Categories
duty of care human rights law safeguarding social care

Safeguarding: An established process, not a civil liberties dilemma

I first published this article 7 years ago. It’s unfortunate that so many people still fail to understand the need for robust Safeguarding processes, especially when the same people often express mock outrage at child abuse cases that the Safeguarding system attempts (& often manages) to prevent.

Child and ​Adult Protection have become increasing concerns over recent years. Several high profile incidents involving abuse of vulnerable people have prompted UK society to look again at the systems we have in place to safeguard those who need it most.

Social media currently features ill-informed and often frankly unconvincing outrage on behalf of Rachel Booth, a school dinner lady who attended a rally organised by Tommy Robinson (EDL founder & notorious Islamaphobe).

Mrs Booth has been suspended from her job as a result of her attendance at the far right rally. She has broken no law and is not being charged with any crime yet her job is in jeopardy (an inquiry is ongoing). Many people consider this to be abusive and an affront to freedom of speech. One particularly ill-informed right-winger even describes it as a ‘thought crime’, reminiscent of Orwell’s dystopian novel ‘1984’.

The inappropriateness & ironic hyperbole of this far right Tweeter’s statement is obvious when you realise what inspired it. Pastor Martin Neimoller was writing about German Nazism, a regime not unlike Robinson’s EDL. The Nazis executed vast swathes of people from minority or politically inexpedient groups without a hearing, often simply because of who they were. The British Safeguarding system aims to ensure the safety of vulnerable people and minorities through proper investigation focusing upon what people do.

As a trainer I am convinced that people make sense of things best when they know the ‘how’ and the ‘why’ as well as just the ‘what’. So read on to understand why this suspension isn’t only appropriate but, in Safeguarding terms, absolutely necessary.

We’ll begin with the Protection of Vulnerable Adults (POVA) system. This was introduced by the Care Standards Act 2000 with guidance from the government’s ‘No Secrets’ document. This outlined the definitions of abuse and of vulnerable adult. It also created the POVA list – a register of the names of people who were deemed to be unfit to work with vulnerable people because they represented too high a risk.

The POVA list was one of three basic lists:

1.The POVA list: related to vulnerable adults
2.The POCA list: related to children
3.List 99: Related to education

These three lists were operated by different organisations but all relied upon the enhanced CRB check. The CRB check (Criminal Records Bureau) check provided information on criminal convictions. The enhanced CRB check provided more than just this basic information. It also noted suspicions and unproven allegations that might be relevant.

When delivering training on adult protection and safeguarding I almost always come across objections when I make this point. This is understandable because it seems to contradict the long-standing legal principle of the presumption of innocence: the idea that we are innocent until proven guilty.

My response to this is always to put forward the following hypothetical scenario from the world of child protection:

Imagine a teacher – a good teacher – we’ll call him ‘Bill’. Bill has been in the job for many years and gets great academic results for most of the children he teaches. Bill specialises in the 7 – 11 year old age bracket.

Some of the children Bill teaches tend to do very badly though. They tend to be little girls with blonde hair and they often become withdrawn and emotionally needy shortly after joining Bill’s classes. I don’t think I need to be too specific here – the results of paedophilia are well known and the above scenario illustrates the point well enough.

Now imagine that this teacher has been working in a particular school here in Cumbria for a few years when he notices that some of the parents have taken to ignoring him. Bill also notices that when they’re waiting for their children at the school gates some of the parents tend to bunch together and seem rather conspiratorial whenever they see him. Bill’s no fool. He knows what’s about to happen. It won’t be very long before he’s formally reported to the local police.

So Bill applies for other jobs in other schools out of the area. His overall academic record is good and the head will give him a good reference (not least because she’s heard the rumours too and wants rid of the problem). Bill leaves Cumbria and takes up a post in a school in the neighbouring county of Lancashire. There’s no conviction and so no information follows him. He’s in a different education authority with a clean slate.

A couple of years later, having continued his abuses with a fresh group of Lancastrian children, Bill moves again, perhaps to Lincolnshire this time. And then a year or two later he moves once more – this time to your home town. Now Bill’s teaching your children.

That’s OK isn’t it?

It doesn’t take a genius to understand that if we can only use convictions to identify abusers we will fail more often than we succeed. But this gave us a dilemma as a nation. Whatever we do we cannot have a perfect system – mistakes will be made. The choice we have had to make as a society, the way through the dilemma, is to consider what the price of our mistakes will be.

If we rely upon convictions only then the price will be countless abused children. Exactly the scenario that ‘libertarians’ like the quoted Twitter-user & far right Islamaphobes like Tommy Robinson claim to oppose. Imagine how many youngsters a teacher will come across in the space of a career. How many vulnerable elderly residents might an abusive ’carer’ come into contact with too?

If we use wider sources of information the price of our mistakes will be some people having to get a different job. Neither outcome is ideal but then it’s not an ideal world. Which price do you consider to be the lesser of two evils? I think – and the government thinks – that the lesser price is the fact that some people will need to get a different job.

So child protection systems solved the problem, at least in part, by considering wider information and adult protection has followed suit – hence the enhanced CRB check (now the DBS). Even then it doesn’t necessarily mean that the individual whose information shows up on the check is barred from working in the care sector but they may have some things to discuss with prospective employers at interview.

Only in the more extreme cases are people actually prevented from working with vulnerable adults and that was what the old POVA list was about. People whose names ended up on the POVA list were legally barred from working in social care.

In 2005 Kings College London produced a report analysing the first 100 referrals to the POVA list. Their findings were significant and in parts very worrying. The document can be viewed online here.

Firstly it was clear that the vast majority of referrals came from the independent sector with only around 5% of referrals generated by the NHS. This is unlikely to be because the NHS does not have any abuse issues – in fact it may demonstrate a culture of neglect and ‘turning a blind eye’ that needs to be addressed as a matter of urgency. When abuse in the NHS does come to light it is often extreme and systemic as was demonstrated in the North Cornwall scandal of 2006.

The report also noted that in many cases abusive practice had been tolerated and left to continue for long periods. This was especially true in smaller establishments. The vast majority of abuse involved front line workers.

Perhaps most worryingly several workers had actually been convicted of relevant offences and yet continued to work in health or social care. The main arguments put forward in mitigation by those accused of abuse were:

Overwork;
Lack of training (particularly relating to challenging behaviour and hostility);
Accidental harm/lack of intent to cause harm;
Mental health problems experienced by the alleged abuser (often linked to working conditions).

“In our reading of the referrals there appeared sometimes to be a merging of poor skills and abuse”

The Kings College report acknowledged the reality of many of these mitigating circumstances and asked for greater scrutiny of employers and their practices when determining the truth of such allegations:

“As a means of reducing harm to vulnerable adults, it is clearly important to ensure that people of general ill-will or those who lack capacity are prevented from working in social care. However, it is also important to balance the focus on individual abusers and episodes of abuse with a wider examination on the quality
of social care employment practice, availability of training, working conditions, impact of under-staffing and ongoing nature of stress.”

“Consequently, it is possible that previous CSCI reports on the provider unit or company may be a valuable addition to the information to be considered in making decisions about referrals. In situations in which a worker claims not to have had training, examination of such records may help provide better evidence. Furthermore, some referrals included evidence about staffing levels at the time of and immediately preceding the incident or periods of misconduct would be useful. Such evidence may help in deciding individual cases, but also identify situations which might give rise to ongoing concern about the safety of service users in those establishments.”

Although several workers were dismissed and some were reported to the police not all of them were prosecuted. This is because it can be difficult to establish guilt in a court (beyond reasonable doubt) even when there is enough evidence (balance of probabilities) to dismiss them.

Differing ‘burden of proof’ has been a long-standing problem, especially in child protection. Child protection (CP) is an area of practice that has provided many answers to problematic issues and so it was used as a basic blueprint to guide adult safeguarding procedures.

Other problems identified by this and subsequent studies involved the lack of partnership working between sectors and what appears to be an element of ‘preciousness’ in some local authorities with regard to the sharing both of information and of resources.

In response to these sorts of concerns and also serious incidents such as the Soham murders (Ian Huntley) and the case of Miss X (Scottish Borders Enquiry) new legislation was drawn up and has been implemented throughout UK.

References and further reading

Department of Health (2000) No Secrets: Guidance on developing and
implementing multi-agency policies and procedures to protect vulnerable adults
from abuse, London, Department of Health.

Department of Health (2004a) Protection of vulnerable adults scheme in England
and Wales for care homes and domiciliary care agencies: a practical guide,
London, Department of Health.

Department of Health (2004b) ‘P1.1 Rounded Referrals, Assessments and
Packages of Care, for adults’ Report of findings from the 2003-04 RAP
Collection, London, Department of Health.

Fyson, R., Kitson, D. and Corbett, A. (2004) ‘Learning disability, abuse and
inquiry’, in: Stanley, N. and Manthorpe, J. (eds) The Age of Inquiry: Learning and blaming in health and social care, London, Routledge.

Health & Social Care Information Centre (2004) Community Care Statistics 2004:
Home care services for adults, England, London, Department of Health

House of Commons Health Select Committee (2004) Report on Elder Abuse,
London, The Stationery Office.

Mathew, D., Brown, H., Kingston, P., McCreadie, C. and Askham, J. (2002) ‘The
response to No Secrets’, The Journal of Adult Protection, 4(1) pp. 4-14.

Social Care Workforce Research Unit 2007) Partnership and Regulation in Adult Protection http://www.prap.group.shef.ac.uk/PRAP_report_final_Dec07.pdf

Summer, K. (2004) ‘Social services’ progress in implementing No Secrets – an
analysis of codes of practice’, Journal of Adult Protection, 6(1) pp. 4-12.

The Nursing and Midwifery Council (2004a) Reporting lack of competence: A
guide for employers and managers, London, NMC.

The Nursing and Midwifery Council (2004b) Reporting unfitness to practise: A
guide for employers and managers, London, NMC.

This bulk of this (now slightly updated) article first appeared on Stuart’s personal blog early in 2010. It has been reposted here in response to current events.

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Categories
duty of care law Mental Capacity Act mental health mental health act social care

Privileged glimpses 25: 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.

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?

Categories
challenging behaviour mental health social care

Privileged glimpses 23: “It’s just behavioural”

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 young woman sat hunched in her chair, not making eye contact with any of the half dozen or so people seated around the little room. It was hot, stiflingly so with so many bodies in such a small space. All eyes seemed to be upon her as a moon-faced man, dressed in an immaculate suit, began to speak.

“How do you feel this afternoon?”

The young woman didn’t answer as she picked imaginary lint from her blouse.

“Have you been taking the tablets?”

The man in the suit, a consultant psychiatrist, seemed to be addressing his patient but his attention had already shifted elsewhere. He had given up waiting for a response even before he’d finished speaking to her. Now, along with everyone else in the room (except the patient herself) he was looking at me, her primary nurse.

“Everything’s been given as prescribed.” I said. “No problem.”

The psychiatrist nodded and half-smiled his approval. My patient, all but forgotten now, stared at the floor in silence.

A few minutes more discussion between the various members of the team followed about the relative merits of antidepressants ensued. Then, again looking directly at me, the psychiatrist asked:

“Do you think you’re getting any better?”

I waited for her to answer, shifting my own gazer toward her in the hope that others would try to include her also. Perhaps this would help her to feel noticed again. Then the psychiatrist spoke again:

“Is she improving, Stuart?”

There was no response from the patient so I explained that she had indeed made progress, she was sleeping and eating normally and had begun interacting with other people on the ward too.

“No evidence of that here, is there?” The psychiatrist quipped, eliciting tiny, almost imperceptible smiles from one or two of the others in the little room.

I explained (again) that these team meetings were intimidating for her and that her presentation on the ward was far more relaxed. I explained again about the work we’d done on the ward and how she was able to talk about her problems with us and her depression was lifting every day. I also pointed out that she specifically asked that I explain this precisely because she lacks confidence in this setting.

“It’s just that she feels much more ‘on show’ during the ward round”.

The young woman raised her head a little and grunted her agreement, albeit rather timidly.

“So you can speak.” Said the psychiatrist. “You just choose not to speak to me.”

Once again the woman’s gaze dropped to the floor in front of her. She said nothing more in the ward round although she did begin sobbing quietly to herself upon learning that she would be discharged home that day.

After she left the room (it’s strange how readily people accept the decisions of psychiatrists and just go) I made the point that although she was improving she wasn’t well enough for discharge yet. I believed, the whole nursing team believed, that another week or so would make all the difference. I pointed out that her lack of confidence in the meeting was evidence that her former high self-esteem had not yet returned.

“That’s only behavioural.” Said the psychiatrist as he completed the discharge forms.

I’m always interested to know just what people mean when they describe a person’s actions as ‘behavioural’. Actually I’d be interested to know of any action that isn’t ‘behavioural’.

In the health and social care context (including psychiatry) what ‘behavioural’ usually means is that we feel powerless to change the behaviour or that we are at a loss to understand it. Actually the two meanings often go hand in hand as a little understanding does tend to point the way to the solution anyway.

It’s not difficult to understand why this young woman was so quiet (elective mutism we call it in the trade). It’s not difficult to see the solution either – a smaller group meeting, perhaps with only one or two people present and some attempt to engage with her as a person rather than as a set of symptoms would probably have worked wonders. It certainly helped in my one to one sessions with her on the ward.

However, such understanding would require a little thought, flexibility and even compassion. It’s much easier to write the situation off as ‘behavioural’, all the time pretending that the word actually means something clinical and isn’t just an excuse for our own lack of imagination.

A fundamental premise of this series and of care provision in general must be that everything we do is behavioural but that nothing is ‘just’ behavioural. If we want to be effective we need to stop hiding our own inadequacies behind this meaningless term and take the time to understand the individual instead.

Everything happens for a reason and effective work with people whose behaviours can be challenging must begin with that ‘cause and effect’ principle clearly understood.

Categories
challenging behaviour mental health social care

Privileged glimpses 21: Consequences, learned behaviour and boundaries

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.

Imagine yourself transported without warning to a completely dark space. You can hear nothing, there are no significant smells, you have no light to see by and there isn’t even a breeze. You have no idea where you are or how you came to be there. What will you do?

When I ask this question in training sessions people generally answer by telling me first how they might feel but that’s not the question. What will you actually do?

Most people say that they’d stretch out their arms and walk forward gingerly in one direction until they find something in their path. This will give them the beginnings of a sense of their environment. If they’re lucky they’ll find a wall – a boundary.

Once they have the boundary they will feel their way around the space until they either get a sense of the size of the place they occupy or maybe even find something really useful like a door.

The interesting thing is that most people report that this would go some way toward alleviating any anxiety they might feel. The more they can understand the limits of their environment the safer they feel. It doesn’t necessarily mean that they will be happy in their new surroundings (although if they find a light switch they might become so) but the more we understand our boundaries the more confident we feel.

This is generally recognised as the reason that children and adolescents rebel – they ‘push the boundaries’, not because they want to break them but because they want to understand them. This is why children from families with poorly defined boundaries are generally less happy and less confident than those who know their limits clearly and without variation.

In fact there is a very strong argument that in order to feel safe and protected by their parents or other caregivers young people need to know first and foremost that the carer can control them. After all if the parent can’t control the child then they can’t be any better at defending against threats either. In short – boundaries allow children to feel secure and also to feel confident enough to concentrate on the massive task of growing up that lies before them.

Clearly the task of health and social care workers is not generally to control the people they work with but none the less there are real similarities between the boundaries that children need and the limits and boundaries that adults need – whether they’re receiving care services or not. Think about the boundaries that are imposed upon you in your working life.

You have shift patterns to stick to and certain tasks to perform. There are shared values that health and social care workers must stick to and there are some very real limits to acceptable behaviour. The clearer these limits and expectations are the happier the workforce is. The same is true for people who receive our services.

If you don’t know what the boss expects you will try to find out. If that means pushing the limits a little to see what happens then so be it – at least you’ll know afterwards and it’s worth a minor rebuke to get the lie of the land. Think how difficult it would be to concentrate on your job if you were forever wondering how far you could go before you faced disciplinary action. We all need to know the boundaries.

If this is true for us it is equally true for the people we work with. How anxiety provoking would it be for a service-user to have to guess what was and was not acceptable? How confident would they be if they didn’t know what would and would not result in eviction from their home for example? How much time could they spend working on their problems if they first had to try to establish the boundaries of their situation?

Sometimes workers think that it is somehow cruel or unprofessional to lay down boundaries for their service-users. They see it as treating them like children without ever realising that all adults, including the workers themselves, need boundaries too. Whether those boundaries are formal or informal, civil or criminal, social or procedural we all need boundaries.

To deprive a person of boundaries is to leave them, clueless as to what sorts of behaviour would be acceptable or unacceptable. Now that’s really cruel.

So what do we mean by boundaries? Well first of all we mean clearly and consistently outlining what is acceptable and what is not. It also means respecting the person enough to understand that sometimes they will push those boundaries just to see how firm they are – this is no different from what we all did as children – and what we all continue to do as adults. We also need to understand that they are grown up enough to accept the consequences of their actions.

Actions have consequences and we do our service-users no favours

by pretending that they can behave inappropriately without facing them.

What they need is the security of knowing that the boundaries are firm enough to withstand the odd bit of testing and the awareness that we as workers are strong enough individually to apply them. If we fail to do this we lose respect. After all our service-users are just as capable of recognising weakness as we are. We also do something else….

When we fail to uphold a boundary we leave the other person with a dilemma. They won’t know where the limit really is – that means they will have to push harder until they find it. Their poor behaviour escalates, not simply because of their own ‘challengingness’ but equally because of our inconsistency. We leave the other person no choice but to push and push until eventually they go so far that we have to act and usually this means major consequences that could have been avoided much earlier if we’d only had the confidence to act sooner.

By contrast, if we uphold the behavioural boundaries we set – if we stick to the ideas we have set about acceptable standards of behaviour then the person can relax – they know what the rules are and so they can stop worrying about them. This means they can get on with the task of working on whatever problems they have.

We also demonstrate our own emotional strength and integrity – itself a vital component of effective therapeutic relationships.

So the next time you consider ignoring unacceptable behaviour because you ‘understand what they’re going through’ or simply because you lack the confidence to deal with it spare a thought for the behavioural effect of your decision.

People who avoid their responsibilities to obtain ‘an easy life’ rarely get it. On the contrary – that way chaos lies.

If you do the same things you get the same results

Maintaining the problem

Most people are surprised to learn that they maintain (and often actually create) the problems they face. Often people will work hard to resist this idea and that can be difficult to overcome but it’s worth the effort. Until people understand their own role in maintaining their difficulties they cannot really take responsibility for solving them. After all – if you don’t think you’re a part of the problem you won’t think that you need to change your behaviour to change it.

This is why it’s often useful to chart a person’s reactions to their difficulties with them. At each stage ask the person what they could have done differently and what might have changed for them if they had? The point here is not to blame the person or accuse them of creating their own problems – it’s simply to get them to tell us how they might react differently in the future and begin to find a way out of their problems instead of making them worse. So we ask what might be different instead of trying to tell someone what we think. It’s always much more effective if the client or service-user tells us the answer rather than the other way around.

This can form the basis of a support plan or other strategy that the person can use to change their situation for the better.

Categories
challenging behaviour duty of care law mental health social care

Privileged glimpses 19: Behaviours that harm other people

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.

Sometimes the harm, or risk of harm, affects others and so we really must intervene. Service-users don’t have the right to hurt others, no matter how much they might learn from the experience.

If, for example you heard of an assault you must take reasonable steps to try to prevent it. If necessary and appropriate call the police or other outside agencies as needed. If an offence has occurred then always report it to the police. That’s part of learning from experience too.

Never fall into the trap of being too ‘understanding’ in these situations. Compassion is important but naivety is not. Shielding a person from consequence teaches them the wrong lesson – it teaches them that there are no consequences and that tends to encourage both more frequent and more serious challenging behaviour. Do you really want your service-users to believe that it’s OK to hit you or your clients? If you don’t then let them face the consequences of their actions while they’re still at the shouting stage.

We know that challenging behaviour, including violent behaviour, escalates if left unchecked. We know that some people are dangerous and that they tend to become increasingly violent so long as they continue to ‘get away with it’. So the obvious solution is to ‘nip violence in the bud’, thus preventing it from escalating.

If you work with people, be they mentally disordered or not, ask yourself this:

Do you ever excuse their hostility because you ‘understand’, because they’re ill, because they have anger ‘issues’ or they’ve been through such a lot of trauma in their early lives etc etc?

If so please understand that the more you excuse the behaviour the worse it will get. People learn through consequence – you did, from an early age. That’s why you’re able to hold down a job. You learned to behave appropriately in society by experiencing negative consequences when you transgressed. That’s why as parents we ‘ground’ our children for example – it teaches them ‘the rules’. We do people no favours by pretending that violence and aggression is acceptable.

When you or others are at risk intervene, do what is necessary to manage those risks but without focussing more than is needed on the behaviour itself and always encourage more appropriate alternatives.

Categories
duty of care law mental health social care Uncategorized

Privileged glimpses 15: A duty of care myth

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.

Many people are confused about the exact nature of their Duty of Care toward the people they look after. To a large extent this is because they think that they are somehow accountable for the actions of other people (in this case the client or service-user).

This gives people the sense that they are:

Hanged if they do and Hanged if they don’t

In reality, you are responsible only for what you do – not for what your client does. If you do all that you can within the law to minimise risk, to help them to make decisions in their best interests and to help the client to cope more effectively then you have fulfilled your duty of care. This is true whatever the outcome might be.

  • You are not responsible for someone else’s behaviour.
  • You are responsible for your own behaviour in the situation in which you find yourself (including acting to keep others safe when necessary).
  • You are not expected to take away people’s rights to choose if they are able to.
  • Care workers are judged upon process – not upon outcome.

 

Do all that you reasonably can within the law.

Categories
duty of care law mental health risk social care

Privileged glimpses 11: Risk-free is impossible

life without riskThis 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.

 Risk free is impossible – managed risk is the way to go.

Individual v Organisational risk

There is much more to the notion of risk than meets the eye. Many care workers think that it is their job to prevent service-users from taking any risks at all but this is not possible. In fact, even if it was possible to prevent people from taking any risks it would not be the right thing to do.

Life without risk would be life without living. It is only through accepting a level of risk in our daily lives that we are able to do anything at all. In fact, even doing nothing is risky. The risk to mental health from boredom and unchanging routine is as great as the risk to our physical health from inaction and lack of stimulating activities.

All activity, from making a cup of tea to crossing the road or even going to the toilet must involve some degree of risk in order for the service-user to maintain or develop skills. There is always a risk of failure when learning to do new things and on occasion that failure can result in some form of harm.

The trick then is to help people to understand the individual risk they are proposing to take. If they cannot understand it (for example if their mental capacity is impaired) then the risk becomes an organisational risk. In that case the organisation that creates the risk/activity for them must manage that risk to bring it down to manageable proportions. This does not necessarily mean remove the risk – simply manage it.

Obviously some things carry more risk than others. An activity that involves crossing the road with supervision might be considerably safer than the decision to go sky-diving but the principle still holds. The task is to make the risk manageable.

Just imagine how empty your life would be without risk. If we need to take risks in order to have a fulfilling life is it not just as important for our service-users?

Just as nobody has the right to remove risk from your life so you do not have the right to remove all risk from the lives of your service-users.

Types of risk

However – you really do have an obligation to manage the risks taken by those service-users who do not understand the risks they take and sometimes to prevent the more extreme or unnecessary risks.

So we need to determine:

  1. Is it an individual or an organisational risk?
  2. Is the risk manageable?
  3. What are the ‘reasonable foreseeable’ outcomes?
  4. Do we need to prevent the person from taking this risk or can we support them in it?

You can follow the entire blog series as it develops here.

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The Convention 1: Why this, why now?

Welcome to ‘The Convention’, a series of blog articles. In this little collection of posts I intend to cover one of my favourite examples of international cooperation, the European Convention on Human Rights (ECHR).

ECHR in sessionThis much maligned and misunderstood convention is one of Europe’s most important safeguards with far-reaching implications that protect us all. For a rights and liberties geek like me the convention is not only fascinating, it’s indispensible.

I should be clear from the outset though. I’m not a lawyer and this series of posts is in no way intended to be a particularly thorough or expert exploration of the European Convention on Human Rights. Rather it is a short introduction to The Convention and the role it plays in our society. If you want advice or information about a specific case then my advice would be to take proper legal advice from a suitably qualified professional. I’m really just a bloke with an interest in rights and a passion for blogging.

Unfortunately the convention has come under attack in recent years. Sometimes these attacks come from those who seek to remove its general protections for their own advantage. More often though they come from people who simply don’t understand the convention’s purpose and history. That’s why I’ve decided to write this series – to help me to explain just what it is that so many people oppose so vehemently.

I’ve met many otherwise reasonable people who think that human rights should be removed, mainly in relation to people they don’t like, people they see as somehow ‘different’ and therefore ‘less deserving’ of legal protection. For example the far right English Defence League (EDL) recently called for the arrest and conviction of Muslim men who had already been acquitted of a murder that might not even have taken place. This anti Muslim group seemed to be more interested in the suspects’ faith than in the fact that there was no evidence against them and no case to answer.
Human rights opposers see the ECHR and the UK’s Human Rights Act as preventing them from ‘dealing with’ those who are different. For example they think that it gives citizens from other cultures, races and religions equality under the law – and they’re absolutely right, it does.

That’s one of the things that the convention was designed to do shortly after the end of the second world war. In fact, when exploring the purpose of the ECHR and the way that it affects us today it’s almost impossible to avoid considering the atrocities of the holocaust, the pressure of the jackboot on occupied Europe, the treatment of disabled people or those from ‘non Aryan’ races and the political violence of ‘National Socialism’.

It’s no coincidence that far right groups such as the British National Party (BNP) and the English Defence League (EDL) would like to see the UK pull out of the convention. It outlaws discrimination on the grounds of race or religion and so prevents them from ever achieving their goals. Similairly the UK ‘ConDem’ coalition government has found some of its more draconian policies thwarted by the convention which upholds the right of citizenship and fair treatment. The previous labour government also fell foul of the convention when it attempted to have citizens arrested and detained for long periods without charge, trial or conviction.
In terms of health and social care much of our domestic legislation such as the Human Rights Act and the Mental Capacity Act is based upon the ECHR and recent alleged care related offences at Castlebeck’s ‘Winterbourne View’ home near Bristol can be linked back to the convention as well.

And yet so many UK citizens oppose the ECHR without realising just what they are arguing against. Principles such as the right to life, the right to privacy and the freedom to follow one’s religion are all ECHR principles. The principle of ‘no punishment without law’ and the rights to liberty and to freedom of speech come from the convention too.

Sexual equality and disability rights in the workplace, as well as in care and other settings link directly back to the convention as do workers rights, freedom from slavery and even from torture. These are just some of the safeguards that we all enjoy because of the European Convention on Human Rights.

Additionally, perhaps most upsetting for neo Nazi groups such as the BNP, the convention guarantees freedom of marriage, respect for family life and the right to a fair trial. It also makes it impossible to prosecute someone for doing something that was not illegal at the time they did it. For example making immigration illegal would not criminalise current UK citizens, whatever their ethnic origin might be. Nor would it make it possible to ‘send them home’ (whatever that might mean).

In short the European Convention can be thought of as a kind of antidote. If intolerance and fascism are the disease then the ECHR is at least part of the cure. Heavy handed governments and unfair, discriminatory street movements, however loud they shout are powerless in the face of the ECHR. No wonder the UK’s neo Nazis want us to pull out of Europe.

If this description seems a little melodramatic read on. As this series develops we’ll consider how and why the ECHR was developed in the first place. The convention was and still is a direct response to Hitler’s ‘Third Reich’ and some of the worst atrocities ever committed on European soil.

Long live The Convention

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/