“You do not have to be me in order for us to fight alongside each other. I do not have to be you to recognize that our wars are the same. What we must do is commit ourselves to some future that can include each other and to work toward that future with the particular strengths of our individual identities. And in order for us to do this, we must allow each other our differences at the same time as we recognize our sameness.” – Audre Lorde
I start this editorial with the powerful words of the Black American feminist and civil rights activist, Audre Lorde. It seemed particularly apposite in the week that we witnessed the brutal killing of George Floyd, a Black man, by the police in Minneapolis, and the outpouring of anger that Black Lives Matter on the streets of America, Britain and elsewhere. Professor Cornell West on television denounced Donald Trump, but also said the failure of the nation—one that allows for endemic inequality and a culture of greed and consumerism that tramples on the rights and dignity of poor people and minorities decade after decade—goes much beyond the current president. His reflections on America speaks to so much about Britain as well. Grenfell, Windrush and the disproportionate number of COVID-19 deaths amongst BAME people and in deprived communities are just a few of many, many examples.
This week in Britain we have seen the enactment of privilege and power, which may also prove to be deadly, in the government press conferences and the rose garden of No 10 Downing Street. As George Orwell famously wrote in his allegorical novel about totalitarianism, Animal Farm: “All animals are equal, but some animals are more equal than others”. Both the US and UK, two rich countries riven with entrenched inequalities, seem to be adrift during this pandemic with a vacuum in moral leadership from those in power and a lack of ability to hold them to account.
Social (in)justice has been a theme running through many of the contributions in previous editions, and rightly so for a journal about social work. This edition is no exception. Both Sally Nieman and Alisoun Milne draw attention to the tragedy and scandal of coronavirus related deaths of older people in care homes. Peter Simcock’s article shines a light on the needs of deafblind people during lockdown, who have remained invisible in policies and public debates. Annie’s interview with ATD Fourth World highlights the links between poverty and the child protection system, drawing attention to particular struggles during the pandemic. Raksha Sidhu discusses a number of intersectional power relationships in her piece on mental health social work.
One of the pleasures of being part of the editorial collective is that we read, and facilitate the reading of, writings from a wide range of people on the same platform; people who don’t often share spaces as equals. In this edition, alongside academics and practitioners, we have articles from three women, Claire Moruzzi, Tanya Killick and Pam Hodgkins, who all have experience of adoption and continue the theme of ‘wondering and not knowing’ that started with the voices of birth parents in the third edition. Also, we have the third, as ever insightful, video from Michael Clarke. A beautifully written piece from social work student, Becky Salter in Wales, is also included in this edition.
Many of these, alongside other articles in this edition, pose questions about what are the lessons we can learn from the pandemic. This is our penultimate edition, with the deadline for submissions for the last edition being the 23rd June. We particularly welcome any articles that continue the themes of looking back on the lessons of the pandemic and looking forward to life after coronavirus. My final words are also those of a Black political activist and academic, Angela Davis:
“It is in collectivities that we find reservoirs of hope and optimism.”
Anna Gupta, Professor of Social Work, Royal Holloway University of London
Covid-19 has exposed serious inadequacies in the UK’s social care system (Pollock et al, 2020). It has made visible, and amplified, a pre-existing seam of governmental ignorance and indifference of catastrophic proportions. Very limited national attention is paid to social care, it is poorly resourced, fragmented and infrastructurally weak, and is conceptualised as the handmaiden to health care. As older people are the majority users of both community based and residential social care services, Covid-19 has, by default, also made visible political, structural and societal ageism and public and policy ambivalence towards older peoplewho need support from services and to the staff that work in them.
The most stark evidence of dereliction of duty relates to care homes. About 410,000 older people live in care homes in the UK, half of whom are publicly funded. The majority are aged 85 years or over, have complex co-morbid conditions and need help with activities of daily living. Dementia is estimated to affect four fifths of residents (Dening and Milne, 2020). There are 15,487,000 care homes in the UK; over 90% are independent providers and the majority are for-profit (LaingBuisson, 2018).
Covdi-19 related deaths in care homes is both a tragedy and a scandal. The death rate in care homes attributable to ‘all causes’, has increased by 220% since the start of the outbreak. Official figures – from May 16th – estimate that 12,526 residents have died from coronavirus. Another 10,610 ‘excess’ deaths from ‘other causes’ linked to the virus have also been recorded; these relate to deaths arising from GPs being unable to visit the home and/or care homes being discouraged, or sometimes unable, to send residents to hospital for treatment (O’Dowd, 2020). A third – as yet unverified – cause is residents dying as a consequence of ‘being left alone without adequate food, water’ or access to pain relief. Thus, overall, 22,000 deaths in care homes have been the result, either directly or indirectly, of Covid-19. This number represents over half of the (predicted) total of all Covid-19 deaths in the UK. It is a figure that warrants analysis as it raises serious questions about what the hell happened to care homes!
There are a number of dimensions to this story of abandonment, mismanagement, and deceit. From the beginning of the crisis the government was preoccupied with protecting the NHS and ramping up NHS capacity. This focus was at the expense of protecting ‘at risk populations’ including care home residents. Valuable early opportunities to reduce the chance of the virus entering care homes were not taken. As Dr Harwood, a Consultant Geriatrician, points out, ‘Care homes were always vulnerable, residents are frail and live communally…’. The situation was made worse by a process of mandating early discharge to care homes of older people who no longer needed inpatient hospital treatment. These patients were not routinely tested. Those who had the virus brought it into care homes where it quickly spread creating, what the scientists call, ‘fatal cluster effects’. It was not until the 15th April, after 5,700 patients had died in care homes or hospitals, that the government ‘required’ all patients discharged from hospital into a care home to be tested (Iacobucci, 2020).
The Department of Health and Social Care (DHSC) was also slow to advise against visits to care homes; another obvious route of infection transmission. Whilst Scottish Care – a representative body for social care in Scotland – advised care homes to close to visits on 11th March and Nursing Homes Ireland – which represents hundreds of Irish homes – banned non-essential visits six days after the first confirmed case in the country, the DHSC did not act until 2nd April.
The other key issue relates to lack of effective protection. Care homes were woefully unprepared to deal with the virus, in good part because they were not seen as a priority for receipt of PPE and testing. An ‘action plan for care homes’ was not published by the DHSC until April 15th: 6 weeks after the government’s national ‘coronavirus action plan’ (which made no mention of care homes) and 3.5 weeks after the Prime Minister announced the UK lockdown. On May 15th – a month after the care homes action plan – Age UK reported that ‘many homes are struggling to access PPE and testing’. Even where testing is available it may not be local: staff from a home in Derbyshire are obliged to travel for an hour to Grantham to get a test if they want one.
As recently as May 18th, the Chairman of the Science and Technology Committee wrote a letter to the Prime Minister stating that the government’s ‘ability to make tests available to care homes has been inadequate’ throughout the pandemic. He accused Public Health England (PHE) of – effectively – abandoning care homes in the first critical weeks. Despite official reassurances from Matt Hancock about the ‘protective ring thrown around care homes’, on May 20th many homes reported that they were ‘still waiting for tests’ and ‘a supply chain to tackle PPE shortages is weeks away’ (Carter, 2020).
There are a number of reasons for this failure. Which agency is responsible for overseeing and managing, the provision of PPE and testing to care homes is one important question. There has been considerable confusion about this. PHE, the Care Quality Commission (CQC) and the DHSC have repeatedly passed the buck about who should manage tests, giving mixed and contradictory messages. Care homes report being told, in the same day, that it’s not CQC but PHE and then later on the opposite.
A key barrier to understanding what was happening was lack of data. The National Care Forum (an independent care sector body) describes care homes as planning their response ‘with their hands tied’ because data about outbreaks were not published until the end of April. PHE had counted more than 4,500 Covid-19 outbreaks in care homes before it issued its findings. For many weeks the government did not include deaths in care homes in its official statistics. This underscores its lack of understanding of the risks care homes were facing and as the death toll rose, its reluctance to acknowledge its own role in contributing to these.
Funding issues are also a contributory factor. In mid May the Government released a £600m cash injection for care homes to help control infection. English Councils have also been given £3.2bn ‘crisis funding’ to support the adult social care sector through the pandemic. These sums have been dismissed as ‘derisory’ by care home managers who consider it insufficient to cover the costs of PPE let alone the extra costs related to testing and the provision of additional staffing. Extra staff were needed to provide cover for sick colleagues and to be able to offer 1:1 ‘isolation care’ to residents with the virus or those discharged from hospital. Some care homes have complained too that they have ‘struggled’ to gain access to the funds local authorities have been allocated.
This inertia and confusion speaks to a larger issue about the nature of the care home sector. Social care services in the UK are among the most privatised and fragmented in the Western world (Dening and Milne, 2020). Care homes operate in the market and are driven by commercial principles; these shape their priorities and whilst there are many examples of excellent care, the quality of care overall is uneven, variable and vulnerable to the vicissitudes of investors and the stock market. Although care homes are regulated by the CQC they sit outside the purview of the public sector; they occupy a liminal ‘off the radar’ status inside the care system, in communities and in the public consciousness. There is also an inherent conflict between care homes being a place of ‘care’ and a place of ‘home’ (Mikelyte and Milne,2016).
Residents are not the only group placed at risk. At least 131 care staff have died from coronavirus. The ONS estimates that (social) care staff are twice as likely to die as healthcare workers (and members of the general population). Most are women. Workers – who called a whistleblowing helpline operated by Compassion in Care – described the ‘horrendous’ unsafe conditions they are facing over lack of PPE and the terrible impact this is having on their mental health and wellbeing. In mid April care sector bodies wrote to Matt Hancock to alert him to the fact that that ‘this army of incredible, often low paid and undervalued care staff’ are risking their health and lives to deliver care to some of society’s most vulnerable people (Dyer, 2020). Staff absences have been running at 10% to 20%. In a sector already facing a recruitment and retention crisis, a moment of maximum peril is being confronted with a bare minimum of resource.
There is another embarrassing dimension to the care home story of shame. In 2017 a report – Exercise Cygnus – was commissioned by the government to explore the UK’s preparedness for the extreme demands of a flu-like pandemic. It concluded starkly that Britain ‘was not adequately prepared’. Three of the report’s key recommendations were to: boost the capacity of care homes, increase the number of care home staff and significantly increase supplies of PPE. It is clear that this was not implemented or even discussed with local authorities or care homes. If it had ‘the care home sector would have been in a much better place at the start of the pandemic’ (Martin Green, Chief Executive, Care England). The government also had evidence from other European countries – exposed to the pandemic before the UK – upon which to base a plan. Both Spain and Italy had experienced significant numbers of care home deaths: a pattern that we could have learned from.
Hubris also played a role. At no point has anyone representing the government acknowledged wrongdoing. This is not only an act of betrayal but one of mistruth. Talk of a ‘protective ring’ rings hollow in the ears of families who have lost relatives and to care home staff with no access to PPE. The politicians’ mantra lacks credibility and is replete with falsehoods and spin.
I will leave the last word to a man whose father died in a care home in April:
It’s a kind of an indictment of the way the care system has been seen over this crisis and reflects how we see older people in care homes …they’re sort of expendable, not a priority and not deserving of treatment. Many deaths, including my dad’s, could have been prevented and that’s the thing I can’t forgive…it’s just wrong… so very wrong.
Dr Alisoun Milne, Professor of Social Work and Social Gerontology, University of Kent
Carter, R. (2020) Covid-19: The support UK care homes need to survive, British Medical Journal, 369: m1858.
Dening, T. and Milne, A. (2020) Mental Health in Care Homes for Older People, in T. Dening, A. Thomas, R. Stewart, J-P. Taylor. Oxford Textbook of Old Age Psychiatry, 3rd edition, Oxford: OUP .
Dyer, C. (2020) Covid-19: Doctors make bid for public inquiry into lack of PPE for frontline workers, British Medical Journal, 369: m1905
Iacobucci, G (2020) Covid-19: Care home deaths in England and Wales double in four weeks, British Medical Journal, 369: m1612
LaingBuisson (2018) Care of Elderly People: Market Survey 2016-18, London: Laing and Buisson.
Mikelyte, R and Milne, A (2016) Exploring the Influence of Micro-cultures on the Mental Health and Well Being of Older People Living in Long Term Care, Special Issue of Quality in Ageing, Mental Health and Later Life, Vol 17(3), 198-214.
O’Dowd, A (2020) Covid-19: Care home deaths in England and Wales rise sharply British Medical Journal, 369: m1727.
Pollock AM, Clements L, Harding-Edgar L (2020) Covid-19: why we need a national health and social care service. British Medical Journal 369: m1465.
 In England and Wales
 NCF is the membership organisation for not-for-profit organisations in the care and support sector
 These will not all be care home staff but the majority will be
 Care England, a registered charity, is the leading representative body for independent care services in England
* ‘’Annie’’ is a pseudonym
Five years ago, you launched a website, Surviving Safeguarding: a Parent’s Guide to the Child Protection Process. Through the site and social media, parents contact you for advice about their interactions with social services and family courts. How has Covid-19 changed things?
Since the beginning of the lockdown, visits to my website tripled from 15,000 to 45,000 hits a month. The sheer volume is a shocking increase. I’m also struck that parents who contact me for advice are sending messages at 2 or 4 am; the times when people feel the most isolated and upset. The reasons for this uptick fall into three categories:
- Legal proceedings have stopped and parents don’t know when their case will be heard or when it will end;
- Contact visits were cancelled abruptly and parents have no information about what this means and are left without strategies to manage their feelings around this;
- Parents are simply on their knees struggling to meet their social worker’s expectations despite the enormity of living on a very low income and having the children out of school.
In a time like this, there’s such a primal urge for parents and children to know how the others are. For the first time ever on this scale, I’m hearing that adoptive parents are now willing to extend information to birth parents to let them know that their children are safe, and so that the children will know their birth parents are safe. Relationships with foster carers are either improving, or are under strain.
Do you see a link between poverty and child protection proceedings?
These families all live in poverty. They have nothing. You can’t dismiss the impact of poverty on a parent’s ability to function. When your kids are hungry or when you can’t afford heat, you can’t fix it just by playing with them. It helps, but it doesn’t fix it. Society still has not grasped the correlation between poverty and child protection. It’s a class issue. In the main, parents don’t set out to fail our children. We don’t set out to live in substandard housing on a rough council estate with only fifty quid a week, choosing between gas on the meter, or food. No one chooses that. But there’s an “othering” of struggling parents who are deemed not good enough by people who have nice warm homes and a decent income.
There’s a lot of pressure put on social workers to react. Social workers want to be reflective; but they have to firefight. They can’t always do the job they set out to do, particularly at the moment. The expectation is that parents will be able to demonstrate sustained changes in a confined time. But that’s such a big ask, and even more so during a lockdown.
A great deal of us are coping with a massive drop in income and the cheap brands aren’t always available, so we have less and less money left. We have no choice but to take buses and queue outside supermarkets. And when you’re a lone parent, sometimes you have no choice but to bring your children on the bus to help you carry the groceries home — but others demonise you for that, sitting in judgement. Seeing panic buying and empty shelves is a hugely triggering time. I’ve felt it myself and I’m in an incredibly fortunate position of having a job.
People need help and support. It’s hard to find the ‘new normal’ under the gaze of your social worker’s watchful eye. But I also see incredible resourcefulness and resilience from people who were barely managing before. Society has a lot to learn from them. Of course, the priority is children’s safety, but I want to see more trust and more faith in parents to find their way through.
What are you most concerned about right now?
One mother I’m aware of had her newborn removed just as the lockdown was beginning. Her social worker has said that a contact over FaceTime would be meaningless for the infant so it has not been a priority to arrange it. But it would mean so much to the mother. And now this mother is entirely unable to demonstrate her ability to parent that child. Her very real relationship with her baby was broken by intervention and it will be very difficult to rebuild it. The baby is bonding with the foster carer, who is unlikely to be the primary carer in the future, so the baby is going to have another relationship broken. Again, safety for children is paramount, but what about their human right to bond and be with their parent?
I don’t think it’s always appropriate that psychological assessments are being carried out during lockdown, unless the assessing psychologist had already formed a strong relationship with the parent. The results will be different than pre-Covid. How can that evidence be used to inform draconian decisions? And it’s exceptionally difficult for a mother to form a valid argument to defend her parenting skills when she gave birth only hours earlier. She is still bleeding and leaking breast milk. And once her baby has been removed, she’s grieving. How can you carry out a valid psychological assessment while she’s grieving and in the context of a global pandemic?
When these cases get to court, some hearings do need to be carried out remotely — but some parents are telling me they don’t understand the technology. They don’t know where to look or where to talk. They don’t know how to consult with counsel or how to speak up or how to raise their hand. Court hearings are frightening enough, plus you have the extra layer as a parent of having that hearing concern your own child. To add the additional layer of trying to navigate the technology as well as navigate a court hearing is fraught with stress and anxiety. Understandably, hearings need to go ahead; but I am worried about parents’ ability to manage in this context.
How do you see the future after the lockdown ends?
I am concerned about the raft of referrals that will overload the system when we come out of lockdown. If a social worker already has a caseload of twenty and that shoots up to thirty, even with the best will in the world, how can they build a humane relationship with families? Children are not being seen at school at the moment — my understanding is there has only been 5% take-up of school places for those children deemed “vulnerable”. And, of course, Covid-19 is affecting all of us, including children whose worlds have also been turned upside down. They will all be reacting to that in their own ways — mine certainly are! When children return to school, will teachers see behaviours emerging as a result of coming out of lockdown that may cause them concern and may provoke unnecessary (or necessary) referrals?
I’m also concerned that vulnerable women may be getting pregnant now because they are trapped and in difficult situations. We’ve all seen the memes joking about how many babies will be born in January; I’m deeply concerned that in January there will be a new surge in investigations and infant removals. How will the justice system cope? How will social workers cope? And, of course, how will parents cope?
I’m worried that families who are struggling have nowhere to go right now, and that this will also cause problems when we come out of lockdown. I don’t think one day we’ll be in lockdown and the next we’ll be back to “normal”; and I think that transition will be difficult, as families will be anxious for support services to resume. I think we’re a long way off “normal” and we will all have to adjust to incremental changes as they come. That’s easier if you have a solid foundation of support — and it’s easier if you “have”. The chasm between the “haves” and “have nots” has never been wider than it is right now, during Covid-19. We are not “all in this together”, and that needs to be remembered.
The one thing that does give me hope now is the rise of mutual aid communities. Even without a central meeting place, parents can find community spirit online. For many years, I bemoaned the closure of the community centre I once relied on. But now with the Covid mutual aid groups, suddenly asking for help is normalised. It’s okay now because everyone is asking and everyone is facing the same risks. Going forward, why can’t we destigmatise a parent needing to ask neighbours for help during a child protection investigation? All parents deserve a helping hand with advice, access to food, or to transportation. Social workers can look to the community to help parents and they can draw on all parents as a resource.
Thank you so much for sharing your experiences and insights. We all need to be mindful of the impact of poverty on the right to family life, both under the lockdown and as we begin the difficult transition ahead.
These are excerpts from an interview with “Annie”, conducted on 21 April 2020, by ATD Fourth World.
“It’s a lot worse than it was”
Thirteen year old Marie’s parents (not her real name), rang their social worker as their daughter‘s behaviour had worsened since the COVID 19 pandemic closed schools and their workplaces. Marie was fighting with them much more, saying her parents were “crazy” and “it was all their fault”. As they spoke, Marie’s parents described feelings of hopelessness and helplessness as their daughter had, over the last few months, begun to use alcohol (and they suspected, drugs), gone missing from school and had broken a door and windows at home. Marie had beaten up her young brother, had pushed her parents around and threatened them with physical violence. They could not understand how Marie, who had been pleasant, happy, out-going and close to her parents, could change so much and treat them so badly. They felt there was nothing they could do. They felt at a loss…and initially, their social worker felt the same way.
Experiences within the family of this kind of behaviour (also known as child to parent violence and abuse, CPVA) are surrounded with a veil of silence, with embarrassment, shame and fear (Coogan & Holt 2015, Coogan 2018, Bonnick 2019). This makes it very difficult for a parent/ carer to start a conversation about CPVA.
The First Step
But reaching out and talking is always a good first step, even though that first step is always very hard. For the people who work with families, like social workers and family support workers, psychologists and psychiatrists, listening to parents or carers talking about these experiences is always a good start. And as more parents began to talk about being afraid of their son or daughter to us and other practitioners who listen and work with parents and families around Ireland, they tell us that listening without judgement is really very important to them.
But what can we do together to end the use of abusive and/or violent behaviour by some children and young people towards their parents? First, we can name the problem and let parents know that they are not alone. Conflict between parents and children is usually a rite of passage, a stage in changing relationships as sons and daughters grow and mature. But in some families, abuse, violence and fear enters the relationship when parents, like these feel they are unable to act as a parent.
CPVA is an abuse of power through which a child/adolescent under the age of 18 years coerces controls or dominates parents or those who have a parental role (e.g. grand-parents or foster carers). It is reported by parents from a wide range of social and cultural backgrounds in Ireland, throughout the EU and further afield.
The Human Rights of Parents/ carers?
This is a question of the human rights of parents and of children: Article 5 of the Universal Declaration of Human Rights states that no one should be subjected to torture or to cruel, inhuman or degrading treatment. Yet parents or carers who talk with us about the abusive and/or sometimes violent behaviour of their son or daughter tell us about experiences of cruelty, of feeling degraded or constantly walking on eggshells. And because parents in these situations cannot live in a close and happy relationship with their child, then the child is also negatively affected by his or her behaviour. It can lead to a move out of home for the child or a placement breakdown for a child in care.
Parents/carers living with CPVA often talk about feeling ashamed, feeling completely powerless and feeling all alone.
No break in a time of COVID 19
Right now, as we live through the time of COVID 19, it is even harder to be at home, together all the time. We are living through uncertain and strange times. Normal routines are disrupted. It is almost impossible to escape the tension and stress if we’re living with it all the time, without the break usually brought about through separation because of school, training course, work or getting together with friends. There is uncertainty about when and how all our lives can begin to return to some sort of normal routine. In lots of different ways, we have all had to adapt the ways we work and live.
But more than that, life continues to make other extraordinary demands of us all at present. Social isolation and social distancing is hard. It is also hard for everyone to maintain personal, physical and emotional/ psychological health but especially when living with the strain of life as we need to live now. It is even harder for families living with abusive and/or violent behaviour. But there is hope.
Where does NVR come from?
Non Violent Resistance (NVR) for families living with children with abusive/violent behaviour can offer hope. It was pioneered in Tel Aviv, Israel by psychologist and family therapist Haim Omer and others. They adopted the principles and strategies of non-violence from socio-political struggles for civil rights to work with families where children and young people use violent/abusive behaviour at home.
Involving trained practitioners working collaboratively with parents, the NVR model moves the focus of intervention to where parents can effectively take action to change relationship and interaction habits between parents and children that can lead to the use of abusive/violent behaviour.
What does NVR mean in practice?
Using the NVR model in partnership with parents, the NVR trained practitioner becomes a type of adviser/coach for parents. Parents are supported to develop skills for de-escalation, self-control, resistance and protest against/rejection of abusive behaviour. This empowers parents to take their place as a parent in the family. Parents commit to avoiding all forms of abusive behaviour and make a clear announcement to the family that specific types of behaviour are no longer acceptable. Although abusive and violent behaviour is rejected and resisted, the child is treated with respect and love as a member of the family. Parents increase their positive presence in their child’s life and make unconditional acts of reconciliation towards their son/ daughter. Parents often also ask the NVR trained practitioner for help in recruiting and co-ordinating a Support Network (people chosen by parents to take on certain tasks to help them end abusive and/ or violent behaviour at home).
Does NVR work?
Parents tell us that the support they receive through using NVR helps them to end abusive/ violent behaviour. Our own experiences and the experiences of other NVR trained practitioners, including those who offer NVR through Parentline and other services in Ireland, is that it seems to be very helpful for parents and in a relatively short space of time.
Is there research about NVR (and where can I find it)?
There is also a small but developing amount of research exploring intervention with NVR. For example, Gienusz (2014) described three research studies in the UK and Germany which found that NVR improves parental well-being, decreases parental helplessness and leads to positive improvements in the child’s behaviour. Haim Omer and Dan Dolberger (2015) outlined the use of NVR with parents where a child threatens to commit suicide. Two research studies, one by Paula Wilcox and her colleagues in 2015 and another by one of us (Declan) in 2016, demonstrated that practitioners who took part in the training in NVR increased their confidence and skills for talking about and responding to CPVA.
Coogan (2018) describes NVR implementation in detail. NVR Ireland, a network of practitioners and academics in Ireland working to resolve the problems of children’s abusive and/or violent behaviour towards parents/ carers, have developed a short guide for practitioners to use the NVR intervention over the phone or through social media platforms (see www.cpvireland.ie and www.iasw.ie ). There are free on-line resources, some of which have been developed by practitioners and academics in Ireland (e.g. www.cpvireland.ie and www.newauthorityparenting.ie ) and in England (www.holesinthewall.co.uk and www.familylives.org.uk ). In this time of social distancing, many services in Ireland are using social media platforms to offer welcome support and a listening ear for parent/ carers coping with intense and stress-filled challenges.
NVR is an evidence-based, non-blaming, systemic and relatively short-term intervention model that empowers parents and people working with them to take positive action to end the abusive and/or violent behaviour of a child. It also helps with respecting and protecting children and all family members. People trained in NVR have been offering NVR support to parents/ carers through a variety of services, statutory and voluntary throughout Ireland since 2011. It seems to work. At a time of COVID 19, social isolation and social distancing, providing NVR on line or over the phone can be a lifeline.
Dr Declan Coogan is an Acting Co-Director of the MA in Social Work and a Research Fellow with the UNESCO Child and Family Research Centre at the School of Political Science and Sociology in the National University of Ireland, Galway. He can be contacted at firstname.lastname@example.org
Eileen Lauster is an independent social worker and tutor with the MA in Social Work at NUI Galway. They are both founding members of Non Violent Resistance Ireland, a network of practitioners and academics committed to developing NVR as a helpful intervention for parent, families and practitioners.
Bonnick, H (2019) Child to Parent Violence and Abuse – A Practitioner’s Guide to Working with Families. West Sussex: Pavilion Publishing and Media.
Coogan, D & Holt, S (2015) New perspectives in Family Violence – Chapter in Christie, A el al (eds) Social Work in Ireland: Changes and Continuities. London : Palgrave Macmillan.
Coogan, D (2016) Listening to the Voices of Practitioners who encounter Child to Parent Violence and Abuse: Some findings from an action research project with practitioners in Ireland Irish Social Worker Journal, Winter, 2016: 41-48.
Coogan, D (2018) Child to Parent Violence and Abuse – Family Interventions with Non Violent Resistance. London: Jessica Kingsley Publishers.
Gieniusz, B (2014) Examining the effectiveness of non-violent resistance approach as an effective treatment for parents of adolescents with conduct disorder Context – Magazine for Family Therapy and Systemic Practice No.132 (April 2014): 42-44. Available at http://nvrpsy.com/
Omer, H & Dolberger, D I (2015) Helping Parents Cope with Suicide Threats – An Approach based on Nonviolent Resistance Family Process Vol. 54, No.3: 559-575.
Wilcox, P, Pooley, M, Ferrando, M, Coogan, D, Lauster, E, Assenova, A & Mortensen, U (2015) Responding to Child to Parent Violence – Executive Summary of the Responding to Child to Parent Violence Project. Brighton. Responding to Child to Parent Violence Project. Available at: http://www.rcpv.eu/78-rcpv-executive-summary-may-2015-english/file ; and in Irish at: http://www.rcpv.eu/60-rcpv-executive-summary-ga/file
Long ago my practice teacher told me that sometimes not doing anything was the most helpful thing you could do. She called this “radical non-intervention”. The key point was that often social work involvement is very difficult for families, and therefore sometimes the best thing we can do is … nothing. To adapt the words of Ronan Keating, sometimes we do social work best, when we do nothing at all.
The term “radical non-intervention” emerged in youth justice. The key insight was that if young people can be kept out of professional systems then they usually grow out of trouble. Radical non-intervention tried to keep young people our of criminal justice systems.
I want to argue for minimal intervention – a sort of radical non-intervention – as a key element for children’s social care in the UK, and that revisiting the concept may be helpful for children’s services, during the pandemic and more generally.
A useful framework for thinking about this is the key text by Fox Harding. Fox Harding set out four value positions – which she called “state paternalism and child protection”, “the modern defence of the birth family”, “patriarchy and laissez faire” and “children’s rights”. I want to leave children’s rights to one side, as they would take this paper in a different direction.
Fox Harding originally developed her thinking during the late 1980s and 1990s, and her work can be understood as an historical account of changing attitudes to children and families. Laissez faire was an approach associated with the 19thcentury and then the “new right” of the 1980s. It referred to leaving the market alone, and emphasised minimising state involvement. Fox Harding argued that this broadly patriarchal and right-wing view, which saw families as essentially good, and therefore argued for them to be left alone as much as possible, had characterised much of family policy. She also noted key thinkers who used psychodynamic theory to emphasise the harm that removal can do to a child, and therefore argue it should be done rarely, but when necessary swiftly.
Fox Harding suggests that the argument for child protection emerged from the recognition that families can be sites for abuse and the misuse of power. A key driver was the feminist critique of the family, coupled with the identification of the harms that children could suffer from abuse. Child protection legislation and our current children’s services emerged from this approach.
In a counter argument to this, others, such as Bob Holman, argued that most families want the best for their children, and that poverty and other structural factors need to be addressed to stop child abuse. This position defended the birth family, but from a left wing position, emphasising the role of the state in supporting family life.
These three value positions can be categorised according to how positively or negatively they view two key issues: family life and the state. The following diagram does this, changing “the modern defence of the birth family” to “family support”, and “laissez faire” to “minimal intervention”:
So, for instance, we may see families as inherently good, supportive, helpful and usually wanting the best for their children. Or we may see them as sites for oppression, where children (and often women) experience abuse and where the privacy and secrecy of family life has allowed this to flourish. Equally, is the state generally beneficent – wanting the best for people and delivered by competent professionals? Or is it something we should keep out of family life as much as possible?
Since Fox Harding published, it seems that there has been strong support for both “child protection” and “family support” but there has been less articulation of the need for “minimal intervention” (though the work of Bilson et al., Bywaters et al.,, Featherstone et al. and others has begun to address this). Perhaps Fox Harding’s characterisation of minimal intervention as inherently a right wing position gives a clue about why people have been reluctant to argue for it.
Support for child protection has come from many sources, including studies identifying the positive outcomes of adoption and many that publicised new harms – such as parental substance misuse, domestic abuse and child sexual exploitation. Probably more important were high profile child deaths, and the tendency for inspection to focus on risk. Such factors have contributed to the stark increase in the numbers of children in care.
In contrast, the arguments for family support are being made strongly. Bywaters and colleagues have established – once again – the central contribution that inequality makes to need for services, and key authors such as Featherstone, White, Morris and Gupta (2018) have begun to develop a social model for child protection which seeks to centre structural inequalities. There has been little shift in policy – but the intellectual arguments are being won.
In the hope that it complements this work, I want to re-examine what Fox Harding called “patriarchy and laissez faire” and defend minimal intervention as an essential set of values for children’s services, and a position that can be supported from a left wing perspective.
The central problem with both family support and child protection is that they tend to see the state, and professionals such as social workers, as positive. This is perhaps unsurprising – who would come into this type of work if they did not have such a leaning?
Yet there are strong grounds for arguing that child protection is a negative intrusion in family life, and while sometimes necessary, should be kept to an absolute minimum. First, it is hard to over-emphasise how traumatizing the process of involvement in child protection is for families. If we think of it as a medicine – it is one with some serious side effects. It should only be used when absolutely needed. Second, the numbers being referred to services, and in particular the rate of children in care, seems to be ever growing – it has risen fairly consistently for 25 years. There is widespread concern about this, though less consensus on what should be done about it. At the least, it provides a case for reducing unasked for state involvement with families. Third, while there is some evidence that care can produce good outcomes for children, there is little evidence that the rest of social work involvement helps children or families. In fact, my hunch is that for most families social work involvement is stressful and difficult and achieves little or no positive change.
A fourth point is that some of the most important ways we have developed to help families – such as Sure Start in England and Flying Start in Wales – tend to result in more referrals of concerns. Maybe this is because they discover more need. Certainly, it suggests that more “support” does not equal less need for child protection. It is possible that more state involvement leads to more state involvement – that an uncritical view of the state may be part of the problem.
Fifth, it is poor working class families that are the subject of all this professional focus. It is also particularly likely to be black families and lone mothers. There are key issues of structural discrimination here about the coercive involvement of the state in families’ lives. Maybe, rather than thinking about how we should be involved, the most radical thing we could do would be to try not to be involved.
A public health focus can help us in thinking about how to provide services for families where there are concerns about child welfare – and is broadly consistent with the “social model” perspective. From this perspective action is needed at four levels. First, it is clear that the most important step we could take to help families would be to create a more equal society.
Second, we need stronger and better funded universal services. Many problems could and should be better helped through effective education, health and other services.
Third, we need effective targeted support for those families most in need. There are important gaps in our knowledge here about what works, but effective help for those with problems is essential.
Finally, there will always be a need for involvement with families against their wishes. There will be serious concerns that need to be investigated. Sometimes children will need to come into care. Yet, to return to the medicine metaphor, this is akin to chemotherapy for cancer. It is a potentially devastating intervention in family life that should only be undertaken when absolutely necessary. It is also an area where we have remarkably little evidence about what is most helpful for children and their families.
It is difficult to think about social work involvement in this way. We like to think about the good we can do. Yet, how can we take seriously our commitment to being anti-oppressive – or to “doing no harm” – if we do not recognise the harm we do by being involved in family life when not wanted?
When I teach students about Fox Harding’s positions I tend to conclude by saying that as a social worker it is not appropriate to solely believe in one position.
It is perhaps, though, not just practitioners who need to be able to hold all these positions in mind. A public health perspective helps us to recognise the need for each perspective, depending on the level of risk within families. All these perspectives are a necessary part of an effective response to the needs of children. I have argued that we have not emphasised enough the importance of “minimal intervention”. However, the hard work – intellectually, for policy and in practice – is thinking about how to integrate all three perspectives into the way we deliver services and help children and their families.
Donald Forrester, Professor of Child and Family Social Work, Cardiff University
Featherstone, B., Gupta, A., Morris, K. and White, S. (2018) Protecting Children: A Social Model, Policy Press; Bristol
Fox Harding, L. (2014) Perspectives in child care policy. Routledge.
In this article, we set about to critically explore disablist and worrying rhetoric which accompanies UK policy response that has, in our new favourite government buzz word, “ramped up” unabated during the Covid 19 situation. We explore the emergent discourses which, we argue, have barely concealed underpinning eugenic ideas. It is thus worryingly apparent that the government views not all citizens as human, but rather that some (those who are elderly or who have underlying health issues and disabilities) are expendable in the fight against Covid 19. We note, in England, unopposed changes to significant disability legislation, namely the Care Act (2014), Children and Families Act (2014) and Mental Health Act (2007) and argue that social workers (and other comparator professions) should join with experts by experience, disabled people themselves, carers and parents in raising concerns about that the hard-fought provisions enshrined in disability legislation, are being eroded at pace.
Covid the Great leveller?
As the journalist Emily Maitlis pointed out, on the BBC programme Newsnight, Covid 19, is not the ‘great leveller’ and will affect some groups significantly more than others. The evidence is strongly emerging therefore that some groups are indeed affected more than others by Covid 19, either directly or indirectly. Those who are older or have complex health issues, those living in care homes, those living in poverty and people from Black Ethnic and Minority backgrounds are disproportionately impacted and are at greater risk of contracting and dying from the virus (ONS, 2020). For us, this has profound personal and professional implications, made acute by changes to disability legislation as well as the worrying public discourse that has resurfaced, about disability, old age and eugenics. The London borough of Newham where we both work, has been the worst hit London borough for Covid 19, with 144 deaths per hundred thousand people, whose population has 78% from ethnic minority backgrounds and where half the children live in poverty (Mohdin, 2020). Of course, the issue about the disproportionate numbers of people from black and ethnic minority communities dying from Covid is also extremely concerning and deserves a more thorough exploration. We now return however, to the issue of disability and ill health
Herd Immunity and Underlying Health Conditions
The initial policy of ‘herd immunity’ encouraged us to take the virus ‘on the chin’ at the expense of older members of the population or those who had compromised health. Frey (2020) suggests that herd immunity is a form of ‘neo-liberal epidemiology’ explaining that the belief in the ‘inherent justice of the market’ had led to this idea which puts profit before people and perpetuates an individualised view of poverty and ill health, rather than focusing on structural inequalities.
NICE guidance gave a ‘frailty score’ to help healthcare teams decide on admissions to Critical Care units in hospitals (NICE 2020). Initially, this advised that those people scoring over a ‘5’, who have lifelong health conditions and disabilities, would not be admitted. Thankfully, this has since been challenged by campaigners and NICE has issued a subsequent statement, retracting from their initial guidance.
We would argue however, that the damage has been done and there remain concerns about whether some groups of people will even be admitted to hospital; i.e. the elderly and those with significant pre-existing health conditions, and who might, or might not, receive treatment. Indeed, John Chisholm, chair of the British Medical Association (BMA) ethics committee suggested that decisions about who should receive treatment should:
Chisholm further points out that so called clinical objectives standards “can be indirectly discriminatory” and “may statistically prioritize the younger [patient] and, where clinically relevant, it may discriminate against those with underlying health conditions”.
Furthermore, there have been reports of GPs sending out ‘Do Not Resuscitate’ letters to be signed by families of people with learning difficulties, as well as those living with complex health conditions. People living in care homes and in the community have felt forgotten, and in fact until recently did not even figure in the daily death count in England, as the Rightful Lives campaign film has suggested ‘to be counted you have to count’ (Rightful Lives, 2020).
Another key issue has been the lack of PPE for front line workers both in the NHS but also for those working in the community. For some disabled people this has meant having to take very difficult decisions about whether to continue living independently with carers, potentially putting them at risk of infection, or relying on family or other voluntary support to meet their needs which may also come with risks. There is also the concern, that for many disabled people, having fought so hard to have their needs met by the state, this might be withdrawn under new emergency legislation.
Current discussions about the end of lockdown return to school and work again appear to ignore the sector of the population who are disabled. Matt Hancock has reassured older people that they have not been forgotten about or discriminated against if they need continue to be shielded when the Lockdown is lifted. But what about disabled adults and children, and their families who are supporting them? As Frances Ryan (2020 points out ‘The idea that poverty, isolation or even early death is somehow natural for disabled people is still worryingly prevalent’.
We would argue that this highlights the ableism prevalent in the beliefs and practices of society that as Fiona Campbell explains ‘produces a particular kind of self and body (the corporeal standard) that is projected as the perfect, species-typical and therefore essential and fully human. Disability then, is cast as a diminished state of being human.’ (Campbell 2009, pp;44). Moreover, recent reports that the weekly figure of deaths of people with learning difficulties or autism from suspected or confirmed Covid 19 should not be included in the death count but rather be reported in the annual Leder Report has further compounded this exclusivity of being human (Thomas, 2020)
We acknowledge of course that medical professionals have always had to make difficult decisions about who would benefit from treatment and there have long been resource constraints within the NHS, particularly with austerity. The Covid19 pandemic however, has brought these issues sharply, and very starkly to the fore. Covid 19 therefore, has metaphorically, shone a very bright light on troublesome issues – much of which the public has not had to confront with such clarity and brightness, and ageist and disablist views, once barely concealed, are flourishing.
Emergency legislation that was rushed through parliament in late March, which introduced the Corona Virus Act (2020), will have significant implications for all disabled people and those with SEND. The Care Act (2014) emergency amendments (contained within the Coronavirus Act 2020), have reduced the duty of care by local authorities. The implications of which could include lack of assessment and the provision of resources for disabled people, especially those going through Transition to Adulthood. At the time of writing, at least 5 local authorities in England, have already announced ‘easements’ they will be making to social care, enabled by this emergency legislation (Hill, 2020). Furthermore, rather than having a duty to provide Special Educational Needs and Disability provision in Education Health and Care plans, as contained with the Children and Families Act (2014), local authorities reduced the duty to show they have made ‘reasonable endeavours’ to do so.
We reflect here whether there has been anything positive that has come or will come out of this pandemic. The emergence of Mutual Aid groups in local communities, and neighbours and friends supporting each other may be something we would not have anticipated for such a prolonged period. Although acknowledging the many challenges for disabled people at this time, Ryan (2020) notes that now that everyone is isolated at home, as many disabled people have been for years, there have been improvements in opportunities to enjoy otherwise exclusive leisure activities such as viewings from the National Theatre or The Royal Opera House, as well as virtual visits to a range of museums. Perhaps a sad indictment that it has taken a global pandemic to think about the needs of people who are socially isolated and who usually remain invisible within popular narratives. Being able to connect virtually with others has been struggle for many of us who are used to physically going into work, but in this environment, it is disabled people who often have the expertise and experience of organising online meetings and events.
We note recent challenges to governmental policy, such as the Care Act (2014) easements, for example legal action has been initiated against Derbyshire County Council. An uncomfortable light has been shone on an array of social issues (for example domestic violence, children at risk of harm from caregivers, education inequality and zero hour contracts to name a few). This provides a strange opportunity and impetus for social workers and other care professionals, alongside experts by experience to resist and fight against governmental disablist and ageist narratives, and the justification of 1000s of deaths. How do social workers therefore, manage the ethical dilemmas and tensions thrown up by emergency changes to disability legislation? Where is the social work leadership that is so urgently needed right now? Where is the social work voice and perspectives on News programmes? How do social workers continue to fight for and promote the rights of a range of people, our government deem sacrificial in this pandemic? Most importantly, the voices of those most affected, must be raised above the disablist, and ageist rhetoric. The implications for social workers and other care professionals, is stark, we need to use this strange opportunity to push back and “ramp up” alternative rhetoric that challenges such widespread disablist and ageist perspectives.
Dr Janet Hoskin, Senior Lecturer in Special Education, University of East London
Dr Jo Finch, Reader in Social Work, University of East London
People who have experienced (or who are experiencing) care have immense courage and are great champions of it. That experience of care never leaves a person. And care leavers (those who have been in care and who are aged 18-25) are true experts of real, raw and exceptional experiences. It’s times like these when we notice how truly amazing society can be in the face of remarkable challenges.
This virus has arrived at a time when we already knew about inequalities, and of course we do not want more. We cannot bury our heads in the sand with this crisis. Some care leavers have great experience in contending with crises.
Social work plays such a crucial role in supporting citizens, of all ages. And it would be right to expect a social worker to harness compassion, creativity, open-mindedness, responsiveness and inclusivity, etc. The opportunity at the moment is to amplify the voices of people experiencing unfairness. Think protecting rights and promoting equality.
We all sit together, figuratively, in lockdown, finding ways to cope, to motivate our minds, bodies and souls. It is an adjustment that requires personal strength and discovery. It’s hard.
For some of the most vulnerable groups, noticing personal strength and allowing personal discovery is frightening though, and is no mean feat.
The care leaver and care experienced group have a voice to be heard. It would be absurd and silly to miss out being involved in this group’s skills and inspiration.
It is hard entering care: being separated, feeling lost and at a loss. And for some care leavers loneliness and isolation (Bright Spots Survey, 2019) is a true experience. At the moment, this may be felt like a doubly isolating time.
Being in care is all about experiencing love. I like to imagine a nation having awareness and pride of care experienced people. We should all be aware and mindful of these young people. Let’s be proud.
Feeling lonely and isolated is a feeling we can all connect with. How care leavers cope is something we should all notice and learn from. Everything is relative now. We share our metaphorical isolation sofa. In it together: sitting together. These are uncertain times but there are opportunities to be spotted too.
We will recover from this together, learning more than we could have dreamt of about ourselves and each other.
Another opportunity is simple: we are reminded of what our motivations in life are. Bacon (1996)  told us ‘Knowledge is Power’ – but the level of uncertainty at the moment is high. The invitation is to focus on ourselves and others. And cope. Privilege is being removed. Struggle and subjugation is being felt more, broadly. And the result: real connections, truth and mutual-empathy.
I have always dreamt of the children I work with taking the knowledge, and therefore their privilege and power, back. Maybe that could be the new national response.
Every person holds the reality to their own experience and existence. Recalling and remembering can illicit shock of self-confrontation: something all too familiar with those who have experienced care. Mentalizing (Fonagy and Bateman, 2004) comes easy when trauma has been lived. Isolation, separation, fear and uncertainty is now something we can all pull on.
The language of risk has dominated social work for so long. Beck (1998) coined the term ‘risk culture’ to describe a shift to make decisions based on a risk we may know nothing about. This could easily open up a discussion about the meaning behind risk. We often can only use our ‘best guess’ when assessing risk. In reality we see this happening at the moment. Barry Mason (2015) brought forward the idea of ‘safe uncertainty’, which for me reflects the point where risk, reality and recovery need to be balanced to form decisions and direction. Is it possible that now is the time to rewrite the ‘system’, both its function and delivery? Some great work has taken place thinking about how to reconstruct language (TACT, 2019). It’s not too radical to think about lived experience being central to re-writing the narrative around how social work is done.
Is social work going to become even more collaborative following this COVID crisis? Carl Jung (1951) talked about the ‘wounded helper’: the idea that those of us who have truly felt inferiority and struggle can hold a position to heal and help. Will we see equality and balance of power more so in social work, especially in relation to struggle? How wonderful that we can now observe the splendour and gifts those who use services give to those who are working for the services.
We create the meaning of what we do in the world we live in, which in turn moulds us into the way we practice. One obvious outcome is to come together to co-produce better in social work: we have a shared challenge, which is real and raw. From here a new shared meaning will evolve. It will be re-constructed. The scope for relational activism (Fisher and Dove, 2019), hand-in-hand, is great and exciting. This new way of being could feel strange initially but we are encouraged, as John Burnham (2010) calls it, to take ‘relational risks’.
Let’s embrace the odd and discomfort and model how those with lived experience could inspire and influence.Social work is a helping profession, supporting those in need of protection and care. Regardless of your profession or position in society, helping is something we all need to take part in. We are switching on our senses to realise how this situation makes us feel individually and collectively.
The impact of the government relaxing statutory duties feels disconnected from where we sit. Social work, key working, is so much more: a vocation, a life choice that runs to the core of our values. We think alongside those we work with to enable possibilities and seek alternative positions to take and embrace the voices of those feeling stuck. It’s all about respecting humans. Is it possible that we can now remove ‘meetings’ that children in care and care leavers are expected to be part of? Isn’t it shaming? Those not experiencing care don’t have to contend with a system and all its ‘meetings’.
When there is austerity, we carry on. A pandemic, we carry on. The micro dynamic is essential to laying foundations for our relationships with people receiving a statutory service. The macro position allows thought too: a wider perspective.
We are not willing to accept duties being relaxed. In fact, we are now benefitting from leaning even further away from this. We are communicating more with our care leavers and children in care. And what a privilege this is. Finally we see and feel the power of relationships, connections and walking together on what is simply a mutual journey. The realisation now is that the statutory guidelines we have followed for years haven’t been enough.
Extended isolation isn’t what we want for anyone, but it is possible that we have now been invited to see the opportunity for connection in a different but greater way, which we may not have caught sight of before.
Being remote reminds us that we face troubles often alone. We strive to have real control over ourselves and this encourages strengths and abilities. Constantly adjusting to a ‘new normal’ is something the care experienced community hold close to their core.
We have to see our struggles that we’ve known to remember and realign our position in the world: both those giving and those receiving a service.
There is nobody stronger to adapt to crisis than care leavers. We may allow ourselves to feel even a small slice of the loneliness and isolation care leavers have faced. It’s mutual now and not exclusive to care leavers, because they are care leavers. Relationships will be realised. Relationships lead to hope, which steer repair and recovery. Could there be a wider, greater acknowledgement and effort to include and nurture care leavers?
Now is the time to stand even taller and be prouder. Especially for care leavers who may already live with disconnection. Their need to carry on is an inspiration to us all. Care leavers deserve the same respect and recognition as everyone else, if not more. Now is our chance to recognise and reward those who we may know less about in our society. We need solidarity.
Care experiences last forever. A chunk of time in life where one tries to fit within a world that isn’t theirs: square peg, round hole comes to mind.
Is now the time for care experience to be noticed across the whole of society: like race, gender and disability, as a protected characteristic, where positive action is taken? In Scotland the Independent Care Review (2020), and of course the Care Experienced Conference (2019) have shown a new way.
There is a community of care leavers and care experienced people waiting to be seen and heard. Let’s clap for care leavers and those with care experience.
Mike S – Mike S is a Social Worker with care experience
Beck, U. (1998) ‘Politics of Risk Society’, pp. 9 – 22, in J. Franklin (ed.). The Politics of Risk Society. Cambridge : Polity.
Bacon, F. (1996)  Meditationes sacrae and human philosophy Whitefish: Kessinger Publishing.
Burnham, J. (2010) ‘Creating reflexive relationships between practices of systemic supervision and theories of learning and education’ in pp. 49 – 78, in C. Burck & G. Daniel (Eds.), Mirrors and reflections: Processes of systemic supervision,London : Karnac.
Fonagy, P. and Bateman, A. (2004) Psychotherapy for Borderline Personality Disorder: Mentalization Based Treatment. Oxford : Oxford University Press.
Jung, C. (1951). Fundamental questions of psychotherapy. Princeton, NJ : Princeton University Press.
Mason, B., (2015) ‘Towards positions of safe uncertainty’, InterAction-The Journal of Solution Focus in Organisations, 7(1), pp.28-43.
On 20th March 2020, the World Health Organisation declared its preference for the term ‘physical distancing’ over ‘social distancing’, a move supported by many health experts, academics, social workers and governments. This term is indeed clearer and more accurate, and it emphasises the importance of maintaining social connection, particularly now. Isolation can have a negative effect on our mental well-being: we must stay physically distant but not socially disconnected. But what about those for whom the physical and the social are not so easily separated? Those who rely on physical contact for communication, for access to information, and for safe travel. Those for whom physical contact is a way in which friendship is expressed and through which they understand the world around them. This is the reality of many deafblind people. Deafblindness affects people in different ways, even though they all have impaired or no vision and hearing (McInnes 1999). Touch is their most important sense: it plays a key role in any interaction, essential when both making contact and communicating. For deafblind children it is ‘one of the primary teaching and learning tools’ (Moss and Blaha 2001:11). Being unable to make physical contact with one’s immediate environment can make deafblind people feel more vulnerable (Kyle and Barnett 2012). Connection is particularly important for the mental health of deafblind people, a group who, at the best of times, experience high levels of social isolation and who are at increased risk of emotional distress (Wittich and Simcock 2019). But does the suggestion that the social and physical can be separated suggest that the needs of deafblind people have been overlooked? As John Finn, himself deafblind, has argued, physical distancing may protect the majority, but has made the isolation felt by many deafblind people much worse (Finn 2020).
The World Federation of the Deafblind (2018) reports that only 50 countries (37%) even recognise deafblindness as a distinct disability. The European Parliament formally adopted a written declaration on 1st April 2004 (Declaration on the Rights of Deafblind People 03A_DN(2004) 04-01 PAR002) acknowledging deafblindness as a third, discrete sensory impairment. It is a complex condition and can challenge a person’s independence and social participation, and also has multiple adverse psychosocial effects, impacting on quality of life (Wittich and Simcock 2019).
In an insightful article in The New Yorker, Robin Wright explores how deafblind people (such as lawyer and disability-rights activist Haben Girma) are being affected by the COVID-19 pandemic. Access to even basic information about the virus is described as particularly problematic, and the lack of sign language interpreters at White House daily briefings is noted. The absence of accessible information is similarly reported by the Royal National Institute of the Blind (RNIB) and Jacqui Bond highlights the lack of sign language interpreters at the Government’s daily briefings in England in the first edition of this online collection. This impacts not only on the Deaf community, but also those deafblind people who use residual vision to access sign language. Needless to say, access to tactile sign language is not even considered in this debate. The adverse impact of a lack of accessible information on the health of deafblind people cannot be overstated. It affects all aspects of their healthcare experiences, and impacts upon mental health, dental care and pharmaceutical based needs, to name just a few (Simcock and Wittich, 2019).
A lack of accessible information also impacts upon deafblind people’s awareness of public health distancing regulations. Some deafblind people explain to Wright the difficulties they experience in maintaining distancing: this includes being unable to see whether they are sufficiently far from others or being unaware of whether people are already in a lift before they enter. Michael Crossland describes such difficulties in observing physical distancing for those living with sight loss. Given that deafblindness as an impairment is often misunderstood, deafblind people in England have found themselves challenged by the police, as they maintain physical contact with another person, who is both communicating with and guiding them (Personal Communication with Specialist Organisation 2020). A welcome amendment was made to governmental guidance in England relating to movement outdoors during the lockdown, for the benefit of those with learning disabilities or autism; however, for deafblind people using sighted-guide support and tactile communication no such clarity is included. That those with sensory impairments may have specific needs is acknowledged in the UK Government’s COVID-19: action plan for adult social care, but it offers no further detail (Department of Health and Social Care 2020: para. 3.19).
The communication difficulties associated with deafblindness are further complicated by the presence of protective equipment, such as masks and gloves; for those using tactile communication (for example deafblind manual and tactile sign language), physical distancing is impossible. Functionally, physical distancing becomes a communication disability. In their blog for the BMJ, Grote and Izagarten, two deaf doctors, lament the push for universal mask wearing, arguing that it leaves persons who rely on lip-reading feeling ignored. For deafblind people, fears regarding communication difficulties have previously been reported as impacting on their experiences of healthcare (Göransson, 2008). A hospital is certainly a setting in which deafblind people can feel vulnerable. In the midst of the pandemic, like other disabled people, deafblind people tell Wright of their fear that clinicians will see their lives as not worth saving. In England, the current NHS England visitor guidance, which does not allow a personal assistant to accompany a person with communication support needs, does little to reduce such fears. Legal challenge of this guidance is welcome (Pring, 2020).
Touch facilitates communication and an awareness of one’s environment for many deafblind people. Nonetheless, close physical contact is both necessary in interaction, and a potential source of vulnerability. Deafblind children experience more touch than their peers, some of which is of a more intimate nature than would be considered usual among sighted and hearing persons. Deafblind people may also receive mixed messages about appropriate touch and lack information on the social and cultural ‘rules’ of touch and personal space (Göransson, 2008). Deafblind people are often concerned that others will misinterpret their physical contact as sexual in nature (Simcock, forthcoming). The COVID-19 pandemic has added another layer of vulnerability associated with touch. Deafblind people tell Wright of their concerns of spreading or contracting the virus, because they touch their faces when using sign language, as well as when they handle their red and white canes used for orientation and mobility.
Wright reports that, according to Roberta Cordano (President of Gallaudet University), planning for the pandemic has completely overlooked and forgotten the deafblind population. I have argued before that deafblind people have been, de facto, excluded from welfare policies and development programmes (Simcock and Wittich, 2019). As a lack of research knowledge is a consequence and possible contributing factor to such exclusion, the recent announcement of funding by the Québec Research Network on Aging for a study by Walter Wittich (Associate Professor, School of Optometry, Université de Montréal) and colleagues, of pandemic preparedness and access to health information for older deafblind people during and post COVID-19 is most welcome. The British Association of Social Workers (BASW) call on the profession to uphold the human rights of those faced with inequalities intensified by the pandemic, in their statement of concerns and demands. The social work profession certainly has much to contribute to the wellbeing of deafblind people. However, as Luey (1994:213) observes, it has been ‘curiously inactive in the field’ and fails to give deafblindness the ‘attention that it deserves’. It appears that principally, it remains left to rehabilitation workers, educationalists, psychologists and specialist health care colleagues to support this population through both direct work and research. As the number of persons living with combined vision and hearing loss is predicted to grow with the ageing of the population, and as deafblind awareness week approaches (24th June 2020), I encourage more social workers to develop their knowledge of deafblindness and to build their capacity in this specialised field. Although some may have forgotten deafblind people during this pandemic, don’t let them be forgotten by the social work profession.
Peter Simcock, Senior Lecturer in Social Work, Birmingham City University
Moss, K. and Blaha, R. (2001) Introduction to Sexuality Education for Individuals Who Are Deaf-Blind and Significantly Developmentally Delayed, Monmouth, OR: National Information Clearinghouse on Children Who Are Deaf-Blind, DB-LINK.
Simcock, P. and Wittich, W. (2019) ‘Are older deafblind people being left behind? A narrative review of literature on deafblindness through the lens of the United Nations Principles for Older People.’, Journal of Social Welfare and Family Law, 41(3), 339-357.
My peers across social work sectors have written eloquently in this magazine about the challenges and triumphs of these times. I wonder what else I could add of value, apart from one more voice in the groundswell of informed scholarly opinions, lived experiential accounts and cold facts to re-create a profession that now needs the brute force of numbers to be heard in the wider field of the politics of health and social care. More now than ever, we need to infect each other with hope (Christian Kerr and Michael Clarke), a sense of solidarity (Nick Burke and Mark A Monaghan), and a greater awareness of the underlying social structures that affect our personal and professional lives (Dr. Sweta Rajan-Rankin).
Over the past 18 years in my time as a mental health social worker and social work manager, I have witnessed a seismic shift in social work which has become largely process orientated. The processes and procedures are admittedly to ensure standardised services and quality assurance, but this comes at the high cost of erosion of personalized care and quality involvement. I have both attended and chaired innumerable safeguarding meetings. All professionals attending, in good faith, can tick each and every box to be legally compliant, and yet the person whom we intend to safeguard is more likely than not, just as vulnerable to harm or abuse as a result of these procedures. People have complex relationships, and often the person who is allegedly perpetrating the abuse or neglect is also the person who provides practical or emotional support and comfort in other areas of their lives. As one of my clients mother who had taken control of her son’s finances and cashpoint card once told me ‘he is my son, nobody cares for him as much as I do’. She didn’t want him buying cigarettes which he would do if he had access to his money. He had the capacity to make the decision to buy cigarettes. So he was at every liberty to make this choice and according to UK law (Mental Capacity Act 2007), his mother could not stop him from making it. Safeguarding procedures were initiated, prompted by recording systems, team meetings, monthly statistics on safeguarding etc. He gained control of his finances, smoked at will, which led to an admission to ICU. Crucially, they are immigrants from an Asian country, deeply rooted in their cultures and at odds with UK norms and laws. What we need for meaningful interventions is time and support for staff, both increasingly in short supply and flexible creative solutions that families themselves create.
People who use services have been suffering changes for over a decade. Social distancing is nothing new for the hundreds of thousands of people who are socially isolated due to mental illness, with day care centers one by one being shut down. Staying at home- for those that do have a home- is nothing new to people who suffer mental illness and who don’t have a carer to accompany them, for fear of ridicule, of crowded places, of losing one’s way, having a breakdown in a public space, or the fear of being assaulted or sexually molested, or in a city such as London, the fear of gangs and coming under crossfire. The viral pandemic seems to me like a wave in a roiling ocean of cuts, closure of services, posts lying vacant, undertows of racism and sexism and lack of real opportunities of employment for people with histories of mental illness.
The new legislature Coronavirus Act 2020 includes the Care Act Easements (Department of Health and Social Care, 1 Apr 2020) which on the face of it is good to expedite services to the most vulnerable populations cutting out the lengthy and time consuming paperwork required to secure funds for clients. But in the long term it can put people deeper in debt as it stipulates that the easements are time limited, and that all assessments need to be completed in full including financial assessments and that people will be liable to pay retrospectively for services received. To illustrate, this is like buying a loaf of bread and being informed of its price at a future date when the customer will become liable to pay for it.
The act also temporarily suspends the need for Deprivation of Liberty Safeguards (DOLS) for changes to care or treatment. These are safeguards put in place for people who are ‘under continuous supervision’ and who are required to reside in a particular accommodation, depriving them of their liberty. Normally when there is a change to care or treatment, such as administering a new medication, or a change of care home, the care home or hospital needs to request a standard authorisation from the local authority. This is a lengthy process and requires 6 assessments, including that of capacity, best interest decision, mental disorder, and so forth. In the face of COVID 19, this means people can get quick care and treatment, but potentially engaging the following Articles of the Human Rights Act 1998-Article 5- Right to liberty and security, Article 8- Respect for your private and family life, home and correspondence and Article 14- Protection from discrimination in respect of these rights and freedoms.
As an Approved Mental Health Professional (AMHP)- a person who coordinates a Mental Health Act assessment (under the Mental Health Act 1983 (Amended 2007)) and makes an application to the local authority toward detaining a person suffering from a mental illness in a hospital or some such care setting, we routinely manage volatile situations with very unwell patients, their families and significant others. This is without any of the protective equipment used by the police or the safety of working in a team that doctors have. With only a pen and a piece of paper – the application for detention, we have thus far managed unsafe, often unhygienic and potentially physically dangerous situations whilst carrying overall responsibility for the safety of the patient.
With the current threat of Corona virus infection, there has been no clear enough guidance nationally on the use of PPE for AMHPs, and it has been left to AMHP leads and local authorities to come up with solutions. Sadly, there has been even less consideration for PPE and safety for people and patients we assess. Often AMHPs go into homes, by force if need be, with the use of a warrant executed by the police. In these circumstances, people will not have a choice about letting the professionals in. Plus patients we assess come from economically deprived areas and live in cramped conditions. Such an assessment necessarily puts both the professionals, patients and their family at a greater risk of contracting the corona virus, and rendering meaningless the calls for social distancing or hand washing by the government.
A council leader of a London borough few days ago sent out a statement in an e-letter to council staff that ‘…..all the more poignant by the sad news of the first care worker in xxxxx to die of coronavirus’. I am shocked that this person can use such a word, ‘FIRST’, because the subtext here is this is most likely not the last and there will be more fatalities. As I write this article, there have been 2 more care staff fatalities. Is it a matter of time before an AMHP is counted among the fatalities? Is there anything we can do to minimize the risk we and our patients face? There have been suggestions and discussions around using video interviewing among AMHP lead networks. As an AMHP of 8 years experience, it is my opinion that this will not work. Firstly, the people we assess are mostly unwilling to engage with us, and hence the need for an assessment under the Mental Health Act. Secondly, patients are often suspicious of technology, and fear they are being recorded, are socially isolated and rarely use tools such as Skype or Whatsapp. Thirdly, if they are not averse to the use of social media tools, they often don’t have access to the internet due to financial constraints. There are no easy solutions here. Employers need to ensure staff that have underlying health conditions are not exposed to such work environments, and to take swift action of removing staff that show any signs of being infected by corona virus. Regarding safety of the patient, AMHPs must go back to the guiding principles of the Mental health Act 1983 (amended 2007), specifically the least restrictive principle and ask- is a mental health act assessment really required and have all other means of engagement and treatment been explored? Has therapy been offered? What has worked or not worked for this person before?- and to proceed from there.
At huge costs to councils and trusts, independent companies are contracted to streamline processes and reduce bulky paperwork. These people have no experience in social care or mental health care. Given the circumstances, working from home could mean care staff giving feedback on forms they routinely use- for safeguarding procedures, Care Act assessments, care planning etc and for senior managers to trust that their frontline staff know their client group, relevant legislature and policies to make sensible, legally compliant and practical amendments. Needless to say, disproportionately, frontline staff are BAME, senior managers white (Kline, 2014), and external corporate staff also white (personal observation). Perhaps this can bring about a much needed balance in power in social care and address some of the institutional racism BAME staff face on a daily basis.
Other ways going forward is for academia, social workers and managers to have more dialogue and solidarity. Quality research and evidence based practice in collaboration with frontline staff can give the field of social work the credibility enjoyed by psychology and psychiatry. In turn, frontline staff need to use the support of literature and research and speak up when we see casual micro aggressions in our work places- calling out a colleague who is mockingly imitating ones accent, or speaking up when we see discrimination, such as at trainings where BAME senior managers are visibly absent. Academia, frontline staff, service users, carers, and managers all as a collective need to speak more to the media about social work. At the time of writing this article, 10 social workers have died from COVID 19 (Samuel, 2020). There has been no national coverage of these deaths. On the other hand, media and popular culture continues to portray negative stereotypes of social work. We know we are not a nosy, officious, goofy, needlessly rebellious, untidy, uneducated, alcoholic and generally dispensable lot.
So what are we?
Raksha Sidhu, Social Worker with specialist interest in mental health and anti-racist social work
Jones, R. (2019) Mental Health Act Manual, 22nd Edition, London : Sweet and Maxwell.
Kline, R. (2014) The “snowy white peaks” of the NHS: a survey discrimination in governance and leadership and the potential impact on patient care in London and England, Middlesex University Research Depository.
Samuel, M. (2020) 10 Social Workers have died fom COVID 19, official figures show, Community Care Online