievances directly with Haringey.

The Guardian has an interesting follow up about the effect of the case on child protection in the UK and asks the pertinent question of ‘Who would be a DCS (Director of Childrens’ Services) in the UK?’. Hopefully, the answer will be found through those who have an interest in the quality of work produced rather than the quantity necessarily but that’s a pipe-dream in a system built on targets that don’t always allow a professional judgement to be made as regards priorities.

The shortage of Child Protection Social Workers increases meanwhile as does the  number of children taken into the care of local authorities. It is no coincidence.

While for Shoesmith in particular, whatever should or shouldn’t have been done will, I suppose, go to tribunal – the sadness of this instance is that there is a group-think about social workers which has been damaged by both media responses and by a government (Ed Balls) snuggling up to the media portrayals of everything being the fault of social workers and social services. There is an inability to detach poor practice by individuals from the profession as a whole.

Meanwhile, the Mail has another ‘social workers want to snatch my child’ story. It is, of course, hard to see this story as anything connected to ‘journalism’ as clearly only one side can be told. But anyone who has a sniff of knowledge of social work departments will know that ‘cuddling your child for too long’ is absolutely not going to be anything close to a reason for removal, intervention or even .

The Mail seems to attract these stories and they tell their readers exactly what they want to read – that those nasty nasty child snatchers might take your sweet child if you just cuddle her too much..

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Election Update

I haven’t been too well over the past week so haven’t been able to update on election news with the vigour that I might have liked. On the positives (well, kind of) I’m hoping the now fairly imminent surgery is going to, at least in the longer term, deal with some of the pain issues that have risen up but on the negatives the thought of going into hospital and the immediate pain in the aftermath is freaking me out a bit.

I’ve never had to deal with chronic pain before and I’m understanding how it affects every aspect of ones life. Hopefully, an end is in sight though.

Enough of the lingering self-pity though and back to election news.

The Guardian has a good summary of where the main parties stand on social policy issues.

From the Labour Party, apart from the ‘National Care Service’, we have a promise to ‘improve foster care’ including rolling out more specialised foster care services and introducing the ‘National College of Social Work’.

The Conservatives are sticking with their rather flaky £8000 insurance against long term care costs and an increased tax allowance for those who are married (or in civil partnerships).

Interestingly

The Tories are expected to repeal the law that set up children’s trusts which placed a “duty to co-operate” on police, schools and social services. They say the trusts didn’t prevent the death of Baby Peter and lead to a ” a buck-passing culture where, because everyone’s in a meeting, no one is responsible”.

I don’t know how these trusts work in practice as I work exclusively in adult services but I think the explanation that they didn’t prevent the death of Baby Peter is facile and disingenuous at the very least.  Those who should have been caring for Peter caused his death and although there was bad practice involved, it doesn’t mean the responsibility should be placed on anyone other than those who killed him.

Much has been made of the local democracy and ‘big society’ idea. I am sure it will work very well in some areas in the suburbs where there is more active engagement. My worry, and I say this living in an inner city constituency with a very high rate of poverty, is that the issues may be hijacked by those with the loudest voices or the narrowest interests who can dictate to those for whom voting and engagement in local issues is not as important as where the next meal is coming from.  Again, I live in a very diverse area but I can definitely see majority interests pushing out some of the smaller but significant minorities in the area where I live.

The Liberal Democrats confusingly promise one weeks respite care for carers. I had thought that was something a lot less generous than what current practice suggests that we do. They do though, prioritise dementia research.

I liked the idea of capping the pay of NHS managers to that of the Prime Minister. I don’t know if that was supposed to be funny but it definitely raised a smile to me. Now, they need to work on capping the City workers pay to that of the Queen… ..  .

Mental Nurse has a more specific run down on issues presented in manifestos as they refer to mental health care in particular in a series of three posts:

This Election in Mentalists (1)  Labour and Tories

This Election in Mentalists (2) Lib Dems and UKIP

This Election in Mentalists (3) Greens, Plaid Cymru, SNP

It makes for an interesting read and they have to get additional brownie points for reading the UKIP manifesto.

Finally, just an unrelated matter but I know something Julie at Campaigning for Health is involved with is the campaign against a local council proposal to build a new school on a disused landfill site. It seems a pretty appalling business so good luck to her with that campaign and if you want to read  more about it, you can find it here – Safe Sites for St Ambrose and Drumpark Schools. She is asking people to link the site which of course, I’m more than happy to do.

America’s Medicated Kids – Review

Louis Theroux is without doubt a very personable soul. He comes across as likeable and curious – the opposite of aggressive, but not in a passive way, more of a reconciler perhaps. So by tackling the issue of whether children in the United States are over-dependent on medication for psychiatric ‘disorders’, he took himself to a clinic in Pittsburgh and met with psychiatrists, counsellors, children and their families to get to the heart of the issues at hand.

There was, without doubt, a bias towards a criticism of the decisions to medicate children as young as six who were diagnosed with bipolar disorder, ADHD and Oppositional Defiant Disorder. We looked into the lives of three children in particular, whose homes Louis visited, and in one case, stayed as a guest, to get into what it was like to be a child with a label.

I had a feeling that Louis concluded with more sympathy for the families than he might have started with – but with a heavy heart – or maybe that’s how I felt after the programme. He asked some very intelligent questions to the families and the doctors.

What was the difference between personality and symptoms? How much of the child is the illness? When the medication starts and the labelling starts, how difficult would it then be to stop?

I was struck by the child whose mother was asked about the difference when she takes her medication and when she doesn’t and she said, of her 15 year old daughter – that when she takes her medication, she is ‘like my friend’ and when she doesn’t, she is obstinate and disagreeable. A part of me remembers myself at 15. I don’t think I would have been a parent’s ‘best friend’ at that stage.

Another angle that struck me was the child with ADHD and Aspergers’ who had begun his journey through the psychiatric system when he had been expressing ‘suicidal ideations’. I can’t imagine how difficult it must be to have a child with these difficulties. How frightening it is. But again, I felt sad that he seemed to have become defined by his diagnoses. It made him now feel special.

I think it was a well-made film and I’d recommend watching it. It is a thoughtful insight into some of the difficulties that exist but I wonder about an over-dependence on medication and not just for children. One family explained that all family members (except their daughter and including their dog) were on some kind of medication.

The film did not tie up with any conclusions. It filmed the interviews, talked to some of the parties involved and left us with an open question – but enough questions were left at the end to suspect that nothing is as straightforward as we would like it. The issue of drugs companies was never really raised, for example.

I am not against ‘medication’ for the record. I have seen how much positive difference a prescription can make to someone’s quality of life and have no doubt that it is entirely the right option for some people and some children as well. I suppose the concern comes in the increased propensity to medicate because it may be easier and cheaper than more costly psychological therapies. And the damage within families may be too high a price to pay for the time it might take to treat by other means.

America’s Medicated Kids is available to watch on the BBC iPlayer.

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America’s Medicated Kids

Tonight at 9pm on BBC2, in America’s Medicated Kids,  Louis Theroux takes a look takes a look the increasingly tendency in the US to medicate young children. He travels to the Western Psychiatric Institute in Pittsburgh which is described as a leading centre in in the treatment of children with psychiatric issues and he meets the children, families and doctors to explore the tendency to medicate children.

As the BBC site describing the programme states

Children who a few decades ago would have been written off as naughty, troubled, or delinquent are now being diagnosed instead: “ODD” for oppositional defiant disorder, “CD” for conduct disorder, “SAD” for social anxiety disorder, “GAD” for general anxiety disorder, and so on.

Critics of the phenomenon see it as rampant overmedication. Some call it “cosmetic psychopharmacology” or “steroids for the soul”. They say kids are being medicated in lieu of proper parenting – or that the diagnoses are being sought by “pushy parents” looking to give their kids a competitive edge – since some of the drugs have “performance enhancing” qualities.

… But while it is easy to make fun of many of the diagnoses – and understandable that we should be wary of the medications – it is clear that for many of these families the medications have been a lifeline.

I am rather fond of Theroux and his approach to documentary making so I’m quite looking forward to the programme and  how he might present these issues which I think are ripe to be explored.

Hopefully, I’ll be able to get back with a review of it over the next couple of days..

Thoughts on the Leaders’ Debate – 15.4.10

I watched the ‘Leaders Debate’ or rather, most of it. I thought Brown did better than I expected and Cameron worse. That may have been due to my expectations that Brown would be poor and Cameron would be polished.  I expected Clegg to make quite a strong showing – it’s easier for the ‘third’ party.

My general political leanings are soft left. I am not a natural Conservative and honestly, can’t consider voting for them so of course,  my bias will show but I don’t need to pretend to be neutral about this..

I was disappointed by the negativity about immigration to be honest. I think it is an easy target and by no means a source of as much concern as the ‘Daily Mail’ would like to have us believe. But I work between the Health Service and Social Care and know the impact and the very real impact a restriction on immigration would have on these services.

About the last point relating to care for the elderly, Cameron’s £8000 insurance against care fees on turning 65 – seems only to benefit the middle classes and protect their children’s inheritances. It does absolutely nothing to address the real funding crises in social care – not least because there is a massive move away from residential and nursing care for a start. Brown and Clegg both talked about some issue of consensus needing to be reached.

About carers, Cameron expressed the need for more respite but Clegg quantified carers getting ‘a week off’. We must have a much more generous system in our local authorities than the ones that Cameron and Clegg have been involved with. I can’t imagine one week being enough.  To be honest, over the last 10 years of my practice, respite and carers services have increased a lot – that isn’t to say they couldn’t be better of course – look at Carers Allowance, for a start – but I think the government have a much better record on carers support than the previous Conservative government.

And honestly, I think Cameron overplayed some of the issues about direct payments a bit – firstly they are being phased out but also, while I as a social worker, might have to deal with onerous amounts of paperwork, the priority was always making it as straightforward as possible for the user/carer – through support networks in place to assist.

One other point, the emphasis on cancer treatment, I know it’s emotive, believe me, I know – I say this as someone who, in my mid-30s has lost both of my parents to cancer – but I am also very aware that there are other medical conditions and more general discussion about health that I would like to have heard. Nothing about dementia for example. That was a shame really.

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‘Arrogant and Enthusiastic Removers of Children’

Quite emotive words there in the title. It refers to a case reported on in which Lord Justice Wall, who today, according to the Times, takes charge of the family courts described the public perception of social workers.

Interesting then that the Times chooses the headline ‘’Judge in charge of Family Courts criticises ‘arrogant social workers’’. Perhaps it’s a matter of semantics but my reading of the quotation given is slightly different.

He said

“What social workers do not appear to understand is that the public perception of their role in care proceedings is not a happy one. They are perceived by many as the arrogant and enthusiastic removers of children from their parents into an unsatisfactory care system, and as trampling on the rights of parents and children in the process. This case will do little to dispel that.”

So rather, he is explaining a public perception rather than directly making those charges himself. Personally, I think the headline is more than a little misleading.

But no matter, it serves the necessary purpose

The Greenwich case involved a mother known as “EH”, who is seeking the return of her son “R”, aged 5, and daughter “RA”, aged 2, from care.

The children were taken into care in 2008 after the parents had taken RA, then a baby, to hospital, where her left upper arm was found to be broken. Doctors considered that the injuries were not accidental, social services were informed and both children were removed from their parents that day.

Initially they went to live with their maternal grandmother but were moved into foster care after a dispute between the grandmother and their father. Since June last year the father ceased to have any contact with the children and the mother has attempted to separate from him, alleging domestic violence.

Social workers refused to believe that the relationship was over, while rebuffing the mother’s request for help in ending the relationship.

It’s easy to see where the criticism can come in and with that information, it is hard to know the workings behind the scenes. There is a signal being sounded though and it emphasises the difficult choices that have to be made. On the one hand, as the the case of Peter Connolly, there are criticisms about being too trusting of parents who say they are not in relationships and hounding a social worker as a result of a poor decision – and being too harsh by not believing a mother who is saying she has broken off contact with her violent husband who has caused physical harm to their children.

Going back to Lord Justice Wall’s comments and the ‘what social workers do not appear to understand’ part. I would venture a guess that he is mistaken. I think social workers understand VERY well how the public perceive them. In fact, I would consider that is it precisely the constant criticism and ridicule that they are held up to that compounds decisions such as these. No-one wants to see their own face and address published on the front page of the Sun and subjected to the kinds of treatment that social workers who have been more trusting might have been.

It is clear cause and effect and as long as the criticism is expounded against ‘social workers’ in general as opposed to those who are bad social workers, it just makes the situation worse.

So thanks a lot Lord Justice Wall – whether the Times played games with semantics or not, I’m sure your stay will be most enjoyable – certainly in the eyes of the baiting press.

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