The tragic case of Stephania and Sam Wolf has been in the news over the last day. Without knowing anything but the most cursory details of this particular case, it raises some issues and dilemmas that I am very familiar with and wanted to explore for a moment or two.
There is the issue of the overstretched carer who has little external supports. Yes, help was offered but help was also turned away. One can also speculate about the pressures that being a sole carer in a small community might bring and how much effort was made by services to actively engage with people who might find their presence stigmatising. One can also speculate about the kind of help that was offered and whether our systems are limited both in the type of help offered (day centres, home carers for example) and also by the ways in which help is offered.
These are the problems that may be created when social workers are berated by the press and in the public perception. An unrealistic image is engendered of the profession and people who might benefit and need social work interventions feel that there is a stigma attached to having a social worker or social services involved. For me, this is far more important an issue for the College to address than whether I feel comfortable telling people on the bus that I’m a social worker.
As long as ‘the social’ is seen as something wrong, unpleasant or something of a punishment, it will make people from all client groups – adults and children – reluctant to engage.
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Now again, I want to emphasise that this is not a statement about this particular case, but there is a dilemma when a family member is a main carer of someone who may lack capacity to make a decision about their own personal care needs.
When would we, as social workers – as representatives of ‘social services’ challenge the carer as to whether they are acting in the best interests of the cared for and when does ‘refusing help’ need to be challenged?
This is one of the most troubling dilemmas as a professional. It is much easier to provide a service and to provide care when everyone agrees of course. When there is a clear capacitious statement by someone who may be entitled to a service that they do not wish for a service – again, that is clear, also when there is blatant abuse it is a very clear judgement to make that the family member/carer is not acting in the best interests of the cared for – but when do we cross the line and demand services go in for the benefit of the person who might not be able to decide for themselves and whose family member is refusing help on their behalf.
Especially if the family member may be living in the same property. There is a risk of ‘upsetting the apple cart’ so to speak and ending up on the front page of the Sun or the Mail being accused of ‘dragging granny away from loving daughter’ or strong-arming services in.
A lot of times though, services are refused, we can and often do have to walk away. People have the right to refuse. Sometimes though, we need to assert the services more fully. Services don’t have to be removal to residential care – that is another myth that does enormous damage in the public perception of social care and often when services might be refused it is because people or their families are scared we’ll ‘put them into residential care’. Often I chuckle to myself that the last thing in the world we are going to do is put someone in residential care if they don’t need it as a package of care at home is infinitely cheaper.. but that’s not always as clear in thoughts and perceptions prior to arriving and being able to say this.
The problem with asserting roles and trying to engage slowly with a view to increasing or accessing services by slow introduction and the creation of a relationship of trust is the time factor that we are all subject to in our day to day work.
Fortunately, in the team I work in, being a CMHT, we are given more time to actively engage with users and carers and can often, even if it is over a period of months, gently prod towards a slow introduction of care services.
Just this week, I have finally, after working with someone for well over a year, persuaded her to give some formal care services ‘a try’. She could have done with those services for a good few years and granted the presence or not is a matter of quality of life rather than life and death but there is no way she would have agreed had we not had that previous relation of trust which had built up over time.
In the adult teams where I previously worked, there would be no time allowed for that. A refusal of services is one less assessment you need to do – and I don’t mean that to sound cruel, it isn’t meant to be – but just that the levels of workload don’t allow you to go back and try and catch anyone who might fall through the net.
Sometimes people don’t want what ‘professionals’ think they should have and that’s fine too. The Mental Capacity Act speaks explicitly about the right to make ‘unwise’ decisions although one persons’ unwise decision is another persons’ fully formulated plan. The provision of this clear statement is to ensure that professionals don’t become too prescriptive in making decisions about whether someone might have capacity or not. There are many decisions everyone makes on a day to day basis that aren’t scrutinised in the way that people whose mental capacity might be being questioned would be scrutinised and it is about shedding pre-made assumptions (apart, of course, from the assumption that everyone has capacity as a baseline).
But back to the Wolfs. If there is one thing that I hope can be taken from this it is that social isolation doesn’t just happen in big cities. It can happen in small rural communities too.
Keeping an eye out for neighbours and acquaintances is worth more than formal care services.