The trouble with Dr Jessen

In the last couple of weeks the Royal College of General Practitioners published their Social Media Highway Code. As a professional with a longstanding interest in how social media can be used constructively in mental health, I’ve often been disappointed that most guidance being issued tends to focus only on the negatives and risks of this new form of communication. The Highway Code is a welcome antidote to that: it acknowledges the risks and and the need to behave online in a professional way. However, it also recognises that social media has rewards and opportunities. I highly recommend it not only to doctors but to all health professionals.

Which makes it unfortunate that today I got caught up in the absolutely atrocious online behaviour of a doctor. A TV doctor, no less.

I don’t actually watch the TV show Supersize vs Superskinny, hosted by Dr Christian Jessen. I work with children and adolescents with eating disorders, and watching a show about it feels a little like taking my work home with me. I know that some people with eating disorders have complained of experiencing triggers from the show.

Ilona Burton is a journalist who writes for the Independent about eating disorders. She writes passionaately and well about the subject, not least because she’s in recovery from an eating disorder herself. In 2012 she was nominated for the Mark Hanson Award for Digital Media in the Mind Media Awards. She also holds strong views about the content of Supersize vs Superskinny, which she regards as socially irresponsible.

Early today, an increasingly heated debate was building between Dr Jessen and Ilona.

Dr Jessen then started retweeting Ilona to his 222,000 followers. The result was that Ilona started receiving tweets from Dr Jessen’s fans, some of them abusive. Ilona was clearly distressed by this, which really didn’t seem to concern Dr Jessen. For that reason I threw my own tuppence into the ring.

I also tweeted him a link to the RCGP Social Media Highway Code, and suggested he pay attention to Section 7, “Treat Others with Consideration, Politeness and Respect.” He didn’t reply directly, but responded by retweeting me.

The result was that I too started getting a large volume of tweets, which quickly turned into a Twitterstorm. As with the content being aimed at Ilona, some of the tweets I received were also hostile or downright abusive. It went on and on, lasting for several hours. This wasn’t helped by Dr Jessen retweeting more of my responses.

Okay, maybe that last tweet by me was a little tetchy, but getting several hours of online abuse does that to me.

I’m a fairly opinionated tweeter, so I’m no stranger to getting hostile messages. I’ve had some nasty stuff thrown my way by supporters of UKIP, and also by people who object to the work of child protections services. I can honestly say that today was the worst and most intense level of trolling I’ve ever been subjected to.

I don’t feel I need any sympathy for that. I’m big enough and ugly enough to handle it. However, I’m saddened that it happened at the instigation of a fellow healthcare professional. I’m even more saddened that the brunt of it was also caught by someone who has lived experience of one of the very conditions that Dr Jessen talks about in his show.

Dr Jessen seems rather unrepentant about all this.

What does the Social Media Highway Code say?

You have a right to express your views openly–but not to do so in a way that causes offence to others or infringes on their own rights….

When part of an online group, don’t be tempted into joining others in making derogatory comments or ‘ganging up’ on another individual – this behaviour could be regarded as ‘cyber-bullying’. Be wary of the power of the mob…

HEALTH WARNING: making derogatory,threatening or defamatory comments about others could have a harmful effect on your career. ‘I was just blowing off steam’ may be an honest explanation, but is not likely to be accepted as a valid justification by professional bodies or employers.

I hope Dr Jessen takes up my suggestion of reading the Highway Code.

Meanwhile, Ilona has posted her own thoughts on the matter in a vlog.

Rich Pickings In Foster Care

In January the Financial Times carried a piece about the investment potential for private companies seeking to invest in foster care. Entitled Fostering Sector Ripe For Consolidation, it begins in seductive fashion not with high finance or balance sheets but with the personal experience of carers who are clearly dedicated to the disabled child they look after. They don’t do it for the money – you couldn’t, because as they say it works out per hour at a fraction of the minimum wage. And that’s the last time children are mentioned as anything other than a commodity.

The economy of care has always been mixed and many private companies do excellent work, often with some of the most damaged children and young people. Yet the language of the balance sheet rather than the review form sticks in the craw and masks the realities of caring for vulnerable children to the standard they deserve.

Companies, including private equity, are attracted to the sector because of the potential for “cost savings” and “economies of scale”. Fostering is a “growth market” – Peter Connolly’s death and the increase in care admissions that followed becomes an investment opportunity.

Large companies from the health sector as well as private equity are gazing enviously not only at potential profits but also at the relatively high number of small to medium size firms who are ripe for a buy-out or as they call it, “consolidation”. Small-scale one or two person businesses, often started by social workers or foster carers from their spare bedroom, propelled the exponential growth in the independent fostering sector that began in earnest in the mid to late nineties. Now, IFPs care for almost 40% of children and young people in foster care.

However, many of the originals are keen to sell. Smaller providers feel pressured because of competition, the administrative tasks around Ofsted and contract compliance and the tender/contract process leaves less room for niche providers. They may also be coming toward the end of their careers and need to provide for their retirement. I’m not blaming them – these small companies led the way in the development of excellence in foster care practice in the days before and after regulation. With the big boys moving in, it’s hard to keep going.

This isn’t the world where we talk of standards of care, of healing relationships between carers and vulnerable children, not even of outcomes or aspirations. This is “the fostering space” where consolidation provides opportunities for profit, where large concerns, often multi-nationals from the health and, latterly, service sectors could invest and please their shareholders. This world has its own language: “It’s a classic private equity play. Private equity have been consolidating and investing in the fragmented domiciliary care space for the last five years and have begun to exit those investments to facilities management businesses. You can see something similar occurring in the fostering space.” I genuinely do not know what that means.

This is not new and I’ve written about it before on NSBS “Children In Care Are Big Business”, to the point where the FT article niggled away but I had not intended to go over old ground again. However, what made me write this was something I found out this week. Another private company (not the one mentioned in the piece) works at a profit margin of 30%.

That’s plain wrong. It may be irrational, it may be unusually high (although but I suspect it isn’t), for all I know I could be a wishy washy mung bean eating sandal wearing pinko liberal bleeding heart, but that’s an excessively high profit margin. As my piece from last year suggested, the best way to make money in fostering is to limit the services you provide for children and cut corners on matching, the process by which a child’s needs are matched with the capabilities of the carers. Take any placement, the money comes in and if it fails, blame the child or put it down to experience and move on to the next referral. Plain wrong.

The other way is to charge an inflated fee, which hurts cash-strapped local authorities struggling with constrained budgets precisely at the time when numbers in foster care are going up.

It chimes with other things that I have been told around and about. Carers from a private company who were told that allowances and services for children were to be cut back because local authorities were cutting their fees, when I know that company has increased the price it charges. A group of carers looking to change providers after the CEO arrived for a football match in his helicopter. Most tellingly, from my own experience on interview panels, the number of social workers seeking to move jobs because their professional standards have been compromised beyond redemption. Managers instruct them to take a placement when they know the match is not right.

I knew one of the candidates. She used to work for a small private company with a deserved reputation for long-term commitment and success with complex placements. The man who put this in place regretfully sold up after twenty years to a large national private company. Now, placement support services like therapy have been cut and she is forced to meet targets regardless of how appropriate the placement may be. That’s what is happening in the fostering space right now.