| Intellectual Challenges: All Community Institutions have a significant effect upon people's motivation and skills, to take responsibility for their own lives. When institutions become institutionalised and assert executive power, they have the effect of disempowering Workers and the Service Users. They become less effective because they become less adaptable to individual needs. Insecure and defensive Institutions arise because initial incompetence (often due to micro-management and risk averse policies) produces 'reaction' from increasingly 'aware' Service Users. As long as there is imbalance of power & responsibility, the relationship between institution and citizen is going to be potentially strained and give rise to complaint & litigation. The necessary skills and motivations are there, within any workforce (and waiting in the wings, within more adventurous projects) to enable Service Users to get the service they need, in a form that empowers. This enables them to take responsibility for informed decisions and thereby reduce the risks to a level that suits them. This then reduces the risk of litigation. Defensive and controlling institutions increase risks to Service Users and increase the possibilities of litigation, due to the fact that they held on to the power. They therefore, by default, retained the responsibility. Risks can not be eliminated without depriving people of their rights and freedoms. The risks must, of course, be seen to be assessed, informed, managed, and reviewed. That also involves 'risk' but it should be the individual professional's accountability, 'supervised' by advisory service managers. Micro-management does not work. It disempowers and frustrates 'responsible actions'. Get your team right, provide the resources and encourage initiatives. The ultimate power should be with Service Users, empowered through the support of competent professionals and other informed carers, monitored by independent agencies, ensuring that a balance of power has been achieved, adequate resources provided, shortfalls recorded and care & risk plans agreed and set down for all agreed actors in the care plan. This does not have to be very complicated. The obligation is to provide services to a level that enables the Service User to enjoy a normal life, as independently and informed as possible, using their own and normal community resources, to provide the bulk of support, with an informed level of risk that the service user 'chooses'. They should have their own 'Notes'. To achieve this, we need to consider the 'optimum' level at which to provide services. Neither inappropriate to the needs and risks, or too restrictive, or inadequate. It is the professionals task to 'advocate' for Service User initially, then to inform and support them in advocating for themselves and to identify how, when and where to obtain the help they may need (contingency plan). All professionals are then responsible (collectively) to ensuring appropriate relationships are established with any carers, family, voluntary, paid and unpaid. That these relationships are acceptable to the Service User and that everyone who is agreed to be involved, is informed and accepts the agreed plan and risks, as ultimately determined by the Service User, adjusting to take account of evidenced impairments of 'Mental Capacity'. Mental Capacity The issue of 'Mental Capacity' is often seen as a problem for many professionals. Being a professional has responsibilities and certain powers. At any point in time we may be asked to give account of decisions and actions. Writing up in diaries and in on-going notes will not cover you. Service users must be informed and their agreement sought. No policy statement, or managerial directive of Institution will protect us. We are required to identify evidence of a person's 'lack' of capacity at any point in time and under certain identified circumstances. We are then obliged to act in the least restrictive way to 'manage', or get others to manage any 'additions' risks that may arise because of this. Any temporary, or permanent 'lifestyle' changes, like ill health, conflict and circumstances, may change 'Mental Capacity', or increase the risks, given an impairment. Some of these we can't know, some we can anticipate and record as potential risks. Life is full of risks, our job is to manage these to a level that is in keeping with the person's normal lifestyle wishes, taking account of 'unrecognised' risks due to an impairment. Our accountability is in the assessments we make, the judgments & decisions we take and our consequential actions. If we take all the power and the responsibility we will be culpable for all consequences. If we empower the Service User, provide the agreed support, and inform adequately, including informing where a support is inadequate, or failing, we have effectively done our job. The responsibility is then others, mostly the Service Users and the care providers. Some institutions will resist you describing the shortfall in service provision, including the restrictions place upon yourself, to do what you professionally believe is necessary. Time and supervisory / practice requirements may mean that you have to act outside your Ethical Brief. Institutions will need to get used to it. It is not enough just to put this in the Care Plan. It has to be a statement of service shortfall, at each instance, or recorded and presented at reasonable, manageable intervals. It is the final professional act before closing any case. It protects you, the Service User, the Carers, the Institution and advises of a potential need to be met and potential risks that may arise. Critique of Social Work & Social Care: Social Work has been progressively displace towards the more Legalistic, Policing and Administration Roles. The Profession has lost the confidence of many Clients and the Community. This is basically due to the confused state of its Institutions. This situation has arisen because of the intellectualisation of the profession. The ability to 'talk' about doing' is appreciated in favour of demonstrated competence in solving social problems. Knowledge is power, even if the 'interpreted' knowledge is inept, or applied ineptly (interpretation is key here). The 'institution' of social work appreciates the status of social work (for the purpose of career advancement and assessment of competence') in terms of the 'power' it has acquired to take action and 'rationalise' the intrusion it makes into peoples lives, including the justification of maintaining budgets,; in terms of restricting funding, rather than most effective and creative use of funding). I use the term 'rationalise', with it psychodynamic meaning, quite deliberately. Having a 'rational' understanding and ability to operate in a structured and considered way, in order to intervene in sensitive family and personal crises, in ways that resolve problems in the least restrictive, most empowering and risk managed ways (etc. etc.) is appealable. So, where is this good practice? Well, it is there but is now relatively rare. It is mostly there in 'newer' social workers, those in training, those who are mature and experienced but stayed at the 'practical' end of social work and, in radical projects outside of the formal social work institutions. So, what about the 'rationalised' services I referred to earlier. Well, this is when practitioners and managers stumble from one social, or institutional crisis to another, scribbling down what they did and why they did it, seeking excuses for failures and mistakes, from their wealth of academic knowledge (or plagiarised) and then presenting these as justifications for the mess, distress & risks they have created by not thinking critically to begin with, at each intervention. It is what I describe as the "Emperor's Clothes" syndrome. The first description is the use of knowledge and experience, within a framework of ethics, to anticipate the 'reaction' of clients to our intervention and making the approach in a way that empowers them, to the degree that they are able, to offer 'real', informed choices, without pre-judgment, appreciating the complex and often hidden dynamics of family and cultural differences (and not just 'race and gender'). It Now, those who have been a frustrated part in this situation and are now clapping their hands with the recognition that this happens, will have no serious problem with this description. (Hi there Compadre) Critique of Health Care:  This page is in the stage of preparation.
To see this in stark contrast, one just has to read some of the better academic works which advance the basic ideas, principles and finer ethics of the profession and then (if you are fortunate enough to obtain the research opportunity) compare this with observations of social work interventions. I have had this opportunity, as someone working outside of formal social work (in the voluntary sector), within social work; as a manager, as a trainer, as a practitioner, as a community worker, an advocate, as a radical practitioner and as a 'service user', an 'observer' in real life 'critical' social work interventions. Just as importantly, I have acted as a 'recorder' of people's experiences at the hands of social work (as well as social & health care). In all these situations I have, of course, met a whole range of practitioners and managers. These had differing levels of practical competence, human & social skills, attitudes and academic knowledge and varying levels of intellectual skills. My on-going research This page is in the stage of preparation. Either Social Work, as a profession, gets its act together; by getting involved in 'Social Problem Solving', or The 'Infection' model of 'Social Ills', along with a 'Disease' model of Social Problems, will take over this domain. It is no accident that the new 'community initiatives' are being managed by GP's, through Neighbourhood Teams - Community based 'Social Health Care'. The models used are flawed but at least they are established frameworks to work within. The medical model, as applied to the how Communities, cultures and Societies become 'sick', is very convincing and highly predictive, at a group and community levels. It is quite a valid 'social' model. In fact, it appears more appropriately when applied to cultures and societies than it does to the individuals, especially in terms of the interpretation of 'mental health'. There are no competent, established Social Work models to challenge this development. As Social Psychiatry starts to gain credibility, the 'organic' health care model will also loose its potency in mental health. Social Health will come to the fore. Its a shame. The balance between 'health' & 'social' models, even with the 'conflict' that was often apparent, was a potentially healthy one; reflecting the tension and balance that is required between individual and community (or State). Well that's my opinion anyway. I really do think that Social Work has lost its way and it has been painful to watch this over the last 25 years or so. There is risk that the power of 'Health Care Experts' will again asset itself disproportionately. Social work, as a profession is becoming increasingly disempowering in its practice, while medicine is now likely to become more liberated, as Patient Power increases. Some patients are challenging the assumptions of medicine, with the diverse clinical information and opinion that is available on the internet. There is also a move towards getting patients to take responsibility for their health. This policy is double edged though. It was institutionalised 'Health Care Expertise' that created the dependency in the first place. As health care once more gains 'social' awareness and an increasing role in community practice, the supposedly independent, empowering role of Social Work will diminish further. I meet individuals who clearly have the right attitude, but they are being sucked into the an increasingly 'local government' determined 'institutional' role. The role is fast becoming 'social policing'. 'Protecting' community at the expense of some individual's liberty and choice. This is a general trend within western cultures, one that arises out of increased 'fear'. The 'good practice' guidelines are given credence only up to the point where 'Law' is seen to override these principles. Underlying 'Human Rights' legislation is still badly understood and poorly interpreted, in social work and health care, but is Social Work that has the prime responsibility. A real challenge will come soon. This page is in the stage of preparation. There are substantially more cases of injustice than come to court , or are reported in the media. This affects Child Protection and Mental Health Practice in particular. Neither of these client groups have potent, independent, Service User representation at Policy Level. Obviously, some practitioners and managers love the increased power that this new 'institutionsl' status gives them but such practices are 'Dependency Creating', not 'Enabling'. It is 'safer' and less mental effort, for practitioners to resort to 'The Law', pretending they are dependent upon doing this, as a 'requirement' of their job description and service conditions. Ethics, Morality and Critical Thinking then go out the window. 'Reflective' thinking is important and is encouraged but without 'Critical Thinking' is very incestuous. Without critical thinking we will tend to assume the status quo is correct & unchallengeable. In Professional Supervision it is being used to 'filter out' personal experience and insights, supposedly leaving behind the 'essential social worker' and 'pure clinical perspectives'. This is a serious mistake and a delusion. It is the personal insight that 'Reflective Thinking' provides that are the most beneficial to Service Users. They appreciate this level of recognition of their problems, if used appropriately, with proper, therapeutic supervision. Critical Thinking also provides an opportunity to see the services as the Service User sees them. It gives an additional set of insights into the pretentiousness and pompousness of over intellectualised professional services and professions ethos. What do you think? I will ask you again in 10 years :-) This page is in the stage of preparation. | NOTE: This Document is still at some stage of development. You are invited to respond and comment on its content and its logic. If you return to the document at a future date, you will be able to see its continued development, hopefully reflecting your own and others commentary. I thank you, in advance, for any contribution that you make. Please also feel free to visit and contribute, in any valid way, to these and other social issues, through our Forums. There is also a Chat Room and protected Chat Space for more serious group discussions and individual counselling. Please feel free o use this space for your legitimate activities. Copyright: Although you will see very few reference to other formal writings in this document, I acknowledge general recognition to the discussions and debates that I have had with students, practitioners and clients over the years. Most of the ideas and theory has evolved through this rather pragmatic process (operational research), rather than any formal reading. If any content of this document describes concepts, theory, or ideas that have been established else where, (prior to my writing, either here or else where - in part or in full), I acknowledge their entitlement to claim them as their intellectual property for financial purposes, if they can evidence this. I also reserve the right to retain them as my intellectual property, with due recognition to those who have made direct contributions, including other writers, should I identify such a past influences. Other than this, I invite you to share and copy any content, to the benefit of intellectual debate and the benefit of individuals and groups, without restriction, other than it be used for constructive purpose, in the wider context of my writing. Should you wish to use any material presented here 'as is', I ask that you then make reference to myself and the web site. The 'Reading Date' would be a useful 'publishing date' for the Current Edition. 1980 is the core publishing date for most of the basic ideas and theory (unless stated otherwise). This 'Reading Date' may be an important part of this 'reference', as the document (by its 'internet fluid' nature) will be constantly changing and this may affect meaning and interpretation, for those following up on such a reference at a later date. Thank you for your cooperation. TRC. eMail: terry.couchman@visitweb.org |
