Ask the Expert: does my relationship break the rules?

Claudia Megele and Peter Nelson (above) answer a social worker’s question about her concerns over her relationship

Q: I am a 23-year-old hospital social worker and work with adults detained under the Mental Health Act.

After we had been going out for four months my 22-year-old boyfriend told me that he was admitted to hospital three years ago with drug-induced psychosis and hallucinations. He still meets his psychiatrist and takes medication. I really struggled with this information and doubted my own skills (I never twigged that he was taking medication). He was not detained at the same unit in which I work, nor does he live in the same area.

Now, seven months into our relationship, he has told me that he has not been taking his medication for more than two months and occasionally hears ‘good’ voices.

1 As a hospital social worker am I breaking any social work rules by being with him?

2 How can I support him without becoming his carer or social worker?

3 He states he does not want to take his meds and intends to lie to psychiatrist?

Claudia Megele replies:

Considering that you have never worked with him in a professional capacity you are not violating any code of practice, writes social worker Claudia Megele.

However, if he was to become your service user then that would raise ethical questions. If there is a chance he might come into contact with your team, you should raise this matter in supervision and establish with your manager about how to deal with that scenario.

People and relationships are multi-faceted and his mental health difficulty is only one facet of his identity. Clearly, this does not make the relationship any easier, but it does not have to be its defining factor.

Couple relations involve caring about and for one another, and that at times can mean that one may end up being the carer in the relationship. Try to think about how and why you began the relationship, what you expected from it and how it has evolved. This reflection might help you decide whether the balance between what you are giving and receiving in your relationship suits you.

He can decide about taking his medication and information sharing with his psychiatrist. His feeling better is positive, but given your description, research suggests that there is a high probability that the situation may deteriorate; his hearing voices may be an indication. Therefore, I would suggest you encourage him to discuss the problem with his psychiatrist so, while he is feeling better, a contingency plan is put in place in case his mental health deteriorates.

You may also consider consulting a psychotherapist/counsellor who can help him address the root of the problem, or consult cognitive behavioural therapy for psychosis services.

He can also engage in hearing voices recovery and support groups. These can complement psychiatric medication and shed light on how things may be improved.

Finally, although you are a social worker you are not immune from emotional and psychological toil caused by deep involvement with someone experiencing mental health problems. You may therefore want to engage in a support group for partners of people experiencing mental health difficulties.

Claudia Megele is a social worker and service director of A Sense Of Self, which offers support groups, psychotherapy and counselling services in London. She has conducted research on ethics and social workers’ decision-making

Peter Nelson replies:

You are unlikely to be breaking any hospital rules because your boyfriend has never consulted the hospital where you work, writes social work lecturer Peter Nelson.

It is for this reason that the General Social Care Council’s code of practice paragraph 3.8, “Recognising and using responsibly the power that comes from your work with service users and cares,” doesn’t apply. Neither does 5.4, which states “you must not form inappropriate personal relationships with service users”.

But you might want to consider section 5.8 – “as a social care worker, you must uphold public trust and confidence in social care services” and must not “behave in a way, in work or outside work, which would call into question your suitability to work in social care services”.

This takes the code of practice into the area of personal relationships, but in this case there is no evidence that this relationship between two adults raises any issues of suitability.

It is understandable to look to regulations from your employer or the GSCC for guidance on professional boundaries, but research recently conducted by Sheffield Hallam University (Doel et al 2009) found that such guidance tends to ignore the ambiguous areas of practice. Instead of expecting prescriptive guidance, professionals should engage in “ethical engagement” in which they exercise ethical sense through regular discussion of these dilemmas.

Reflecting how we might respond if he was a service user may help in answering the question about your boyfriend’s refusal to take medication. The GSCC code of practice section 4.1 states that we must recognise “that service users have the right to take risks”.

Your boyfriend is capable of making his own decisions, but if his health deteriorated significantly, such that he poses a danger to himself or others, then you would need to take action and seek help.

Peter Nelson is principal lecturer in social work at Sheffield Hallam University

Views from CareSpace

● Titchmagoo: You are not breaking any rules/ethics. You must, if this is a serious relationship, let him know you are supportive and care; continue the relationship if you both want it. If possible, explain that you can advocate for him but not be his social worker.

● Shirack: There are not many perfect relationships and you seem to have chosen someone who is a bit fragile (who isn’t?). It may or may not work out but what the hell, enjoy it while you can; we can’t all have superman/woman for a partner.

● Rupert M: He is still entitled to make his own decisions if deemed mentally capable. People are entitled to confidentiality and the protection of their human rights – gentle persuasion would be the best course of action. What might his reaction be if he found out that his girlfriend had gone behind his back to the psychiatrist?

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