What I’ve learnt about Social Work

A couple of ‘anniversaries’ have come up recently for me. It’s six years since I published my first post on this blog. It’s one year since I left my social work job. These milestones have caused me to reflect on the nature of the profession and the sector that I work in in a number of ways.  I read my first post yesterday and it drew me back to why I started writing in the first place. I’d tried writing blogs before this one. I wrote a stupid little diary as an angst-ridden teen which was much more interesting when I looked back on it than while I was writing it. I made a conscious effort here though, to write about social work and social care.

Over the years, writing and publishing posts has helped me in ways I can’t begin to elucidate but I’m going to try. I’ve written about social work and social media many many times but in looking back over the six years and learning more as the conversations grow and develop, I’m going to indulge myself again and share some of the things I believe that writing here has changed and shaped my perception of the career I chose.

What I’ve learnt about social work by writing about it.

I never really ‘expected’ a career in social care when I started working in the sector. I didn’t know what I expected to be honest – possibly because I didn’t ‘expect’ very much. In all honesty, I was grateful to have a job that didn’t involve me having to work in a shop or an office. I was grateful that I could be paid to do something that I actually enjoyed doing. My expectations weren’t exactly stellar but I never really thought about ‘career’. That wasn’t for people like me. I’ve written a few times about how I moved from a support worker in residential care to a social work student and then a social worker. It wasn’t something I was planning or expecting but a happy coincidence. My first job after I qualified was busy and I constantly felt incompetent or that I should be doing something different or better – most of the times, I was probably right. My manager at that time ranks as one of the worst I’ve had. She was, quite frankly, a bully. I didn’t bear the brunt of it though. I kept my head down, did as I was told and relied a lot on the support from older and more experienced colleagues.

I went away, returned to social work and new legislation, procedures in a much better place. When I started writing this blog, I was finishing my ASW training. In the borough I worked in, we completed the training ‘full time’ with placements in other teams. I’d moved from adult social work into mental health social work for a few years and the ASW training was the logical next step. The service needed more ASWs. I wasn’t actually too keen. I remember a conversation I had with the service manager at the time when he told me that it would probably be the last opportunity I would get (I was on the last ASW training) before the rush of nurses and OTs and the shift towards AMHP training. Last chances. They can be quite a pull. I was struggling at work too for various reasons and to be brutally honest, welcomed the idea of taking some time out to do more training. I didn’t really think too much of the thought of what it would mean in the long run.

The course was the best I’ve ever done. Far surpassed my initial social work training in terms of quality of teaching, level of understanding, support and knowledge gained. I started writing here as my thoughts moved towards returning to work and a job I wasn’t sure I was even very good at. I’d had time out to study and I’d enjoyed it and I was worried about going back to the day to day ‘grind’ and becoming jaded. The ASW training lifted all the lingering inertia out of me. I wanted to do well. I wanted to learn. I was sad that the learning was coming to an end. So I started writing.

After the first few months, I forced myself to write something every day (giving myself weekends off). I wrote a post before work religiously for a number of years. Yes, the quality varies massively – but it forced me to find things of interest either in the news, from work or from my ‘outside work’ life to trigger. Some posts were longer than others, some more interesting than others. It was a good discipline, looking back and I don’t think I could return to it.

It taught me much more about the profession – I’d thought in terms of myself as a ‘adult social worker’ or a ‘mental health social worker’ but I hadn’t really thought about ‘social work’ per se because the work and the culture in childrens services, as I saw it, was so very different.

Then people seemed to be interested in what I was writing and I saw it was an opportunity to ‘sell’ social work. I explored for myself what being a social worker meant to me. I’ve been through the tunnel and out the other side with it to be honest. I’ve had, as we all do, those good and bad days. By writing I was able to share some of that. I was able to better reflect on what I was doing on a day to day basis and how it fit back in the profession as a whole more than my own little part of it.

As I wrote, I learnt how proud I was to be a social worker. That was something quite new for me. We joked about it but I didn’t realise, until I was writing for an ‘external’ audience, how important it was to me to represent the good work that is being done, by good people – often unnoticed – in the sector.

The blog also gave me a voice. I’ve made an issue of the fact that I’ve never been a manager. I was able to tell people who would never otherwise have listened, what it was like to work in the field and to have changes happening around you when there was no thought or consideration given to the experiences or voices from the ‘coal face’.

I was, and still am, amazed that people listened to me. Me. I’m not anything or anyone special. I don’t have any particular professional status. I haven’t written reams of peer-reviewed papers. But people seemed to read, listen and respond to me. That helped my confidence as an individual and as a practitioner enormously. So this blog and the other things I’ve written over the years, have given me confidence and have helped me to reflect on what it is to be a social worker, what it is to work in social care – and health services – and to realise that I could use my voice in different ways, even if I couldn’t always say things to my managers or in the Trust or local authority I worked in, someone, somewhere might listen and make things better in some ways.

I learnt a lot from blogs and comments from people who use social work and social care services particularly. I could never have the same interactions with people I worked with on a day to day basis because however pleasant and approachable I think I am, there is an undeniable power that I had in my statutory role. Reading about how people feel when they are detained under the Mental Health Act or have treatment forced on them, is an insight which – while hoping I was always sensitive – I could not get from other sources. Listening to how people felt when they experience crappy social workers or crappy carers or crappy systems, reinvigorated me to stop feeling so powerless in relation to the organisations which I worked in and realise the immense power I have in other people’s lives and to make sure I used it well. I may not be able to help those who have experienced the worst of statutory powers but my growing awareness of the impact would, I hope, help those who crossed my path.

Ultimately, and ironically, writing about social work, understanding its important and having more confidence in my own voice and opinions is what led to me having the confidence to leave it behind me. Isn’t life funny.

What I’ve learnt about social work since leaving it

I’ve written  my ‘goodbye’ piece to my Trust and local authority so won’t go over that ground again. It’s been an interesting year as I’ve left behind  a specific ‘social work’ job and moved into a job that doesn’t require a professional registration. In some ways, it’s solidified my determination to identify and pretend I’m still a ‘social worker’. It’s also though, allowed me to see the profession ‘from the outside’. When people meet me now, they don’t necessarily know what my professional background is so I have heard some interesting perceptions about social workers and can distance myself when I choose to.

A few weeks ago, I was at a meeting with various people from various places. When we drew to a close and had that brief chat before we headed off in our separate directions – we were talking about some of the difficult situations that had arisen. The person sitting opposite me said “You should try being a social worker”. In the skip of a heartbeat, I responded “I am… I mean, I was.. er.. I’m still registered”. Then I realised, coldly, that of course, no one in that room apart from me knew that. That was an odd feeling. I had, so long, identified as a social worker than having it not be either immediately obvious or relevant was another step away for me.

I get pangs of wanting to go back. Particularly, I miss some of the day to day work with people that I don’t get now. Then I try to remember what it was like, last summer, when the cuts bit hard and the stress levels were enormous. I’m happy where I am now, really I am but it’s not quite the same as sitting in someone’s front room – building a relationship with them and their family – and being ‘there’ to help see through some of the complications of ‘services’ to make things work out a bit better. Or meeting someone in hospital – or when you rock up to carry out an assessment and being able to follow it up through discharge to a better place. I have to admit i’ve occasionally glanced at social work jobs just to see if they tempt me back. I wouldn’t say ‘never’ but the longer I am away from the ‘coal face’ the harder, I think, it will be to go back. Maybe I’m kidding myself into thinking I will. I need to have that comfort blanket of believing that if I applied for my old job tomorrow, I’d be able to slot back into it.

I’ve learnt that social work is about so much more than local authority social work or social work within the NHS. I knew this, theoretically, of course – but now, as one of the ‘outsiders’ I see how important it is that social work doesn’t become pigeon-holed into only meeting statutory social work with a job title that includes ‘social worker’ in it.

I am using all the skills I gained through my training and my experience in my current job. Being a social worker, I believe, with my knowledge of assessment processes, experience, use of legislation and value base make me able to to what I do. Could someone without that do it as well? Yes, they can and they do – sometimes far better – but for me, it’s a good fit.

I now have a little distance from the profession which allows me to cast a more critical eye too. I was incredibly frustrated by the battles between BASW and the nascent College of Social Work back in the day. I see some kind of impasse has been reached now but I do wonder how sustainable it is to have two organisations – in a profession which has never particularly clung to representative organisations – battling for the same space.

With initiatives such as Frontline and the posts of the Chief Social Workers (who, it seems, have turned out to be mouthpieces for the govt – but I wait for them to prove otherwise to me) it has become really important for social workers to help define social work and not allow it to be defined for us by the Department of Health and the Department of Education. It isn’t only about child protection social work. It isn’t only about statutory social work. I am still as much of a social worker as I was last year, even though I don’t NEED to be a social worker for my post – perhaps I need to convince myself of that too but if we allow others to define the profession too narrowly, we will all lose out by it. In a world where I see the profession increasingly fragmenting, the real strength and voice can only come in unity. That’s what I’ve learnt.

In all, I remain incredibly proud to be a social worker. Although I was desperately sad to leave my last job and can’t help feeling tinges from time to time about whether I did the right thing, I can’t go back now. I have landed on my feet and the amount of learning I’ve done over the last year has been enormous. Mostly it’s about building on the skills, knowledge and values. You can’t be a social worker without all three of those. I’m still working on all of them and so very much locate myself within the profession. Will professional organisations, voices and representatives acknowledge that? I hope so.

Social work allowed me to create a ‘career’ when I never really thought I would have one. It’s allowed me to build confidence in myself so I can better represent and advocate others. It’s given me a great gift and I never expect to lose sight of that, forget the opportunities I have been given and stop fighting for the necessity of good social work. That’s done together though and we can build a better ‘social work’ with more voices.

That’s what I’ve learnt.

As I move on with both the writing and the career, I can’t help but feeling rather self-satisfied too. I am proud of what I have achieved so far but know there’s a long way to go. Pride isn’t particularly pretty but I’m hoping the confidence I’ve gained can be used to better represent, advocate and drive improvements for others as well as for me, rather than allow me to sit in a self-satisfied space and relax.

Bedlam – Do we need stories to understand?

I watched Bedlam, a documentary based on the work done in the South London and Maudsley (SLaM) NHS Foundation Trust last week and this week. I was reassured by last weeks’ episode, titled “Anxiety” which followed some people who had obsessive compulsive disorder so I was looking forward to the episode broadcast last night titled “Crisis” which was based in an assessment ward (which they called a Triage ward) where, the programme makers told us, decisions were made about whether to admit over longer periods or discharged home.

The “story” aspect of the programme focussed particularly on four people – two men and two women who had found themselves in situations which had necessitated (or where they had chosen – in the case of informal patients) to be admitted to psychiatric inpatient wards.  Fashionable documentary style is very much in the ‘story-telling’ vein. We like stories. We like stories with ‘happy’ endings and as the programme finished, they made sure we had the resolution we required but I was left uncomfortable by a number of aspects and details in the programme. Maybe I was more critical this week because it was an area I had more experience of but I didn’t walk away from the programme thinking it had necessarily reduced stigma and instilled a greater understanding of the mental health system as it is. Of course, that’s not the purpose of TV programmes at 9pm. The purpose was entertainment and perhaps that’s where some of my discomfort lies.

I saw a lot of the positive waves of support for the programme, helpfully tweeted out by NHS Maudsley through the programme. Interesting (but of course, unsurprising) that they didn’t deal with some of the criticisms. I know the issue of capacity to consent to filming has been raised and the programme makers have addressed it.

The producers state

One of the complex questions for filming on the ward was that of patients’ capacity to consent. We’d agreed a rigorous consent protocol with the Trust which included getting an initial steer from a lead consultant in charge of the patients’ care before even approaching an individual. At times we just got a patients’ consent to film them, we had to return to them at a later date to get consent to broadcast the material. We filmed with one lady, M, for a number of days while she was on the ward and then when she was discharged home we met her for lunch and she decided not to be involved further. Central to the filming was a respect for people’s right to privacy and we respected M’s decision.

Clearly they have covered themselves legally but some of the situations presented made me wonder how much thought had been given to the future impact of the broadcast on recovery in the long term and a full understanding of the implications of being filmed at your most unwell “in the public domain” for perpetuity – and the effect on yourself and your family of this. Of course, I’m sure these issues were covered but I was uncomfortable in the same way that I was with the ‘much lauded’ Protecting Our Children series. I’m not sure that seeing people at their most unwell or disturbed is ‘entertainment’ and now ‘educational’ it is. Do we need to ‘see’ crisis? Do we need to see a psychiatrist telling a patient he is going to use section 5 (2) of the Mental Health Act to demand that he remains on the ward when he has asked to leave? Are some things necessary to film and show on the television with real people to understand?

Perhaps I’m too sensitive because I’m thinking that for me, the thought of being filmed if I were to be restrained and forceably medicated by a team of staff is abhorrent personally. And thinking about the shots of someone being ‘persuaded’ to take their medication and forceably injected, I wonder how much it was necessary to see it. It reminded me of Panorama where the abuse at Winterbourne View was shown – not because there was abuse, clearly, but because I wondered at that point too, how much needed to do shown on camera and whether we were indulging voyeurism too much. Of course, legally, the Trust and TV production company had consent tied up but I can’t say it didn’t leave me with unease at the way we view entertainment and couch it in ‘education’ and ‘attention raising’ to make us feel better.

My other discomfort, and I’ve been criticised for raising this, was some of the racial undertones and stereotypes that I felt were perpetuated by the ‘storytelling’. Dominic, the white middle class man who would be someone who could be ‘identified with’ by many at home, was a ‘danger to himself’. Rupert, a black man, was presented as having been a ‘danger to others’. I felt distinctly uncomfortable not with the people telling their own stories in the context of the programme but with the narrative of the documentary makers that ran over it. The sequence with Dominic and Rupert singing together, seemed particularly focused on the viewer ‘empathising’ with Dominic – possibly at Rupert’s expense. Dominic was someone who was ‘like us’ – at least, until he got his ‘new’ diagnosis of having a personality disorder which immediately ‘othered’ him. Rupert was presented differently. Perhaps I am too sensitive to these things but having worked in mental health services in central London, it’s hard not to attune to race as an issue – particularly when we look at compulsory admissions.

Lots happens on admissions ward but in terms of staff, we only saw doctors and nurses. It’s a shame that there was a missed opportunity to see some of the multi-disciplinary work that happens on inpatient wards constantly especially as people move towards discharge but perhaps that’s an unfair criticism, after all, it isn’t an ‘entertaining’ as seeing people in distress. The ‘follow ups’ we got intimated that hospital admissions were successful. If that’s the case (and it isn’t always although obviously, we hope it is), I’d have liked to have seen some of the ‘why’ that we saw last week. Apart from seeing someone medicated, what other ‘tools’ are used to help prepare someone to move out of crisis. In my view, that’s an opportunity that was missed.

Early in the programme, I heard the documentary makers mention that patients who were ‘informal’ needed to see the doctor before they could leave the ward. This, I have to admit made me bristle. I hope it was a misunderstanding on the part of the documentary makers as it is veering dangerously close to ‘de facto detention’ on the part of the Trust. Someone asked me, during the programme to explain this better so I’ll give it a go. An ‘informal’ patient is a patient who chooses, willingly and with capacity understanding the implications of their actions, to admit themselves to a psychiatric ward. They are free to leave whenever they like. They are not under any compulsion to stay. If staff feel they are making a clinical decision that there is a need for someone to  remain on the ward, or ‘see a doctor before they leave’ they have to ensure they have the legal authority to do so so as not to breach article 5 of the Human Rights Act – either by a detention under the Mental Health Act (known as ‘sectioning’) or by using immediate short term holding powers under section 5 of the Mental Health Act (5(2) is where a doctor can compel someone to stay on the ward until an assessment is carried out and 5(4) is where a nurse can do so for a much shorter period). Leave cannot by restricted for an informal patient. If they need to stay, or if their leave needs to be restricted there are legal processes which need to kick into place. Detaining someone is a massive infringement of human rights and needs to be considered carefully. It cannot be a flippant comment by a member of staff on a ward about ‘staying to see the doctor’.

So Bedlam this week, definitely not leaving me feeling that it was waving the flag for stigma busting. It’s a shame as the opportunity was there but the need for stories and entertainment were paramount. Personally, it compounded my view that fly-on-the-wall wouldn’t be my personal format of preference for gaining insights into worlds that might not be apparent to others. I am of the view, and I am aware I’m probably in a minority on this, who thinks that created drama without ‘real’ people on camera – at least during their moments of crisis – would be a better way to achieve this. Drama created by people who have understanding and experience, absolutely,  but I’m not sure how much seeing the ‘real time’ distress and illness is a help to those who are experiencing it. Is that my inherent paternalist nature creeping out? Perhaps it is. Perhaps I overthink things and should let people get on with it but frankly, after last week, I was disappointed with last nights’ episode – as a rather sad epilogue, I am also thinking, thank goodness the Trust I worked in didn’t agree to TV cameras. Stories are good. Stories are necessary. But do we need every part of a story to understand? Do we need to see the needle being injected, the distress and confusion, do we need to see all that in ‘real time’ to understand? Maybe we do now. I accept I probably don’t  hold the majority view on this, judging by the waves of praise for the Trust and the TV production company  but it doesn’t shake off my general unease.