When we hate we damage our own mental health. We subject ourselves to anger, resentment and frustration. When we hate because of irrational prejudices like racism or religious discrimination we find ourselves worn out by self-censorship as we try to deny the reality in front of our eyes.
Why do it to yourself?
This series of blog posts first appeared a few years ago on a now defunct blog called ‘Care Training’. It was inspired by the training maxim of ‘making the unconscious conscious’. It is intended to take what really ought to be the most basic principles of health and social care and put them down on paper. The series isn’t only an exercise in stating the obvious though whatever the title might suggest. It’s actually intended as a philosophical foundation manual for workers and informal carers to help them get their care ‘on track’ and then to keep it that way.
The first of the Mental Capacity Act’s underlying principles is:
An assumption of capacity
This means that we need to begin by assuming that everyone we meet is capable of making this particular decision at this particular time unless we have reason to suspect otherwise. In other words that person is ‘Most people’ in relation to the ‘three types of legal status’ table below:
Three types of legal status
| Most people
Make their own decision |
Bournewood gap
Follow Mental Capacity Act 2005 |
Mental Health Act
Follow Mental Health Act 1983/2007 |
| People whose capacity to make the decision is not in doubt | People who are not detained under the MHA but who lack the capacity to decide | People who (because of a mental disorder) are deemed to present a risk to self, risk to other or are at risk through self-neglect. |
This might seem very obvious and reasonable (in fact it is) but it doesn’t sit too well with common practice in a number of care environments. Let’s look at an example.
When I was still a young man I worked as a care assistant in a Learning disabilities residential home. Looking back I can see a number of problems with the way the home was run but at the time, having come into a system that was already established, I thought that this was how learning disabilities establishments were supposed to operate. I didn’t know any better.
One of the fundamental mistakes I used to make related to the residents’ ability to make choices. This mistake covered all sorts of decisions from what to watch on the TV to whether or not they wanted to come on group outings to the local swimming pool.
The house was set in its own grounds in a beautiful part of Lincolnshire and the lawn and garden were nothing short of stunning. The home employed a full time groundsman to keep everything in good order and he did an excellent job. Consequently, many of the residents used to enjoy spending time sitting under the trees in the grounds or walking around the landscaped garden.
However this wasn’t always possible. You see, along with all the other staff there, I would take it upon myself to stop residents at the door and expect them to explain to me why they were safe to go outside. If I wasn’t completely satisfied then I would prevent them from doing so – this wasn’t difficult because the doors were always locked and only the staff had keys. Only if I was happy for them to leave would I let them go outside.
The problem was that this was the wrong way around. I emphasised the word let in bold for good reason. You see it wasn’t up to me to let people do anything.
We use the word ‘let’ a great deal in health and social care but that implies an authority we do not usually have. I can only let a person do something if I have the legal power to prevent them – and usually I don’t.
It wasn’t up to me to let people go outside into their own garden. They went because they had a right to and unless I had good reason to interfere with that they didn’t need my permission at all.
A more recent illustration of this comes from the N. Cornwall Learning Disabilities Partnership NHS Trust inquiry that took place in 2006. There were 40 referrals to the POVA list (now the vetting and barring list) and many of them were to do with staff preventing people from using areas that they had a right to without good reason.
Whenever we are tempted to take control of other peoples’ choices it’s useful to begin by asking ourselves:
“Who put me in charge?”
Unless you can demonstrate that the individual lacks the capacity to make this particular decision at this particular time then nobody put you in charge. The person has a legal right to make their choices whether we like it or not.
Even if the person lacks capacity (in which case you may very well be ‘in charge’) you will still need to act in their best interests and that doesn’t automatically mean doing what is best for the staff or for the relatives.
People have the right to occupy their own space, to make decisions about when they get up or go to bed, to choose who they spend time with and whether or not to involve themselves in activities. They also have the right to disagree with us and to ignore the preferences of family members just as you have. Your relatives have no right to tell you what to do (assuming you’re an adult) and the same is true for your service-user with capacity.
Who put us in charge?
This series of blog posts first appeared a few years ago on a now defunct blog called ‘Care Training’. It was inspired by the training maxim of ‘making the unconscious conscious’. It is intended to take what really ought to be the most basic principles of health and social care and put them down on paper. The series isn’t only an exercise in stating the obvious though whatever the title might suggest. It’s actually intended as a philosophical foundation manual for workers and informal carers to help them get their care ‘on track’ and then to keep it that way.
Just a quick post today. This one is as obvious as it gets.
What people say may not be what people mean
There are many reasons why people in health and social care settings don’t say what they mean and it’s worth taking a little time to think before deciding whether or not to take what they say at face value.
Here are just a few possibilities to consider…
People may be too frightened or insecure to tell the truth. Or they may know that what they have to say will be unpopular. Many would argue that fear of exposure and a basically unpopular message explains why people are often less than honest about their true intentions. The truth may be too problematic (or the other person’s reaction too scary) to admit to honestly.
The service-user who is always satisfied with the care we give them may genuinely be happy with what we do but, realistically speaking, the person who never feels dissatisfied is pretty rare. That’s why inspectors such as those from the CQC sometimes worry when an organisation receives no complaints at all. Are the service-users too intimidated to say what they actually mean.
There is a power imbalance between nurse, carer and service-user and it’s easy for people to be intimidated by that imbalance – even if it’s unintended. If it is intended, if the nurse is a bully for example then it’s even more of a problem.
If nobody in your service ever complains it’s a good idea to ask yourself why. You may want to look beyond their words and understand the fear that prevents them from being honest.
The other possibility I want to consider here is the ‘challenging behaviour’ strategy of taking people at their word even if you don’t think they’re being honest.
Sometimes people will tell you things they don’t mean because they have a hidden agenda. In those cases you may want to consider acting as if they’re being honest with you even though you think they may not. This more or less guarantees that the solution you give them, although appropriate for the problem they stated will be unlikely to match the subtext. Stick to the stated problem until they tell you what they really mean.
This means that over time they learn that it’s better to be clear and to be honest.
This series of blog posts first appeared a few years ago on a now defunct blog called ‘Care Training’. It was inspired by the training maxim of ‘making the unconscious conscious’. It is intended to take what really ought to be the most basic principles of health and social care and put them down on paper. The series isn’t only an exercise in stating the obvious though whatever the title might suggest. It’s actually intended as a philosophical foundation manual for workers and informal carers to help them get their care ‘on track’ and then to keep it that way.
In spite of having had my own issues in the past I began my nurse training with a very superficial mindset. I believed, without even thinking about it, that there were essentially two types of people in the world. There were ‘the mentally healthy’ and then there were ‘the mentally unhealthy’.
As a student nurse I believed myself (very arrogantly, I might add) to be one of ‘the mentally healthy’. I thought that people were born to mental health or to mental ill health and that the work of mental health services was to protect ‘the mentally unhealthy’ from themselves either by medication or by more social methods.
I’m embarrassed to acknowledge that my training did little to challenge that idea. There were a couple of outstanding exceptions but in the main the discriminatory attitude went relatively unopposed. Fortunately things have moved on and continue to do so but the student nurse training of 20 years ago was very definitely saturated by an ‘us and them’ ideology.
Of course, nobody ever came out and said it quite so bluntly, so starkly as I just did but there were plenty of references to ‘chronic illness’ and ‘irrecoverable’ conditions to illustrate the point just as clearly. Nowhere was this more obvious than during placements on the wards where people were described as ‘revolving door’ or ‘long stay material’ as though their very essence was illness and nothing more. I’m ashamed to say that for my first few years after qualifying I bought into this mindset completely along with all its negative (and essentially false) assumptions about incurable psychotic illnesses and irredeemable personality disorders.
I was glad to be one of ‘us’.
Then an interesting thing happened. I moved away from my first job on an acute psychiatric ward serving a large, deprived inner city area to my home town and began to meet up with old friends – many of whom I hadn’t seen for years. Around half a dozen of us met up for a meal in a local pub one night – it was a way to reintroduce myself to my old mates. And we had a good time swapping stories of our schooldays and catching up on the events of the intervening years. That was when it first began to become clear to me that there really is no ‘us and them’.
Of the six of us sat around that pub table five were taking anti-depressants. Every single one of my old friends had been prescribed pills to make them feel better. But they were my old mates. They were my best friends. They definitely weren’t to be considered as ‘them’.
That was the beginning of a mental journey that led me to rethink my old assumptions about mental health and illness. I needed to work out what was different between my old school friends and me. It surely wasn’t simple biology as I’d been taught. They couldn’t all have ‘the depression gene’ (whatever that is).
Finally it dawned on me – Sally had had a point. The difference isn’t just biology, although that can have a part to play. Biology is not the complete answer. It’s not the complete answer by a very long way. Attitude, social situation, environment and general coping style are just as important – arguably very much more so. This matters.
Once we acknowledge the impact of social skills, environment, opportunity, coping methods and psychological style we begin to see that given the right life chances people can be far more than they might appear. Our own assumptions about ‘them’ keep people from overcoming their problems by limiting those opportunities. It’s truly amazing what people can do when we treat them like ‘us’.
There really is no such thing as ‘us and them’.
I hate ‘staff mugs’!
Yes, I know… Many perfectly caring and compassionate care workers have no problem at all with this sort of seperation. They use crockery reserved only for staff because that’s what they’ve always done. And they never give the practice a second thought. It’s just a cultural ‘norm’ in many care organisations. But I hate it. I hate it with a passion. Not because I particularly care about the type of drinking vessel anyone uses but rather because I couldn’t give a fig about it. But I do care about culture. I do care about perception and I do care about discrimination.
Of course care workers who defend the use of staff mugs don’t talk about discrimination – they talk about hygiene. They talk about infection control and they talk about good practice and cleanliness. And so they should.
Obviously hygiene is important and clean crockery is an important part of the whole infection control system. That’s why we wash cups and mugs in the first place, isn’t it? But if we’re washing them properly does it really matter who’s drunk from a particular mug before? The whole hygiene argument for staff mugs makes no sense at all to me unless we have no faith in our own kitchen processes.
So are our cups and mugs clean or aren’t they?
If they are then we shouldn’t need to indulge in cultural discrimination. If they’re not then how can we possibly countenance sharing dirty crockery among service-users in our care? And how can we seperate ourselves from such a practice and then talk about hygiene?
Can we really justify giving our service-users mugs that aren’t clean enough for us to use ourselves?
Of course it’s not really about hygiene at all. The whole cleanliness argument is just a big red herring that generations of care workers accept uncritically because that’s what human beings do. We accept the status quo, especially if it seems trivial and move on to other considerations. But this isn’t trivia. This is a significant, long-standing cultural artefact of discrimination.
Care workers seperate mugs because the culture seperates people. Staff mugs are a vestige of the ‘us and them’ culture that devalues and disempowers service-users. We may talk about equality and shared care but our most fundamental values tell a different story.
So yes – I’m irritated by staff mugs. In fact I’m outraged by them. They may not be the most pressing issue in social care but given how little effort it would take to remove them they are inexplicably common.
And worst of all – nobody actually intends to discriminate against anyone by using them. But still they do.
ARTICLE 14
The enjoyment of the rights and freedoms set forth in this Convention shall be secured without discrimination on any ground such as sex, race, colour, language, religion, political or other opinion, national or social origin, association with a national minority, property, birth or other status.
As most people are aware many forms of discrimination are unlawful in British society as they are throughout much of the rest of the world. However the nature of discrimination (what it actually means) isn’t always so clearly understood. The confusion about what is and is not discrimination isn’t helped by the way that certain individuals or groups claim ‘discrimination’ when really they are simply failing to get their own way. A recent example of this involves Father Raniero Cantalamessa, Pope Benedict’s personal preacher who likened the current criticism of the Roman Catholic church to anti-semitism. Cantalamessa claimed that the current outrage at the Catholic church’s failure to protect children from paedophile priests is anti-catholic discrimination.
In fact nothing could be further from the truth.
What we see is arguably pro-Catholic discrimination in that the leaders of the church appear to be receiving preferential treatment. If the management of any other organisation had protected paedophiles from the law and knowingly continued to place them in positions of trust with vulnerable children they would be prosecuted. The ‘blind eye’ that the current Pope himself turned in the past would, according to UK law at least, result in prosecution and very probably a lengthy prison sentence. If there is any discrimination at all it is not anti-Catholic. It is pro Catholic.
The desire to protect children from abuse is not discrimination and such claims are merely an attempt to distract attention from the real issue – the repeated abuse of children by paedophile priests in the full knowledge of a hierarchy that was more interested in secrecy than in upholding the law. This would be a problem in any organisation, not just a Catholic one.
Criticising criminals for their abuse is fair comment. The reason for criticism of the church hierarchy is not their Catholicism, it is their criminal behaviour in shielding abusers from justice and continuing, consistently to place paedophiles in positions where they can repeat their abuses of vulnerable children.
We can see then that what does or does not constitute discrimination depends upon relevance.
It would be discriminatory to treat all Catholics, or even all Catholic clergymen as though they were child abusers. This is because Catholicism is not relevant to paedophilia per se. Not all Catholics are paedophiles and not all paedophiles are Catholic.
It is when we make unreasonable distinctions between people that we are guilty of discrimination. For example when we make assumptions about someone based upon characteristics that have nothing to do with the issue at hand. This sort of discrimination, based upon irrelevancies, is what happens when people make judgements based upon skin colour, religious affiliation, nationality, ethnicity, disability, profession or sexual preference.
Skin colour for example has nothing to do with trustworthiness and disability does not invalidate a person’s right to be treated with respect. In both cases, colour and disability, the ‘condition’ is irrelevant to the point under consideration.
However the fact that an individual belongs to a group that is regularly discriminated against does not mean that they can do no wrong. A gay man who assaults his neighbour in a dispute about a garden fence will still be prosecuted. But he will be prosecuted because of the assault. His sexuality is irrelevant. He may claim discrimination on the grounds of his sexuality but his claim will not be taken seriously by the courts because his sexuality is not relevant to the case at hand.
On the other hand a gay couple refused accommodation in a hotel or guest house would be supported under anti-discrimination legislation for exactly the same reason. Their sexuality is not relevant to their right to use services.
Similairly if I, when I was manager of a residential drug rehabilitation unit had to evicted an Asian man because of his use of illicit substances on the premises he could not then have claimed racial discrimination. Actually, anyone who knows me would understand how ludicrous such a claim against me would be but that’s not the point. The eviction would be because of the rules of the service which are applied equally to all service-users regardless of skin colour or racial type. Colour is simply irrelevant and therefore the decision to evict is not discriminatory – it is simply an appropriate response.
The basic ‘rule of thumb’ then for front line workers is to ask if the alleged discrimination is relevant. Is your action the result of the individual’s need or behaviour or is it motivated by the fact that they belong to a particular group.
If it’s because of individual circumstances and would be the same whatever subgroup the person belonged to then it’s probably not discrimination. I say probably not because there is the additional aspect of institutional discrimination that we will consider in a later post. If it’s because of the subgroup they belong to (eg Catholic, gay, disabled, Asian etc) then there’s a good chance you really are discriminating.
As ever ‘relevance’ is the key when deciding whether or not you’re being discriminatory.
The Human Rights Council recently expressed grave concern at discrimination & violence based on sexual orientation
Their concerns are mirrored by the Crown Prosecution Service here in UK who reported on prosecution rates for ‘hate crimes’ here.
About ‘The Convention’
This series of posts first appeared on Stuart’s blog in June 2011. It is not intended to be a comprehensive or even particularly authoritative reference guide to the ECHR. Rather it is a brief introduction to a much larger and infinitely more fascinating subject. You can download the entire series in PDF format here: https://stuartsorensen.wordpress.com/amj-freebies-downloads-and-services/
Are you married?
If not, do you plan to marry one day?
If so would you like to be free to marry the person of your choice?
What if you fell foul of the UK’s racial purity laws?
What if you fell in love with someone from a different ethnic group?
How does the prospect of imprisonment ‘grab you’?
Of course there are no ‘racial purity’ laws in UK. You are free to marry whomever you wish, regardless of their race, creed or colour. That’s good isn’t it?
Things weren’t always this way in Europe. During the Nazi occupation marriage was strictly managed according to racial values and characteristics. The German state took it upon itself to interfere in the reproductive rights of citizens in a number of ways based upon the prejudices of Nazism and the myth of Aryan superiority. That’s why article 12, ‘the right to marry’ (along with article 14 ‘freedom from discrimination’) are so important.
ARTICLE 12
Men and women of marriageable age have the right to marry and to found a family, according to the national laws governing the exercise of this right. Nobody can interfere with this right, especially if their objection is based upon arbitrary or prejudicial grounds.
In fact the term ‘civil partnership’ itself only came about so that a distinction could be made between religious marriage and state institution. The newspapers may talk about ‘gay marriage’ but the law does not.
Remember what we said about religious freedom – it’s a right so long as its expression does not interfere with the lawful rights of others. In this case Ms Ladell’s actions very definitely impeded the rights of others and also constituted discrimination on grounds of sexuality. That’s why she was sacked and why she lost her appeal. This may seem harsh but to restrict gay relationships on religious grounds is no more reasonable than to restrict inter-racial marriage on ideological grounds.
About ‘The Convention’
This series of posts first appeared on Stuart’s blog in June 2011. It is not intended to be a comprehensive or even particularly authoritative reference guide to the ECHR. Rather it is a brief introduction to a much larger and infinitely more fascinating subject. You can download the entire series in PDF format here: https://stuartsorensen.wordpress.com/amj-freebies-downloads-and-services/
Mind The Care Training 