The Spirit Level: The Movie – An interview with director Katherine Round

In 2009 the groundbreaking and controversial The Spirit Level: Why More Equal Societies Do Better was published. It argued that almost every aspect of society was improved by greater equality, and made worse by greater inequality. I interviewed producer and director Katherine Round, who plans to make a movie based on the book.

Z: What made you want to turn The Spirit Level into a film?

Katherine: When I read the book I was struck by the power of the evidence within it that inequality underlines many of the social problems we are most concerned about, and felt that if this message could be taken out to a wider audience it would really have the potential to make a significant contribution to public policy and from there hopefully we’ll start seeing improvements in areas as diverse as child poverty to mental health. I have long believed that film has a very powerful role to play both in raising awareness of issues and offering solutions – presenting factual information in a way that is accessible to new audiences. There are lots of people out there who would never pick up a book about the need for greater equality, and it is these people that a film can engage. The film The End of the Line, which examined the impact of over-fishing on the world’s oceans, was subject to an impact study on its effectiveness. The film was found to have been effective not just at spreading the message, but also changing policy (both government and retail). I hope The Spirit Level film can be as successful.

Z: What are the effects of inequality on society and the economy?

Katherine: The analysis conducted by Richard Wilkinson and Kate Pickett shows that a range of social ills are more common in societies that have a bigger gap between rich and poor. For example; social mobility is less likely, there is more violent crime, more mental health problems, and poorer educational performance. And, contrary to what many believe, these problems impact on people even if they’re at the higher end of the income scale. We’ve been fed the view for years that inequality is necessary for economic success, but the reality is that it is a destabilising factor. Vastly unequal societies prohibit large sections of the population from participating in the economy without taking on debt. What we have seen is the creation of debt-based economies which are unsustainable, with wealth flowing upwards and the rest maintaining their position through borrowing. This inevitably collapses, causing recession.

Z: Some people have disputed the findings of The Spirit Level, and argue that inequality is not necessarily bad. What is your response to that?

Katherine: The critiques to the book have mainly come from a small number of politically-motivated sources, who by cherry-picking data and the inconsistent removal of different countries, have found they can show something different. This is the reason that the authors of the book used statistically sound epidemiological methods and data sources – to ensure that there was no bias and that their analysis was rigorous. They even added an additional chapter to the book answering their critics point-by-point.

Z: What do you hope the film will achieve?

Katherine: I hope the film will enable more people to be aware of how damaging the current levels of inequality are to our societies. By giving people ways they can influence change – as consumers, citizens and campaigners – I hope that we will be able to make an intervention in the debate, build the social movement for a fairer society, and ultimately make changes that improve people’s lives.

Katherine is attempting to crowfund the making of this movie. To make a donation, go here. (Note: donations end on Sunday night)

What can Obamacare teach the UK healthcare system?

Finally ‘Obamacare’ has been made law in the USA and now more people in the USA will be able to access good quality healthcare without discrimination on age, sex, gender, race or disease. In the UK however healthcare discrimination is still very evident against our older (and younger) people, people suffering from mental health problems and people  with disabilities. A focus upon discrimination is interesting in that it helps us to explore some of the problems within the UK healthcare system which focuses more on meeting targets and measuring effectiveness by throughput e.g. bed usage, immunisation, screening, mortality rates etc. In fact some of my colleagues how found themselves to be criticised for keeping people alive in that the patient spends longer in the bed/service than they would have otherwise done. If we are so obsessed with  collecting numbers perhaps there should be more focus upon reducing staff sickness rates for all the burnt out  staff who can no longer fight the system, or the numbers of readmissions for people who were discharged too soon? 

To be fair efficiency is an important part of any system in order for it work effectively but sometimes  in the UK I think we lose sight of what our healthcare system is about. While the USA have changed their focus  to ensure that discrimination does not affect any person’s ability to access healthcare for as long as they need it, in the UK, we appear to be creating so much bureaucratic red tape that people can no longer find a way in to the system. If we are fortunate to be able to access treatment  by getting into the system via a hospital bed or outpatient appointment we then have to be satisfied with becoming a target for not falling or catching an infection ( while we are receiving said treatment) or for being fixed/cured within a certain time frame. If we do not meet these targets (and this is where people are blamed for but usually have no control over what happens to them once in the system e.g. bed blockers sorry delayed discharges), them people no longer matter because essentially they do not make the figures/ targets look good. 

I for one am in favour of the Care Quality Commission  for trying to see through this  healthcare maze that we have created in the UK but  even they are criticised for not measuring the right thing at the right time.  Perhaps this is not thier fault because they are commissioned to measure what the government wants them to measure. Maybe, just maybe, the  UK government are asking them to measure the wrong thing?


The Smalley case and the “innocuous” remarks

More revelations on the UK Council for Psychotherapy’s bungled fitness for practice hearings into John Smalley, a Jungian analyst with the Independent Group of Analytical Psychologists. And believe me, this one’s a corker.

The story so far…The UKCP took over three years to investigate complaints about Mr Smalley, a Jungian analyst with the Independent Group of Analytical Psychologists. At the end of a long sequence of delays, they decided that seven allegations had been proven, but also decided not to sanction him. The fact that he admitted in the hearing that he destroyed his notes doesn’t seem to have prompted a sanction. The UKCP’s laughable response to this is that they didn’t sanction him for destroying his notes because there wasn’t a complaint about destroying his notes.

In my last post we discussed one of the proven allegations – that Mr Smalley inappropriately tried to set two of his clients up in a business partnership with each other. Smalley claimed to have given them a strict set of conditions to avoid the business relationship impacting on their therapy, but since his notes were destroyed, there was no evidence to corroborate this.

One of the other allegations found proven was that Smalley made “remarks regarding other analysands that were capable of being understood to be derogatory and capable of being overheard.”

Two incidents in particular seem to have been discussed in some depth. One of them is relatively minor. A client was leaving his session, the complainant was arriving, and the complainant heard Mr Smalley say, “Silly bugger.”

And the other one…well, let’s take a look. Here’s the incident being discussed by the complainant, and the response by Smalley’s barrister.

Now, this is on a different order altogether. As with so many of the allegations in this case, the complainant and Mr Smalley had wildly differing accounts. However, even if one accepts the barrister’s account as being true, and all he said was, “You might want to hang around, I’ve got an attractive client next”, then even as an “innocuous” joke that would be totally inappropriate.

And if the complainant’s account were accurate….well, then that would be dodgy as hell.

So, Mr Smalley set up the complainant in a business relationship with one of his other clients, and talked about setting up him up in a romantic relationship with another fellow client (albeit possibly jokingly). Arguably, such actions could be interpreted as slightly cultish.

So, what were the UKCP Panel’s findings on Mr Smalley’s remarks?

Not so innocuous after all, then.

But hang on a minute, the UKCP still managed to not apply a single sanction to Mr Smalley. Not even a caution. What did they have to say about these not-so-innocuous remarks when they made their decision about sanctions?

And that seems to be more or less it. All that stuff about time management sounds far more relevant to the more minor “silly bugger” incident than the one where he’s suggesting the complainant hang around to catch a glimpse of an attractive woman who’s coming to therapy. Utterly pitiful decision.

Fun fact: As this website shows, John Smalley used to be chair of ethics for the Independent Group of Analytical Psychologists.

To be continued…

Making Social Work Work Better

I’ve been trying to be positive about some of the changes taking place at work recently. Being ‘in flux’ is nothing new and I have been working in the sector (and in local government) long enough to be no stranger to reconfigurations.

Being of a mind that criticism is easy but needs to be couched in ways that things can work better, I’ve been thinking about ways that my job could be better and how I could be more effective in it.

Of course, this will go nowhere,  but it’s an interesting thought experiment for me and helps me to retain hope.

There are a few themes I want to consider. It’s a bit of a fantastical ‘dream list’ of where I’d like to see social work in the future.


‘Personalisation’  has been a massive driver but the increased workloads and paperwork have not led to better outcomes for most of the people I work with because the focus of the agenda has been on smaller specific groups of people who have fitted the model of wanting and managing well with direct payments.

There is nothing more morale sapping that completing a review for a service under so-called ‘personalisation’ agendas which have been forced onto people who don’t want them and telling them that they now have a ‘personal budget’ – not to do whatever they want with, but to have the same service provider, providing the same service at a higher cost.

It feels like a con because it is a con. This is not ‘personalisation’. This is language which has been distorted by government and policy and mashed into the conveyor belt which is the only way that local government commissioning is able to operate.

The word and the process of ‘personalisation’ has been hijacked and contaminated by providing a front for more cuts and attempts to disperse responsibilities from the state to the individual.

So how to make things better?

Let us aspire towards excellence. I said to someone earlier in the week, I don’t want to do ‘ok’ work, I want to do excellent work. I want to go home and  be proud of what I have accomplished with someone and their family.

How can this happen? By moving the personal budgets beyond direct payments or managed LA budgets. By bringing people with experience of using services and social workers who are asked to implement the systems, into discussions with commissioning teams. By breaking down block commissioning – which may be more costly. Real, true ‘co-production’ which involves discussion with all groups of users not just those who always come to the meetings. Using Individual Service Funds, using Trust Funds, using small providers, providing genuine choice and different options not just ‘choice’ within the context of what the local authority approves of – for all user groups not just the ‘easy’ ones.

Choices will need to be made in terms of funding but the cost of leaving work feeling that I could have done much better, is not something that I want to aspire to.


I mean by advocacy, being given – and taking where necessary – the role of speaking up more cogently for people who use the services we provide on one hand – and of our own profession on the other hand.

Social Workers have a unique position in seeing the effects of social policy experiments taken at national and local levels. We shouldn’t need to be constrained by managerial approaches which have driven us into the ground because actually, our employers are scared of some of the values we have.

I wonder sometimes if local authorities WANT social workers who are anything other than automatons. Then I think it is a necessary part of my role to be a proverbial ‘fly in the ointment’. Fortunately, I have a manager who thinks in a similar way, but we need to push this upwards to a policy-making and commissioning level.

Rather than waiting for social workers to be given a voice, we need to seize the voice. Newspapers and media companies may want personal stories but I genuinely believe there are stories we can comment on without needing to draw on the lives of those who use our services.

We have to use our voices politically and waiting around for BASW or the College of Social Work is all well and good but we need to do more.

I see a future of social work as pushing it’s own voice out whether people want to listen or not. People ARE interested in social work and what we do, they just don’t actually know what we do.

Political Developments

We are well placed to have a strong voice in political and social developments and must use that. I think it would give the profession as a whole more credence. We must remain clear about the goals of ‘social work’ and why social work is necessary.

‘Social Work’ is more than statutory social work however having social work in local government is essential too.  As skilled professionals who work on the ‘frontline’ we can’t allow our voice to be co-opted by those who claim to speak for us.

However I’d like to see a more cohesive social work voice that isn’t limited to local authority workers and embraces the voluntary sector. I see more social work taking place outside the local authority bounds but we have to use and build our professional knowledge and take responsibility for our collective professional growth and influence.

New ‘Social Work’ ways of working

We can embrace both technology and social media to promote and present different ways to provide ‘social care’ and social services. We can incorporate our professional skills in terms of active learning and reflection to use new forms of communication and collate and innovate in the field to look at the ways we build communities and relationships more broadly and what that can mean to social work as a whole.

We are able to build links more easily both across the sector, nationally and internationally, across different professions but most valuably with users of the services we provide.  Perhaps ‘virtual’ space and communities of interest rather than just location should be considered as places in which some of our expertise could gravitate. We have to take new opportunities and learn in non-linear ways.

Research into Practice

We have to build positive links with universities and organisations committed to research and encourage more practice-based research. We can’t allow the repository of knowledge of the profession to lie solely in academic institutions. Links between practice and academia have to flourish in order for the profession to flourish. Maybe there needs to be more systems of secondment. This may exist in some places already but I haven’t seen it locally.

We talk about using evidence-based and evidence-informed practice but when discussions are raised about changing things locally, we are presented with policy decisions already made. I’d like to have more autonomy personally and as a team to pursue both original research and change models of practice accordingly.

I have to think that things will get better for and in social work. We have some excellent skills that are not necessarily lauded. We are able to draw in the ways that society impacts on the individual and the ways through some of the difficulties faced. We have to shout out this unique expertise and the values that underpin it so both it is recognised as a skill and that we recognise it ourselves as skills we use.

Sometimes we get caught up in the day to day work or caught in the mire of negativity about social work to forget what a fantastic job this actually is. I desperately want it to get better. I believe it will, otherwise, I don’t think I could continue.

Welfare – A Review of Cameron’s Speech

Prime Minister David Cameron
Cameron announced a raft of changes to the welfare system yesterday in a speech in Kent.  His plan to cut back on ‘welfare’ made me angry for a number of reasons but I thought I’d look through the text of the speech itself to comment. So here is the text – with some coments.

On my first night as Prime Minister, I said we would build a more responsible society.Where we back those who work hard and do the right thing.

See that – linking work with ‘the right thing’. What about those who cannot work or are not able to work? Is ‘work’ inherently more valuable that other activities that we might to which would otherwise further the society we live in.

Where we look after the elderly and frail.

Well, he isn’t doing very well at that, is he? The Social Care White Paper has been delayed and there have been excessive cuts in social care services locally as LA budgets have been slashed. And no proposals to tackle the funding gap in social care.

Where – as I put it – those who can, should; and those who can’t, we will always help.

Who is the ‘we’ here? If it’s social care and falls to local government you can forget it because of the slashing in local government.

Building that society is simply not possible without radically reforming welfare.Today, almost one pound in every three spent by the Government goes on welfare.

I think it’s deceptive to lump ‘welfare’ into one pot and criticise. Welfare is the net that holds up some of the most vulnerable in society. Criticising welfare en masse is an explanation of his lack of understanding of what it actually is.

In a world of fierce competitiveness – a world where no-one is owed a living – we need to have a welfare system that the country can properly afford.The system we inherited was not only unaffordable.It also trapped people in poverty and encouraged irresponsibility. So we set to work.

By all means change the system, but play the policy not the people. We deserve more.

In two years, Iain Duncan Smith has driven forward welfare reform on a scale and with a determination not seen since World War Two.He is a great, reforming Minister, with a passion and commitment that shine through.And he is delivering remarkable results:Over 400,000 more people in work than in 2010.

Bleurgh. Duncan Smith is anything but a ‘great minister’.

Tens of thousands of claimants of incapacity benefits re-assessed, and found ready for work.

At what cost? Is this a success when the process of assessment is so poor? Appeals are frequently won. The assessments can’t actually be that good. Why privatise the reassessments rather than relying on consultants/GPs/health professionals? In order to achieve desired results.

We’ve established the biggest-ever Work Programme – and we’re well on our way to getting 100,000 people into jobs.We’ve helped tens of thousands of young people find real work experience

For free – replacing otherwise paid jobs?

Reformed and reduced the extent of tax credits. Tightened up housing allowances.

So people are pushed out of their local areas.

Capped benefits so that in general, no one can claim more than the average family earns.

Without consideration of family size.

And we’ve laid the foundation for Universal Credit.This has the potential to be one of the most significant reforms for a generation.Ending the nonsense of paying people more to stay at home than to get a job – and finally making sure that work really pays.

The logic is there but diminished by the actual lack of jobs and disconnect between size of family and average income.

What Iain Duncan Smith has achieved over the past two years.Refusing to accept the status quo, turning around huge numbers of lives is truly remarkable.But the job we have set ourselves, of building a welfare system that truly works – that supports the responsible society – that job is not yet complete.So today I want to talk not just about what we’ve done, but where we go from here.

I’m going to skip the next part of his speech for reasons of time and space – it also contains the only part of the speech I actually agree with. I prefer non-means tested pensions which are £140 per week – however if you think about needing to save money – some of the winter fuel allowances seem to be obvious targets. Funny how Cameron here remembers his election promise while conveniently forgetting his ‘no top down reorganisation of the NHS promise’.

I’m baffled by his claim that DLA claimants do not need to provide medical evidence because that doesn’t link in with my own experience of DLA forms. You have to give details of your GP/Consultant – if the DWP doesn’t actually CHECK up on those then surely that’s not the fault of the claimant. Maybe, you know, it would actually be cheaper to check with involved medical professionals rather than engage a private company to ‘assess’ claims.

Interesting that by starting with an attack on ‘workshy’, Cameron tackles in the first part of his speech, pensions and DLA. DLA is not a non-working benefit. Sometimes that gets muddied but it is a benefit which pays/compensates for additional costs in someone’s life due to disabilities WHETHER THEY ARE WORKING OR NOT.

Then Cameron plays his favourite game of ‘divide and rule’ playing on the baser nature of jealousy of our compatriots.

Take a couple living outside London.He’s a hospital porter, she’s a care-worker.They’re both working full-time and together they take home £24,000 after tax.They’d love to start having children – and they know they’d get some help from the state if they did so.But with the mortgage and the bills to pay, they feel they should keep saving up for a few more years.

But the couple down the road, who have four children, haven’t worked for a number of years.Each week they get £112 in income support, £61 in child benefit, £217 in tax credits and £141 in housing benefit – more than £27,000 a year.Even after the £26,000 benefit cap is introduced, they’ll still take home more than their neighbours who go out to work every day.

Can we really say that’s fair?

Firstly, I  had to chuckle wryly at Cameron’s example. I wonder if he is tackling the issue of those ‘fat cat’ public sector pensions and pay freezes as he attacks the low paid public sector workers.

But as for his example? Firstly targeting the family ‘with four children’ to make his point leaves a bitter taste. Why should the income of a childless couple need to be equivalent to a family with four children who will obviously need more to survive? It is a game of jealousy and numbers. We can’t know the histories and lives of the ‘couple with four children’ to make rash judgements about their lives.  Is this ‘fair’? Well, maybe I’m alone in thinking that actually it might be but it isn’t my place to judge.

He shares some other examples about housing allowances and cost of housing in London – to which I say that destroying local communities in the south east due to housing costs will be equally damaging in the long run in terms of accessing familial support.  He goes on

What these examples show is that we have, in some ways, created a welfare gap in this country between those living long-term in the welfare system and those outside it.

Those within it grow up with a series of expectations: you can have a home of your own, the state will support you whatever decisions you make, you will always be able to take out no matter what you put in.

What like..  trust fund kids? I despise a cabinet of millionaires who have never understood the need to exist on benefits and who imagine that somehow this is a great life to lead, attack ‘entitlement’ of those who need to claim them.

Then he goes on to some of the ‘problems’.

Why does the single mother get the council house straightaway when the hard-working couple have been waiting for years?

Because governments and local councils wanted to make sure children got a decent start in life, so mothers were given priority for council housing.

Well yes, exactly – and how is that a bad thing?

Why has it become acceptable for many people to choose a life on benefits?Because governments wanted to give people dignity while they are unemployed – and while this is clearly important, it led us to the wrong places

I don’t think it has ever been acceptable but it has become necessary. It makes me wonder if Cameron actually knows how much Job Seekers Allowance is. It doesn’t allow a great deal of dignity.

You can give a drug addict more money in benefits, but that’s unlikely to help them out of poverty; indeed it could perpetuate their addiction.

You can pump more cash into chaotic homes, but if the parents are still neglectful and the kids are still playing truant, they’re going to stay poor in the most important senses of the word.So this government is challenging the old narrow view that the key to beating poverty is simply income re-distribution.

Interesting that a government of the right is suddenly interested in how money is being spent. I despise the connection made between neglectful parenting and poverty. Poverty may be more than income redistribution but Poverty is NOT bad parenting. I could make a cheap jibe about leaving a kid in a pub but that would be a low blow. What is inherently damaging is the way Cameron makes these links without thought which will no doubt, increase stigma.

Then then he says

For example, the state spends almost £2billion a year on housing benefit for under-25s.There are currently 210,000 people aged 16-24 who are social housing tenants.Some of these young people will genuinely have nowhere else to live – but many will.And this is happening when there is a growing phenomenon of young people living with their parents into their 30s because they can’t afford their own place – almost 3 million between the ages of 20 and 34.

While for many others, it’s a trip to the council where they can get housing benefit at 18 or 19 – even if they’re not actively seeking work.Again, I want to stress that a lot of these young people will genuinely need a roof over their head.Like those leaving foster care, or those with a terrible, destructive home life and we must always be there for them.But there are many who will have a parental home and somewhere to stay – they just want more independence.

Cameron’s stated intention to cut access to housing benefit for under 25s is deeply retrograde. Yes, people can stay at home and honestly, a lot of people who have supportive parents in the same area where they work/study probably do  but this is a dangerous line to cross from his world of happy Chipping Norton families. Is there going to be an expectation on parents to support children to 25? How will this impact on poverty rates and access to jobs. How can a young person ‘get on their bike’ and get a job if they have no access to accommodation – because local housing allowance is an ‘in work’ benefit.

I’m skipping through the last part of the speech with one exception. This little nugget.

There are more than 150,000 people who have been claiming Income Support for over a year who have 3 or more children and 57,000 who have 4 or more children.

The bigger picture is that today, one in six children in Britain is living in a workless household – one of the highest rates in Europe.

Quite simply, we have been encouraging working-age people to have children and not work, when we should be enabling working-age people to work and have children.

Seriously if Cameron thinks people have children to have benefits, he might be reading the Sun too much. Why should we stigmatise larger families? They will be the people paying for our future?.

There’s more than I’ve been able to cover but I think we can see the way of movement of Cameron and his Conservative-led government.

We need to challenge the government and press narrative which stigmatises people who need to rely on welfare because actually, it does create a better society.

What damages is stigmatisation and expectation of support where none exist.

What grates is a speech about ‘entitlement’ from an Old Etonian.

No, he can’t help his background, of course not, but he plays easy games in attacking poverty while not showing any evidence of understanding it beyond anecdote and games of jealousy with what your neighbour might be getting.

But benefit reform in general is popular with the public. I see it as a genuine social work role to advocate and fight for those whom I work with who are stigmatised by the government narratives.

It damages and must be challenged.

Pic by Prime Minister’s Office – Flickr

Penny vs Starkey Intellectual Deathmatch

Ahh, dammit Rupert Murdoch, you got me eventually. After reports came out of a massive bust-up between the feminist writer Laurie Penny and the historian David Starkey, the Times dribbled a couple of teaser snippets onto YouTube, with a link to the whole thing (or at least the main highlights), so long as you pop a shilling in the slot of the Times paywall. It’s a blatant attempt to get us to sign up to their paid-for service, and they reeled me in, hook, line and sinker. Oh well, at least I finally get to read Caitlin Moran’s columns as well as her Twitter now.

So, given that I’ve been reeled in, what do I actually think of the affair?

Penny and Starkey’s respective sympathisers seem to be scrambling to cheer on their chosen side. I actually think Penny and Starkey have a few things in common. Both can be funny, insightful and combative. Neither shies away from a fight. Both have an unfortunate tendency to reflect the prejudices of their political tribe.

Penny in particular has developed something of a reputation as a lightning rod for all sorts of thunderbolts aimed in her direction. Some of the criticisms aimed at her carry some weight – for example her unashamedly partisan reporting style. Others less so, such as when she gets derided as a rich girl turned far-left. I understand that her upbringing, while financially comfortable, was by no means rich. And besides, is it necessarily wrong for those born wealthy to embrace leftist politics? Just ask George Orwell and Joe Strummer.

Things seem to have begun to stir when Penny accused Starkey of “playing xenophobia and national prejudice for laughs”. Then things really kicked off when she interrupted a discussion about Britishness to enquire unprompted about Starkey’s residence and ask him where he was domiciled for tax purposes. He angrily responded to this by saying he’s domiciled in Britain and he pays his full taxes. He then declared, “As you have chosen to be personal and invidious, let me share a little story with you” and launched into this rant.

Frankly, I can’t claim to be overly impressed with either of them. Penny shouldn’t have made a baseless insinuation about his tax status. Starkey should have been more aware of how he would look bellowing and jabbing his finger at a girl half his size.

Later on, Penny claims that the reason she charged an excessive amount for the event described was because she felt she was being set up for just such a confrontation, and she did it as a way to back out. Which strikes me as rather odd. Why not just say no? And why did she then say yes to this event? [EDIT: Penny responds to that query here.]

The debate then ended in the following manner.

Next week: cage fighting with Will Self and Slavoj Zizek.

More on the Smalley case and the destroyed notes

Time for some more revelations about the John Smalley case, a spectacularly mishandled fitness for practice inquiry by the UK Council for Psychotherapy.

The story so far…The UKCP took over three years to investigate complaints about Mr Smalley, a Jungian analyst with the Independent Group of Analytical Psychologists. At the end of a long sequence of delays, they decided that seven allegations had been proven, but also decided not to sanction him. The fact that he admitted in the hearing that he destroyed his notes doesn’t seem to have prompted a sanction. The UKCP’s laughable response to this is that they didn’t sanction him for destroying his notes because there wasn’t a complaint about destroying his notes.

Let’s have a deeper look at what he was accused of, and how the absence of notes affected these. Remember, in nursing, medicine and just about every other regulated profession, the mantra is, “If you haven’t documented it, you haven’t done it.” A constant reminder that if one day you’re being questioned about your actions, you need to document what you’ve done.

From what I’ve seen of the the case, a lot of disputes came down to the complainant’s word against Mr Smalley, with often differing accounts between the two parties. For example, one of the allegations found proven was that Smalley smoked during therapy. Smalley admitted smoking in sessions, but insisted this was “often just one cigarette”. The complainant, on the other hand claimed that he chain-smoked.

Obviously, one wouldn’t expect Mr Smalley to document how many cigarettes he had, but here’s a more pertinent issue. Another allegation found proven was that of “introducing one analysand to another in circumstances where that introduction created an appreciable risk of potential serious difficulty for either or both of the analysands.” Smalley introduced these two clients to each other with a view to them going into a business partnership together.

Smalley stated that he put conditions in place around this arrangement.

Now, personally I wouldn’t think it appropriate to introduce two clients to each other for any purpose other than group therapy. Even so, the fact that he did this might provide some degree of mitigation. The trouble is that the complainant flatly denied being given these conditions.

What about the other client who was invited to form the business partnership? He was invited to the hearing, but was only able to partially corroborate Smalley’s account.

Given this clear disparity between accounts, the obvious question would be, what was in the notes? Smalley’s answer to such a suggestion appears to have been, “It’s not my practice to keep notes and there’s no professional requirement to do so. Any notes that I did hold in relation to the case would have been destroyed when the relationship terminated.”

As the mantra goes, “If you haven’t documented it, you haven’t done it.”

To be continued…

Broadening access to Independent Mental Health Advocates

Support each other

The statutory role of the Independent Mental Health Advocate (IMHA)  grew from the 2007 amendments of the Mental Health Act in England and Wales (with a start date of 2009).  IMHAs have particular status in terms of rights to information and access that other advocates may not have within Mental Health services.  Currently commissioned by PCTS, from 2013, Local Authorities will take over commissioning of IMHA services and the right and access to good services is intended to be a safeguard within compulsory mental health services.

Last week, Community Care reported on a study conducted at the University of Central Lancashire about the use and understanding about the use of Independent Mental Health Advocates (IMHAs)  among Mental Health Professionals in England. The study has (not, I suspect, coincidently) come at a good time for the change in commissioning arrangements and a look at where things are and where they should be going.

The article itself draws attention to the conclusions that

Some professionals saw advocacy services “as challenging, even irritating and inappropriate”, the research found. One professional told researchers advocates were “amateurs meddling” and a “bloody nuisance”. Others, particularly approved mental health professionals (AMHPs), supported advocacy “but had little or no direct experience” of service users using it.

As a Mental Health Professional (and AMHP) who has had some experience of uses and referring to IMHAs, I was disappointed by this initially. Particularly the terms with which advocates were mentioned. ‘Nuisance?’, I hope so. ‘Meddling?’ well, why on earth not? Surely being a nuisance to professionals and meddling is exactly what a decent advocate should be doing – however I would find the distinction between so-called ‘mental health professionals’ and ‘amateurs’ as advocates offensive and an indication of scant respect. Respect at every level in mental health services, social services and health services has to exist.

Community Care in a blogpost have put together some of the quotes pulled from the report by social workers and AMHPs in relation to advocates which makes interesting reading alone.

My experiences have been mixed to be brutally honest. Working predominantly with people with cognitive impairments which are significant and may not be able to instruct an advocate, I’ve found our IMHAs who have come from a mental  health advocacy background, have been less than understanding of the need for non-instructed advocacy skills. I have been told following a referral I made, that they would not work with ‘Mr Brown’ because he has an advanced dementia and they were only able to do what he asked as his advocate.

I felt some of the attitudes I’ve seen by a couple of our IMHAs towards older adults with cognitive impairments have been less than positive – and I do feel quite protective towards my client group and want to ensure equal access. If only, I have thought to myself on many occasions, our IMCAs (Independent Mental Capacity Advocates) were also our IMHAs (I can’t praise our IMCAs highly enough – even (or perhaps especially) – when we disagree!).

I am always (in a nice way, of course) a little jealous of the advocates I work with. I think their job has a lot more credence than mine in some terms because while I can advocate for my clients to a point, there’s a point at which I am a part of the oppressive systems that need to be advocated against.

I understand that and respect it. I’d certainly not see advocates as any less ‘professional’ than other members of the team I work in. There has to be a distance though – which doesn’t need to stop us being friendly, personable and pleasant to each other – but does demand that sometimes we will be coming from different angles. That’s important to protect the rights of those being advocated for.

The report itself can be read here.  It explains the context of. It explains that access to an IMHA service which should be offered to everyone who is subject to a detention over 72 hours or a Community Treatment Order/Guardianship – is sparse which particular under-representation in the following areas

There was a strong consensus that those who need the IMHA service the most,access it the least. Specific groups of people that may be under-served by IMHA
services are:
 People from BME communities
 People with learning disabilities
 Older people, with dementia
 People who are hearing impaired or deaf
 Children and young people
 People on CTOs
 People placed out of area

And the issues which have coloured my own personal experiences of using IMHAs was mentioned in the report

The development of IMHA services is based on a model of instructed advocacy provided by mainstream advocacy providers. This may inadvertently disadvantage qualifying patients who have specific needs including people from BME communities, older people, children and young people and those with sensory impairments ..


There was little evidence of commissioning based on needs assessment and equality impact assessment and there was evidence in the case study sites that specific needs had not been considered. In particular, gaps were evident in relation to people from BME communities, people with learning difficulties, older people, children and young people. Further, it was evident that generally service users, particularly qualifying patients, were not being directly involved in the commissioning process or in
monitoring contracts.

So it would be unfair of me to lay the blame at the lack of capabilities of particular advocates and more on the commissioning process which sees ‘Mental Health Patient’ as a block group of people with similar needs and commissions accordingly.

The report makes a number of useful recommendations and is a good read for anyone involved and engaged in the provision of mental health services in England and Wales, whether as a professional, user, advocate, carer or commissioner.

The role of the advocate was strengthened by legislation and it is important that the benefits are not lost. I have seen such incredibly useful work done by advocacy services locally that my main gripe is that there should be an equality of access and opportunity for all who are treated compulsorily by mental health services in society.

I want more ‘nuisances’. I want more ‘irritants’. I want more challenges.

That’s what an advocacy service should be about.

pic by sparkypics at Flickr

Betraying vulnerable young people

The more I listen to the unpleasant guff that comes out of David Cameron’s mouth, the more I’m convinced that he just doesn’t get what it’s like to be poor. He and his old Etonian chums have never had to live on the breadline, and I suspect don’t know many people who have. It’s simply another world to them.

If my assumption is correct, it might go some way to explaining his latest brainspew which is a proposal to scrap housing benefit for the under 25s, on the grounds that they can just move back in with their parents if they fall on hard times.

Well, yes, that’s what people are able to do, yes? Just clear out one of the spare rooms. Maybe ask one of the servants to move out? Or perhaps let young Tarquin borow the summer retreat for a while. It’s what all the everyday folk have the capacity for, eh what?

Sarcasm aside, what on earth does Cameron think these young people will do if their parents, for whatever reason, can’t or won’t support them? Apparently the proposal will have exemptions for special cases, such as people fleeing domestic violence. No doubt people claiming such exemptions will be treated every bit as fairly as those trying to claim disability benefits.

Go to a homeless hostel? Most of them charge rent, which they expect residents to pay by claiming housing benefit. Where else are they likely to go? A cardboard box in an alleyway seems the most likely answer.

There’s been a fairly sensible response from Liam Byrne, the Shadow Work and Pensions Secretary, who points out some of the pitfalls.

This is a hazy and half-baked plan when we need a serious back to work programme for young families.

“Many young families with their first foot on the career ladder will be knocked off if help with their rent is taken away. And young families that want to work won’t be able to move where the jobs are.

“The way to get the spiralling benefits bill down is start getting young people and young families back to work.

Cameron has said that he won’t try to implement this until after the next election, presumably because the Lib Dems would be likely to hit the roof if he tried it now. Or possibly this could be a bit of mouthwash to play to his base of pig-ignorant right-wing bigots, rather than a serious policy suggestion.

Either way, if he’s saying this won’t be done until he wins the general election, you know what to do, eh?

It’s Not All About Sickness and Health


As it is carers’ week I have been reflecting on the role that carers play and I have decided to put my thoughts down. Partly because I think they might be of interest but also partly because I wanted to take some time to explore an aspect of caring that we may not always give our fullest attention to.

Caring seems to me to wrapped up in a number of powerful societal images. There is a sense of duty and stoicism about it, a classic “stiff upper lip” aspect.  Spousal carers would often use the phrase “in sickness and in health” to explain why they were offering so much of themselves to the person they were caring for. As well as the sense of duty there is an aspect of love, the powerful emotional ties felt between people who care and people who are cared for, toward the end of my Fathers life my Mothers love for him was expressed in the affection she sowed while caring for him, their intimacy and shared experience was moving and affected everyone they came into contact with, right to the very end it was obvious that here was a couple who were in love and had the roles been reversed the same would have happened. It was touching and inspirational all at the same time.

As someone who has worked with carers, had some experience of caring and now teaches others it seems this pastoral element of caring is a characteristic of our society, it seems bound up with so many altruistic, powerful notions we have came to rely on carers without being full aware of the complexity of the role they play. On the surface carers are admired for their commitment and dedication, we encourage and support them and we dedicate weeks to them. We have a deep seated respect and admiration for them. This is perhaps related to our own awareness that it is unlikely we will never have some or all aspects of this role in our life, we respect it because we know we might have to do it. We support it because it feels “right” but also out of awareness that we too will one day walk the same path.

Yet we need to also recognise that carers experience other emotions, they can become angry, frustrated, they can feel a loss of their own identity and experience a sense of their own lives, their own aspirations and desires being stymied by their role. For some they can feel resentment toward their role and this resentment can become enmeshed in their feelings about the person they care for and can spill over into their attitudes and behaviours toward the person they care for. This seems in direct opposition to the image we have of carers and we can struggle to understand how this can happen. Our image and ideas about carers are in opposition to these negative and challenging behaviours we find it hard to assimilate these opposing feelings.

As a Social Worker I always struggled with this. Reflecting on it now this struggle had two main themes. One was that I found it hard to “go there” to that place of challenging emotions, I feared that if I explored them I could inadvertently destabilise the situation and might contribute to it breaking down, there was an organisational aspect to this as well as I felt that it was important that if the situation did break down the organisation could not be seen to have contributed toward this. Secondly and most significantly was a lack of ability on my behalf to recognise that there should be nothing unusual in carers feeling conflicted, after all we all do. I love my job but there are times I become frustrated and annoyed by it, there are aspects to any situation that bring us to boiling point, finding someone to share these feelings with contributes to your ability to manage them and to feel more skilled.

For carers I have found that exploring all of their feelings is important, on many occasions I have seen carers showing a palpable sense of relief that someone is giving them permission to examine there own emotions in a non judgemental manner. Indeed I have found that carers find this kind of support as meaningful as any other and more meaningful than most. For professionals it is important that we are willing to go beyond the stereotype and populist images of carers and be willing to support carers emotionally as well as practically and socially.