Capacity, lawyers and ramblings

First - I have no idea why this blog has got rid of all my spacing but don't have time to work it out right now, apologies!! During the course of my MA I have done some basic learning on capacity. I know the 5 key principles of the MCA and broadly understand the DoLS. But in terms of application there are still areas I'm unclear on and how well trained different professionals may be in this field. Recently I witnessed a client who needed to go to court and give a guilty or not guilty plea. The weeks before the hearing their mental health had deteriorated quite a bit and it was thought this was largely due to the anxiety about the upcoming hearing. In the days before, my client was asked to call the lawyer to tell them the plea so they could prepare the case. The client refused to do so and then when they did call, it was only to sack the lawyer and ask for a different one to represent them. On the day, the client was incredibly anxious, did not really engage with the lawyer and so it was suggested that they say that the client lacks capacity to make a plea and therefore can be assessed by a psychiatrist. When I was informed of this I thought it was the right decision and wondered why none of the staff had thought in the day or two before that this might end up being the case. Someone expressed the view that the lawyer had only said this because they didn't know how to deal with the client, having only met him years before and therefore wanted to avoid it going to trial if a non guilty plea was given. This lead me to think firstly did he have the capacity to make the decision to change lawyers at the time and therefore end up with one who may have been less experienced at 'dealing' with the client and also it felt sad that it was looked at in that way rather than think we are protecting the client's mental health. I still find it hard to know whether they did have capacity in these two decisions regarding the lawyer and the plea. They can retain the information and communicate the response but can they understand it? I struggle to know. I suppose that's the purpose of the assessment. We had assumed the client had capacity and I had done everything to support the client in making the decision, explaining the outcomes of both pleas and I was aware that the client could make an unwise decision but was it one they understood? Also, are there any lawyers with specific training in working with clients with mental health difficulties? Or much training in this matter? Apologies if this is a really obvious question .

My post on Guardian Social Care Network

The Guardian kindly asked me to write a post about my career change!

http://www.guardian.co.uk/social-care-network/social-life-blog/2012/apr/05/swap-advertising-social-work?CMP=twt_gu

Midway point of placement and the Guardian Open Weekend

I'm now approaching the midway point of my placement. And i'm enjoying it more than ever. I'm particularly enjoying the work I do with one of my clients who was recently released from prison. After i set up our first keywork session to create some realistic goals we can work on together, i now regularly receive notes under the office door or thrust in my hand with more goals to work on! Whether or not they are achieved, it feels like a good mindset to be in and i feel like i've developed a really positive relationship with him.

And i found out yesterday that I'll be getting a third client next week, which is exciting as students normally only get 1 or 2. This might sound very small compared to the caseloads you get in stat settings but it's very different being a keyworker in a residential setting as the face to face support is much greater.

One of the things i'm loving is the randomness, the charmingness (i know it's not a real word!) of working with people everyday. The unpredictability of it. While some days may be stressful or emotional and full of incidents or clients shouting, many days are spent laughing with the clients. Or sharing lovely days out, like our recent picnic and ice cream in the park which the clients have been talking about ever since.

My uni work has been driving me pretty mad as the uni have totally mucked up all our portfolio requirements. They have realised now, at the midway point, that most of the students on the course were working to the criteria set out by our course leader, that was in fact wrong. So all the students and their supervisors have become somewhat panicked, realising the evidence that has been 'ok-ed' at the midway point, may in fact not be OK. Joy!

Next week I start to have some days off for exam revision. I admit i'm pretty tired now, trying to sustain uni work, placement work etc so I'll be glad when exams are over and I can have a weekend away for a proper break.

Last weekend, I had a fantastic time at the Guardian Open Weekend. I went to four back to back sessions.


One was a panel debate about the nature of communities, including Camila Batmanghelidjh, the founder of Kids Company, and somewhat a hero of mine! She spoke about the fact that the issue of revenge has still not been addressed, young people don't feel they have been heard, for example young people feel they are being used to sell the Olympics and then won't benefit from it. She also discussed how we need somewhere for young, unemployed people to go and do something even if there is no labour. They shouldn't be stuck in their own living space, they need to be encouraged to create a community. She explained that people assume that behind every child is a competent carer but that is not true for 1.5m children in UK who become marginalised with their needs unmet. These sometimes, vulnerable individuals may not have the baseline competences to seeks out social cohesion. You need economic resources and social confidence to seek this out.

Sue Marsh was one of the panellists in a talk about the shape of the welfare state, discussing issues such as the fact that the child in poverty is more likely to have a parent in work than unemployed, alcoholic etc. Parents are not able to make a living wage. She also said that we have the lowest level of benefits in the developed world with 94% of those on JSA getting jobs in the first 6 weeks.

The talk on what the new age of protests was achieving was also interesting - discussing whether they are successful given that often they do not serve to veto law, ie tuition fees, NHS bill etc or is it an acheivement anyway, to get those who are voiceless onto the front page? or to raise the consciousness of a generation. It was also mentioned that while once you could not imagine the end of capitalism, now radical systemic change is more on the agenda.

It was amazing to have so many under 18s in the room asking questions and expressing their desire to be able to vote. It was such a fantastic, buzzing atmosphere and I loved the opportunity to listen to such a range of speakers and be surrounded by people who give a bit of a sh*t about the world we live in. I really wish there were more events like this, even if not on this scale, but with opportunities to hear experts speak and debate on their subject.

Sharing feelings

Before and after every group we run, we have a pre and post group.

The pre group at the start of the day, i particularly enjoy. We go round the room and everyone just discusses how they feel. It could be anything from - "tired, i didn't sleep well" to "anxious about the day because i found yesterday particularly hard..." etc

I think there's something incredibly refreshing about this group. For one thing, it helps just to relieve you of any negative feelings you might have about the day ahead. For another, it allows you to feel some empathy towards your colleagues and judge the way you behave with them accordingly - i.e if you know they're having a bad time in their personal life, or even that they didn't sleep well last night, you might be a bit more patient with them or give them a little extra support. If you know they're feeling demoralising, you can try to inspire them etc.

Anyway....just a little thing i like and think could be transferred in some way across different settings.

Control issues

Historically the issue of control has always been a big one for social workers and some of the dichotomies involved in partnership working vs control.

One thing that I have found a struggle is my own lack of control in this role. In my past career I felt pretty much in control of everything I did, I had my to do list and I got on with it, in I would say quite an efficient way.

But working with people is different, (it's not rocket science I know!) People won't attend that meeting just because it's on your to do list or answer the phone because you want them to or get up in the morning because you believe it's best. And sometimes however hard you think you're working or however much effort you believe you're putting in, you won't see the progress you were hoping for. In fact they may go backwards sometimes. Basically you can't control what's going to happen, you can only do what you think is best with each intervention and each decision but the control and the responsibility lies with them not you.

People are unpredictable. And that what makes working with them so bloody interesting

Ups and downs of therapeutic setting...

My placement is very big on reflective practice (which I realise would be less the case if I was in a social work setting but I’m actually in a therapeutic setting.) There’s lots of positives about this, obviously.

But at times it can be quite difficult. For example, I came to supervision today with a few concerns that I wanted to raise about my placement at the moment. I’ve felt a bit demotivated recently. Partly this is because I have one client who is barely ever in the project and has currently left (can’t disclose more details) and we’re not yet sure will return. My placement should now be picking up pace and I should be getting my second client soon, but I have only had one actual keywork session with my first client and what I feel is fairly little client interaction of late. Although I see clients around the project to have little chats with, I haven’t had a much of a supporting role to any.

My supervisor turned it all back on me and asked me to think about the issues it brings up for me – am I too driven by getting things done, and isn’t the fact my client isn’t around, giving me things to think about and write about too. I meed to think more about my own issues and how I’m dealing with my feelings.

I’ve thought about this quite a lot. At the time I felt quite angry – I felt that my supervisor was absolving himself of any responsibility towards my placement (not just for the above issue but for others brought up too) – but then I thought, there is definitely some truth in the things he is saying. I can be very goal driven, wanting to be busy, efficient etc and perhaps don’t quite know what to do, when there isn’t anything to do.

On the other hand, as this is my placement, I would like to feel constantly challenged and as if I am developing and I feel that the placement can be incredibly slow, with days going by where I really don’t feel I have done anything at all. Today for example I took part in cleaning group with two clients, spent a few hours doing “room checks” – ie measuring the temperature of the water in each bedroom and checking the room for safety reasons. Did some uni work and then had supervision. When a lot of days are like this, I don’t feel I’m achieving too much.

But it is interesting. Partly because I think its teaches me a lot about me. Definitely one of the biggest things I have been struggling with is learning how to give up control – something so important when you’re working with people, as opposed to standard targets – learning the limit of your role and how to leave responsibility with the client.
On the other side, I do wonder how this would differ in a social work setting. As I’m in a therapeutic setting, there’s no abundance of case loads. We have 7 clients in the project at the moment – everyone keyworks with one or two- or is therapist to one or two, and it’s not about working through a time scale, it’s an ongoing process, of possibly years – so in many ways it feels a lot more relaxed, less pressure to get things done…which is counter to all the managerialism and target driven culture complaints that social workers often receive.

Anyway…that’s my rambling.

Questions on residential homes within mental health settings

While lying in bed, having left placement early today as not feeling well, and feeling sorry for myself, I thought it was time for a short blog post.

I’m not going to write another diary type one, this is a more pondering post…

I had a short chat this week with a senior staff member at my placement about whether we thought social workers should recommend clients to this place.

The setting for my placement is a residential home with groups including therapy group, art and music, gardening etc.

We discussed whether, although it was beneficial to a few people to be there, could it do more harm than good for others?

Whilst I very much like the recovery model, I do question how many of the clients in the house are likely to recover, and obviously recovery is in itself a relative term, but I mean recover to feel confident living in independent accommodation at the least.

While there is obviously a question as to whether this place or places like it can help as much as we’d like towards that goal, there also remains the question as to where these people might be if these places didn’t exist.

Perhaps the answer is the old style institutions. So in that respect, surely these residential communities are a positive step on.

The difficulty with places like this, in typical systems theory – is that everyone in the place has a big effect on others, every incident can be hugely impactful and can serve to slow down or halt other people’s recovery.

Equally, as people choose whether to engage with groups etc, if they choose not to engage with them, or even their therapy, or at worst not to comply with medication, often little progress is seen.

Whilst I understand the trend has been towards community mental health, it’s clear for some that’s not an option – so is there a better alternative than these places? And is it wrong to categorise them as “these places” – do they differ wildly? I assume if there were some renowned for amazing recovery rates it would be known, but maybe I’m wrong. Equally, just because one recovers doesn’t mean one doesn’t relapse shortly after – so it’s difficult to measure success.

Finally but importantly, there’s the question as to what the clients themselves want. There is one client who has been there 5 years, rather than the 1-2 years they predict – and is seen to have been barely progressing of late (although i understand since they joined has progressed a huge amount). But perhaps this person doesn’t want to move on, is comfortable where they are. If the aspiration is not towards independent living then the motivation to engage is low – what’s ideal then??

Anyway, what a disorganised ramble! Apologies!