Introduction:Firsts of all, let me apologise to any 'Service Users' out there and any 'Voluntary Groups' and 'Professionals' who do not have an interest in the politics of Social and Health Care and just want to get on with the job in hand. Next, let me apologise for the 'intellectual' character of much of what is written in this and other sections. It is our Mission to get through barriers and prejudice; both within society generally and within Organisations and Institutions. This often requires sound, logical, comprehensive argument, anticipating every challenge and barrier that is put up in defence of current practices. If you want more down to earth accounts of our purpose and intentions you will find this else where in our documentation. You can also find stimulating material that 'Service Users' and Professionals present to us and give permission to put on display. I suggest you read the section on 'Lets Cut the Crap', if you want a counter-balance to the material here. This section is designed to 'talk through' and, if necessary, 'break through' the intellectual, political and quasi-legal barriers that are often artificially put up by institutions, to disable wider criticism, complaint, minimise demands and justify current practices. Further more, If you feel, as a Service User, or Professionals, that the service you receive, or provide, is adequate in itself and adequately supported by the institutions providing the service, we apologise for any offence you may feel. This is not intended. We understand that there are many 'good practices' out there and value the contribution these can make to services generally. A good quality service is often won against the odds, given the restrictions imposed. If you do have example of 'good practice' please feel free to submit them for our publication. It is one of our missions to promote good practice, even where it does not fully meet our radical criteria of anti oppressive, empowering, service user centred, self advocating user-professional partnerships. We understand the constraints that you are often working within, even if managers do not recognise, or accept this (Trainers often do). I, and my colleagues, have to work in such limitations and going outside the institutional boundaries is tolerated and supported, where it provides safe practice and produces good results (in spite it requiring us to step outside of, or go beyond policy frameworks at times. Institutions have become 'self protecting'. The workers within them often have the compassion and insight that demands they take some risks; sticking to their ethics and best practice inclinations (focused on the individual) instead. Promote Support & Wider Understanding:It is our mission to provide information, advice and therapeutic services to directly support people in crisis and to advance public and professional understanding of the issues surrounding mental and emotional well-being, and what has usually been miss classified as mental illness. The concept of Mental illness suggests that these problems are of a rather isolated, 'pathological', very personal and rather 'organic' nature. They are not! We will demonstrate this in all but the most extreme, minority of cases. We will seek to support people from their own, considered perspective, and empower them to take greater control over their lives, even where there is accepted organic damage. We accept that there is a biological basis for 'how well' and in 'what way', we do-or-don't cope with psychological & emotional problems. We contest that these genetic, physical, or organic features are not 'primary' in mental health, ever! We will show how these same aspects of 'self' have many personal and social benefits in different circumstances. There are some more advanced psycho-social propensities, which some citizens exhibit, that miss match current 'selfish' philosophies and practices and disable people. The problems become 'personal' and pathological, because they do not constructively fit into modern, conventional perspectives. These wider, positive features of the person's adaptive 'security' system' can have attendant vulnerabilities (negatively consequences), affecting our ability to 'cope' in some (mainly abusive & disempowering) situations, mainly because of the learned, prejudiced and institutionally limited perspectives of others. This is a necessary historical phase which get distorted by selfish interests. One glove does not fit all, in all circumstances. What you experience in the services provided often had an original, constructive purpose, which became distorted and engrained. We will seek to support you in obtaining the skills, information and knowledge to understand how you can manage your own situation and personality better. In doing so, we hope to help you 'empower' yourself and gain the confidence & skills to withstand the institutional restrictions. We will seek to help you obtain the appropriate support that 'you' need to resolve the residual problems you may have; with yourself, your family, your community and society. We will try to help you understand your experiences in a constructive light, drawing on your legitimate life history and insights, which may have become distorted because of the 'ignorant', often benign intrusion of others, &/or your consequential loss of self confidence. Basically, we argue that these problems are not what they are assumed to be. Historically, 'health treatments and cures' have become the route to try resolve most of the underlying issues. This is because the local doctor once had conventional wisdom as well as medical knowledge. His, or her, conventional wisdoms and educated perspective, were drawn from their general knowledge of the community and wider experiences of life that the profession and the training allowed them. This wider perspective was beneficial. This was (and is) also true of the 'original' concept of nursing. We will demonstrate that the modern, pure, 'clinical health' perspectives are not effective on their own and constitute an emergency 'band aid' only, often too late, or inappropriately applied. That is changing, but attitudes are entrenched. The social care component (originally available in health care) has been largely removed, except in the more enlightened community medicine. Sadly, the social care aspect has been transferred to poorly trained, originally well intentioned & motivated, but poorly paid care workers, largely working in the private sector with inadequate quality control. Social Work is now more legalistic, intellectual and institutionally constrained. It provides little direct, socially reparative, or individual therapeutic support. With the best of intentions it is becoming increasingly difficult to provide an individually directed, empowering service, within the family home and general community. There is a lack of specialist knowledge in formal Social Work. Psycho-social knowledge, expertise, skills and, especially, 'insight', are sadly lacking in areas like mental health, learning disability, alcohol & drug, psychological & emotional abuse, older age / dementia, and in other specialist areas. In many ways, Social Work (in the UK at least) has shot itself in the foot. It has lost credibility with those who have suffered at the hands of its interventions, at its inability to intervene until crisis arises. But for the intelligent efforts of a dedicated few, often self appointed specialists, there is an inability to justify its errors and lack of convincing argument for its failing in the eyes of the more enlightened middle class. The GSCC (UK Governing Body for SW) attends to specialisms very badly, beliving that generic social work skills are mostly adequate, along with extensive general and specialist legal training. One of their explicit roles is to protect the status of 'Social Work' and they do this at the expense of specialist knowledge, but mostly at the expense of 'insight'. The consequence is a group of Social Work professionals largely trained in anti-discriminatory and empowering practices having to resort to institutional methods, contrary to their ethics. The guidelines set by governing bodies and governments are such that the professional status of Social Work takes high precedence over Social Care work generally. There is little, if any, plans for any kind of intermediate specialist status, never mind equivalence of status between Social Work, Community Work, Community Care work and Social Care in general. A situation of that has been evident for many years and is unmistakably status and financially driven. Skilled and highly trained Social Care Workers and Community Workers would expect higher status, challenge the institutions more and demand more remuneration. The same is true in the health care sectors & trusts. The GSCC position is protectionist of Professional Status rather than the safety of clients / service users. Prescriptive legal guidelines and policies means that child & family work is often limited to delaying and reacting to the crisis. This often means that workers are going straight to legal interventions and child removal. This isn't just the case where they have been clearly seen to get it wrong, It also includes the times they have taken an inappropriately institutional approach to common problems. The criteria for attending, supporting and intervening is set at a minimal level, protecting the institution without protecting the family or the child. The greed, misfortune, family history of neglect, abuse and prejudice play their part in making poor parents. Attitudes, prejudices and conduct of professionals and the This is especially the case in poorer and single parent families, where there is less pressure to look and reparative interventions. Ignorance about poverty, alcohol & drug and mental health issues, means that these are seen as acceptable 'reasons' to remove children rather than put in the effort and resources necessary to protect children and resolve underlying social and personal issues of parents. Thankfully, in the process of providing support services, some professionals are once more (often accidentally and sometimes purposefully) attempting to provide the other 'personal', or 'social' inputs that are beneficial. Unfortunately, the available resources are usually inadequate, given the problems 'we' have generated by our distorted focus and the 'dependencies' that existing services have created. ractitioners are becoming distressed, ill, and disillusioned. In effect, various professional services have become too 'pure', dogmatic, intellectual and fragmented. The 'social care' component has become separated, fragmented, commercial and highly intellectualised through 'policy', especially at the higher managerial level. Colloquially, what is called the 'jobs worth'. For largely financial reasons, the social care component is no longer seen as a legitimate part of direct nursing, or specialist social work. One end of the services has becoming intellectualised, aloof, well paid and detached and the valuable 'social and practical skills' end is becoming increasingly impoverished, underpaid, over demanded and demeaned by the intellectual brothers and sisters. It is a characteristic of our modern society that the plumber, electrician, and car mechanic were unrecognised as valued contributors to society until the 'intellectual' is forced to pay substantial figures to get these problems resolved. Our culture has become skilful at intellectualising social problems away as they are intellectualising their personal problems. This is understood, in psychoanalytical thinking, as intellectualisation and projection. Sadly the intellectual elite (and now the plumber, electrician & car mechanic) don't pay enough to ensure the average mother, father, cleaner and sanitary worker, is appreciated for the substantial and significant contribution they can make (given the appropriate resources and recognition). Things will not improve until there is proper equitable appreciation of the valuable services that all people can provide in avoiding the likes Aids, MRSA and Environmental Problems (generated by unfettered and relatively ignorant, application of 'intelligence'). It is this same kind of limited perspective that also restricts the perception upon the causation and appropriate resolution of mental, emotional and social distress. There is very little flexibility in the 'system'. Services are becoming risk and litigation adverse, they have become somewhat detached from everyday realities and circumstances. The services have become institutionalised, depersonalised, disempowering and blaming. They are (like the medical model) prescriptive. It is now 'your fault but you are too stupid to know that'. The intellectual expert 'knows best' but it is still your responsibility that you have these problems. Its has become a classic Catch 22. The 'class system' is still there, it has just changed. Not a Marxist analysis, a true intellectual one; we have become intellectual snobs but often don't have the intellectual (reflective) insight to recognise it. It is our mission to demonstrate that the initial 'psychological trauma' reaction to dramatic change, personal crises and social conflict and distress, is usually 'natural and purposeful'. Unfortunately, by the time we are adult these 'natural' reactions to resolutions of this 'trauma', are undermined, distorted and corrupted by quasi-professional and corrupted social perspectives. We intend to show how we can individually and collectively, get back in touch with these 'natural' defences and recoveries, assuming that we want to and have not been pushed into denial by previous disempowering treatment (given that institutions can tend to take that 'responsibility' away from people, along with their rights). We will help peel away the artificial 'intellectualisations' and reveal the social and personal truths. In the process we will take advantage of the wonderful discoveries that have both helped produce our problems and give us the means of recovery and resolution. Medicine has its benefits in this area, when things have gone too far. Technology has the means of facilitating our lives as well as intimidating and disabling us. The positive results are more about our intentions rather than the prescription. Medicine is there to help us recover and overcome disablement not to replace our initiative and our social support systems. Technology is there to 'extend' our senses, not to replace our common sense. We need to take control of the machine and steer it in the right direction for us. Promote Basic Ideas: (see Techniques)We need to remember that ourselves, our families, teachers and communities (through their upbringing) tend to predispose us to being as self sufficient and independent as possible. This is fair enough. We are not self sufficient of course. Human beings are, actually, highly inter-dependent. Much of our 'independence' is artificial and sometimes quite dishonest (although not intentionally so. For the most part our 'defence system' works ok, but during times of crisis, or after prolonged periods of stress, our underlying vulnerabilities can start to show. It is also possible that social experience have made some people entirely lacking in this confident sense of self sufficiency, they may already feel incompetent as a result, perhaps because they had already discovered for themselves that 'independence' was an unreal expectation. Alternatively, our distressing experiences, especially while young (but also intensively at later periods in our life), can harden and sharpen our 'defences'. This can be beneficial to us of course, we can resist what we know we don't want, but there is a warning. This hardening can also make us less aware of any developing and underlying vulnerability, so that we may still ineffectively 'react' to a crisis, or the circumstances of ourselves & others). Hardened defences stop everything getting through; good and bad. There are still the same kinds of social pressures to 'manage', or 'cope with' our natural reactions to distress and, as a result, we may not have built up an appropriate, or inadequate support structure (and the social expectations) for when this is eventually needed. Because we are all 'apparently' self sufficient (most of the time), we (and others) do not get the range of experience we need to manage crisis as well as we might. There is often this unreasonable expectation that we should be fully self sufficient. It is possible to talk to good friends and supportive family, but sometimes this puts stresses on them which they may be unable to manage, especially in modern society and fragmented communities (or where they have become convinced that you can manage). We are unskilled at communicating our distress and tend to be defensive for fear of the expected reaction, which our experience and our own attitude leads us to expect. Sometimes the reactions are good, but is is the poor reactions that cloud our future confidence in making 'necessary disclosures' about our early mental and emotional states. We may eventually be forced to rely upon the professionals, community services and institutions for this support, for ourselves, our family and our friends. This often generates some resistance and can even tend to undermine our insight, as there is often an inherent sense of failure involved. Institutions are not always very good at understanding the legitimate basis for this resistance, anger, or the sense of failure that they can help to generate. It is also not unusual to see these 'natural' and 'socially learned' reactions to the intrusion of institutions as part of the person's problem. A person, however mentally distressed, at risk, or in need of help, can naturally and reasonably be angry (and even violent), towards any intrusion that they feel is unwarranted and unreasonable. 'Collapsing in defeat' is another possible reaction. Walk a mile in their shoes! Our initial and on-going reactions to crisis and the changing stresses of life, are often unpractised and are therefore often very defensive. People's reactions to us, even when we are trying to be reasonable, may also be unpractised and defensive. The miscommunication that ensues can cause discomfort and fear. This, in turn, can exacerbate the 'initial problem', magnifying it for all concerned. Panic can set in and confidences lost completely. The original person 'with the distress', and those trying to provide support, can end up in a spiral of conflict that leads to the most vulnerable person (at the time) 'breaking down' and being unable to deal with any of the responsibilities, including taking decisions. We will seek to help you to understand how most of these various reactions to circumstances and crises feel natural for you, a family member, friend, or client / patient. We will also explain what kinds of responses, or reactions can be most appropriate and beneficial in these circumstances (if any). In doing so we will also help identify those reactions that are likely to be least beneficial, especially those that will antagonise a situation. Remember, we all have an established investment in these various relationships and have established patterns of response that normally work for us well enough (most of the time), but are not necessarily effective at times of crisis. The established day-to-day responses are not necessarily the best ones to use in the kind of emergency episodes and crises we are discussing here. Its all well and good putting some responsibility on the other 'person' at these times but a defensive response, or over reaction will actually make both your own and the other person's (relationship) situation even more difficult. It is all about getting and hearing the underlying messages, reading the clues, understanding vulnerabilities, recognising defences and then finding the right channels to get the message across. In many ways, it is about establishing trust and rapport appropriate to the new, 'emergency' situation. For instance, whether you are the person in distress, or the listener, blame and accusation at these times is useless, except for the purpose of communicating that we are unable, or unwilling, to accept any responsibility. Hear the message. There are time when both parties are in distress and communication may fail both ways. Recognise the messages. Refusing to take responsibility at the time (because you feel that the responsibility is not yours, or you are genuinely unable to cope with it) is perfectly reasonable. This is very mature and, of course, difficult to achieve if the crisis is already well established. The message is not always received so well either, is it? Receive it and act appropriately, or take the distressed consequences of 'overwhelm'. Each person still needs to try and give as much 'explanation' as they can and resist getting into an argument. Each person, to the best of their ability, needs to help the other person to explain what is is that is distressing them, or inhibiting them in helping. Where it is recognised that one of you is unable (at the time) to accept even this level of responsibility and communications fails completely, it is important to accept this and 'withdraw' as best as can manage and introduce someone else into the situation. Someone who is not caught up in the dynamic that is failing. Recognising this is the first problem, acknowledging it is the second, taking some responsibility and the steps to resolve the problem is the third and taking back control of your life (or giving it back), accepting appropriate responsibilities, is the final stage of resolution. It is therefore part of our mission to seek to help you (and others) understand these, often unrealistic, social expectations and the heavy burden that others put on us and that we then perpetuate for ourselves in large measure. We will try and help you recognise and understand the vested interests of others, as well as the good intentions, both those that are constructive and those that disable (whether accidental, or purposefully). The purpose is, of course, to ensure that you are (and remain), the most important part of your recovery from distress, or providing support. That any dependency that exists, or is created during the process, is only temporary. Ensuring that you are empowered by the process of support (and providing support) and have reasonable control over your part in it. Promote Communities & Attitude Change:We will show, for the purpose of bringing about appropriate changes, that modern, well intentioned, 'quasi-scientific', social conventions, conventional & professional wisdoms, and other forms of 'self interest', have produced this effect. The 'self interest' is often short term and the consequences affect us all, directly, personally and collectively. The original 'good ideas & practices', that were developed as improvements over previous practices, often get adopted and corrupted by the institutions and well meaning individuals, who misunderstand the original, intended objectives and methods. The person treated becomes 'alienated' from and through the 'treatment' process. Modern societies have changed the way we relate to each other as families and communities. We are accountable to many institutions and the relationships with them are complex and frequently confounding, especially in crisis. The old family and community support structures have been disrupted out of all recognition, in our response to modern social demands. We mostly accept the changes and the benefits, freedoms and securities they create. Unfortunately, our institutions (we) have taken inadequate responsibility (in real terms) for providing adequate, replacement support structures, for when things do go wrong, as can be predicted.. Any attempt to put responsibility back onto families and communities, without adequate resources, is doomed to make these problems bigger and perpetuate the dependencies. Change the way society is organised and you have to take collective responsibility for the impact upon people's ability to manage, especially when they are in crisis, or no longer feel they have the knowledge and skills to cope. Not to do so not only impacts on the individual and families (important enough), it also seriously impacts of the communities in which they live; disruption, conflict, criminality, financial burden, stress, distress and increased demands on time and other resources. This may sound harsh but the fact is that relationships, families, institutions and societies become 'sick' and 'project' their problems onto individuals that are most susceptible (least resistant) to this 'dumping'. This is what we mean by the processes of 'disempowerment', 'institutionalization' and 'alienation'. The problems of some individuals, a culture, a society and its institutions, are often projected onto the most vulnerable individuals. Like all self-fulfilling prophesies; people get the results that might be expected; a negative reaction, or a bigger problem and unresolved conflict. The defensive reactions, of those abused in this way, feeds the original prejudices and resentments, and the conflict escalates both ways. Roles become entrenched and communication fails completely. This is as true in all directions, for individuals, for communities and for cultures. The resultant 'stand-off' positions are often a long way from the original differences in 'belief systems', that produced the original conflict. This feature is entirely characteristic of any conflicting 'mental health' perspective as is for cultural, social and class differentials (and these are very closely associated). The evidence is there and so commonplace that we miss it, or it so worrying to our artificial security that we choose to ignore it. Another important point in 'Our Mission' is to ensure that there is no misunderstanding concerning these issues. Managers of institutions are often very good at picking up on 'ideas' but poor in ensuring they are implemented properly. This is often because they have misunderstood the original idea, the good, attitudes and practices that went with them. Sometimes it is because they have the intention of providing a good quality service but are unable to maintain the resources for it. Sometimes, though, they don't care enough. The same is also true of the Government Initiatives, based upon demonstrated good practices. These get distorted out of recognition. Much of what I have said here appears to be putting the responsibility back on the 'individual'. That is true, but no in a 'static' way. We are arguing that the 'power' should be put back with the 'individual' at the earliest opportunity, with an expectation that they then take 'responsibility' for their own lives and problems. This is a 'dynamic' process, where the person is given the information, skills, support and resources necessary to be able to take back these responsibilities. Institutions of all sorts, differentially 'disempower' people in the process of offering any service. We have to take responsibility to ensure people are 're-empowered', if Community Care is going to work at all. This was the original concept. I know; I was there, helping write the proposals. Promote Understanding of Institutions (The System):The inefficient and late interventions in the development of problems arises because specialist 'Service Providers' conserve their 'well tuned and highly targeted' resources for those that most need them. This does seem reasonable, doesn't it. This does mean, however, that those who are in the early stages of crisis of any kind, either get no service at all, or else get very poorly resourced support, by skilled professionals who often have inadequate specialist knowledge and experience. Again, there are no surprises there. Unfortunately, the relative ignorance in a particular field also means that the services is prejudiced also, responding to fashion trends. Early interventions are now the responsibility of GP's (and Primary Care Trusts) and there is decreasing 'social care' input at the early stages, because of lack of skill and experience at this level, because of professional ignorance. Governments intellectually address the issue of 'the gap' in service provision, and Professionals talk all the time of talk about a 'seamless' services. These are often wonderful ideas and practices, developed and tested by very skilled and committed professionals. Unfortunately, they are then often 'intellectualised', drafted as policy, made 'requisite' for professionals and the resources issue completely ignored, or 'played around with' at a paperwork level. Managers of these services sometimes know this is what they are doing, but more often, they are ignorant of it. As in any relationship; It takes everyone to make it work and just one to cause it to fail. Most specialist mental health care is concentrated at the 'secondary', specialist health service level and GP's do not have the wider skills, and do not invest in, or adequate value, social care resources at the 'Neighbourhood Team' level. They are geared towards physical health and fearful and ignorant of mental health and old age 'memory and confusion' problems. Primary Care Trusts also inadequately represent 'mental health' in their considerations. The service is limited to some basic counselling and referral to specialist health services, once things have progressed to a serious level. Lets not pull any punches here. In the early days of the development of health and social services provisions, and other services; like community housing, pensions, employment, etc., Policy and Practice guidelines were there as a genuine attempt to ensure that professionals and others worked within a general framework and along particular lines, to ensure that people got the services and care they needed. They were, at least, intended to ensure minimum standards were maintained, acting as a safety net, below which people should not fall. At best they were intended to promote best practices, as these were understood and 'tested' at the time and even to advance services further, through research, experience and feedback. With our increasingly Account and Solicitor led services, Policy Document of these institutions have become 'legal' documents. I have contributed to these myself and can understand the reasons for this. Accounting and Legality are progressively being incorporated as part of on-going professional duties. Originally, 'awareness' was all that was required. Now active participation in monitoring budgets and identifying, arguing the legal and financial case, is a primary responsibility of professionals providing the direct services. This takes away time that had been allocated to the direct management and provision of care, support and therapy. These 'Policy' documents are extensive and yet unrealistically obligatory. In contrast to the highly detailed and legally precise 'Policy' documentation of institutions, if you wish to register a complaint, lay grievance, or register any professional / service user concerns about the actual implementation of 'policy and practice' requirements, you will often be asked to keep your material brief and to the point. This seems reasonable at first glance and it is certainly a good Idea to summaries each of you points of concern, and itemise each of the aspects that affect these. The point is here, if the you just present the Bullet Points, the issues you are presenting can often be dismissed at the first stage. In legal argument the detail is important, it carries the evidence. We therefore have a dilemma. Insight into the fundamental problems is filtered out, or dismissed. Built into the 'system' is the legitimization of treating people 'badly', in the name of Human Rights. The logic is very convincing. If someone is treated outside of 'Mental Health Legislation', against their will, then professional's, as well as the client / patient, are at risk. And so they should be; if they are culpable in some way. If it is a professional's judgment that the person is in need of 'treatment' and they are refusing, then professionals have considerable powers to use 'Mental Health Legislation' to assess and treat people against their will. That seems to be reasonable too, if it protects them, or others. In fact, protecting others can also be seen to protect the individual also; from the consequences of themselves. Below that critical 'level', primary services accept little responsibility other than medication. In effect, you wait till the problem gets bad enough, assuming nothing else 'medically' can be done. In the process of using legal powers (as in child care), because of the 'over clinical' and legalistic way this is done, the service user is often protected 'in Law', but often only on paper. For those of you that have been there you will understand, for those that have not yet, you may have some difficulty understanding. The very process of assessment and treatment under the mental health act can be traumatic and disempowering. It need not be. The Mental Health Review process can also be intimidating and condescending. This was not the intention of these processes, it is usually the consequences of 'over cautious', legalistic process, geared to protect the legal process and professional practitioners. At both ends of the process people unnecessarily suffer. We have 'lost' skills at this early level of psychological and emotional problems. These may have been crude and untutored at times, they were certainly undervalued. They were often provided by family and 'general' professionals, religious leaders and community volunteer, who had some extended social skills and the communities confidence. Health Visitors, Priests, Almoners, old fashioned GP's, wise old, nosey neighbours and dedicated, relatively skilled volunteer services. It was not a perfect system and some of the theory was rubbish but people got a few important inputs; appreciation of the problem, time and significant social input. There was even evidence that these inputs were becoming increasingly skilful and less prejudiced. Mistakes were made with this rather amateur social care and higher level, professional intervention did became necessary but that is almost all that we have now; without the necessary early social inputs. We have lost more than we have gained but the current generation of professionals and manager do not realise this. Our community have now become dependent upon 'professional' inputs and professionals are scarce, expensive and overly 'medically' and 'legally' orientated (protectionist), at least the service managers are. Even where community projects are still in place these are often 'purchased' by the professional services, or sponsored by them. This means that the natural responsiveness and creativity of these support services are distorted by 'professional' requirements of the funding bodies. These organisations and services risk becoming part of the institution and geared towards 'serious' problems at the expense of early interventions. It is all to do with the money in the end and the 're-creation' of community initiatives and extension of social skills, has become starved of resources and initiatives undermined in their enthusiasm. To further frustrate the creative process of community initiatives there is also a 'felt' requirement to employ specialist professionals to run them, thereby constraining the natural re-creative process. Fear of being sued and criticised have stunted the growth of initiatives. The expertise for monitoring and moderating community initiatives, without heavy handed professional interventions, has been lost. You are either on your own, or have to accept the over zealous and often interfering oversight of the 'professional' funding bodies and over-restrictive legal requirements. New initiative have to play ball with the big boys and these tend to be bullies, who believe they know it all. These days it is often necessary to 'prove' a service against established criteria, laid down by professional and legal bodies. If these criteria for judging community initiatives were reasonably representative of reality, intelligent and flexible, there would not be a problems. They are not. They are protectionist rather than protecting. They ensure the new initiative are carbon copies of what already exists, good and bad. What already exists are 'professionalised ' and 'institutionalised' forms of community initiatives, often distorted beyond recognition and inhibited in their operation by risk adverse, litigation conscious, service managers and funders. More time is often taken up in covering our backs than in providing the practical service. The irony is, when we intelligently focus on the needs of the service users, with their basic wishes at our hearts. If we truly (not just nominally) put them at the centre of the picture and their natural support structures in a secondary position. If we offer informed choice and provide advice and suggestions. If we seek to appreciate and value their wishes and their perspectives on a situation. If we protect them from the worst of the ignorant interventions of community and professionals. If we remain open and flexible, thoughtful and considerate, to their 'stranger' expressions and explanations. We are half way towards a 'safe' arrangement. If we give adequate explanations of our task; in terms that make sense and empower them. If we work 'with' them rather than for them (or worse still against them). If we are open and honest in our appraisals of a situation, having a clear head about what we are doing and why, taking account of and seeking to balance the person's wishes, needs and risks. If, even were we have to rely upon 'legal' interventions, we (or one of us) remains focused on the person's needs and longer term support, with their 'empowered' interests at heart, ensuring the correct and appropriate, minimally restrictive effects of interventions. If we do this much, without condescension, or a 'humouring' approach, we nearly have it sorted. If we do all this; supporting whatever else seems to be appropriate and to work for them, referring aspects onto others, and we can minimally show we have informed and included others in this process; then we have effectively met our legal requirements, whatever the outcomes. If we take this approach, even with the mistakes that can happen, we are rarely criticised and often thanked for our efforts. If the person feels that we are there for them and we have been demonstratively available and conscientious in the eyes of those around us and surrounding the person. If we are able to intelligently and professionally, logically and verbally account, at any time, for our actions and decisions, taking account of others, then with all this we are protected in law and appreciated in the eyes of the community.. If we hide behind legality, make excuses for not doing things, delay until the conditions are perfect, or refuse to get involved in some way, in case we are sued. If we spend over 50% of our time, justifying our actions on paper and further time presenting arguments for funding proposals. If we remain silent as these problems develop, or are censured when we express them; This is when institutions get into real difficulties. We are not seen to be out there, dealing with people and their problems. Our explanations are seen as excuses. Our failings are not justified, in spite of all the recording. In fact, the recording becomes the evidence of our 'up front', professional impotence. Descriptive Summary:It is our intention to indirectly and directly benefit anyone who has experienced; physical, psychological, emotional, vocational, or spiritual trauma, abuse, ill health, or personal distress. We will follow these initiatives up with Consultancy & Training and via Published Information, ensuring Service Users and Professionals have the widest perspective on the issues and contemplate the positive and negative impacts of their actions. We will seek to advance the development of good quality, cost effective, person centred services and opportunities for personal 'recovery', 'rehabilitation' and 'growth'. Our mission is, if you like, to empower people to have a greater say in the way services are applied, even where there are 'legal' restrictions on the person's actions. Dignity is fundamental in any personal recovery of any kind. For this to happen, professionals also have to feel 'empowered' to do the best for their clients / patients and to have the flexibility to adjust their approach to take account of a person's sensitivities and broader human and moral rights and responsibilities. Our mission is to enable this to happen, and to provide 'forums' and other opportunities to gain the necessary insights and to reflect on good practices, in the light of service user's opinions. Our service is not just directed towards those who 'qualify' for statutory services, or the more discretionary community and health care services. It may be supportive towards volunteer support services and individuals seeking their own resolutions. It is not just attentive to formal diagnosed condition but is responsive to those problems that are not 'formally' recognised, whether of a recognised character or not. In this respect we are able to support and advise upon, dealing with the abuse and bullying of any kind, whether attended to by police, or not, whether physical sexual, emotional, or psychological. Our purpose is to counter the current trend of institutionalisation. At one phase of the development of social and health care professionals, from the 60's and through the 70's, there was a positive trend towards the development of professional autonomy, with professionals taking considerable responsibility to establish 'contracts' with their clients and patients and providing a direct, high quality support. The specialist professions looked as if they would increasing move towards the kind of professional autonomy appreciated by GP's. In fact, the reverse has been the case. GP autonomy has been largely sequestrated by PCT's and Health Service Trusts (Committee Micro-Management). Over that same time period there had been a growing trend to have representative 'service users' playing an active part in the development and even the implementations of services, taking the initiatives from 'active' service users themselves. Alternatively, this was with the assistance of professional and volunteers, working with groups of service users towards that end. The modern trend has been to have professional committees onto which service users are rather 'nominally' invited. Modern professionals and their Managers do not seem to be able to recognise the important difference, including the reduction of 'cost' that are the bonus of incorporating 'service users' into the provision. These 'institutional' agencies, along with 'generic' services, skills and finance of Local Authorities Social Services, now hold control of the policy and funds provided to the specialist professional service, which they do not fully understand. The specialist skills have been progressively geared towards assessment of need. In real terms, the most highly trained professionals are once more becoming 'agents' for the state. The gatekeepers of funds, monitoring and policing the implementation of services, to ensure there is 'value for money' and budgetary controls. Services once more, becoming risk adverse, inhibited, protectionist and increasingly institutional. The communities they serve also become risk adverse. This was predicted as a risk in Community Care, right back at its early development (60's trough to the 80's). Typically, in terms of 'the history of welfare state', a whole generation later; 'the baby is thrown out with the bath water'. Services are becoming depersonalised, with just 'nominal' inclusion of the service users. All the evidence is there but many modern professionals and service managers are not capable of recognising it, or appreciating the difference between 'empowering' user participations in the services and the nominal inclusion. The evolving new institutions have effectively 'bought out' the service user, voluntary initiatives and impose their institutional and restrictive form of policy on the 'non-profit' agencies that they fund, or purchase services through. The 'authority' for these more 'creative' organisations has been kidnapped by the institution, distorting their whole purpose, initiatives and freedom of 'service user' action. The process is gradual, largely ignorant and increasingly disabling to growth of ideas, sense of empowerment and full community education and participation. It is at the earlier stages that the most highly skilled assessments and interventions are most needed, with the inclusion of 'service user' groups. independently well supported. It is at the early stages where 'social interventions' could prevent institutionalisation and increased dependency on support services. It is this end that least qualifies for the funds and resources available and it is at this end that initial problems become chronic conditions. Generic services not only have inadequate skills, knowledge and insight to deal with these problems, they have often seconded their specialist personnel to agencies dealing the the resultant 'chronic' problems, making them less able to 'prevent' serious problems. If community care has stopped working (or is failing), it is because the more institutional thinking professional, managers and Government Ministers, have 'disabled' the original ideas, much like they disable the service users who come to them with their problems. If community care process is to progress further, the current service managers need to stop jumping onto the 'ideas' band wagon, attempting to hijack the concepts and implementing them as their own, distorting them out of all recognition, and institutionalising them in the process. Even the managers of 'service user' groups and initiative can become seduced and institutionalised in this way. The 'State Controlled' system can be likened to an 'old hulk of a ship', that was built well, served a good purpose as a cruise ship, requisitioned during the wars and gave a good community service and has survived many storms. It became tatty and a bit out of date and has had many a 'make over'. It looks better but is quite tired and overweight and the officers need to retire soon. Lots of new little ship around it are serviced by her but her heart is not in it and the service is poor. When one of these little ships gets into trouble because of the poor service, 'the hulk' want to drag it along with her to dock. These in turn end up dragging their passenger along with them, some of then lashed to life-rafts and in tow themselves. The passengers and crew of these small ships and boats scream out that the 'hulk' is going in the wrong direction but the the Admiral, officers and crew are watching out for the rocks and icebergs they are encountering. They apologise for being so busy but they have their 'orders' from government, who are saying press on home. They relay back to their charges that they have heard their calls and have taken their views into consideration. The flotilla collectively head for the icebergs, stormy seas and the rocks. All perish. Those left behind have inadequate fuel and provisions and are left to drift, becoming increasingly isolated. Never mind, another hulk will be along later to pick them up and help them recover. | Its A Challenge:
We offer a challenge: If you feel that you have a substantive argument, that you feel undermines what we are setting out to do, the very basis for doing it, the theoretical precepts, the logical implications, or any other aspect of our 'mission', we invite you to present your argument, in any form you wish.We will, in response, direct you to the existing logical arguments and substantive evidence that counters that challenge, or Otherwise we guarantee that we will either identify the counter to an argument, or, failing this, concede to your soundly argued perspective. Do you accept the challenge? Do you want to contribute to the debate?. Do you want to contribute to the Web Site? Do you wish to contribute to the Campaign for improved and empowered services. We genuinely welcome all constructive contributions; criticisms, with tested and thought through resolutions. Service Users:
Although not a universally acknowledged as an acceptable term, this is the term that is currently used to identify those of us who 'receive' services from professional groups and agencies. It is not ideal but is an attempt to resist 'objectifying' people who receive some kind of health, or social care input into their lives. The Irony is that the term also works against 'user inclusion' in some ways. This is in the sense that you / we are also the potential, or actual provider of the services in various ways. We collectively 'own' these services and have a legal and moral right to influence the development of them. We can also help run them and determine how they are provided. In some instances, we are also the direct providers of a service. At present 'Service User' is the best term we have available, which does not connote being 'done to'. Whether we like it or not, it was the term coined, almost unanimously, by delegate to a number of Conferences, for people with learning difficulties, some 30 years ago. This was soon after the concept & practice of 'Community Care' was beginning to evolve. An initiative that began with the Campaign to improve services to people with learning difficulties. There are problems with all these terms; like patient, client, customer, people, citizen, etc. The concept of 'Social Inclusion' assumes (rightly) that there has been some 'exclusion' of important groups, and that society is magnanimously 'giving back' status, in our relationship with professionals & institutions. Actually it is 'Service Uses', and those professionals who appreciate themselves as 'service users', who have demanded this status of 'citizen user' of our collectively owned, public services. We seek to continue this wobbly trend and are confident the process will continue until professional managers fully understand the principles involved. The term 'Service User' helps us re-frame this relationship, but it is the underlying attitude & ethic that determines the true character of an 'empowered' partnership. Whatever the term used, it needs to connote a potentially active & informed participation, at all stages & levels. This should be from assessment stage, through the provisioning, to review & completion. The term, & the philosophy behind it, does not ( should not), give the impression of mere representation, or token inclusion on paperwork, or in a meeting. Informed service users and their representative, will eventually determine Policy and the acceptable Practices for the services provided to meet their needs. This philosophy will eventually be sustained for all service users, of any public service. It will be enlightened professionals that will ensure the necessary self-advocacy for this to happen. Professionals:
By this term, we mean those trained &/or expertly experienced, ethically guided employees, involved in assessing needs & risk, and in providing appropriate services to meet these. The professional services provide support that is geared toward protecting us, maintain safety & security, ensure justice, promote recovery, or help overcome the various problems we encounter in life (which affect our health, personal & social wellbeing). A classic definition requires that Professionals are understood to be 'paid'. In fact; the essential requirement is that they are (or can be), ethically & legally 'accountable' for their expert actions & advice. This, of course, means that they are usually 'retained' for that purpose, but this does not have to be the case. Volunteer , or independent 'professionals' can have a similar expert status but must be willing to be 'accountable' for their actions in some way, even though they are not paid. They also have the benefit of not being so constrained from expressing criticism of institutions, although funding agencies can now be seen to try & exercise this kind of restriction.This group of Professionals may be considered to include not only Consultants, GP's, Nurses and Social Workers but also Care Workers, Managers, Hospital Cleaners, Benefit Officers, Housing Officers. Police Officers, Court Officials and the like. Such professionals have an obligation, collectively determined by ourselves, to assess us for the appropriate allocation of services, support, advice & sanctions. This assessment is legally required as an assessment of need, not conditional on resources available. Shortages of resources must be declared separately.Professional Agencies:
The services provided by these professional agencies are, ideally, determined via an informed dialogue; between interested citizens, people currently receiving services, those who have done so in the past, the professionals themselves, the overseeing agencies & representatives of service users & the professions, and our local and national political representatives.The level of funding and general disposition of these services, evolves over time. It is influences by many things but is rarely adequate for the purpose. There is a balance between established conventions & evolving ideas. Progress is often two steps forward and one step back. Apart from the responsibility for 'assessing' our needs, they & other professionals, have a responsibility to enable and provide direct services & care to ourselves as service users. In doing this, within the constraints imposed, they do not always honestly state the position. They are often constrained by policy in ways which contradict their professional ethics and are counter to the original governmental policy (or, at least, the original intention of it). More importantly, ways that contradict the 'spirit' in which their services are developed and offered. Professional Agencies can become defensive and allocate too much of their time and resources covering their backs and too little time meeting the challenge of providing a good quality, comprehensive and preventative service. Ironically, it is this defensive position that causes most of the legal, ethical and media problems. Too many people remain at risk, in spite of more resources being put in. Like the Media perspectives that they are concerned about, they become concerned with negative impacts and are therefore risk adverse. While attending to the negative possibilities they generate too few positive outcomes. The Media (& therefore the public) focus remains on the failures, delays and waiting lists. People no longer expect a great deal from public sources and with adequate, good quality, empowering support, they can actually do a great deal to help themselves. To do so they (an we) have to take some risks. Risks that the first attempts will not work. Risks that the outcome will not be perfect but will satisfy the person adequately and reduce the consequences for others. That is the best we can expect. What is the Professional Role:
In essence, professionals take on those responsibilities that were once undertaken by the Elders, Grandparents, Aunts, Uncles, the Extended Family, Wet Nurses, Busy Bodies, Nosey Neighbours, Gossips, Wizards, Barbers, Story Tellers, Officials and Sooth Sayers of previous epochs, cultures & tribal systems.Modern Professionals do their best but are still a poor replacement, constantly seeking to improve their role but rarely developing the mystical properties that citizens find attractive. In taking over the roles, professionals do not always improve upon them and sometime, in trying to purify the role, they actually loose some of the essential qualities that make them most effective. These 'mystical' qualities are the catalysts that make the technical magic work. It is the 'bedside manner' of the older GP and the un-analysed 'social care' component of Nursing. It is the quiet, unassuming affection and respect we feel for our charges. It is the appreciation of the stubborn individualism that appears to work against our expertise and yet, keeps the person wholly themselves, in spite of their problems. It is the gentle struggle between those doing and those being done to, which leaves both sides slightly stretched, slightly dissatisfied but both empowered and potent. It is doing those little things, just enough, that break the rules, steps outside the circle of blind policy and make the individual feel special. It is the use of human instinct, well honed intuition (established wisdom of experience), lateral thinking and the creative use of knowledge and resources.Although politically incorrect to some, it is the love we let them borrow, for long enough, until their friends, family and neighbours are able take over once more. It is being the projective object upon which all the frustrations and worries can be loaded, while they struggle to recover and regain their relative independence. We are the Cart Horses of caring, not the thoroughbreds of the academic racetrack. Professionals differentiate and become specialist, or remain generic but in either case they are becoming overly intellectual presently. It is an historical phase we go through now and then, individually and culturally. Our institutions and managers are keen to give over the responsibilities but are unable, or unwilling, to give over the appropriate level of empowerment to administer those responsibilities. Professionals, on the other hand, will have to be more accountable for themselves. In finding their feet, professionals are now expected (rightly so) to give up some of their power to the people they provide a service to. As 'experts', this is difficult for them to do. To do it, they to must also be empowered. They need to become independent practitioners, adequately, trained supported and encouraged to take decisions in the interests of their charges. This is especially the case with the new 'Capacity Act' (UK). It is a trend that is unavoidable and natural development of these professions. These are exciting times but users of services need to find a new balance and take on more of the power, and some of the responsibilities that were once afforded the professionals alone. The objective now is to see a true partnership but not everyone knows, or understands that yet. It is a period of adaptation, every bit as essential as those that have happened in the past and those which are happening, else where, in our societies and cultures now. Professional Partnerships:
To obtain a true partnership there have to be understandings on both sides. Perspectives that will sometimes stretch the professionals understanding of individual experience, perception, beliefs and conceptualisations. Many of us have become adept at this and I will not pretend it is other than a considerable challenge. This is especially the case in some forms of abuse and in the case of Mental Health, Social Pathology & Dementia.It is difficult to establish and maintain a rapport of conceptual understanding with a disturbed, distressed and dysfunctional person. When we are adequately prepared for this, and it is otherwise possible to do so, it is necessary to protect ourselves from the impact it can have. To do, this requires more than academic understanding and counselling skills. It requires us to reflect on the least of our own psychological and emotional aberrations and scale these up to the level of the service user's experiences. We can then only use these as a base from which to operate. We next have to be creative and lateral in our thinking and make a leap of imagination, based upon what we are told by them, checking with the person that we are half way near to their account of their experiences and perceptions This approach is not the classic case of 'humouring' the person. It is necessary, bizarre as it may seem, to accept the person's account as real as any experience that we have had. For the person it real and although unique to them, has features that are common with other peoples' experiences, some of which are socially accepted as legitimate perceptions and perspectives. The difference we experience, in working with those who seek, or are deemed to require our help, is that they are either feeling very unsafe and confused by their experiences, or, they are secure with them but unable to translate them into meaningful communication with others, to the extent that they and others may be put at risk, or the person becomes socially, psychologically, or emotionally isolated. As in most cases, where we are required to solve a 'conflict' problem, we have to start with where things are at, and work through to a point where both sides are at least partially partially satisfied. To do this requires us to 'understand' where the other person is coming from and for us to help them understand where we (and others) are at. Both are accepted as valid, if conflicting positions, but both seek to compromise to the point where real some communication can begin. Once this is done, it is only our general social skills that can eventually enable the person to understand their own perspective in the context of others and thereby achieve a compromise that both sides can live with. Mostly we have to help the person feel safe with their experiences and understand these in the wider context of family, friends, employers and neighbours, etc.. They are not alone in the peculiar character of their perceptions. Their experiences do have a validity and t is our job to find out the how & the whys. In this way we can help them establish a 'bridge' with the more common psycho-social experiences and wider perspectives . and to the greater understanding of themselves, ourselves & the perspectives of others. Doing this is (& has always been) a creative process. This process goes on quite naturally in the 'normal' world. People experience alternative, or distorted perceptions and perspectives at various times of their lives. For some, this is part of their natural creative process, largely safely under their control and directed towards creative, or spiritual expression of various kinds. We may not fully understand the mechanisms involved but we can appreciate the public outcomes of their expression, if it finds rapport in our own 'on-the-edge' understandings and experiences. It is important to remember how strong a contrast we can experience between differing cultural perspectives. Some cultural practices and perceptions are equally as extraordinary to us as any expression of 'mental illness'. This has been particularly noticeable during historical periods of exploration, but modern insights can have the same impact. These alternative perspectives and cultural variations puts the abuse and mental health issues into some kind of tangible perspective. We are not required to agree with and adopt the alternative perspectives on life, other cultures, humanity, sanity and alternative normalities, but we are to be expected to seek an understanding of them so that we can engage with them effectively. This is not that intended to be anything more than a metaphorical comparison:
It would be nonsense to expect a police office to become an actual criminal, in order to understand and deal with criminal behaviour. It is not ridiculous, however, for them to establish a rapport with criminals, such that he is able to understand and in some ways empathise, with their thinking processes, purpose and intent. Adequate professional supervision, job satisfaction, social recognition and sufficient remuneration should ensure they remain on the right side of the professional relationship. Similarly, people who have become experts in breaking and entering and in picking locks could well become expert locksmiths and security advisors. In much the same way, those most competent at producing computer viruses and at hacking computer systems can, in their rehabilitation, become experts at computer security. And so it is with our dealings with those who somehow become alienated, isolated and psychologically, emotionally and socially distressed. We need to gain a rapport that produces a deeper mutual understanding, which then enables us to bring the person into a social context in which the constructive features of their personality, intellect, perceptions & conceptualisations have some social validity., | |
