The Reality of
Accessibility of Service to People in Distress:
We intend to inform Service Users & the various Institutions, Agencies,
Managers and Professionals, providing service, of the realty of the
services available. How they are seen by the average member of the
public, Service Users and Family Carers, especially when the Service
User is in Crisis. See - Access to:
Community Care,
or
Health Care
for descriptions of the referral process (including some realities).
There is, of course the 'Big Government System' that we all have to
survive, but we will concentrate mostly here on the Community Care
Services and the Health Care Services. These are the ones that are
formally involved in dealing with Personal Trauma, Physical & Sensory
Disability, Health Crises, Drug & Alcohol Dependency, Mental Health,
Personal & Social Distress,
Child & Family Welfare, Re-enablement & Family Carer Support.
For the time being, we will refer to 'Other Services' which can become
involved in 'Community Care' and 'Health Care' support. These will
include the Police, Housing, Ambulance / Para Medic Services, Charitable
Organisations, Private Care Agencies and the appropriate Education Services
for Children, Adults and those with Special Needs.
We will inform & support Service Users, Family Cares & Professionals, to
get the best out of the services available to them. In doing so will
report the shortfalls, gaps, prejudices, inappropriate attitudes and
practices, and also seek to explain how this has happened (and persist),
and how they can be effectively countered.
There needs to be greater frankness with you, as Service Users. There is too
much reliance on the good will of Family Carers and Voluntary Community Agencies,
who often work beyond safe limits, jeopardising themselves & others
quality of life and liberties. There is also too much inappropriate use
of the power of institutions, who are invested this power in
order to 'protect' these 'Service Users' and their 'Family Carers', as
well as the Community at large.
There
is too much 'putting responsibility' for the failures, in individual
lives & relationships, on the individual and the family. The new 'social
rules', legal restrictions on established practices, and de-restriction
of commercial amenities, means that the shortfall of 'mediation' must be
met by the state in some trusted 'Community' form. Institutions now
collectively have this responsibility, but shift it around whenever they
can, to avoid it.
All this said, if the
problems are clear and immediately demanding, Institutional responses
are quite good, if rather formal at times. There are well trained and
sensitive staff at the end of the referral process. If you have reached
this point, I am pleased for you. If you feel that an earlier access,
prior to crisis, would have been beneficial, if you believe greater
publicity about the services is needed; let the professionals know
through their established procedures. It helps them and institutions to
develop the service for the future.
Speak up, for yourself
politely, if and when you can. If you get angry, as some of you will
(often quite reasonably), put your hands behind you back and speak with
a low, purposeful growl, rather than shout. You are less likely to be
construed as potentially 'violent', or as being unreasonable and become
summarily dismissed, or interpreted as ranting (see below for context
and explanation:
Anger, Fear & Frustration).
We have provided general
guidelines on how to approach the Health & Social Care institutions.
These have been separated for 'Health Care' and 'Community Care'
services. They each have their own style and process. In fact, Health
Care & Social Care should be considered under the heading of 'Community
Care', along with all other community resources. Unfortunately the
integration is not that good yet, to honestly include them as 'a Unit'.
Off from each of these pages
(top left) will be additional, fine detail information and critical
perspectives, some of which will be contributed to, by yourselves, and
some of which will be your own contributions. Please feel free to
respond and correct some of our assumptions and biases. Most important,
provide us all with how to succeed with the Institutions and their
referral processes. For a more critical perspective on Community
Services, read on:
Institutions, Family and
Community:
The local Institutions (Statutory & Private) now play a
very potent part in effecting good and bad consequences for
'responsible' and 'irresponsible'; Personal Relationships, Families and
Communities. They have effectively replace the older, established
mediators of family and community conduct (Church, Lord & State) and
methods of social control / order (Family & School Discipline, the
Copper's clip round the ear).
These institutions are now
collectively
responsibility for sensitively assisting with problems that arise, which
go beyond normal & reasonable parental and neighbourhood controls and
support. Modern Families are not only more constrained in their actions
(often rightly so, if to an extreme), but also increasingly distracted
towards meeting their own immediate personal & family needs (often in
the absence of wider family group supports) and the demands of bosses,
tax collectors, water companies, and sundry other, increasingly
'demanding' institutions.
Our intention is to improve
the working / living environments, relationships and mutual
understanding of Professional Health and Social Care Workers, Police,
other Statutory Bodies, Service Users and Family Carers. These
'required', integrated support systems need to be more accessible and
adaptive to individual needs, and demonstrate greater understanding,
fairness, justice and flexibility, in response to level of
understanding, the expressed needs & crises of all kinds.
Without this, people will
not trust, and are already somewhat reluctant to use, these Community
Services confidently. They will, instead, resort to covert, underhand,
negligent, aggravated and possible criminal actions, to express their
frustrations and to meet, or divert the crises they are 'reasonably',
unable to manage. Alternatively they will beak down, trying to manage
the impossible and / or put family members and others at risk in some
way.
We can not tell people the
'can and can't' of certain critical aspects of 'community management'
and then not put in place adequate and appropriate resources to replace
the more traditional methods and styles we are seeking to replace. At
the very least there is a need for education and more immediately
available, sensitive mediation and support. 'No Blame No Shame' is the
buzz phrase. Where are the necessary, trusted resources? The absence,
given the increased imposed restrictions, is Unjust and Culpable. It
creates serious problems, as we will show.
Anger, Fear &
Frustration:
There are too many instances
of identifying a person's 'natural' reactions, (like anger, frustration,
loudness & fear) to inept and insensitive professional and
institutional interventions; as unreasonable and 'probable' indicators
of potential violence. The expectation is already there and that is what
we are hen watching for. It is well known in science and psychology,
that if you are looking for something you may expect, you will often
misconstrue what you see. The secret is to approach observations
cautiously with eyes and mind open to all possibilities.
The 'clinical', supposedly
detached, approach of professionals and the 'distorted', &/or
misdirected, purpose of
institutions; often see this 'angry' behaviour as part of the 'symptoms'
, of a condition, or 'a character' that the person may, or may not have.
It is a lot of assumptions and misrepresenting of observation, without
recognising the 'context' created, which may reasonably be expected to
bring about such reactions, if only because of misunderstanding and due
to the frustrations of delay and rejection. Institutions have histories
- some bad.
In the UK we are
particularly sensitive to this because we are uncomfortable with other's
peoples anger (but mostly we fear our own). Our own fears are
understandable. There are very occasional real risk situations, but as
professionals, we need to be more circumspect, more respectful of those
we approach, whatever their history. This history of the institutional
approach is no better. You may pay the price (in violence) for the inept
conduct of previous professionals. You could also become skilful at
stopping the rot. I have. We create these problems.
Come on professional's
everywhere (Police, Social Workers, Psychiatrists, CPN's, Housing
Officers). What would you do if someone turned up at your door and came
out with a bunch of formal justifications for their intended actions (or
worse still; 'I would like a word with you' and little else), as they
marched you away, with police in attendance, without (in terms that you
can reasonably understand) adequate explanation and justification; on
the basis of 'edicts' (to protect them); following laid down procedures
(to protect you), and having been provided with information from sources
you do not feel, or may even know are otherwise not reliable (if
not entirely antagonistic).
It really is not so rare.
Watch out for it in your work and you will now see 'this' happening. Not
everything is as it seems. It is fundamental to human activity and
observation. What we may expect we often generate. It happens in
personal relationships and it happens equally in professional
relationships. It can even 'make' people 'mentally ill'. I have seen and
dealt with many such cases and undone much of the damage done. I made
the same mistakes myself, very early on. I realised this quickly and
apologised. The situation settled quickly and was resolved to mutual
satisfaction. I have had more conflicts in my personal life, than ever
in my professional role.
This above tendency
is particularly evident in mediating 'normal' Adolescent Conduct, in how
we deal with Mental Health issues, misunderstand and talk to people with
'borderline' learning difficulties, and in the Care of the Elderly who
have some measure of dementia.
The Institutional and Professional Monitoring agencies often make things worse,
in their own relative ignorance; of people's and even the various
Institution's practical, day-to-day, inadequately resourced realities.
Frustration, anger and aggression are to be expected. Grow up & Face up.
Attitudes & Prejudices:
Condescension, prejudice,
miss-diagnosis, indifferent treatment, over restrictive practices, over
simplified assessment, insensitive approaches and disempowering
behaviours, are all characteristics of Institutionalised & impoverished
services. Those committed people at the sharp end - Professional, Practitioners,
Paid Carers,
Family Carers and especially Service Users, loose out big time and get
the brunt of the frustrations and anger.
What essentially happens, in
modern 'Community Based', 'Community Orientated', 'Community Care'
services, is precisely the same as happened in the old 'Institutional
Building', Ward, Admin office. Professional Workers become an increasing
part of the 'Administrative system', justifying, protecting and
responding to 'The System' at the expense of flexible,
'individual', service user arrangements.
As I have described else
where, this process (without progress) is described as 'regression to
the mean'; a process by which everybody appears to get an increasingly
'consistent', but 'average' (usually poor average) service,
with 'apparent' efficiencies. It is so obvious what is happening that it
beggars believe that managers are unable to either see it, or are not motivate
to do something about it.
This 'process' is often
justified as all that can be managed with the funds available. It is
also said to be done in; 'The Best Possible Taste, (& Intention)' of
making services 'Consistent'' and 'Safe' for for its 'Users'. Not true,
it is well known that People do good and bad jobs, and receive good &
bad, safe & unsafe services, using the same amount of money, with
simpler, user friendly, less defensive systems, often with less
complaints and less litigation.
That is how we get concepts
like 'Best Practice', based upon the beneficial effects of
professionals, well motivated as teams, supporting and sharing with each
other, on a day-to-day basis, with good administrative systems &
support, geared towards flexibly representing 'individual' Service User
needs and supporting the various & diverse, flexible & innovative
interventions of diverse Professionals. Trust is central to this.
Done it, Developed it,
Managed it, worked within it and got the badge. So have many other
effective Leaders, Managers and Practitioners, who established the Best Practice
Models that Government and Professional Bodies refer to. Old
Institutional methods are resistive to dying. They plod on 'being safe'
(for everyone 'but' the service user), bleating the same old tired
excuses & justifications, but pretending 'Best Practice', 'People
Focused',' Least Restrictive', 'Radical' - but in name only, on a
pamphlet, or invited on committees to reflect upon limited 'given'
options.
Unfortunately, in their
complacency, Institutions become increasingly dangerous and risky to Staff and
Service User alike. Meanwhile keeping 'managers' and the 'institution',
apparently safe for years, until the house of card collapses. They are
then seen
for what they are; a system of collective justifications for doing what has
always been done, with new names, new 'initiatives' , frequent
'reorganisations', and new image & letterheads; but, the same old
attitudes, prejudices & practices beneath. Everyone gets sucked in
in the end. It is insidious.
Information Recording
Systems:
Add to that, the
inappropriate use and mismanagement of 'Community' funds, in 'protecting'
institutional interests; Through investments in Computer and Paperwork
Information Systems that are largely designed to 'justify' expenditure
and institutional actions, establish arguments for continued, or extended funding, or to register
the fact something has been done, in case there is a complaint, i.e.:
extensions of Accounting / Finance Systems.
These
system rarely fully represents the 'shortfalls' in provision, and only cursorily
address the Service User's wishes. Where there is a mechanism for
identifying shortfall in service provision, it appears to be largely
overlooked, or ineffectual, because, like all the other tacked-on
'Utilities' & 'Modules' (afterthoughts) it doesn't have the robustness
and integration necessary to provide a consistent and reliable picture.
When these systems do
attempt to represent the Service User's wishes & expressed needs, these
are often as 'additional comments', qualifying the professional's
assessment. Even where the impression is given that the system is User
Friendly (which is not often) they are not 'Person Centred' in the terms
that the original Professional Organisation / Discipline intended. User
perspective are often just 'written' in a quasi, 'Person Centred' way,
on the record.
The more beneficial purpose of
IT & paperwork system, for directly 'facilitating' practitioner contact and support of Service Users is
almost absent. What is more, this largely ineffectual and duplicating
system of recording 'in case if litigation', consumes vast amounts of
Professional Practitioner time, distracting from direct work with
Service Users. This
can and does, 'put them at real and unnecessary risk'. Particularly
those waiting on waiting lists, or whose problems are so complex that
they require exceptional amounts of 'administration' to reflect the
exceptional amounts of work done.
This is not to say that
recording is not important, but that it should be 'intelligent' and
purposeful.
Recording for the purpose of communicating to Service Users, colleagues
and involved agencies is essential .Recording for the purpose of getting
resources allocated to individual, or to show shortfalls in provision is
critical. 'How' that communication happens is
what is in dispute. To have a single, inflexibly system, designed for
the institution's purpose, or even worse, for the Technologist's benefit,
is a misuse of a resource that could otherwise facilitate the provision
of a better and more reliable service
How do I know? I have
designed such 'failsafe' and 'expert' computer systems. I have
implemented them successfully, tested them and adjusted the basic
concepts for reliability and facility over years, since 1980. They are
aids to professional practice rather than to accounting. In being aids
to practice they save on resources by making the 'system' more efficient
and professionals less frustrated. The same information is then
accessible for statistical purposes and can be used to monitor any
professional category, contacts, follow up and reviews, automatically
feeding back 'failures' to the next level of authority, who is then
required to respond in some form.
Apart from using the basic
system as a Management Tool, in my own social care and commercial
operations, I further tested a modified version of this system, which
was used in a client, commercial 'logistics' and accounting operations,
for over 5 years. This had minimal requirements for repair and minimum
training requirements, beyond the necessary knowledge to do the job and
the level of understanding of Microsoft Word. If systems are designed to
'facilitate' the worker's task, if they are 'intuitive', logical and
avoid duplication (but rather reduce it) the
relationship between user and machine is
less problematic.
This
page is in the stage of preparation.
