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.