The big difference between the work I am doing now and the work I was doing 18 months ago is the role that compulsion plays in my day to day work.
A couple of weeks ago, a nursing student came up to our office – her placement is on the attached ward and one of the CPNs was showing her around.
As I was introduced, my name was followed by the epithet, added by the CPN ‘She’s a social worker. She sections people’.
Of course, before I had time to digest this mentally, CPN was bouncing off cheerily on her way again and into the room next door.
I don’t think it is how she perceives me. We have been working in a team together for a few years – but she possibly chose the easiest form of describing what has become an important part of my job.
When I was undertaking the ASW training, we had lots of discussions about the change in role that it entails. We train as social workers and emphasise person-centred models as much as is possible. It isn’t always possible in a statutory environment where choices are oft constrained by budget. More recently, especially with the Mental Capacity Act taking hold, we make many more formalised and documented decisions on behalf of others with the requisite checks and balances.
There have been occasions where I have used the Capacity Act in its current form to make decisions which force people to move into residential care when they have not been in a position to make a decision but then, I did that before the formalised nature of the Mental Capacity Act too – and one thing I will say, is that it feels a lot ‘better’ with a legal framework in place – even when it is the same ultimate decision being made and the same balancing of best interests. It has a less arbitrary nature though.
The use of the Mental Health Act though is more of a difference from the work I had been doing previously. It is a method of compulsion that has a different but nonetheless bitter taste. Although the more generalised ‘good’ can be clear, it is also a traumatic process to get to that point.
So sometimes I do compel people to do what I tell them to. Using a legal framework – and sometimes calling on police support. The legal framework is our own defence of the actions we take.
It is tyrannical in a sense. At times brutal. There is no escape from that. Of course, this only happens when the medical recommendations are in place and an established need meaning that all possible options have been explored.
But it doesn’t stop the discomfort. The need to adjust from a default ‘gentle persuasion’ and ‘working together’ demeanour to a ‘firm and insistent’ approach. Quoting legal codes at people who are in extreme distress. Because we have to.
I have been for a few days arranging an assessment which will be happening later today. Although there is always a fair bit of trauma involved, his history indicates that the assessment will be particularly traumatic for him – indeed – the process is likely to exacerbate any difficulties he is having. As always it is a matter of balancing risks. Ensuring an assessment is a genuine assessment rather than going through the motions.
I have been told, retrospectively, by people who I have been involved in detaining compulsorily (because, yes, I do have to re-establish an ongoing relationship) that they were surprised to see me take a different role from the one they had been used to see me in.
And providing an ongoing role as care coordinator to someone that you have detained and assessed in that more formal setting is something that was extremely difficult for me to get my head around.
The student nurse in question asked me if I enjoyed my job. My hope would be that no-one enjoys using any form of compulsion in this job. That is a clear sign of a poor choice of profession or professional. I enjoy aspects the work, I replied. And it’s true, I do. Just not these parts.
When I was asked as I applied for the ASW training why I wanted to do it, apart from the obvious (and true) my manager made me, I said that I didn’t want to do it but I felt I could a job that needed to be done fairly, compassionately and respectfully. That’s as much as I can hope for.
But the actual enforcement of the law – well, it still plays on my mind and will likely do for a long time.