In danger of too much coercion

health policy is taking a worryingly coercive turn, according to approved
social worker Paul Jewitt.

endured the training provided by a leading institute on assertive outreach I
feel I must offer some words of caution. I know it is a requirement under the
National Service Framework for Mental Health, but I must protest at the
assumption made by many that a move to more aggressive policing of mental
health patients in the community is either desirable or practicable.

this is also a theme of the government’s proposed changes to the Mental Health
Act 1983 and in my view equally misguided. I work with a team that calls itself
an assertive outreach team. It focuses on restricted patients – the group the
tabloid press would describe as posing the greatest risk to the public.

operate in several ways that combine to produce a model that is
multi-disciplinary, multi-agency and effective, without the need for any more
coercive powers than we already have. We work by consensus and contractual
agreement using the care programme approach that involves clients being part of
the process and accessing services, as well as providing their own relapse
factors and prevention methods. It also includes establishing agreed boundaries
that permit early intervention and the prevention of crisis.

has the advantage of allowing clients to take as much responsibility for their
own actions as they are able to. It also avoids being patronising or
over-controlling while recognising the need for control of risk for public

is really the key: the balance between care and control must be agreed and
managed or it will not work. Too far into the control end of the spectrum means
resentment, refusal and ultimately failure. Too much care leads to failure of
boundaries and a state of anarchy.

must stop trying to treat our clients as though they are stupid just because
they have a mental illness. We must also recognise that working assertively
should be something we all do in order to intervene both minimally and as early
as possible. There will always be those who are reluctant to engage and will
need to be monitored closely. This can, however, be operated by the method
outlined above without the need for an additional and expensive extra team. Let
us put the money where it is needed and make sure the existing services have
the resources to deal effectively with the needs of a group of people who are
disadvantaged in so many ways.

Jewitt is a forensic social worker and approved social worker with Luton
Offenders Outreach Team.

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