The Death of the Independent Living Fund

Yesterday was quite a day for adult social services. As well as the more obvious announcements of the cuts to local authorities and the unveiling of a so-called ‘Localism Bill’, Maria Miller, the minister for disabled people announced that the ILF (Independent Living Fund) would be ‘financially unsustainable’ after 2015.

Financially unsustainable.  It didn’t need a whole lot of foresight to see this coming. Back in June, the ILF was closed to new applicants after running out of money – so the budget for this year lasted between April (when applications opened) until June (when they closed).

Community Care writes that

Miller said that the ILF would stay in place to fund existing users until the end of this parliament in 2015.

Its payments would most likely be transferred to councils to administer as part of personal budgets, though Miller’s statement does not specify whether funding would be protected at existing levels after 2015.

And so it starts, the shaking off of responsibility of central government to provide additional support for disabled adults and the move of the responsibility for the additional funding to local authorities.

There are a few things that it is important to bear in mind at this point. The ILF is only or has been only accessed by people who are most disabled and have the absolute highest care needs. It was set up in 1988 although the rules regarding eligibility were reviewed in 1993. The purpose of the ILF was, as it’s name suggests, to maintain and allow for people with high care needs to remain living independently in the community rather than the alternative which was and is residential care.

The current rules state that someone is eligible for ILF funding when input from a local authority reaches a current level of £340 per week, the ILF funding will match that amount that the local authority on a pound for pound basis.

In my current incarnation, I don’t come across people who have ILF payments frequently – it has, like DLA only been available for people between 18-65 and over 65s can only claim if they had an existing award prior to their 65th birthday.

In the past though, particularly when I was in a generic adult social services team, I had a number of dealings with the ILF. On a personal level as well, my father received money via ILF.

It’s worth remembering that the model for ILF payments in 1988 was revolutionary and one that has and continues to have a major impact on the progression of adult social care. The ILF gave the money for the first time, directly to the disabled adult to choose their own service providers and/or employ their own PA (personal assistant). The Independent Living Fund was very much the forerunner of the direct payment/personal budget progression and the model for both monitoring and extending budgets directly to adults with social care needs themselves was trailblazed by the ILF.

The money provided by the ILF had, of course, guidelines attached regarding what it could be used for but it was money given in addition to the very bare needs met by local authorities. It was and is money that contributes to providing a better quality of life for people with high level needs because, believe me, you don’t get to £340 per week level of needs if you don’t have very high level of support needs.

The difference that the ILF money made was for a carer to accompany a service user to the local shops rather than go out and do the shopping for them. It was the difference that allowed a carer to take a service user to the local swimming pool rather than relying solely on day centre services. There is no doubt in my mind that ILF money contributes precisely to quality of life differences rather than the life or death care that local authorities provided.  These are the examples that are often given for ‘care planning’ with personal budgets provided by the local authority – the difference is the amount of money that you have in the ‘pot’ and the potential doubling that happened when the ILF contributed – acknowledging that those with very high care needs had.. well.. the need for care over and above the bare minimum to retain a positive quality of life living at home rather than in a residential setting.

This is my main sadness is seeing its demise. It’s hard to stomach for the government but quality support and quality of life costs more money. Yes, the money has to come from somewhere but it shouldn’t  be a ‘burden’ . We, as a society,  should be prepared to pay the cost of it.

I know exactly what will happen when Maria Miller shifts the burden of cost of care back to the local authorities – the levels of care provided will fall through the floor and although  for some people (those currently in receipt) that money may well be protected for a period of time,  for those coming up through the ‘system’ who don’t have access to this additional support, it will create a group of people who may be living at home but on whose family the burden of care may well fall more heavily – removing the independent from the idea of independent living and replacing ‘living’ with ‘existing’.

As Lord Morris is quoted as saying by the BBC

“This will not save money. If you make it harder for disabled people to live at home, it will cost more because more of them will have to be in hospitals and other places of full-time care.

“It will mean far more of them having to be in institutional care at far greater cost to the taxpayer.”

It’s so horrifically ironic that as policies shoot away into the distance taking the goal of ‘personalisation’ as a mantra, that the very first forerunner  of that policy  which was revolutionary at the time – is being put down with no evidence that there will be any central government funding to replace it.

That’s not to say that the idea of the ILF needed to stay the same. I have no doubt it needed to develop – not least because I felt the age limits were at best arbitrary and at worse discriminatory –  but by pushing the burden back to increasingly pressed local authorities the government has alerted us to its real intentions about the cost-saving implications of the move towards personal budgets.

How Fair is Britain?

Today, the Equality and Human Rights Commission publish their first Triennial Report about Equality, Human Rights and good relations.

Some aspects of the report have been published over the weekend but it is worth reconsideration and reflection.

The report is divided into eight areas – Life, Legal and Physical Security, Health, Education, Employment, Standard of Living, Care and Support and Power and Voice.

Time, as ever,  hasn’t permitted me a full brief of the details but one of the most obvious thoughts to jump out from me through my initial glances is that race is important. Of course, this comes as no surprise to me, after all, I work in a Mental Health team in Central London but anyone who feels that discrimination and oppression is somehow invented cannot escape from the figures presented.

The study itself looked at different outcomes in various categories in terms of ‘

‘Age; Gender; Disability; Ethnicity; Religion or belief; Sexual orientation; Transgender status.

Where appropriate, the Review also takes into account the impact of socio-economic background, or class.’

(nb just if I happened to be a social work student or a student of sociology/social policy – I would hold onto this report and keep it dear, it will be absolutely priceless in essays and research!).

There is masses of data present in  this report but I’m just going to pick out a few pieces which I find particularly interesting or of which I have particular experience.

In the Health section

The incidence of disability rises with age and older people (65 and over) also have a higher rate of depression than younger people. There is evidence to suggest that the health service sometimes deals with some older people in ways that they find humiliating or distressing.

This might sound obvious but it is crucial that the higher rates of depression in older adults is accounted for. Working in a specialist older adults mental  health team, when explaining to colleagues in other teams who usually assume that most of my work is with people with dementia, I often have to add ‘depression’ into the mix. This is increasingly important as the ‘Payment by Results’ and outcome measures creep into Mental Health Services. I am well overdue writing a specific post about ‘Payment by Results’ in Mental Health but each time I think about it, my heart sinks.

This higher rate of depression needs to be provided for and I fear that through various means and changes that are taking place in the services, it may be lost to teams such as ours unless it is very severe.

The second part that notes the health service deals with older people in ways they find humiliating and distressing definitely bears out to my experience. I consider it partly because no-one in the health service knows what it is like to be very old – we are, of course, working age by default. We might have elderly parents or spouses but in a way that we all might experience ill health, we can’t obviously have experienced being elderly. As long as older adults are seen as ‘the other’ ‘someone else’ that almost allows a sense of different treatment and attitudes.

Even in my team, although it pains me to say it, I’ve heard some appalling language and assumptions made just because someone is old. The increasingly elderly population and the perception that people who have no economic output are less ‘valuable’ that people who work is a modern attitude that permeates not just the Health Service but society at large.

This ‘being a burden’ is an attitude that has played out in wider scales but it is always a challenge.

On similar lines

Overall, around 1 in 5 of us report a disability or limiting long-term illness (LLTI). The available evidence suggests that people who report a disability or LLTI are as likely as average to say that the health services treats them with dignity and respect.

So who is the health service treating with ‘dignity and respect’? Or are we more critical when we are more vulnerable? I am inclined to think that the more people are ‘like us’ the more likely other people are to treat them with dignity and respect.

Is the answer training? Possibly although there is already a lot of training. Personally I think the way to improve is through having good and strong managers who take to task firmly those who step out from the line. The difficulty is that if the attitudes are coming from GPs and consultants, who reins them in? The hierarchies within the health service are immensely powerful.

In the Mental Health Section

Groups vulnerable to pressures such as poverty and victimisation show high rates of mental illness. The risk of having poor mental health scores is higher for certain ethnic groups with high poverty rates.

which doesn’t come as a great surprise. The correlation between the stresses of poverty and poor mental health are very well established but put on paper

The risk of mental health problems is nearly twice as likely for Bangladeshi men than for White men

which is a massive proportion. I wonder how many specialist provisions exist for Bangladeshis within the Mental Health system. I know this is very much related to poverty and specific areas where the community lives but it is something that absolutely needs to be addressed.

Personally, I feel that tailoring services to particular ethnic and cultural groups is valuable within mental health services although of course, this tailoring has to happen on geographic lines where the needs are greatest – however, these services cost and tend to be less than popular among those of the majority who might feel excluded. I’ll be interested to know about what effect these figures and this report might have on the commissioning of services.

In the Care and Support section

Unsurprisingly, women are more likely to provide informal care than men.

Different ethnic groups draw on different forms of care to different extents. Black children are more likely to be in formal childcare than others; Bangladeshi and Pakistani children are much less likely. Meanwhile, Bangladeshi and Pakistani
people are significantly more likely than average to provide informal paid care (more than twice as likely as White people). Some literature suggests that this may, in part, be because formal care services are not always appropriate to meet the particular needs of some ethnic minority groups.

I thought this was a crucial paragraph. Black children are more likely to be in formal childcare than others. That starts a child off with so many more challenges throughout their lives. I know it is a generally perceived fact within the childcare system and I hope it continues to be a focus for support and evaluation of options.

The last sentence there is also key. Is there a difference in availability of specific services for people with particular ethnicities.

On a personal level, although theoretically our service should provide culturally specific services, it is sometimes hard to source carers with particular linguistic skills for example. This may be a matter of access to training  from those within these particular communities and a lack of enthusiasm and active engagement by service providers. Specific services also cost more although to be fair, everywhere I’ve worked, this is something that has ‘been allowed’. The problem is not paying for the care but finding the care in the first place.

Britain’s demographic trajectory – in particular its ageing population – is creating new kinds of chronic disadvantage. Over the next decade there will be a steep increase in the demand for personal care for older people. At the same time, more people who might have cared for their parents will have dependent children. This often means a concentration of informal care provision falling on a relatively small group – the dutiful middle aged. Most carers are women although a significant number are also children.

I think this raises a massive ‘red light’ to services and a big push towards where we are heading. It’s no surprise that the ‘ageing population’ will demand more care and the issues of how that will be funded have not yet been resolved, however add to that people who might be having children later than previous generations and you do have the challenge of the dual caring role – caring for young children and elderly parents.

This will be an increasing issue not necessarily today, but in 10-15 years time when the people who are in their late 30s and early 40s have children and whose parents might need that support in their late 70s and 80s.

While the study talks of the ‘dutiful middle aged’ this will be a group of people who have grown up in a prosperous society and might not have been as well-adjusted to the nature of the caring role as their parents’ generation. Most important to note is how much of this care role may fall on children, especially as parents grow older.

We are still waiting for the outcome of the Commission on Funding for Care and Support but someone will have to pay either for care or to support carers more substantially. This is not an issue that will fade away – quite the opposite.

In the Power and Voice section

In the Westminster Parliament, despite some evidence of progress, most religious and ethnic minorities are still under-represented. However, lesbian, gay and bisexual (LGB) people, and some people from ethnic and religious minorities, are more likely to take part in other forms of political or civic activity and more likely to feel able to influence local decisions.

People with a disability or a long-term limiting illness are generally less likely than those without to say that they can influence local decisions, and a majority of polling stations at the last election presented at least one significant access barrier.

There are a few points there. The lack of representation in Westminster seems to point to a particularly privileged group of people who go into ‘career politics’. It’s interesting to contrast with local activism which is usually carried out by a different group of people. Perhaps there is a greater feeling that local decisions can actually be changed and influenced by active minority interests.

Worryingly the fact that polling stations have access issues is one that needs to be addressed immediately. I wonder if the lack of engagement with the parliamentary process from specific groups of people allows national politicians to increasingly stigmatise these groups.

people’s socio-economic background affects their sense of power and voice. Professionals are more likely to vote, more likely to hold elected office, and more likely to feel that they can influence local decisions than people from lower occupational groups.

This sense of entitlement should come as no surprise, perhaps the weakening of the union movement is changing perceptions or just the innate nature of the existence of the perception of a ‘ruling middle class’. I would hope that Citizenship classes at schools could challenge some of these assumptions but I have no idea what happens in Citizenship classes!

National engagement through local engagement seems like the obvious way to have different kinds of voices shouting at the highest levels.

The report identifies particular areas in which work and progress can be made but I think while some of the findings are not surprisingly, it is useful to see them placed in terms of data that can be analysed and measured.

Data means that the next triennial review in 2013 can be matched and progress can be matched.

The worries remain mostly about money and funding. Everything costs, including changing attitudes throughout society and creating a ‘fairer’ Britain.

I wonder how many of the challenges specified in this report will be picked up by both a government and an opposition couched in creating fairness across our society.

To me, it seems like the white, middle class earner is doing quite well out already in the ‘fairness’ stakes so more attention on the deficits of equality would actually be the way to go if we do want to create a ‘fair’ Britain.

But the rhetoric of fairness seems to be appealing specifically to the ‘haves’ – rather than the ‘have-nots’ but at least we have a baseline of what we expect a ‘fair’ government to be working towards.

Very apt timing for the report. Let’s see what the Government does about it.

Bel Mooney, Disability and Sex

There is something of a theme for the week and while I wanted to move onto other subjects and events, I was unfortunate enough, in my daily trawl of news websites to come across this ignorant abomination of a ‘column’ by Bel Mooney in, yes, you guessed it, the Daily Mail.

There is so much in it that angered me starting with the headline

The madness of offering the mentally disabled sex with prostitutes at taxpayers’ expense’.

What decade does she exist in that she thinks that ‘works’ as a headline. ‘The mentally disabled’ – thereby she says all she needs about her own attitudes and prejudices, immediately stripping any humanity from those who have learning disabilities of a wide range and using their disabilities as their defining point and mark.

Also this ‘taxpayers’ expense’ lark – I wish there were a greater understanding of the role of Personal Budgets for this reason alone. Everything is at the taxpayers’ expense. Trident is at the taxpayers expense. Soldiers in Afghanistan is at the taxpayers expense. Being a taxpayer gives me the right to decide on some of the things for which public funds may be used at elections but we all pay tax. You know, Bel, it may surprise you but even disabled people pay tax.

Phew.

It gets worse of course as she brings up the chestnut of ‘human rights’ and smirks and sniggers at the woolly do-gooders, in the persona of course of the man’s social worker’ who obviously have little understanding. I wish she would attend one of my AMHP (Approved Mental Health Professional) or BIA (Best Interests Assessor) Forums. She would be hard pressed to find a less woolly bunch of people who are incredibly keyed in to legal minutiae and who tear apart case law savagely piece by piece. Compassion and wooliness do not have to co-exist.

Then she goes on to show a widespread ignorance of the Putting People First agenda which she might well have typed into Google but she might need to use more robust research tools than Wikipedia to have any kind of authority.

She writes

The 21-year- old’s trip to the Dutch brothel, where he hopes to lose his virginity, will be funded through a £520million scheme introduced by the last government called Putting People First: Transforming Adult Social Care.

The original 2007 document (written in the usual tedious socio-speak jargon) sets out Labour’s ‘ambition to put people first through a radical reform of public services, enabling people to live their own lives as they wish… and promote their own individual needs for independence, wellbeing and dignity’.

If she had done a little more research, for example, she’d have discovered that the precursor to the Putting People First agenda was the Direct Payments legislation which was implemented and championed by the previous Conversative Government who were all in favour and pushed through the 1996 Community Care (Direct Payments) Act. The Putting People First agenda was an attempt role out the steps taken in Major’s administration to a wider ‘audience’ and in fact, if anything, broadened the scope of the direct payments system. So blaming the Labour Government doesn’t quite work here.

This is NO TAXPAYERS MONEY – This is NOT A STATE ‘HANDOUT’ – this is money which is provided to meet social care needs and would have been spent – possibly at higher levels in any case. The idea is to save the taxpayer money – believe it or not – by achieving better outcomes to the service users and more choice.

So her next point that she

can’t help wondering about the ‘human rights’ of all the sad, shy people who write to my Saturday advice column, desperate for love and – yes – sex.

No one will give them a handout to buy what they cannot find in the usual way. No one considers it their ‘right’ to have a holiday paid for from the public purse just because they’ve got mental problems – as so many have. There’s no lobby for the lonely.

Now, I’m sure most Daily Mail readers can sympathise with the ‘sad, shy people’. But there’s a big difference – they do not have disabilities that preclude them from making the same choices and they would not be entitled to any services under the increasingly strict ‘Fair Access to Care Criteria’.

And this ‘right to have a holiday paid for from the public purse just because they’ve got mental problems’ – she fails to ‘get’ the CRITERIA part of the conditions. The money is not given because ‘they’ve got mental problems’  but because they have an illness or disability that severely restricts them in many ways and these are not ‘holidays’ – often the holidays replace respite breaks which would otherwise have been in residential care homes in the UK. Does she think her ‘sad, shy people’ would REALLY be eligible for residential care services?

She picks up nicely and ties this all in with the demonisation of social workers which is such a strong theme of the hateful Daily Mail – because y’know, all these ‘madcap’ schemes are dreamt up in social services offices. It’s all the fault of those woolly social workers.

She highlights that

The assessment is carried out by a social worker, of course, and the payment is given in addition to benefits.

And it seems that many councils, through their social workers, are using the Putting People First money to fund visits to prostitutes and lap-dancing clubs, sex courses, subscriptions to internet dating sites and holidays in places such as Tunisia.

How many times does she want to emphasise that this is all the fault of social workers? Not enough, it seems. And seriously, where is the evidence for ‘many councils’. She has come up with one case example and if she’s going to use the example of the holiday to Tunisia, I’d fight to the death that it is a much better and cheaper use of public money than a week in a residential respite home in Bognor Regis. Surely the right wing understand the beauty of CHOICE – that is why the programmes were brought in in the first place.

She goes on to tell a couple of stories of people she has known who had disabilities and had relationships and good for them. Seriously.

Personally, although I feel fairly neutral about using money from Personal Budgets to pay for sex services, the matter is that this is a question of choice from people who have the capacity to make these decisions but need assistance in the arrangements of these services.

I have personally recommended various internet sites to help people make social connections – not for sex or even for love but through common interests and yes, one of the Personal Budgets I set up included a laptop and broadband subscription. I know, it’s nothing racy but it has improved the quality of someone’s life more than an afternoon a week at a day centre would have.

I would place more value on a loving mutual relationship than casual sex but that’s my own decision and perception – maybe disabled and not disabled would make other decisions and the idea is that decision remains with the service user and not the social worker and that is the key misunderstanding and ignorance of Mooney. She thinks that somehow this money is ‘controlled’ by her, as a taxpayer and that the social worker makes decisions on behalf of the user.

There are stringent requirements and they are met. No more money is spent than would otherwise have been and why should we set stricter moral bounds to people with disabilities than those who are able-boded and able to make choices for themselves.

Saints and Scroungers – a review

I didn’t plan to watch ‘Saints and Scroungers’ on BBC1 last night. Really, I didn’t but it was nestled between The One Show and Eastenders (I never claimed to have particularly high brow TV viewing habits!) so it just happened across my TV screen.

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It made me feel very angry. That was my one sentence review. In more detail, the premise of the programme is to highlight ‘benefits cheats and to track down people who deserve government help’.

Even typing that sentence made me feel faintly nauseous. It isn’t like it’s hard to find instances of people who have defrauded the benefits payments system, after all. You only need to (and I know, this is a big ask) read the Daily Mail where there highly skilled *cough* ‘investigative’ reporters are more than capable of fulfilling that self-satisfying smug need to ‘feel better’ that exists within the general populace.

The ‘scrounger’ in this sense was an ‘unremarkable grandmother’ who had CONNED THE SYSTEM (a not-so-gentle reminder every now and then that that’s you and me, you know, The Taxpayer) out of £600,000 she wasn’t entitled to.

Fair cop – it’s a heinous crime and she was caught. My problem is not that particular instance because it is a verifiable conviction from a repeat offender. My problem with the programme is the way it was couched in a self-satisfied smugness and a perception that the benefits system must be so easy to defraud that ‘we’ are all being defrauded. The cost of the reputation of people who are entirely entitled to live and receive welfare benefits is the perception that fraud is entrenched in the system.

This programme was a case type in stigmatisation and alienation of people who might access welfare benefits and as such, although it highlighted evidence of a criminal offence, the language and presentation was such that we can all go and pat ourselves on the back for not claiming benefits.

The ‘saint’ I thought initially was a young boy who had been paralysed in a motorbike accident whose mother was nursing him and who was CLEARLY entitled to all the money he received in payments. Actually, the saint was the Citizens Advice Bureau advisor who had told the family about all the benefits he had been entitled to.

This part was equally nauseating. Firstly, the CAB advisor seemed quite happy to present herself as a saint. I know they do a good job – don’t get me wrong – I’ve come across countless amazing CAB advisors but it is hardly deserving of sainthood to advise someone who is very clearly an eligible recipient of their benefits. Also, alluding to this as ‘sainthood’ is a little cloying to say the least.

It places an almost Victorian overlay of Deserving and Undeserving Disability. This young man clearly deserves our support. He looks the part and is well-spoken and able to talk to the cameras about his disability.

I did have a brief thought about what the role of social services would have been in this case and how much they might have been deserving or not of ‘sainthood’ but to be honest, I’m glad they steered well away from this condescending and nauseating programme.

I also wonder if it was a coincidence (and I’m sure it wasn’t intentionally done) that the person who defrauded the benefit system was an older black woman as opposed to a younger white man who was rightly receiving his entitlements and doing so ‘fairly’ according to the programme. I know it might be complete coincidence and I don’t doubt it wasn’t intentional  but it does build on subconscious (or perhaps fully formed) prejudices and compound them which can be a dangerous thing in tough economic times.

Why did I continue to watch it? I was tempted to switch over  but then decided I might write about it… look what I do for you, dear Reader!

In the end the feeling I was left with was not a satisfaction that my tax paying money was funding a poor, disabled boy and that police were working to route out the con merchant grandmother who was ruthlessly defrauding the state but an immense discomfort that I don’t need the payment of my tax money to be justified to me.

I don’t want or care to be frank, whether those who receive ESA and DLA etc are good and honest people or not – they are entitled to that money regardless and no-one receiving a benefit to which they are entitled should EVER have to justify how they spend that money to anyone – least of all, me, an average taxpayer.

Do we forget that people who don’t work are probably taxed the most harshly through indirect taxes? We are ALL taxpayers and I don’t want to feel that my taxes should be making me feel better. My taxes are also paying for the Trident Programme and I feel much more strongly about that than the odd benefit fraud to be honest – and whatever the media perception in – I remain convinced that there are far more people not claiming what they should and are entitled to than those who defraud the system.

I don’t WANT to live in an society that does not have a fair benefit system.

I can’t promise I’ll watch the next episode because this one was too much to stomach.

And I really really don’t want my TV licence to be paying for such utter, pointless, cloying and irrelevant tripe.

Officers or Nurses

I know I shouldn’t go to the Daily Mail website. It is a form of morbid curiosity but I saw this article headlined and couldn’t resist

Chief Constable Peter Fahy of Greater Manchester Police says that he needs ‘more mental health nurses as much as officers’ because, and I quote

‘there were so many disturbed patients being let out onto the streets by the NHS that officers were having to ‘pick up the slack’.

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‘Let out by the NHS’ – I wonder if that’s the new term for a hospital discharge. .

I don’t even know where to start with this. Of course, I don’t have the figures to hand and don’t know what the time spent on s135 and s136 is on Greater Manchester’s police force but it’s a valid use of police time.

s135 is the part of the Mental Health Act that allows an AMHP (who would have a warrant) with a police officer to enter a property to remove someone who is mentally unwell to a place of safety for an assessment to take place.

s136 allows the police to remove someone who they believe to have a mental disorder to a place of safety for an assessment to take place.

And the use of s135 and s136 powers is not about ‘apprehending criminals or ensuring no crimes are committed’ but rather an act taken for the safety of the patients and the general public to ensure that an assessment can take place.

Public safety, I thought that was what we were to expect from the police as much as ‘apprehending common criminals’.

I ponder at his comment that

‘We have to train our staff to a professional level of someone like a mental health nurse to enable them to deal with these cases.’

Seriously? He thinks he is training his staff to the level of a mental health nurse? I have to say I am fortunate to work in an area with some really wonderful police officers but it’s a bit like MPs saying they are social workers because they deal with a bit of paperwork every now and then. It denigrates the work that is done by professionals and that it should be acceptable to make an issue of it is a surprise. If it is acceptable.

The article goes on

He said: ‘Officers are very good at being able to detect the burglars, the car thieves, the hoodies, basically your common criminal.

‘But what we are talking about is a particular type of disturbed individual whose irrational behaviour is outside of the norm.’

He told the conference: ‘I really feel for my own staff who are sent to domestic violence or mental health cases, dealing with vulnerable people when that officer is trying to do his best and then a tragedy occurs.

‘Even if they have done their best, the Independent Police Complaints Commission will treat the officer as if they are responsible.’

Mr Fahy also called on magistrates to lock up suspects until proper risk assessments could be carried out.

So much to pull apart in those sentences. Firstly, I think he is underplaying the skill of his own officers. He distinguishes between ‘common criminals’ and somehow manages to put mental disorder as ‘outside of the norm’. I’d love to know what his idea of normal is. .. oh wait, I think it is very clear. The fact that he refers to ‘hoodies’ says it all really.

I wonder how much he is just riding on the crest of Daily Mail readership but there’s some serious problems with what he says. The assumptions that he draws that mental illness = danger. That domestic violence is ‘just a drag’.

The police should be dealing with ‘common criminals’ rather than ‘domestic violence or mental health cases’. Interesting interpretation when he wants to pick and choose what help to give.

I would feel very sorry for any mental health nurses he did want to employ but I think it was just a matter of rabble rousing.

In the meantime it does nothing for the cause of working together and combatting assumptions and stigma against those who suffer from mental illnesses and need the support of services, including the police force, at some of the most difficult moments.

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Looking for beds

Something of a theme on my caseload at the moment is one of ‘delayed discharges’. I have three people in hospital medically ready for discharge and am waiting for residential or nursing placements to ‘pop up’.

It’s a warped kind of waiting game with no beds being available locally and people increasingly being shipped further and further out of London or at least towards the suburbs as the hospitals become desperate for beds and the lack of resources becomes painful.

One of the three has been on the waiting list for a local residential home for months. Another has a devoted wife who has constantly cared for her husband for decades through his progressively deteriorating dementia and another – well – the hiccoughs are proving to be way too many to detail succinctly..

But the result is the same – people who have strong local attachments, families and spouses are having to be placed outside the local areas.

It’s a subject matter that I have personally brought up again and again – going directly to commissioners when necessary but there is no aspect of my work where I feel ‘less heard’. Of course, placements can’t spring up overnight although some people imagine they can – and the brutal truth is that a placement usually only becomes available when someone dies.

That’s why the dementia residential placements locally have been so sparse – often they are taken up by people who could be very well physically and this means that those who need the beds are waiting longer and longer.

A part of the problem is that there was a feeling that ‘Extra Care Sheltered Accommodation’ – namely sheltered accommodation with additional 24 hour support on site – would ‘divert’ some people from residential care. In fact, the extra care sheltered properties, which we were told when they were established would be an ‘alternative’ to residential care, are not – at least in the local area I work (and it really could change from borough to borough) – not geared to meeting the needs of those who have 24 hour support needs. This is a particular issue at the moment as they seem to be incredibly reluctant to take anyone who doesn’t fit in to the ‘kind of person they want and would be ‘easy’ to manage’ making it more of an alternative for sheltered housing than for residential care.

I would love for there to be a widespread rethink of residential and nursing care provisions in the context of meeting individual needs. Prior to my qualification, I worked for about 7 years in a small group home for adults with learning disabilities and there was a massive focus on individuals and meeting particular needs. Of course, the funding is massively different level and that will always be the ‘sticking point’. There are vast amounts of funding available for younger adults compared to over 65s – simply because there is not the money there to provide the same levels of funding. Local authorities are not able to pay high care fees and the cheapest fees often involve large care homes. That isn’t to say they can’t involve personal care but more often than not they don’t – and certainly not where they need to be.

For every problem I find though, money is the answer – unfortunately – and in these times of shrinking budgets, we are left to provide what constitutes poor outcomes. I’d love to imagine a world where some kind of charity or donor could set up some smaller group-home like care structure for older adults too but the costs are way too high.. maybe that’s a project for the future..

Working in central London probably exacerbates the problem in some sense that the housing prices and land costs in the area that I work are particularly high – definitely favouring residential redevelopments for bankers as opposed to more substantial community resources.

But there is something incredibly cruel about ‘shipping out’ the older and the frailer to outlying areas. I know there is a move towards less residential care services but that isn’t the answer as there will always be some need for the provision.

Depression and Disclosure

My brain is slowly chugging back into something akin to functioning mode – after just a few days away it is always surprising how quickly it is possible to switch off.

Fortunately (or not, as the case may be) I don’t have much of an opportunity to stand still as my working week starts with a 9am Mental Health Act Assessment which was set up for my return.

So I’m charging my work phone in order to check the messages so that I’ll know if I’m still needed.

In the meantime there seem to be a gaggle of stories worthy of comment of which I can only touch on a couple which link in a way to depression, work and stigma.

A report in The Independent yesterday notes that

The blight of depression affecting hundreds of thousands of people across Britain is costing the nation’s ailing economy £8.6bn a year, £3bn more than a decade ago

Of course, there is no doubt about the debilitating nature of depression but I was curious as to why the costs relating to depression should have increased so sharply.

The research quoted by the Independent, allays this  figure  not to increased costs for treatment of depression through the price of medication or treatment on in-patient wards but rather the cost of lost labour due to the difficulty of managing return to work although all those factors would contribute to an increased national cost.

The ‘New Horizons’ strategy which is due to be published later in the year is said to have a stronger focus on ‘public mental health’ and broader preventative measures and until anything is published it is hard to comment or critique any potential plans.

Oil on canvas

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Interestingly though, Margaret Wallace, the Chief Executive of SANE is quoted as saying

There has been continued loss of psychiatric beds for inpatient care, the closure of day centres and impoverishment of occupational therapies. While the Government is planning to increase the availability of cognitive behavioural therapy for those with mild to moderate depression, we are aware from the many thousands of people who contact Sane that there will continue to be many with complex diagnoses who may not be included in such programmes, and who continue to struggle without the necessary psychological support

It’s an interesting and useful insight into the measures that have been promoted by the government towards shifting money to more CBT (Cognitive Behavioural Therapy) and preventative work at the milder end of the ‘depression’ scale – but the gap remains with those who are suffering more acutely.

The trouble is that working in the secondary health care services, it’s always difficult to know about the people who you don’t see or know about – although there is no doubt that between mild and severe, is a large group of people who may be unable to work but not able to access sufficient support.

It leads me on to another story that had been rumbling in the background relating to Christine Laird – the Chief Executive of Cheltenham Borough Council – who, in the words of The Guardian,  was taken to court by the council that

claimed Christine Laird fraudulently or negligently withheld details of a history of depressive illness when she became its managing director.

To sum up, Laird was employed in 2002, underwent significant stress at work including allegations of poor treatment at the hands of some in the  and left in 2005 requiring a period of treatment at a psychiatric hospital.

The key to the case revolved around a medical questionnaire that Laird had completed when she applied for the job in the first place.

To the question: "Do you normally enjoy good health?" she replied "Yes". To: "Do you have a mental impairment?" she replied "No".

The court was told Laird suffered "three episodes of depression with associated anxiety" between 1997 and 2001. But she saw it as "stress-related illness and not depression" linked to "non-specific, non-recurrent events".

I wonder how much work-related stress and depression are linked to be honest. I know a few people personally who  have what I would consider to have suffered from bouts of depression but have insisted that it is recorded as work-related stress on any documentation for work purposes. I suppose the hope that the stigma related to ‘depression’ is still too high but this case doesn’t really help matters. 

The Court highlighted the ridiculous nature of those specific questions – ‘normally enjoying good health’ can be interpreted so broadly as to be largely insignificant. It is also a completely value-based judgement. As for asking about a mental impairment – again, is it asking for a legal definition in accordance with Section One of the Mental Health Act (1983 as amended 2007) or is it asking for an ‘average man on the street’ definition which would probably stigmatise ‘mental impairment’ to a much higher degree.

Laird won her case but was instructed to pay partial costs amounting to £190, 000 but leaving the council with a bill for £1.6 million.

Of course, it is always important to be truthful on medical questionnaires but it is possible to see where the discrimination can fall.

It is hard enough for work to be found at times without giving employers more reasons to refuse to employ someone with a history of mental ill-health. The questions were poorly structured and perhaps a more straightforward way of asking where no doubt could have incurred should be and probably is now, written into the application forms but I wonder how much influence they would have on the appointment of a perfect potential employee who has, in the past, suffered from a depressive episode.

Quite rightly, campaigning groups have welcomed the court ruling against Cheltenham Borough Council but I wonder how many councils will be more wary to employ someone with a similar background in the future – maybe reports from medical professionals will be relied on more strongly in these circumstances and a type of ‘well note’ will emerge where it is possible to explain what can be done rather than where problems lie although to be honest, that is a little fanciful.

Would an employer make this effort for a potential employee when there is another potential employee without a similar medical history? Realistically it is unlikely and that is a cause for sadness.

The ease at glossing over any past problems can be all too tempting in a culture that judges health and competence so narrowly.