news analysis of ground breaking Scope report and unqualified staff working in mental health

It may be advisable to print this document as it is
long.

(see below for analysis of proposals for unqualified staff to
work in mental health)

Tackling social exclusion is the cornerstone of New
Labour’s policy on care. But a ground-breaking report from
disability charity Scope reveals that disabled young people with
high support needs are still being excluded from society.
Alex Dobson reports.

Exclusion still the norm for young disabled
people

Practitioners have often voiced concerns that there is very
little information available looking in any kind of depth at young
disabled people who have physical, sensory, communication and
cognitive impairment.

And alarmingly, while government strategies are targeting
education and helping people back into work, a new report by the
disability charity Scope indicates that for this vulnerable group,
much more basic issues need to be addressed.

The report, That Kind of Life¹, used a number of
methods to find out what the young people really feel about the
quality of their lives and is one of the first to seek the views of
young people with complex needs.

The answers are likely to make uncomfortable reading for policy
makers. Young people report major failings in the very services
that are aimed at providing teenagers with a better quality of
life. Key issues highlighted were isolation, lack of control, not
being listened to, feelings of being unsafe, and the denial of
opportunities to make a contribution to their own communities. They
also point out there are significant differences between what
social exclusion means to government and what it really means to a
young person with high levels of need.

Difficulties with communication were found to be key. Those who
communicated by using body language were sometimes labelled as
attention-seeking. Failure to recognise the need for assistance
with communication inevitably led to breakdowns of understanding
between the individual and the service on offer.

Rights, accessibility and choice were also raised as issues.
Engagement with local communities, the opportunity to “go out and
about” like other adolescents, and living close enough for your
family to make frequent visits are fundamental rights. Yet the
evidence is that young people are being denied some, or even all,
of these. The picture is one of individuals who are assumed to be
“happy to go along with anything”, and as a result are being denied
any real choice.

In the first stage of the research project, four groups were
asked to describe what social exclusion meant to them, while the
second stage involved researchers drawing on the individual
experiences of 44 young people between the ages of 15 and 20.

“The first stage of the research took four to six months and the
second stage took a year,” says report author Jenny Morris. “We
took a long time to do the visits because they were not traditional
interviews and we needed to be sure we were finding out what the
views of these young people really were.

“What we found was that unless policy is informed by the
experiences of these young people then it will not address their
needs.

“Many of them were even denied the possibility of communicating
because adequate assessment was not given – or the equipment
provided was unavailable,” adds Morris. “Inadequate or out of date
– it amounts to a violation of their human rights. These people are
being silenced because they are simply not given the support that
can allow them to have a voice.”

These results will come as no surprise to others working in the
field. Beverly Dawkins is profound and multiple learning
disabilities officer at Mencap.

“In Mencap’s experience, people with more profound disabilities
do encounter the difficulties highlighted in Scope’s report,” she
argues. “There has been a steady increase in the number of children
and adults with profound and multiple learning disabilities in
recent years. This trend is set to continue as medical progress
advances and yet, families and carers often face isolation and
ignorance as they struggle to gain understanding and appropriate
services.”

“Service providers must be challenged to meet the needs of
people with more profound disabilities – some of the most
marginalised and vulnerable members of society,” she adds. “They
also need to offer more high quality, targeted support services to
parents who desperately need them.”

Paul Gemmill, director of policy at the Disability Rights
Commission (DRC), has serious concerns that the needs of this group
of young people are not being adequately met, and the report
highlights many of the issues that the DRC was already aware
of.

“It demonstrates what we have found in our work, that disabled
young people often fall between the cracks. There are gaps between
health, education and social services, which means that the young
people concerned often don’t get the necessary support. Each sector
is saying that another service should be responsible.”

Gemmill says that cost is often used as a way of denying choice,
but argues that careful consideration of all the options can result
in a much more successful outcome without putting an extra burden
on overstretched budgets. “The report details the way in which
young people are often placed in residential or nursing homes a
long way from their own families and community. This is an
extremely expensive option that benefits no-one,” he says.

The government white paper on learning difficulties, Valuing
People, was published in March and has a strong emphasis on
independence, choice, social inclusion and civil rights. So it
seems unfortunate that the experiences of these young people seems
to run counter to the government’s admirable aims.

But what is the government currently doing to address the needs
of disabled young people? Valuing People has at its centre three
core principles. First, that service models require appropriate
implementation; second that relationships between staff and the
service user are the cornerstone of successful outcomes; and third
that it is the individual being offered the services who is
pivotal.

The government says that it is also addressing at least some of
the issues with a series of initiatives including:

– £60 million of the children’s services grant earmarked
for more support for families with disabled children from 2001-2 to
2003-4, resulting in more home-based help and more access to key
workers.

– £220 million from 2001 to 2004, as part of the Special
Educational Needs and Disability Act, to improve the accessibility
of mainstream schools for disabled children.

– Additional family support through statutory and voluntary
sectors, including co-ordinated health and social care packages to
an additional 6,000 severely disabled children by 2002.

– New National Information Centre for families of disabled
children launched this year by Contact a Family, with government
funding of £500,000 a year.

– Action to enable more disabled children to use sport, culture
and leisure activities.

– Workshops run by the Children and Young People’s Unit, which
will focus on the needs and views of children and young people with
disabilities.

– £10 million initiative to supply communication aids to
children with special educational needs and disabilities. The
project will have at its heart the concept of “personal” equipment
geared to individual needs.

While this list of proposals measures is welcome, That Kind of
Life suggests policy makers need to focus social exclusion measures
not just on jobs and education, but on policies that can deliver
basic human rights.

Richard Parnell, head of research and public policy at Scope,
argues: “This report can help make the difference between young,
disabled people taking part in life or being excluded from society.
It’s clear that they are marginalised and excluded because of their
disability, and that their needs are not being heard in the arenas
where policies are developed. Therefore, current initiatives to
tackle social exclusion will not address their experiences as they
grow into adulthood.”

“We want them to ensure that they go beyond the physical and
basic needs of these young people,” he adds, “and take into account
their views and opinions on how they wish to lead their lives, if
they are ever to achieve true equality.”

¹ That Kind of Life, published by Scope in
partnership with Jenny Morris and funded by the Community Fund,
will be able from late September from 020 7619 7341. The report
will be priced at £3 for individuals and £12.50 for
organisations.                    

—————————————————————————————————

A new grade of worker to relieve qualified mental health staff
of mundane tasks has been proposed by a key report, but will the
idea come to fruition? Anabel Unity Sale
reports.

Proposals promise relief for mental health
workers

Reinforcements for staff working on the front line in mental
health services could soon arrive in the form of non-qualified
workers who will free up approved social workers to focus on
clients’ more crucial needs.

The proposals to recruit support, time, recovery (STR) workers
have come out of the final report from the workforce action team on
the mental health National Service Framework.

The team was set up by the government in late 1999 to
investigate the short-term practical solutions necessary to deliver
the mental health NSF. It was also charged with coming up with
innovative ways of ensuring the appropriate workforce is recruited
and retained.

The establishment of an entirely new non-qualified workforce to
deal with mental health service users is the most radical solution
among the report’s proposals.

STR workers would take the strain of dealing with users’ more
mundane needs away from qualified professionals. They would promote
independent living among users, provide support with daily living
activities and encourage clients to take responsibility for their
practical needs. STR workers would also be part of a care team able
to spot the warning signs of relapse and facilitate early
intervention.

The report spells out what would be expected of STR workers:
they must listen, talk, spend time, empathise, be accessible and
flexible. It also stipulates what they won’t do: co-ordinate the
care programme approach, provide clinical or medical treatment, be
involved in sectioning or compulsory medication other than to
support the client, or be a service manager.

STR workers would have either “a small caseload with intensive
activity, or a large caseload of more general support” depending on
the user’s needs and the service setting.

If each STR worker had an average caseload of 10 users, the
report predicts that England would need to employ about 10,000 of
them.

Existing mental health staff in non-professionally affiliated
roles, such as assertive outreach team support workers, could
easily be converted to the STR role. Others, such as acute ward
nursing assistants, would need the focus of their work changed and
additional training and support undertaken before becoming an STR
worker.

Steps are proposed to stop highly trained staff disappearing up
the career ladder and into management through the creation of a
senior practitioner grade for approved social workers. The report
emphatically adds that there is a “real need” to minimise the risk
of losing such skills by “rewarding continuity in practitioner
roles”.

Acknowledging that ASWs carry weighty responsibilities, the
report recommends that they receive the equivalent of five days’
continuing professional development each year to help them do their
job. It also suggests that a national pay agreement could help
tackle the recruitment problem among ASWs, currently exacerbated by
varying pay levels.

Most mental health personnel would agree with the need to
recruit more staff, have protected study days and a nationally
negotiated higher wage for ASWs. But does the government feel the
same? Can existing staff expect to see tangible change as a result
of the 175-page report?

While the Department of Health would not be drawn on the extent
of the report’s influence, a DoH spokesperson says health minister
Jacqui Smith is examining its recommendations closely before
deciding on any further action.

Action team member and Dorset council social services director
David Joannides is adamant that the report is neither a wish-list
nor a blueprint. “Much of the report provides health, local
authorities and individual managers with a framework for tackling
most of the workforce issues that are within their ability to
develop,” he says.

Joannides is confident that introducing STR workers would help
reduce ASWs’ workloads. He says a similar approach of using
unqualified staff in services for older people and disabled people
has been successful.

He explains: “[Unqualified] people can be equipped, trained and
skilled up to provide support and recovery assistance that the
current workforce is struggling to do.”

Ironing out pay inconsistencies for ASWs would also help in
recruitment, Joannides says. “Recruitment and retention would be
assisted by fairer remuneration, but to be quite honest we need to
understand more about what retains staff.”

Melba Wilson, policy director at mental health charity Mind,
supports the idea of STR workers being part of a user’s care
team.

She says: “If it’s a question of STRs trying to promote better
mental health through early-warning mechanisms, this is a good
thing.”

Establishing such a workforce, she says, could help attract back
some of the “good people” who have left mental health services
after becoming disillusioned. This would include black and Asian
people who could target mental health service users from those
backgrounds, she adds.

But Wilson warns: “The fear is there won’t be safeguards of
accredited training and it won’t attract people. This has to be a
thought-through solution, otherwise it is just a good idea that
falls on the cutting room floor.”      

* Final report of the Workforce Action Team from www.doh.gov.uk/mentalhealth/wat.htm#report