Down on record

Depression
is widely encountered by social workers in the course of their work, but they
themselves are also vulnerable. Researchers Nicky Stanley, Jill Manthorpe,
David Brandon and Woody Caan report on a survey of Community Care readers on
their experiences of depression and the role played by their workplace.

Depression
is widespread among users of social care services, including older people,
mothers and adolescents. Social workers are expected to assess and respond to
people with depression. However, the profession may have much to learn from
examining its own experience of this issue.

The
survey described in this article focuses on the effects of depression in social
workers themselves and examines the role of the workplace in relation to
depression.

This
survey was completed by readers of Community Care ("Social care
work and depression", 12 April) and Professional Social Work last
year. Social workers who had themselves faced depression were invited to
complete questionnaires describing their first-hand experiences, the problems
encountered and the support received. The research team received nearly 500
responses, which testifies to the widespread nature of depression among social
workers.

Ninety-five
per cent of respondents were professionally qualified social workers, 71 per
cent were female and 69 per cent were practitioners. Three-quarters were
currently employed by local authorities, while 13 per cent worked in the
voluntary sector. The majority were working in children’s services, adults’
services or mental health social work.

Almost
three-quarters of respondents said that their depression had started after
entering social work. More than half reported that their colleagues knew about
their depression. Of these, 47 per cent described their colleagues as
supportive or tolerant. Managers were less likely to be described in these
terms – 19 per cent were seen as critical or hostile, compared to only 4 per
cent of colleagues.

The
majority of respondents had received professional help for their depression,
usually from their GP (67 per cent). Nearly all of those who had seen their GP
had been prescribed antidepressants. Thirty-eight per cent had seen an
independent counsellor, but only 15 per cent had used a workplace counsellor.
Similar proportions had seen psychotherapists (16 per cent) or psychiatrists
(14 per cent). Six per cent had received in-patient treatment for their
depression.

Support
from friends was identified as valuable by half the respondents and help from
family members was seen as useful by 38 per cent. Prescribed medication was
used and considered to have been effective by 45 per cent. More than a fifth
reported that alternative approaches, including exercise, listening to music,
taking a holiday, relaxation, and hobbies or other pastimes, worked for them.

While
social workers benefited from support provided by significant people in their
lives and made some use of non-medical support and self-initiated strategies to
counter depression, this survey indicates a predominantly medicinal response to
depression.

Eighty
per cent of respondents identified work as a cause of their depression, with
some specifying high workloads and lack of support. This confirms Balloch and
colleagues’¹ finding that stress at work is very common for social
workers. As in their study, this survey also identified domestic relationships,
bereavement, physical ill health and a range of other personal problems as
contributory factors. However, such issues were mentioned far less frequently
than work problems.

Two-thirds
of social workers responding had taken time off work as a result of their
depression. The majority of those who took leave had less than six months off,
with 44 per cent taking less than two months off.

Forty-two
per cent of respondents said that they had received no workplace support.
Managers were even less likely than practitioners to have had such help. The
two types of support most frequently encountered were support from occupational
health services and reduction in or support with workloads.

As
the table shows, workplace counselling was offered in less than a fifth of
cases, and reduced or flexible hours or a change of work were only available to
about 10 per cent of the group.

When
asked what services they would have liked that were not available, the largest
group of responses concerned support and understanding from work. Respondents
said they would have liked:

–
"An understanding from colleagues and managers that depression is an
illness like anything else."

–
"A non-hostile environment."

Other
responses on the same theme covered general improvements in management and the
workplace such as a quicker response from senior managers, and "time off
to provide respite from work pressures:

–
"Time out – caseload relief."

Respondents
also stressed the need to receive support or be able to take leave without
incurring stigma:

–
"An ability to take time off without workplace knowing the
‘illness’."

–
"Stigma-free therapy."

In
describing the impact of their depression, three-quarters of the respondents
mentioned low confidence, two-thirds had experienced tiredness or irritability
and just over half the group described a lack of concentration. The following
comments illustrate the negative impact upon them and their work:

–
"Can’t cope with difficult clients on bad days."

–
"Feeling of being no good".

Other
adverse effects were described by between a fifth and a quarter of the
respondents. These included communication difficulties, impaired judgement at
work, absenteeism, conflict at work and problems with timekeeping.

However,
about two-thirds of respondents pointed to increased understanding or insight,
empathy and the development of survival skills as positive outcomes. Nearly a
third mentioned experience of using services, expertise on mental health and
the breakdown of user-practitioner barriers as other beneficial effects.

This
survey identifies the workplace as contributing to social workers’ experience
of depression. Some stresses experienced by social workers are organisational,
such as high workloads, inadequate supervision and staff shortages, but others
are located in the demanding nature of the work, as has been argued elsewhere².

A
number of respondents described violence or aggression from service users as
having a severe impact upon their mental health. Interviews are currently being
undertaken with a proportion of the respondent group, which aim to draw out the
causes and responses to depression in more detail. These findings will be
compared with those from an earlier study of depression among nurses³.

The
workplace is also implicated by its failure to deliver a satisfactory response
to social workers with depression. Nearly half the survey respondents received
no support from their workplace. For many, the attitudes they encountered at
work will have exacerbated their loss of confidence.

While
hard-pressed social work teams may find it difficult to provide the flexibility
and relief that staff need, the high costs to services are apparent in the
amount of sick leave taken and in the respondents’ reports of reduced
efficiency and impaired performance.

Open
acknowledgement of depression among practitioners by employers might contribute
to a more sensitive and supportive response from organisations. 

David
Brandon who initiated this survey sadly died in November. He was visiting
professor of social work at Nottingham Trent University. Nicky Stanley and Jill
Manthorpe are lecturers in the department of social work, University of Hull. Woody
Caan is honorary senior lecturer at University College London. The authors
would like to thank all those who responded to the survey.

References

¹
S Balloch, J McLean and M Fisher (eds), Social Services: Working Under
Pressure, Bristol, Policy Press, 1999

²
R Davies (ed), Stress in Social Work, London, Jessica Kingsley
Publishers, 1998

³
W Caan, L Morris., M Santa Maria and D Brandon, "Wounded healers", Nursing
Standard, 15 (2), pp 22-23, 2000

Support offered by the workplace

Type
of support  and % of respondents

None
– 42%

Occupational
health support – 20%

Support/reduction
in workload – 20%

Workplace
counselling  -18%

Reduced/flexible
hours – 12%

Change
of work – 11%

Access
to private health care – 1%

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Will
adoption bill bear fruit?

The government may have reinstated birth parents’ rights in the Adoption
Bill but many omissions remain, says the Children’s Society’s Julia Feast.

The government has said that it wants a complete overhaul of adoption
services and to achieve this will bring in legislation. A surprise proposal in
the recently published Adoption and Children Bill, to remove the rights of
adopted people to access identifying information about their birth parents, was
dropped by the government after an outcry. But perhaps the shock of this
possibility has at least made people sit up and think about the needs of all
people affected by adoption.

Thousands of birth mothers who felt they had no choice but to place their
babies for adoption, because single parenthood and illegitimacy were frowned
upon, have been longing to find out if their now adult child is alive and well
and also to let them know of their interest in having contact.

Take the case of Irene who searched for information about her daughter Anna
whom she placed for adoption more than 50 years ago. After a 12-year search
Irene learned that Anna had in fact died when she was 11 years old. As Irene so
poignantly describes: "All the dreams and hopes I had created over the
years had to be rebuilt, while I came to terms with her death and the
realisation that I will never meet her again. Although at least I am no longer
in a state of anticipation as I now know her destiny."

But it is not just birth mothers who want such access to information. It is
birth fathers, siblings and other birth relatives.

In 1975 adopted people on reaching the age of 18 were given the right to
access identifying information from their original birth certificate, which has
given adopted people the opportunity to find and make contact with birth
relatives. But birth relatives have not been afforded the same rights to access
identifying information about their adult child’s adoptive identity. They have to
rely on the adoption agencies’ discretion to offer an intermediary service for
birth relatives. Alternatively they can use the government’s adoption contact
register (set up in 1991) to let the adopted person know of their willingness
for contact.

However, research by the Children’s Society has shown that 75 per cent of
non-searching adopted people have never heard of the register’s existence.¹
If the government wants the adoption contact register to be the only official
means for people to make contact with each other then it will need to invest a
lot more resources to make sure it is properly advertised and does the job it
was set up to do.

Since the adoption law review first began over a decade ago, professionals
working in the adoption world have also been calling for adoption legislation
that reflects practice and the attitudes of modern society. The bill partly
succeeds as it closely meets the needs of children waiting for adoption and
this is welcomed.

However, as it stands, it fails to address the needs of all adults affected
by the adoption process. The bill makes no mention of intermediary services nor
incorporates the practice guidance for intermediary services that was issued by
the Department of Health last year.² Some adoption agencies and local
authorities have in fact been providing intermediary services for birth
relatives for many years, but this practice needs to be prescribed in
legislation otherwise availability of such services will remain a postal
lottery. It is not good enough for it to be left to regulations. If the
government is truly committed to introducing adoption legislation that meets
the needs of society in the 21st century then it should amend the injustices of
the past, experienced by many birth mothers and other relatives including
siblings who felt they had no real choice in the adoption decision.

The Children’s Society research has also shown that adopted adults have
valued the fact that they can obtain information about their origins. In 90 per
cent of cases where a non-searching adopted adult was informed of a birth
relative’s enquiry they took up the opportunity to have some form of contact
with the birth relative. Many adopted adults report that having the opportunity
to access information has meant that they are able to build a bridge between
the past and the present. As Lisa says after she was told about her birth
mother’s enquiry: "Knowing that I have not been forgotten, knowing that I
was loved and not abandoned had a really positive effect on how I felt about myself."

In just 6 per cent of cases did the adopted adult feel that they should not
be informed of a birth relative’s enquiry. The majority reported that it was
their right to be informed of a birth relative’s enquiry so that they could
take their own decisions about whether or not to have contact. They welcomed
the opportunity to receive information that could help them make informed
decisions that may have a profound impact on their lives. This was certainly
the case for Monica who learned that there was a history of breast cancer in
her birth family and it was essential that she be screened at regular
intervals.

The research also revealed that non-searching adopted people were just as
likely searchers to think about their birth parents as they grew up. The
majority of searchers and non-searchers (80 per cent) said the contact with a
birth relative had answered important questions.

When the law changed in 1975 there was considerable debate about the
introduction of the right of adopted people to access identifying information.
Fears were expressed that birth parents would suffer distress and embarrassment
if their adopted children suddenly approached them. In practice, these fears
appear not to have been realised.

However, this change in legislation did much in paving the way for more
openness and a greater understanding of the adoption experience. It gave anyone
affected by adoption (both professionals and service users) a greater insight
into the lifelong implications. It enabled adopted people to answer important
questions they may have about themselves and their origins.

Adoption practice is now framed within the principle of openness. Adoption
and all the issues that go with it do not stop when the order is made. It is a
life-long experience. Adopted people and their relatives should have
opportunities to seek information and re-establish contact if so desired across
their life span.

Happily, the government has changed course on rights to information but will
it take this opportunity to address the needs of all people affected by
adoption – including birth relatives? This is a lifetime opportunity to get the
legislation right, so let’s hope the government will listen to evidence-based
practice, research and hard facts rather than the anonymous voice of concern.

Julia Feast is leader of the Children’s Society’s post-adoption and care
project.

References

¹ David Howe and Julia Feast, Adoption, Search & Reunion –
The Long Term Experience of Adopted People, The Children’s Society, 2000

² Department of Health and the Children’s Society, Intermediary
Services for Birth Relatives: Practice Guidelines, DoH, 2000

Websites

1 The Adoption and Children Bill and other government documents about
adoption can be found at www.doh.gov.uk/adoption/pmreview.htm 

2 Intermediary Services for Birth Relatives: Practice Guidelines can be
viewed at http://tap.ccta.gov.uk/doh/coin4.nsf/ 

——————————————————————–

A case for training

Social
workers encounter many difficulties and dilemmas when attending court as
witnesses, and it is one of the most stressful areas of their work. Children
and families worker Margaret Willis reports on her study of staff’s court
experiences

Social
workers have a duty to protect vulnerable children from physical abuse,
emotional abuse, sexual abuse and neglect. In the most serious cases this can
involve them in elaborate legal proceedings under the Children Act 1989 and in
having to give evidence against their clients in court.

In
order to protect children from abuse, social workers have to deal with the UK’s
adversarial legal system, which often exposes the social workers themselves to
aggressive cross-examination and scrutiny in court. This can bring them into
conflict with the traditional values of social work, with its allegiances to
work with individuals and families and ideas of caring and nurturing.

A
further conflict for social workers is that the process of seeking a court
order to protect a child can have the effect of alienating the parents, with
whom they are required to work in partnership.

In
my experience it is clear that many social workers find court attendance to be
very difficult. There does not seem to be enough support, training or guidance
in this area.

I
undertook a piece of research with a view to discovering what social workers
felt about attending court; how they viewed working with the legal profession;
how difficult they thought it was to work in partnership with parents; and what
they thought was lacking in terms of training and support.

The
research used a combination of quantitative and qualitative methods. Thirty-six
replies to a questionnaire were received from social workers working for a
council near London. For the qualitative component of the research, six social
workers from different backgrounds and with different experience were
interviewed. Their responses reinforced the findings from the questionnaire.

The
significant findings from the questionnaire were:

–
A very high proportion (91 per cent) of social workers rated training as very
important.

–
68 per cent of social workers had received no training on their social work
course.

–
66 per cent of social workers had received some in-house training, but usually
for just one day.

–
Many inexperienced social workers had received no in-house training until after
they had had to attend court.

Four
out of five social workers thought that experience was very important, and
attending court became less difficult as court processes became more familiar.

Nine
out of 10 social workers rated the support they received from the child care
legal team as very good, while only 31 per cent rated the support they received
from their managers as very good and 27 per cent ranked the support received
from managers as very poor. It was felt that more support should be given by
managers, especially to less experienced social workers. Managers often seemed
too busy to give the necessary support and inexperienced staff reported that
they were often left to attend court on their own.

Social
workers said the most difficult aspects of working with lawyers were their own
lack of training in law and legal proceedings and the perceived elitism of
legal professionals. They said lawyers and barristers undermined their
confidence by criticising them.

The
great majority of social workers (84 per cent) found it difficult or very
difficult to work with parents after court proceedings, and seven out of 10 had
found that giving evidence in court was very difficult or difficult.

The
most important findings from both the quantitative and qualitative research
were that social workers rated the importance of training very highly and saw
their lack of it as the most difficult aspect of their work with the courts and
the legal profession.

The
survey suggests that social workers should be given appropriate training on
social work courses and that training departments should ensure that there is
adequate post-qualifying training, especially for new and inexperienced
workers. It should be possible for this training to be co-ordinated and shared
by several local authorities. There should also be more attention and awareness
given to the need for social workers to have adequate support when they attend
court.

Margaret
Willis is senior practitioner, London Borough of Bromley.