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).
Hello.
ReplyDeleteWish 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.
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.
ReplyDeleteThanks for your very entertaining comments. I'd love to know who I'm talking with. You can email if you like.
ReplyDeleteI 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?
ReplyDeleteAs 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.
ReplyDeleteDear Social Worker,
DeleteWho 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.