What is it like to be a deprivation of liberty safeguards (Dols) best interests assessor (BIA)? What are the rewards? The challenges? The frustrations?
These are some of the questions that I asked in a recent survey of 78 BIAs as part of my dissertation for a master’s degree in psychology of education. Some of the answers were surprising.
Despite a popular perception that the concept of deprivation of liberty is unclear, most BIAs did not share this perspective, with 84% describing guidance as clear.
Effort and skill
BIAs reported having large workloads that required sustained effort and skill to manage; 88% felt they had a great deal of assessments to complete; over half felt they were working too hard on assessments; and over 90% felt that there was inadequate time and resources to complete assessments. This level of demand was predictable given the tenfold increase in Dols applications in 2014-15.
BIAs are independent professionals whose role is to establish whether people living in registered residential homes or hospitals are being cared for in a way that deprives them of their liberty and whether that care is in their best interests. They come from a range of health and care backgrounds but the majority are social workers; 80% of participants in the survey were from a social work background and 60% had at least three years’ experience as a BIA.
The survey used established psychological scales that covered factors such as role demands, ambiguity in the role, burnout, managerial support and overall job satisfaction.
It was expected that levels of demand would predict symptoms of burnout given the association between these factors among social workers and other allied health professionals. However, this wasn’t borne out in the research.
Instead, BIAs reported high levels of wellbeing and job satisfaction, and levels of burnout were significantly below those reported in other caring professions. The pattern of reported burnout indicated that BIAs have low levels of emotional exhaustion and feelings of depersonalisation (the process of becoming emotionally hardened towards service users), but also experienced low levels of personal accomplishment – this contrasts directly with the burnout profile of most social workers, with a study by Community Care being the latest research to illustrate this.
Any dissatisfaction that was reported focused on the lack of constructive feedback and, in the case of BIAs employed by a statutory service, pay. Employed BIAs were, however, more likely to experience support from colleagues and managers, which impacted positively on wellbeing and job satisfaction. The research also showed that any ambiguity, however minimal, about BIA work can have a big impact on wellbeing and, in some instances, confusion and some lack of clarity about what had to be done matched the impact of workload on stress levels. One implication of this finding is that BIA training and ongoing continuing professional development needs to be acknowledged as key in how BIAs subsequently experience their work.
So why the contrast in patterns of stress and wellbeing compared with other qualified social care and health professionals? While high workloads and intense demands are a shared feature of BIA, social work, nursing and therapy roles, BIAs report significantly higher levels of autonomy and decision making power. For instance, 77% felt that their powers to make decisions matched the responsibilities assigned to them and 89% felt they had the freedom to organise their own workload and try out new methods in the role.
Given these contrasts in how work is experienced, one possible explanation for the variation in burnout and wellbeing between BIAs and other health and care professionals is offered by the job demands-control psychological theory of stress at work, developed by Robert Karasek.
This theory proposes that the way in which work (and the workplace) is organised has as much bearing on stress levels as the work itself, because having the autonomy to make decisions, the opportunity to continually learn and develop and the chance to apply a range of skills can allow us to actively manage and prioritise our work. This can lead to improved efficiency and control over our work that has a knock-on effect on stress. A large body of research shows support for the theory with autonomy and control at work being consistently linked to factors like reduced stress, increased satisfaction and better physical health.
However, this theory comes with warnings attached as our ability to draw on our skills and autonomy can eventually become inhibited when demands get too high.
It is perhaps unrealistic to expect local councils to make big reductions in the workload of BIAs given current demand, but it may be possible to enhance those aspects of work that can promote wellbeing such as regular feedback, providing more learning opportunities and creating reflective spaces for BIAs to meet and share experiences.
Emma Fowler is learning and development officer, adult safeguarding at Manchester City Council