Surviving The Referral & Assessment Process:
There are a number of things we can do for ourselves;
UK: Social Care Services & Support;
This support (in whatever form) is available for anyone assessed as 'in need' of Social Care support. This decision is obtained by a Community Care Assessment (Social Services). You will need to contact your local social services to get an ‘Assessment’. You should think about how some support will help you remain, or become more independent, less at risk, or overcome social stress & isolation.
There may be a 'Single Point of Access' telephone number, or you may have to phone, or visit a Social Services ‘Area Office’ (see Local Authority’ web site, or phone book. Where the primary problem is identified as ‘physical’, or ‘mental & emotional health’, your GP can refer you. You are entitled to this Assessment 'by asking'. Insist on a visit, ‘as explaining on the phone may be a problem for you’. You will need to convince the person that you require some form of Social Care & Support.
I have to be frank with you here. If you suffer from a ‘minor’ physical problem, or depression, and there are no other disabling problems, you are unlikely to get help there, except, perhaps, short term, via your Neighbourhood Team. These relatively minor problems can now be dealt with by the GP, Physiotherapy, District Nurse, Counselling, Paramedical & alternative therapy staff, or Neighbourhood Team, etc.
More serious Physical & Mental/Emotional problems will be ‘clinically’ dealt with by Health Services & your resulting ‘dependencies’ then dealt with by, or through, Social Care / Community Care services. Physical Rehabilitation is a joint venture. The ‘physical’ side of Health Care is usually very good, at all levels. It is well understood.
The ‘disability’ and ‘social mental health’ perspectives, (that is the psychological and emotional impact on us when our lives fall apart in some way) are less well understood, at this ‘clinical’ level. Impersonal ‘objectification’ is still part of the health workers defence mechanism. Forgive them if they lack bedside manor, or act as ‘experts’ on you. Take from them what seems valuable and leave the rest. Let them know what you do accept.
Social & Community Care is the reverse of this, in many respect (perhaps it should be). Its primary purpose is to integrate, or help re-integrate a person into the community. The ‘clinical’, or medical perspective is outside this picture, and its contribution requires translation into a more commonly understood language. Social Work, on the other hand, needs to be aware of its increasing ‘linguistic formulations’ (Joke J). Words are not magic, they need translating into action.
Social Care’s increasingly rigid perspectives & ‘private’ language is quite disabling, especially when mixed with ‘hidden’ prejudice about what is ‘normal’ & ‘acceptable’ conduct & thinking. It is almost as if Social Care (Social Work in particular) were competing with the worst side of Health Care for terms and categories that are ‘exclusive’ rather than ‘inclusive’. Hopefully, one day soon, Social Work (& Health Care) will understand its true vocation and recognise ‘Social Inclusion’ for what it is.
For yourselves, take confidence from the fact that being a ‘Nuisance’ is not adequate grounds for Mental Health treatment, (or for being ignored). Neither is being ‘very angry’ and finding it increasingly frustrating to get others to understand your perspective on your problems, even to the point of babbling. The service is not user friendly and sometimes does more damage than it does benefits. However poorly you feel, you will need to take some responsibility to get the support you need; to get the support you need. ‘Ask a Friend’, to help. Also make sure that the service you get is the service you expected. If not, make suggestions, or complain.
The services are increasingly run by Accountants and Solicitors. They are Perfectly lovely people, but are not the most skilled at ensuring a smooth, uncomplicated, efficient low cost, ‘person centred’ service. These days, the ‘protections’ they put in place usually cost more than the savings on over spend that would have happened anyway, to the cost of being sued (but more about that else where).
For now, try and be as clear and confident as you can, what it is that you need to become and remain more independent in you actions and more responsible for you own life. To do this, you may have to accept ‘some’ dependencies upon others, but these should help your greater, overall independence and initiative taking (taking decisions for yourself). To be a ‘Service User’ you do not need to be a ‘victim’, ‘pathetic’, or ‘disabled’. Just in need of support towards sustainable independence (this is true for the Family Carer and the person they support).
Things are improving here, with the development of ‘Social Psychiatry’ and Joint Health & Social Care working, but it is patchy. There is still a tendency for ‘mental & emotional health’ aspects to be seen as organic and therefore ‘clinical’ problems. This (in itself) is not a ‘failing’. Specialism is necessary, because of the complex nature of knowledge, techniques & skills involved. This is how we advanced. Learning technique is a ‘shortcut’ but it gets things started.
Basically, no one person can be expert in all things, these days. There is increasing need for ‘Liaison’ practitioners, who have general understanding in both/all camps and can translate one to the other (and for you). To some degree, this is what I am doing here. GP’s once had that role also (and perhaps some still do). The GP is the ‘Generalist’ and the Consultant is the ‘Specialist’. It works well (except the specialist sometimes needs to get over themselves). Good ‘’Generalists’ are the more important (Ask Einstein). They put everything back together, in simple terms.
The development of specialist ‘techniques’ and of ‘structured’ interventions, means that an increased number of people can be trained up to be available to help you. It requires re-integration, however.
Joint working has been difficult in the past, because of these differing perspectives and knowledge bases (and different philosophies). Hey competed to be right. Both sides now have to work to understand the other, respecting both contributions to your support. This, at the end of the day, needs to be in language and concepts you can understand (or that can be explained to your benefit, or that you learn about if you wish). You become the expert on you, when you have knowledge and choice.
Our Perspective: Mental and Emotional problems arise from essentially social causation. We are each born with differing propensities in different areas of ‘being human’. Human beings are a ‘divergent’ species. This means that they genetically have evolved very successfully and have, within their ‘genotype’ (their genetic makeup), most of the ‘common’ human traits, but can also be more disposed (or dominant) in certain selected areas.
Some are better disposed towards one ‘social disposition’ than another. Some are practically intelligent, some emotionally / socially intelligent, some intellectually intelligent and some creatively intelligent, with any mix of combination. When we find our niche, we are settled. If we are forced into an inappropriate niche, or coached along lines that are not true to ‘us’, then there can be problems. Sometimes these problems then become society’s problems also.
Often, and for the same kinds of reasons (misunderstanding & misperceptions), we can then respond poorly to these ‘social’ circumstances, especially if our perspective is the one at odds with the majority. T odds is not wrong (Remember Einstein & others). Those with whom we live, work & obtain services may then further respond inappropriately to our ‘response’.
These problems can become very serious, in terms of conflicts that can ensue. If they become ‘entrenched’ and you are in the minority but know you perspective is reasonable, you can find yourself ‘prejudice’ against for having ‘any’ differing views, not just race & gender, etc. The argument ‘they don’t understand me’ is true, more often than we realise. Listening & Understanding is an active process where ‘perspective’ & ‘context’ are everything. People can drive you Mad having convinced themselves that you are; beware it is very common.
Part of the Social Care role is to get each side to appreciate this and enable ‘translation’ of these perspectives and understandings. This is already understood for Race & Sexual Orientation and Gender. Most problems then settle down, with greater mutual understanding. Differing Mental and Emotional dispositions and perspective are more problematic. They can ‘challenge’ others security for their own disposition. They can become defensive, dogmatic and controlling.
In the mean time ‘clinical’ interventions can help significantly. If there is a clear ‘organic’, ‘chemical’, or ‘physical’ contribution to a mental, or emotional difficulties their value can be well appreciated. That is, if one has a clear chromosomal, identified genetic, chemically induced (Drug Alcohol & Solvents), or physical trauma, with direct psychological and emotional effects, the bodies imbalance can be rectified, at least in part.
Where there is no proven organic causation (as most cases of depression & psychosis; including schizophrenia & Bi-polar disorders), there can still be considerable benefit from clinical treatments. Overcoming a lifetime trauma, which brings about many of these conditions, is hard work and the clinical intervention can be the first step towards conquering a ‘disability’ threat these conditions can induce (whatever their cause).
If you are asked what the nature of your problem is, try to explain these best you can, in your own terms. Let the ‘Assessor’ (Care Coordinator / Social Worker / Community Care Officer) to identify these problems in their terms, but ask for explanations which are acceptable to you. You need to ‘Think Independence’, ‘Reduced Personal Risk’ and ‘Being Enabled’.
There is likely to be misunderstanding on the part of the Assessor. Don't get mad at them. It is a complex situation. They have to protect spending also, which is good. The balance is sometimes lost and often, not enough consideration is given to your lack of knowledge of the service.
You can challenge the decision made, if need be. The assessment is of 'you need', not the institution's idea of 'need' and definitely not its ability to pay for services. Tell them this with confidence and don’t get 'mad' at them. Refer to this page. There are links here to help them too.
Your 'need' is any requirement necessary to bring your personal independence and access to Community, up to the level of the 'normal’ expectations of the average citizen. The 'Best Value' standard is used (appropriate, local and good enough quality service, at an affordable price).
They are then options available to 'Service Users' (Support & Respite) and, separately, options available to “Family Carer’s” (Respite). Your Family Carer can access other services 'on your behalf', to assist in your care & support towards ‘greater independence and inclusion’ (with necessary support).
OK; having agreed, often with some argument, that you require a certain level of support, to maintain your independence, you may then be provided with a service, or told you do not meet 'their' criteria. Don’t be put off. It usually means they don’t have enough money available for you.
If you believe that you physical, health, learning, mental health, or social inhibition, of any form, 'disables' you from being independent, reasonably safe, or enjoying normal community access, get this recorded in a Community Care Assessment. You are entitled to that much, without argument. Ensure they are not restricting your access by assessing you against the ‘costs’.
If you have a severe restriction on your ability to manage independently there should be no problem, but if you have been ‘managing’, this could work against you. Tell them why this is no longer possible, or how this is becoming difficult in some way. It is not enough to say ‘because it is there and I am entitled to it (even though you may be)’.
Often it is because there is more than one problem. Combinations of problems can be a reason for failing to manage independently in any case. Each problem may, or may not be severe, but the combination can be very inhibiting and disabling. This can include people’s ‘reactions’ to you, including that of professionals, and even the ‘Assessor’.
Some aide, or adaptation, for giving you increased physical independence in the home, is obvious. Mobility in the home and in the community is also quite clear and easy to understand. Having Agoraphobia, Severe Depression, mild learning disability, a Psychosis, an Early Stage Dementia, a Chemical Dependency, and any/or other combination of physical, psychological, emotional, or social problems’ can be more problematic.
Firstly, they are often seen as ‘medical’, or ‘mental health’, which (like physical disability, cancer, stroke and severe dementia) they can be. The ‘disability’ that ensues is not medical however, and, whether or not you accept all medical ‘treatment’, the ‘disability’ is ‘social’. This is where Social & Community Care comes in. It is simple really, but professionals get caught up in their “specialism’s” these days. You may need to educate them a little.
Ask to see the Community Care Assessment, They are required to give you a copy, 2 weeks is an acceptable delay.
Direct Payments is one you may get more likely, where there is a dispute about your entitlement.
BULLET POINTS:
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