Wednesday, 19 November 2014

Recovery in Mental Health: the Mersey Care Conference on 14th November 2014: Part 1

The annual Mersey Care Social Care conferences, held in Liverpool each November, are always extraordinary affairs, crammed with eminent and fascinating speakers. This year was no exception.

Roger Phillips, presenter on Radio Merseyside and a staunch advocate for mental health, kicked off the proceedings as ever, with an overview of the conference.

Lyn Romeo, Chief Social Worker for Adults in England, was the first speaker. She pointed out that it is in the nature of social work to have to grapple on a daily basis with risk, uncertainty and anxiety. The issues social workers have to deal with are frequently complex, challenging, and require a sophisticated response.

The role of the social worker should be to empower. Social workers employ the professional use of self to ensure and promote choice and the human rights of the people they work with.

Social work should be focussing on the social model of mental health, and should be working on a shift away from the medical, medication led model of intervention in mental health. What matters most to service users is empowerment, promotion of human rights and allowing them a voice. Hence, it is important to stress the social approach to AMHP practice within the Mental Health Act.

Lyn touched on the integration agenda, stressing the importance of social work integration in overall service provision in mental health services, and that social workers should be providing a model of leadership.

Lyn also spoke about the impact o0f the new Care Act on social care provision, andthat it should also be influencing health provision.

The concept of “eligibility” in the Care Act presents a challenge. There is a major role for social workers in recovery, as well as understanding and evaluating risk, taking into account the individual service user’s own perception of risk.

There followed an inspiring presentation of Mersey Care’s Recovery College programme. The programme was officially launched in September 2013, and it has led to a transformation of the culture of service provision. “Recovery is about having and building a meaningful, satisfying and contributing life”. It is therefore about the development of new meaning and purpose in one’s life.

The key components were identified as a move to person centred “dafety planning”, streamlining the route to employment and meaningful occupation, and empowering selrf management and learning.

The key to the success of a Recovery College is peer support workers. Their job is to create hope, control and opportunity for students of the college, in order to allow them to develop their own expertise in their own recovery. It is about creating a route to recovery from mental illness, rather than a form of therapy.

The Recovery College has managed to obtain funding from the Department for Work and Pensions. The philosophy is that public services are best delivered “with and not “to” people. This requires a shift from the idea of “fixers” to that of “enablers”.

So far, the Recovery College has run 70 courses, involving 600 students. 84% of students attended after enrolment, and 82% of these attended the full course. This is an impressive achievement, and evidence that the Recovery College is providing what service users actually want and need.

The average number of students per course was 7, which was felt to be a good size for participants to feel comfortable. The courses range from half a day to six weeks in duration.

The rest of the presentation was devoted to two service users. First of all was the extraordinary and inspiring Iris Benson, who eloquently and movingly told her own story of recovery against incredible odds. She is an expert by experience. She even had good words to say about the social workers who had helped her during her recovery, describing them as engaging, facilitating, supporting and encouraging.

She stressed the importance in the success of the College as being co-production, co-facilitation and co-delivery of courses, involving both professionals and service users.

Equally extraordinary was Wayne Ennis, another service user, who spoke about his experience of peer support: “You have the answers in yourself”.

David Hewitt was the next speaker. David is a Mental Health Tribunal judge, and also author of The Nearest Relative Handbook. He spoke of Deprivation of Liberty: Is it the start of a service user journey of recovery?

He stressed that as far as the Deprivation of Liberty Safeguards are concerned, there is still a great deal to be done. He examined the recent Supreme Court judgments relating to Cheshire West et al, looking at what this decision establishes, but also what it leaves unsaid. There is still a need for greater clarity. He expressed some concerns about the “acid test” posited by Lady Hale in the judgment, although he felt that overall the judgment had assisted clarity.

[Lady Hale stated: “it is axiomatic that people with disabilities, both mental and physical, have the same human rights as the rest of the human race. It may be that those rights have sometimes to be limited or restricted because of their disabilities, but the starting point should be the same as that for everyone else.” Deprivation of liberty happens whether or not the person is aware of it.]

He also quoted Lady Hale as saying that “DOLS have the appearance of bewildering complexity”, a sentiment with which most who have to grapple with it professionally would agree.
David posited that change is the overall determinant, suggesting that change surely cannot be determined when deciding deprivation of liberty. He gave the example of 2 people in a care home. One came from their own home, while the other came there from a high security unit. Comparative to their backgrounds, one was in a more restrictive environment, while the other was in a less restrictive environment. However, the environment they were in was identical.

[However, there is already a challenge to this. On 18th November 2014 Justice Mostyn took issue with the Cheshire West judgment in a Court of Protection judgment [2014] EWCOP 45. He found it “impossible to conceive that the best interests arrangement for Katherine, in her own home, provided by an independent contractor, but devised and paid for by Rochdale and CCG, amounts to a deprivation of liberty within Article 5. If her family had money and had devised and paid for the very same arrangement this could not be a situation of deprivation of liberty. But because they are devised and paid for by organs of the state they are said so to be, and the whole panoply of authorisation and review required by Article 5 (and its explications) is brought into play. In my opinion this is arbitrary, arguably irrational, and a league away from the intentions of the framers of the Convention.”]

David discussed the case of Munjaz v. Mersey Care Trust, which dealt with issues of “residual liberty”. He posed the greater question, what is liberty? And who says what liberty is? There is an assumption that we can all agree what liberty is or is not, but this is not actually true.

David suggested that a law cannot be a law unless a citizen can regulate their conduct according to the requirements of that law, and cited the case of HV V.UK 2004, which concluded that any law should be sufficiently precise to allow the citizen to foresee the consequences of their actions. He appeared to be suggesting that the Cheshire West judgment, and DOLS, does not meet that requirement.

And on that bombshell, I will end this segment. The concluding part of my review will come in the next few days. (There was, as always, a huge amount of fascinating content).


  1. Hello.

    Wish I'd been there. Thanks for this. What about a piece on recovery colleges some time in the future?

    Two observations. One is about Mostyn J's rather spectacular toys out of the pram fit of judicial picque in which he says he isn't going to apply the Supreme Court judgement because he doesn't want to. This appears to be challenging the basic hierarchy of the Courts and the basis of a common law system (or indeed any other judicial system) that some judgments take precedence. He states that if K's care package were organised and funded by her family alone, it wouldn't amount a DoLS. Yes it would? See Munby J's comments about family care amounting to a DoL and the state's duties in: Re A (Adult) and Re C (Child); A Local Authority v A (2010) EWHC 978 (Fam). The state has duties beyond providing care, but also in regard to monitoring and safeguarding too. These are 'positive obligations' in terms of the Human Rights Act and mean that the DoL in a domestic care situation is therefore imputable to the state.

    Please post a reference to David Hewitt's observations if you can. He's always an interesting commentator. However, if he's serious about the view that 'a law cannot be a law unless a citizen can regulate their conduct according to the requirements of that law' then it's not only DoLS that goes out of the window but most of the Mental Capacity Act, The Children's Act and come to think of it, surely the Mental Health Act as it applies to many detained patients currently unable to 'regulate their conduct' as well? They didn't deliberately become ill after all. The law isn't just about sanctions and punishment, after all.

  2. Anonymous 1 again. I've just remembered, Mostyn and Mumby have a bit of 'previous' that might add a frisson to their regard for each others' judgments. Apparently, after appearing before Mumby in the issue of Earl Spencer's divorce Mostyn represented the Earl. After losing the right to have the case heard in a closed court session, Mostyn, a keen farmer, apparently named his latest batch of seven pigs after his thoughts on the case's high court judge, : James, Munby, Self-regarding, Pompous, Publicity, Seeking, Pillock. The Earl later unsuccessfully sued Mostyn for incompetent counsel and revealed this interesting anecdote.

  3. Thanks for your very entertaining comments. I'd love to know who I'm talking with. You can email if you like.

  4. I would have liked to have been present at the conference particularly to hear the experts by experience talk about their recovery. However, I am disappointed that this summary reports Ms Benson as saying that she 'even had good words to say about the social workers who had helped her' - I feel confident that she did not insert the word 'even' when she spoke. It would not be reported in the same way about other professionals so why social workers?

  5. As a social worker I would like to pronounce the death of social work in mental health. Am I empowered? I'm a slave of my empty pocket and landlord. The people I 'see' on a monthly basis if they are lucky are better off financially than me, and still beg. No-one has choice. As long as you don't have a decent society, the rest is just blah Blah blah... like this jolly conference we read about. Choice? After so many years, how can we refer to it. Choose life, a la Trainspotting.

    1. Dear Social Worker,

      Who is begging? The only begging that one hears about today, by the people, is to de medicalise. Stop drugging the population of vulnerable people. Which is costing the NHS billions. Mental health needs an overhaul on how to wean people away from the poison that is being put into their bodies on a belief system. Crime against humanity. Then maybe social workers can get on with really helping those who are effected by psychotropic drugs that do not work.