Value of experience

    At last, it looks as though some real efforts are being made to
    support the employment of mental health service users in local
    authority social services. This is in sharp contrast to many
    survivors’ experience of health and social care services, which
    have often been less accepting than mainstream employers. Social
    care workers who have had breakdowns frequently talk of
    unsupportive agencies, colleagues who no longer know how to relate
    to them and managers who sideline them. These are grim messages
    about the underlying value base of social work and social
    care.

    It is important to build on the positive new developments now under
    way in social services to support mental health service users as
    workers. This is especially so at a time when a new Social
    Exclusion Unit report has highlighted the importance of positive
    employment in challenging the marginalisation and stigma faced by
    many mental health service users. (Sadly, the report has largely
    ignored the excluding effects of the present benefits system and of
    proposed mental health legislation extending compulsion.)

    Arguing for the recruitment and retention of people with experience
    of mental distress to local authority social services can hardly be
    dismissed as special pleading. Over and again in recent research,
    one clear and simple message has been emerging about what service
    users want from social care workers. Whether children interviewed
    by the Department of Health, peer research by homeless teenagers in
    The Netherlands or service user research about what adult service
    users want in the UK, the message has been the same. Service users
    want workers who listen, treat them with equality and respect and
    have empathy and warmth. Who is more likely to be able to offer
    this than people with shared experience, as well as the essential
    skills?

    But there are still some fundamental barriers to be dealt with
    before this can become a routine possibility. Social care must stop
    talking about working with “vulnerable” people, as though there are
    two classes of humans: the “together us” and the “hapless them”.
    There are no invulnerable care workers and it is time that practice
    and thinking were more determinedly based on understanding of our
    shared humanity and interdependency. We have a reminder of the
    consequences of not doing this: the move towards a more technical
    approach to care management has been one of the biggest social work
    disasters of the past 20 years.

    It is doubtful, however, whether people with experience of distress
    and the psychiatric system will ever be accepted fully and equally
    as co-workers, while mad and bad are treated as the same. This is
    likely to happen as long as abuse and violence are explained away
    in terms of “mental disorder” without independent evidence. This is
    a situation perpetuated by defence lawyers seeking to get their
    clients off criminal charges on medical grounds and by
    psychiatrists expanding their diagnostic empires by medicalising
    people’s behaviour and experience. Until this arbitrary association
    is challenged, there will always be fear and uncertainty about how
    predictable, how reliable, how safe mental health service users
    are.

    Equally, it is not enough for social services just to open their
    doors to mental health service users or survivors as workers. They
    must also ensure that the working conditions they offer are
    positive and supportive. Yet there can be little doubt that terms
    and conditions of employment in local authorities have deteriorated
    over recent years. This creates problems for all workers. For staff
    with experience of distress it may impose insuperable obstacles.
    The positive negotiation of reasonable adjustments under the
    Disability Discrimination Act 1995 to meet the individual needs of
    survivor workers should be seen as a priority by employers. But it
    should never be treated as an alternative to ensuring good quality
    employment is ensured for all. And, for survivor workers, such
    standards must also mean that there are no “glass ceilings”, but
    instead truly equal opportunities in employment, real career
    structures and no ghettoisation in mental health or user
    involvement – unless that is what the worker really wants to
    do.

    There is one beacon to guide us here. A key senior manager who has
    successfully taken forward the employment of mental health service
    users in NHS trusts is Rachel Perkins, herself a survivor. Our hope
    must now be that we can look forward to seeing many similar
    champions emerging in local authority social care.

    Peter Beresford is professor of social policy, Brunel
    University, and is involved in the psychiatric system survivor
    movement.

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