There’s a simple lesson to learn from abuse by health and care
professionals. Life is complicated. Relationships between service
users/patients and professionals can be complex. But when it comes
to abuse, the buck must stop with professionals. There must be no
blaming of service users. We’ve been down that road too many times
before with the physical, sexual and domestic abuse of women and
children. The primary responsibility of the professional – whether
they be counsellor, gynaecologist, social worker or support worker
– is to avoid abuse and abusive relationships.
Abuse thrives on vulnerability, inequality and secrecy. No wonder,
then, that it can loom so large in professional practice. People
often come the way of professionals at particular times of
vulnerability – which may include trying to deal with prior
experience of abuse. It’s easy to be overawed by the closed-door
ethos of the consulting room. Most of us have to make a determined
effort not to defer to doctors. Add to this the confidential issues
and emotional intimacy that may also be involved, and the
importance in professional relationships of clear ground rules,
informed consent, explicit boundaries and good supervision becomes
At the same time, there may be more basic questions we need to ask.
Is the potential for abuse just a personal matter, or do we need to
look more carefully at the particular professional role, its
underpinning philosophy and world view, the nature of relationships
associated with it and the organisation in which it is located?
Such questions have been asked particularly of counsellors and
psychotherapists, who may be operating on their own, in private
rooms, with the power to reinterpret everything in someone’s life.
But they apply more generally.
Popan, the Prevention of Professional Abuse Network, does important
work here, working both to educate professionals to avoid getting
into abusive situations and with service user groups to support
them to gain the skills and knowledge to deal with professionals on
more equal terms.
Transparency and accountability are clearly crucial to minimise
professional abuse. However, there will always be some predators
for whom professional practice is more a route to access to
vulnerable people than to supporting them. This is why effective
control and regulation are so important. In addition there is
always a tension in regulatory and professional bodies between
safeguarding the rights of service workers and safeguarding those
of service users.
Social work seems to generate fewer complaints than do some other
“helping” professions. Bearing in mind all the pain and
difficulties associated with complaining, this may not mean much.
However, with the establishment of the General Social Care Council
(GSCC), social work and social care have at last taken on the issue
of regulation systematically. Community Care‘s own
research (news, page 6, 1 April) suggests that most social care
workers support this move and think it will raise standards. More
worryingly, while there is strong support for striking wrongdoers
off the register, there is also uncertainty about how well this
will actually work, with few practitioners feeling that
registration will prevent unsuitable people from working and many
worrying that innocent workers could be put at risk.
The GSCC will need to convince everyone that it isn’t just another
bureaucratic institution, but instead an active outreach
organisation. During consultation, service users argued that at
least half of the GSCC’s board should be service users and that it
should prioritise a proactive approach, going out to service users
rather than expecting them to come to it. User involvement is the
only effective route to accountability and transparency.
Professional abuse raises its own particular difficulties in the
way of enabling involvement, but commitment and imagination will
find ways past these. One year into the new council, we must hope
it will have the courage to involve service users on equal terms to
work out its own long-term principles and strategy for countering
professional abuse and forcing it into the spotlight.
Peter Beresford is professor of social policy, Brunel
University, and is actively involved in the psychiatric system