Sometimes love is not enough

Yesterday evening, I watched When a Mother’s Love is Not Enough, a television programme that explored the issues and difficulties involved in being parent to a disabled child and was extremely honest, compassionate and thought provoking, and at times, a harrowing indictment of the ways in which the social care system lets down the millions of informal carers that it relies on to function in a manner that the state can afford.

The stress experienced by carers is widely acknowledged and this programme did not pull any punches, with parents who had come to the brink of killing both themselves and their child telling their stories.  As they described the exhaustion and frustration caused by being unable to comfort a child who cries for days at a time, or is abusive and injures himself relentlessly, or is reliant on you for all his needs yet unable to communicate or relate to you in any way, I found a new understanding developing for those who do find themselves before the courts having taken drastic action in moments of despair.

I remember a tutor once questioning why our courts often treat carers who snap or abuse those in their care more leniently than we do those who abuse children.  Her argument was that carer stress is no different than the stress suffered by any parent who is sleep deprived during the first few months with a newborn.  My argument was then, and remains, that the situations are very different: as a new parent, you know that sleep deprivation is inevitable but will not last forever, and you choose to experience that.  Most carers, however, do not consciously choose to become carers- they fall into it, as a spouse becomes old and frail, or suffers illness or trauma, or a child is born unexpectedly disabled.  Carers cannot usually take refuge in the hope that the situation will improve after a  few months, and rarely have the small army of helpers that a new baby frequently attracts.

As social workers we are required to offer carers an assessment of their needs, in addition to assessing those of the person they care for.  However,  due to the chronically underfunded and overstretched social care system, many local authorities set the threshold for receipt of services under the Fair Access to Care Services legislation at those carrying a ‘critical’ or ’substantial’ risk to quality of life, and additional funding to meet carers’ needs is simply unavailable, or very low priority.

The implications of this are obvious. If a carer was able to access emotional support, advice, and practical help such as respite care and support from professional carers to enable them to pursue other interests, their physical and mental health would benefit, impacting upon the people they are caring for.  It may also help to prevent today’s carers becoming users of mental health services or the criminal justice system tomorrow. This would require increased financial investment however,  and social care has traditionally been the poor relation to health, education, justice and all manner of other funding priorities.

Commenting that both the current Prime Minister and the leader of the opposition have experiences of caring for disabled children, the presenter wondered what effect this might have on future policy decisions affecting carers. It seems unlikely: recent policy consultations have focused upon the future of adult social care funding, but sadly emphasised care for older adults, ignoring the needs of younger people.  Would things change very much under a Conservative government? Who knows- as yet, very wisely, David Cameron is keeping specific policy intentions largely to himself.

On a personal note, however,  as I prepare for my final placement within a mental health service the need to be aware of both the role and needs of carers has been highlighted again, with an impact I hope will not fade from my mind quickly.

 

 

 

Changing views about ‘recovery’

Once again, I have had to rethink and challenge my attitudes and beliefs.  This time about mental health, provoked by the literature review I was required to write. I eventually chose the concept of ‘recovery’, which proved fascinating- and challenging.

To give a quick synopsis, the recovery movement argues that everyone who experiences any form of mental ill health can recover.  Recovery is defined in various ways, largely by the individual, and may not include clinical recovery, in which symptoms and medication use are eliminated; instead it may be defined in terms of quality of life.  It  involves self-management and determination, rather than relying on professionals to determine how an illness progresses, and joint decision making about treatments etc.

Prior to this, I had no difficulty in accepting that some people could recover from some forms of mental health difficulty.  I knew for example, that some people suffer one episode of depression, or anxiety, and no more. In that sense, they achieve clinical recovery, in the same way as somebody who has had a broken leg does.  I also knew, that some people with bipolar disorder could become stable with medication use- after all, I have!  I did not, however, believe anybody could effectively manage their condition without medication use.

However, if I am honest, I did not totally believe this also applied to schizophrenia or other psychotic disorders.

I guess my mind has been infiltrated by the views of the society it exists within.  I believed schizophrenia to be a lifelong, deteriorating, extremely disabling condition- a life-sentence of doom.  I have heard about people who claim to have been diagnosed with the illness and now use no medication, no psychiatric services, and live fulfilling lives with high status jobs etc.  I have heard about them- and viewed them with high levels of scepticism.

This has been influenced by other users of local services with whom I’ve had contact who equate recovery with refusing all ‘evil’ medication and coping alone-  but still exhibit severe symptoms and are easily identifiable as ‘ill’.  Some have later successfully chosen suicide.  At the time, I did not want to settle for that type of life- I wanted to eradicate my distressing symptoms and regain a ‘normal’ life, working, independent, and within mainstream society. I wanted to be able to forget I had a  mental illness.

Now that’s my reality, maybe I am more able to see the value in other views too. If I consider the ways I maintain my wellness, I realise that my medication probably plays very little part in that- I am aware my doses are very low, possibly more placebo and reassurance than much else, and I use daily self-management techniques to preserve my stability.  I am also able to see that my views of ‘normality’ are very much socially constructed- and know that wherever dominant attitudes exist, resistance also exists. I believe far more in personal choice and objectives now, rather than people being fitted into boxes shaped by ‘government’ or ‘mental health service objectives’.  I understand that hope is extremely important when faced with any form of illness- mental or physical.

I’m also able to accept that some people relate to psychotic symptoms differently than I did, and not everybody experiences them as distressing.  Some people are able to live alongside them, and find meaning in them.  My reading has actually forced me to re-evaluate some of my past experiences, and has changed my views on all psychotic experiences as being irrational: with hindsight, I can see my psychotic experiences were my mind re-formulating certain other experiences that I was unable to process at that time.

I guess what I’ve come to accept now is that sometimes, for some people, anti-psychotic medications are not the best approach to their psychotic experiences, but rather the use of psychotherapeutic methods may be more appropriate- and equally(or more) successful.  And some people may choose neither, preferring to live ‘in recovery’ with their experiences, integrating them into normal lives, according to their own definitions of what a normal life is- and that is just as good.

Talking to the media…

There’s been a lot of negative press recently in the general media about social work, from some areas more than others, but this morning, BBC Radio Manchester gave quite a lot of coverage to the profession, throughout the breakfast show.

The programme coincided with some statistics gained by the Press Association that within the Greater Manchester area, 24 Serious Case Reviews have been undertaken since the Baby Peter case in 2006.  The different social workers (and student!) were interviewed at the BASW England conference, held in Liverpool on October 8th, and Hilton Dawson was also interviewed.

Overall, the coverage was very positive- emphasising the very difficult job that is children’s social work today.

Personally I learned a lot from the experience.  I learned that in a media interview, it is essential to frame your sentences carefully, so that your words cannot be used to make an implication that may only be partially true.  In this interview, for example, I was asked two different questions. The first questioned whether it is scary entering social work, given the current difficulties.  My answer was used in the programme- introduced as ‘a student who thinks she is mad’ for going into social work.  The second question asked why I still want to do it, to which I answered that it is also a very rewarding and important career, and that I am passionate about protecting vulnerable people of all ages, preserving their rights and empowering people to change their own lives.  That answer was not broadcast.

So I learned!  In the above example, I should have answered the first question with a ‘but’ that lead onto the second part.   If ever interviewed again, I will remember this experience!

However, for the record:

I am PROUD to be entering the social work profession- NOT at all mad!

Too much choice…

The mental health pathway for my course is assessed by means of 2 assignments- a literature review, of your own choice but discussed with the tutor to ensure suitability, and an essay about assessment within mental health services, including assessment of risk.

The first gives me a headache- for no other reason than that it is too open. It means I have to choose one fairly narrow area to study, as the word count is only 3000 words. Later in the year I have to write a journal article of 6000 words related to my particular placement setting, also an independently chosen topic (which replaces the traditional Masters dissertation).  So during the year, I am able to study two areas of particular interest to me in relative depth.

My problem is, there are so many areas I would like to study, as they interest me. For instance, early intervention services, self harm, mental health promotion services, the most effective interventions with suicidal people, mental health and parenting, social work practice with the psychoses, to name but a few.

I guess the best way to choose would be to adopt a pragmatic approach i.e. to sacrifice personal interest somewhat in the interests of literature availability.  After all, there’s no point making things more difficult by choosing  a topic that is fascinating, but which has received very little recent attention within the academic press.

An afternoon spent with the electronic library might be a good plan for tomorrow.

Back to uni

Today was day 88 of placement; in 4 more weeks it will be over.  Tomorrow I return to university to begin the second year of my MA.  The combination of both has put me in a reflective mood.

It seems like only yesterday that I was starting the first year of the course, full of hopes mixed with a huge dose of trepidation. For most of the year I felt very intimidated by many of the other students, who all seemed far more experienced and confident than myself. I wondered if I was setting myself up to fail, doubting my own ability to cope.

Now, at this stage of my placement, I have suddenly noticed changes in myself. Over the last few weeks, I have developed into an assertive, confident practitioner, not afraid to fight for a client’s rights. My assessment skills have been refined, as have my advocacy, negotiation and communication skills. I’ve learned how to raise difficult issues with people and handle their reaction.  I’ve become a more analytical practitioner too, and better at prioritising my workload. I’ve also discovered I’m far more emotionally resilient than I thought, and developed effective strategies to deal with stress.

And now I have no doubt in my ability (and desire, which at one time I doubted) to become a social worker.  I’m eager to return to university tomorrow, and no longer feel intimidated.

So tomorrow is the beginning of the mental health specialist pathway, the next step on the way to qualification.  I’m looking forward to it; I feel ready to return now and am keen to get stuck into my real area of interest.

Realising that this time next year I will be qualified is downright scary though, especially as I think back on how quickly the last year seems to have passed.

A carer’s lot

A few weeks ago I went down to my mother’s for 10 days.  She had recently had a mastectomy, and was having some problems with her recovery, and as my father was going abroad for business, I slipped back into my role of  ‘young carer’.  Except that the role didn’t seem to fit as well now as it used to do when I was a child.

I’m 38 now. In my entire 38 years, I’ve probably had only about 6 whole years where I can say I have not been a carer in any shape or form, 4 of which encompassed my early childhood.  I went from being a carer for my bipolar Mum, to a carer for my husband, who had physical and learning disabilities (a long story) and a mental health problem, almost without any break in between.  The last 2 years have been bliss-  the only person I’ve had to care for has been me!

So I went to stay with Mum for 10 days. I was physically and mentally exhausted, due to the combination of being on placement, and being on placement on public transport, which has made every day ten times harder, given the geographic area I cover.  I would have been quite happy to spend all 10 days asleep.  Mum, on the other hand, was manic.  Not even hypomanic- she was full blown manic.  At one point, I debated calling her GP and requesting him to arrange a mental health act assessment.

Exhausted carer+ manic relative= not a good mix.  It is tiring, frustrating, anger-provoking, embarrassing, scary and hurtful.

You get to the point of praying for the crash down into deep depression that almost always follows a manic episode, although you know the depression is possibly more painful for the person involved.  But for the carer it’s easier to manage: you can usually predict with accuracy what the person will be doing- the boundless energy of mania totally evaporates and rising from a chair becomes a challenge.  Suicidal feelings are fairly easy to deal with in the worst depths of depression, becoming more dangerous when the person improves and energy levels increase again.

Sadly, this didn’t happen, and I will admit that I was glad to come home and leave Mum behind.

It was a very timely reminder for me though, as I begin the mental health pathway of my training in three weeks, of the incredibly hard and stressful work done by carers of many people with severe and enduring mental health conditions, and the need for professionals to consider their needs in addition to the needs of the client.

Anti-oppressive practice?

Yesterday I went on an unannounced visit to a carer’s home with a recently qualified male worker, to observe the way the checks are done.  Some very real safety concerns emerged, but the carer gave two explanations, which, while not seeming totally plausible in terms of the actual concerns, were certainly partially credible.  The issues obviously needed addressing, but there are ways and means… and the ways my colleague chose to address them left me cringing.  His manner was very authoritative- fair enough, it did need to be- but was also very judgemental, accusatory and sharp.  I sat desperately wanting to say to her ‘don’t worry, things can be easily sorted’, as she looked like she was going to cry.  Today her support worker received a telephone call in which she did actually break down in tears.

I’ve accompanied this social worker on other visits too and his manner was much the same.  I am not sure whether there are cultural influences affecting the way he relates to people, or whether he just has poor interpersonal skills, but I find him very oppressive and judgemental, making hugely value-laden statements about, and to, service users.

I know the code of practice says I should challenge these sort of statements and attitudes, but to be honest, as a student that is extremely hard to do.  I have no status within the team; it risks my reputation within my placement; and there is also the fact that other team members are aware, one having commented to me about it, yet it seems to be the team culture to just accept it.

So I’m afraid that on this occasion I have decided simply to learn from this worker’s practice; he has taught me far more about anti-oppressive practice by his lack of adherence to the principle than if his practice was exemplary.

Hitting the ground running

I posted a while ago about spending some time with the local authority fostering team to gain extra experience and meet the assessment requirements for my placement.  I began last week and from now on, I will spend two and half days in each location.   Fostering was certainly very different from the children’s advocacy service where I’ve been based until now.   Mostly in terms of the workload.

I have heard a  lot recently about children’s services wanting to employ experienced social workers who can ‘hit the ground running’ without needing a lot of  supervision and support, which is the fear about newly qualified staff, especially those who have not had statutory placements, during training.  My experience of this team has been that they just need bodies who can hit the ground running- experienced or not!

In the two days I’ve been there, I have shadowed a social worker to do a foster carer’s annual review, a foster carer supervision session, and an initial assessment of prospective foster carers.  Tomorrow I go alone to do a supervision session for a kinship carer, who has not had one for over a  year due to long-term staff sickness; I also need to contact another carer to arrange a supervision session, and for both I will arrange their annual review.  Then on Thursday I am to carry out initial assessments with two prospective carers.

I must admit it amazes me in some ways- I know I am competent to do these, and if I wasn’t, I am confident enough to say so.  But it does surprise me that they are willing to allow a first year student go out and do this type of work alone having not observed my practice, and having only watched one of each type of assessment (especially as normally they only have second year students in the statutory teams within the authority, not first years).

It is a fantastic opportunity for me- but it does really bring home how desperately short-staffed and overworked these teams really are.

Reflections after two thirds of placement

Yet again it’s been ages since I last posted- I totally underestimated how difficult this stage of the course is.

I am effectively working full-time- for no salary- and then coming home at night and having to write a reflective log, thinking about what I’ve learned that day.  At weekends I write the essays, or update the records evidencing my competence in the key roles of social work, ready for each supervision session and my final assessment portfolio.  In this time too, there is often reading to be done, to give me a vague idea about what and why I do what I am doing during the week!

It is safe to say I am totally exhausted at the two-thirds stage of placement.

However, I am absolutely loving the placement, and, in contrast to my views before, I could actually see myself working in children’s services (although I think I would still prefer to avoid child protection work).

What has most surprised me, probably, is the realisation that much children & families work is actually done, not with children, but with the families ie. adults!  For example, to protect children, you have to work with those caring for them- their parents.  Arranging foster care involves mostly working with adults, to recruit new carers  and then to support them in their role.  Some roles combine working with children and adults, but few roles work solely with young people, certainly within statutory services anyway- independent agencies may differ of course.

It may sound very naive, but probably like most of the general public, I thought of children’s social work as child protection;  this placement has opened my eyes to the many different roles that exist within children’s services!

Although I am loving my practice experience, however,  I am avidly counting down the days to my break in a week- Dad is going away on business, so I am going to stay with Mum for 10 days while she recovers from her recent surgery.

Penalising the poor

It suddenly went manic at placement this week, hence no posts- too busy during the day to write, too tired once I get home!

But today this story lept off the front news page of the BBC at me.  The government is hoping to reduce the unpopularity of it’s student fees by offering an arrangement whereby students can choose to avoid paying tuition fees by also waiving their right to further financial support via loans/ bursaries/ maintenance grants.  This, the government says, will enable students to go through university and graduate without also accumulating huge debt, and it is thought the scheme will be very attractive and beneficial to those students who choose to live at home to reduce their costs.

However, just which students will this scheme benefit?  It sounds great- students who are just beginning careers/ adult life will be able to avoid huge debts (mine total approximately£17,000 and I avoided tuition fee loans- now the average will be larger than that).  But it doesn’t take a huge IQ to realise that most students rely on the loans and grants schemes, along with credit cards and overdrafts to survive university- even those living at home during their courses- so this scheme will benefit mostly those whose parents or partners have high enough incomes to support them for three years.

This will exclude many of the very students the government is continually telling us it want to attract into higher education- those from lower income families, those where nobody has previously been to university, looked after children… There is no mention of any intention that this initiative might lower state costs in higher education provision, thereby possibly enabling the level of tuition fees to be reduced, or maintenance grants to be increased.

So: richer students will benefit, while poorer students will still be discouraged from entering higher education due to the cost.

And, as these same richer students will only be denied a student loan- which as the name suggests is repayable anyway- those poorer students who will continue to repay (possibly soon-to-be increasing) fees and loans on graduation will now also be in the enviable (?) position of subsidising the education of those in a more enviable financial position to themselves!

New labour/ Old Tories????