Tom* has battled alcoholism and substance use and has a borderline personality disorder that had him engaging with everything from Alcoholics Anonymous to psychology experts, but without much success.
His breakthrough came when he told Lee – his caseworker – about a passion he had for music. Lee was able to make that a reality by grounding his support in elements of strengths-based practice that included a person-centred approach and the least restrictive practice.
“He was someone who would benefit from some structure, but hadn’t found the approach that suited him yet,” says Lee, who works for Hampshire County Council’s north west mental health and substance misuse social care team.
“Tom has been open to several services for years and had engaged with Alcoholics Anonymous, detox services, domestic violence support and psychologists – he knows more jargon than I do!
“But when I would suggest similar options, his words were: ‘not another one’ and ‘good luck to you if you think it will work’.”
“The difference came when Tom said he had a passion for music – not just listening to it but performing it too,” says Lee. “He is also passionate about his community and wanted to raise money for the growing number of Ukrainians settling in Hampshire. He had some music equipment and chose to busk to do that, so I will be going as his roadie, with his dog, to watch.”
“When I’ve worked with people with longstanding severe and enduring mental illnesses and used medicalised approaches that were not strengths-based, the level of engagement has been virtually zero. This is because they do not involve the person.
“What the strengths-based approach has managed to do is turn that around 100%. That is because that drive, the pride and the ownership come from the individual – not me. They create the networks, the bonds and the friendships, and I can’t tell you how powerful it is to watch someone experience that kind of growth.
“Tom has gone from texting me almost daily and going from one crisis to another including challenges with a flat he couldn’t move around in – to a flat that is now habitable,” says Lee. “And he’s engaging with family members and has a better relationship with his sister – someone who he had not talked to him for a month.”
If I told you some of the things I’ve done in this job, you’d be surprised. I’ve even ridden a horse – and I have a phobia of horses!
Connecting with social workers
Lee believes that these positives are due to Hampshire’s commitment to supporting practitioners in delivering strengths-based tools.
Strengths-based practice is an approach that emphasises people’s strengths, resourcefulness and ability to find tools to face life challenges. Within that, practitioners can employ the person-centred approach, which focuses on the elements of care, support and treatment that matter most to the person, their family and carers. The least restrictive practice, also strengths-based, aims to enhance a person’s autonomy, while respecting their rights, dignity, and privacy.
“At Hampshire, I have the freedom to practice in a strengths-based way, I can instantly connect with the social worker, set up a care plan and, in a joint meeting, reflect on where the individual is now, and where they would like to be,” says Lee.
“If that requires supporting them to busk, join a social club or take up gardening, that care plan can change to meet those needs. I have yet to have anyone at the council tell me: ‘we are not paid to do that’.
“If I told you some of the things I’ve done in this job, you’d be surprised. I’ve even ridden a horse – and I have a phobia of horses!”
Lisa Murley, a senior social worker with 30 years’ experience, agrees. She sits in Hampshire’s least restrictive practice team – one of several project teams established through the adults’ health and care directorate.
The multi-disciplinary nature of the team means Lisa gets to collaborate with behaviour specialists, a speech and language therapist and other third-party specialists, who are trained to assess the communication and behaviour of vulnerable adults. Some in her team also work with the authority’s partners in health and are involved in developing a trauma-informed care pathway.
“The strengths-based approach is a move on from the care management model where individuals would present you with a problem and you would present them with a solution,” says Lisa. “With the strengths-based model, it’s about how you collaborate with the person – proactively building on their strengths and identifying opportunities to improve their independence.
“In the HCC least restrictive practice team, we aim to reduce restrictions in people’s lives, reduce distress and improve quality of life.”
According to Lisa, person-centred planning is a good example. It encourages conversations about what is important to that person, what they can already do for themselves, what can make their quality of life better and what is important for them to help them achieve this, she says.
Lisa recalls working with a woman with learning disabilities who wanted to leave her residential home, and she was able to use the strengths-based approach to support this change.
“She wasn’t happy where she was living,” says Lisa. “There were restrictions around her diet, and her movements outside the home and inside – for instance, she couldn’t go downstairs after a certain time because staff had to mop the floors.
“She wasn’t really being treated as an adult or with dignity, either, and this caused her distress. She would respond with behaviours the staff found challenging.
“We carried out person-centred planning and a functional assessment to find out what behaviours she was displaying and the functions behind them to develop a positive behaviour support plan.”
Part of the work involved also reassuring her parents, who didn’t think the woman would be able to cope in supported living housing. But through using the person-centred approach to identify the woman’s strengths and opportunities, and helping the parents to understand this too, Lisa and her team were able to help her transform her life.
“We supported her to move to her own flat, which has 24-hour staff available, and she was extremely happy. She has the freedom to choose her support and has her own vehicle,” says Lisa.
A perspective from an approved mental health professional
The successes around using strength-based practice have translated into Hampshire developing a new Mental Health Act (MHA) referral process guidance.
Approved mental health professional (AMHP) Byju Mani has been heavily involved in rolling the guidance out, which has been based on person-centred, strengths-based and least restrictive approaches.
Byju explains that, as an AMHP, his role is to support the empowerment of clients, provide proportionate intervention under the MHA and prevent hospital admission with least restrictive options.
He says: “MHA assessment is often viewed as an opposite of the strengths-based approach because it deals with crisis and risks and can lead to a person being detained under the Mental Health Act.
“But a strengths-based approach to MHA assessment considers what crisis a person is in, their relationship to people in their communities, and what skills and resources we can use to support them to meet their needs.”
“By adopting a strengths-based approach, the AMHP collates all the information to understand a client’s life situation, needs, problems and risks in the context, and [also] their strengths and available resources to implement a least restrictive care and support plan,” he adds.
Byju has seen the impact of using these approaches while helping an individual who risked being hospitalised due to an eating disorder.
Byju was able to use least restrictive practice, motivational interviewing skills and solution-focused conversations to speak with the individual and their family about concerns raised about her health and safety.
“The positive experience the person had was more about our intervention and communication that helped to give her independence and respect,” Byju says.
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*The name has been changed