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People are both similar and different; diversity is the recognising and valuing difference. Diversity relates to distinction such as gender, age, religion, race, culture, education, occupation, language, attractiveness, health, physical appearance. Cultural diversity is one aspect of diversity with a multitude of differences which come from our cultural heritage. Every aspect of life is touched by culture, culture affects how people perceive things, and it influences how people attribute meaning to communication. When cultural communication systems are unknown or ignored, messages are likely to be misinterpreted resulting in barriers to communication. To ensure effective communication Human Services workers require awareness of and sensitivity to cultural differences to enable them to successfully serve a diverse range of people. This essay examines effective cross cultural communication for the Human Services worker, as culture refers to the language, knowledge, rituals, values that connect any group of people, in the scope of this essay the context of cultures is that from different countries. Firstly, it looks at some of the differences and problems when communicating cross culturally. Then the essay proposes solutions to reduce communication barriers and, finally proposing principles human service agencies should adopt to enhance communication.

Working cross culturally the human service worker faces many challenges to effective communication because of the complex nature of culture, intercultural behaviours, core values and expression provide much possibility for misunderstanding. According to Fouad Arredondo “communication patterns, styles, symbols and gestures are highly culture bound and unconsciously scripted.” (Fouad Arredondo 2007 p42). Several variables can be considered to assist in the understanding of cultural differences to identify why problems arise, individualism versus collectivism is one variable. Individualistic cultures are where emphasis is on individual achievement as contrasted to collective cultures where importance is on what is best for the group. Counselling itself is a culturally specific activity having evolved from a Western philosophy of individualism, asking a client from a collective culture to focus on hyperintrospection and hyperindividualism will not resonate result in a lost opportunity. Whilst not speaking the same language is a more obvious barrier to communication, consider the communication barrier created when a client for whom English is a second language is expected to verbalise highly complex emotions. (Wheeler 2006 p150)

Cultures can also be distinguished as having low context or high context communication, in low context cultures such Australia or America communication is direct, the meaning is in the message. Asian, Mediterranean and Arab cultures are high context where communication is indirect and it is equally important to look at the implicit meanings and body language. Misunderstandings arise when there is a lack of awareness in the different style of communicating. For example, Indigenous Australians would consider it rude to directly ask a question and instead hint (Mundine 1999, p. 1). This is similar to Asian concept of “saving face” indirect communication is used to prevent discomfort for either party. In some Asian cultures this is extended to some not disclosing physical abuse for fear of losing face or embarrassing the family (Devito 2009, p. 281), however withholding such information creates a barrier to communication for the human services worker.

Non verbal communication is another factor which in which meaning differs between cultures, and if these differences are not understood leads to communication breakdown. In some cultures nodding the head means no, or the nod of a head from a Chinese person does not implicitly mean that they agree. In Western culture direct eye gaze is considered a sign of honesty, in cultures such as Japan however, direct eye gaze is a sign of disrespect. De Vito (2009, p. 133) concludes “try visualising the potential for misunderstandings that eye communication alone could create.”

A Human Services worker lacking awareness of cultural-based norms, such as family structure and gender rules, risks violating these rules, their behaviour impeding trust and confidence. For example, married Muslim women cannot touch a man other than their husband. Lack of awareness or sensitivity to these norms creates conflict and a lost opportunity for engagement. Another barrier to communication results where the Human Service worker consider their own culture to be superior to others cultures. Gamble and Gamble conclude that “ethnocentrism is key to failed intercultural communication efforts.” (Gamble Gamble 2009, p.27).

Finally, cultural stereotyping is a barrier to effective cross cultural communication, whilst it is necessary to group people to simplify understanding differences, it is problematic perceive that ‘all are the same’. For example, to believe that all immigrants from the Middle East are unable to assimilate into Australian society is cultural stereotyping. Stereotyping demonstrates a fundamental lack of understanding of diversity leading to a breakdown in communication. This paper has looked at some cross cultural communication differences and problems that arise that can be covered in the scope of this essay, the paper now proposes solutions to enhance communication and reduce communication barriers.

To enhance communication and reduce barriers in cross cultural communication the Human Services worker develops knowledge and skills. Integral to this is self awareness, being aware of and challenge one’s perceptions and bias. Workers must to increase intercultural communication competence by developing knowledge of different cultural differences, Gamble Gamble confirm it is vital to make the unknown known “…we need to conduct ourselves in a manner designed to reduce the strangeness of strangers; that is, we need to open ourselves to differences by adding to our storehouse of knowledge, by learning to cope with uncertainty and by developing an appreciation of how increasing our cultural sensitivity positively affects our communication competence (Gamble Gamble 2009, p. 30). It would however be uninformed to believe that a person can ever completely understand another culture making it necessary for Human services workers to be comfortable dealing with ambiguity. As important as it is to be familiar the difference in culture conversely it is important not to allow cultural traits to hinder understanding nor to focus excessively on differences. Clients are individuals; human services workers serve a person, not a culture (Egan 2006).

Empathy listening skills are integral to effective communication and equally so when communicating interculturally. The Human services worker should put themselves in their client’s shoes to imagine what is like from his or her world view point. Listening skills and careful observation of cues such as non verbal signals should be taken into account interpret full meaning, particularly when communicating with a person from a high context culture. To enhance communication the human services worker should also regularly seek confirmation of understanding. A deeper level of trust and confidence may need to be built with people from some cultures before they disclose emotional or what they consider to be shameful. To enhance communication with these people it may take patience, time and also an appropriate level of self disclosure on the workers part. To reduce communication barriers the worker may ask permission before asking sensitive a sensitive question. Workers should also be aware and sensitive to taboo subjects, in some Indigenous Aboriginal communities it is shameful to talk about mental illness, to reduce communication barriers workers would avoid using certain words or lables (XXXXX). Working with people who speak English as a second language poses another set of challenges in communication, to reduce barriers workers should speak slowly, be patient and allow pauses, alternatively an interpreter could be offered. (Kenny 2009).

To reduce communication barriers for their diverse range of stakeholders it is vital for Human services agencies should foster their own culture where diversity is embraced and celebrated. A philosophy of respect of individuality and uniqueness which commitment to self development and ongoing learning is promoted. This philosophy should be brought to life by encourage a diverse range of workers with difference backgrounds and experience. A culturally specific approach to training programmes, developing intercultural communication competencies when working and human services workers be regularly reviewed against competencies identifying areas for development.

Culture influences everything about people, including the meaning attributed to communication, this poses challenges for the human services worker when working cross culturally. This essay has considered some of the communication differences and issues that Human Services workers face working interculturally, it has also looked at ways to enhance communication and also principles agencies should adopt to reduce communication barriers. The essence however is that ultimately no two people even those from the same culture are the same, innumerable differences makes each person unique. Human Services workers require cross cultural competency to effectively communicate with the diverse range of people that they meet the most fundamental of these abilities being willingness to learn and respect of all individuals.

Biblography

DeVito, J 2009, The interpersonal communication book, 12th edn, Pearson Education, Boston, USA.

Egan, G 2006, Skilled helping around the world: addressing diversity and multiculturalism, Thomson Higher Education, Belmont.

Fouad, NA Arrendondo, P 2007, Becoming culturally oriented: practical advice for psychologists educators, American Psychological Association, Washington.

Gamble, TK Gamble, M 2009, Communication works, 10th edn, McGraw Hill, New York.

Kenny, S 2006. “Developing communities for the future, 3rd edn, Cengage Learning, South Melbourne.

Mundine, J 1999 ‘Face to face: communication protocols’, viewed 12 August 2010, http://www.nipaac.edu.au/Face2Face_CommnProtocols.pdf.

Wheeler, S (ed) 2006. Difference diversity in counselling: contemporary psychodynamic perspectives, Palgrave Macmillan, New York.

Aboriginal Mental Health First Aid Training and research program. Cultural considerations communication techniques: Guidelines for providing mental health first Aid to an Aboriginal or Torres Strait Islander person. Melbourne: Orygen Youth Health Research Centre, University of Melbourne and beyondblue, the national depression initiative 2008

Viewed 20 August 2010

http://www.mhfa.com.au/documents/guidelines/8307_AMHFA_Cultural_guidelinesemail.pdf

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This assignment will focus on addressing the distinctive features of a professional assessment in social work. It will look into the importance of assessment, the assessment process and law and policy which relates to assessment. Finally it will address assessment in practice with regards to two service user groups’ namely older people and mental health.

Assessment is part of the foundation of social work practice, the better the quality of assessment the more effective it would be (McDonald, 2006). Coulshed (1991) describes assessment as analysing process of selecting, organising and synthesising information. McDonald (2006) describes it as an intellectual process, it is a tool used to make sense of information relevant to issues examined. Assessment is used in many different forms and with different service user groups, some forms of assessment include; risk assessment, the single assessment processes and mental health assessments. Assessment is essentially identifying the needs and risks in an individual situation to judge which intervention, services and resources would be most appropriate (Adams, Dominelli and Payne, 2009). The 1990 National Health Service and Community Care Act placed the assessment of community care services as statutory work. This enabled social workers to justifiably claim to be doing statutory work, which needed extensive knowledge and to be done quickly (McDonald, 2006). Community care assessment can be a gateway to other services, depending on the level of the patients need.

The assessment process varies between social workers because of their social work experience, theoretical orientation of the social worker, the social workers values and the relationship between service user and social worker (McDonald, 2006).

Social workers also need certain skills to be able to achieve an effective assessment these include listening and communicating skills, being able to counsel and understand a service user’s problem, have an insight of other services available to the service user and be able to weigh the risks the service user may face daily against the resources that may be available to the service user (McDonald, 2010) (Harding and Beresford, 1996).

The Victoria Climbe inquiry stressed the importance of assessment (Laming, 2003). If assessment is done properly and as a cycle constantly evaluating Laming (2003) predicts that social work practice and the help given to the family would be more effective. Parker and Bradley (2005) understand that assessment is a continual process and use the ASPIRE model to show how assessment should work. The ASPIRE model stands for assessment, planning, intervention and review and evaluation (Sutton, 1999). This model shows assessment as a process that never stops because service user’s situations change over time, reviewing and evaluating the situation and continually reassessing helps to discover if the approach taken is effective or if the service user needs a different one in place. Milner and O’Byrne (2002) have similar recommendations to Laming (2003) they conclude that intervention is more likely to succeed when assessment is effective (Parker and Bradley, 2005).

Within any setting assessment involves a number of features according to Milner and O’Byrne (2002) these include preparation, planning and engagement. The first step involves identifying the main people surrounding the case and then establishing a deadline under which information has to be collected. The next step involves the collection of information. This includes what the individual wants, their problems and information from other sources for example professional statements. The next part of the assessment process involves looking at the data and assessing their needs, by taking into account how they are currently functioning and weighing the risks. The last step involves producing an action plan. This concludes what help is needed, what resources are available and when reviews will take place (Milner et al, 2002).

There are a number of policies and guidance which highlight the importance of assessment and the need for them to be used by social workers. The National Health Service Community Care Act, 1990 section 47: Assessment of Needs for Community Care Services is an essential part of the legislation when assessing an individual’s needs. Under this section when it appears that any persons for whom the local authority may provide community care or services or may be in need of any other such services the local authority should carry out an assessment of their needs for those services. Upon receiving assessment results the local authority can then decide whether their needs are great enough to be given provision of services.

Fair Access to Care Services (2003) guidance understands that consistent access to services should be across the country but provision is prioritised into set criteria according to risk and independence. All local authorities have the same eligibility criteria. However they can come to different decisions. This is guidance not law, so any local authority can decide on the scale the individual would be on before services can be given (Clements, 2004).

Features of assessment in relation to older people

The NHS plan (Department of Health, 2000) and the National Service Framework for Older people (2001) introduced the single assessment process (SAP). The aim of this process is to provide person centred care to service users and also their carers. Parker and Bradley (2003) concluded that the government produced this new process because historically there were a number of criticisms involving team working within different disciplines. The SAP was produced to prevent questions being needlessly duplicated by different disciplines and to share the information between all and to ensure person centred care. The National Service Framework for Older People was the first wide-ranging strategy that focused on fair, quality health and social care for older people (National Service Framework for Older People, 2001). The aim of person centred care is to ensure all older people are treated individually, that they receive care appropriate to them. Social workers must also take into account anti discriminatory practice when involved in assessing any individual, the service user’s decisions must lead the process. Social workers will have previous experience of the assessment process, and possibly of older people in similar situations, it’s imperative that the service user is safeguarded against direction from the social worker to ensure that the social worker does not lead the assessment. The process must focus on the service user’s views and perspectives throughout.

The SAP involves three broad levels (McDonald, 2010). Contact assessment, which includes individuals who may need support from different services. Overview assessment involves mental, physical and social needs including the impact of their needs on the family and carers this level supports multi disciplinary teams. The last level is a specialist assessment, taken when more understanding is needed regarding an individual’s need and how they can meet it. Another assessment available is a comprehensive assessment. This is offered when the older person needs intensive and long term treatment.

A comprehensive assessment involves basic details, the category of need, the support network the individual has, current problems, carers views, a risk assessment of their current lifestyle, the individuals current strengths, social network and living situation as well as more extensive information.

Assessment uses theory and practice to understand the situations of an older person. It involves problems, risks, needs and resources of the older person. It requires professional judgement to take into account all information to give an opinion, whether the older person needs services and resources to be available for them (McDonald, 2010).

When processing an assessment with older people there are key elements the professional must consider. McDonald (2010) suggests that good quality assessments of older people involve specific components. These include using a strengths perspective, the older person still has the ability to know where their problems lie and how they would deal with them using this throughout the assessment identifies their strengths. Another component includes coping skills, as they grow older they focus more on what they can do and less on what they have difficulties with. Focusing on their strengths rather than problems ensures a positive approach to the assessment process. Social workers must ensure anti discriminatory practice takes place, an important component of this is citizenship, it involves the service user participating in decision making. When moving to a care home for example the older persons care plan should involve advocacy so they can continue to make decisions regarding their health and social care, societal changes and their living environment within the care home. Respecting their decisions is a value social workers should have in practice. Social workers need to understand that family and carers needs may be different to that of the older person and these may need to be a priority. The social worker must also tell the older person about the assessment process giving information about why it’s being conducted and what the aim of the process is.

Although the SAP was produced to bring all information together there were criticisms of working with different disciplines. A literature review by Challis, Clarkson, Williamson, Venables, Hughes, Burns and Weinburg (2004) found that there was a lack of trust between disciplines when implementing the SAP. The SAP is a long process and each level takes time that some professionals don’t have. Also if the older person is having difficulty they may need to make provisions to enable them to continue with tasks they find difficult until a decision is made regarding resources available to them. However they may not be given the amount of resources and services that the service user expects. Those who are not eligible have needs but are concluded to have not sufficient needs to receive help. These older people are expected to use provisions around them, for example family and friends to help with the problems they face (Henwood and Hudson, 2008). Henwood and Hudson (2008) found that those older people who had sufficient money to fund their services felt that they had to discover their own way to find the right services available, having not received the advice and information that other older people going through the assessment process would get.

Following from the assessment process the older person then receives an individual care plan. This care plan shows the objectives and outcomes from the support provided. The individual care plan builds on the older persons strengths, how they can address their needs, the older person should also agree to the care plan being implemented.

Personalisation is now being introduced in the UK. This new method of assessment involves a self assessment of needs. A Personal budget questionnaire is then completed. This questionnaire is simple and designed to help the older person give information about their needs. The social worker will complete it with the service user and family member. The decision of eligibility is then decided. If they are eligible they will be allocated a sum of money through a personal budget, further assessments would be completed to calculate how much the service user would have to contribute. Once the budget is agreed upon the service user can plan where they want to spend their allocated money on the support they want.

Features of assessment in relation to mental health

There are a number of different assessments which are involved in the mental health services. Depending upon the individual’s circumstances specific assessments would take place. Section 47 of the National Health and Community Care Act (1990) states that any individual who has needs of services under a local authority the local authority must carry out an assessment. A decision then follows this assessment. Depending on the mental health of an individual the assessment would focus on their problems and needs and how they could achieve the best outcomes. Standard 2 of the National Service Framework for Mental Health (1999) specifies “that any service user that has contacted their primary health care team with a common mental health problem should have their needs identified and assessed”.

Previously the Mental Health Act 1983 and the Common law of necessity have been used to assess the needs of individual with mental health problems. Recently the common law has been replaced by the Mental Capacity Act. Assessors within this service now use a broader approach to include the criteria of both the Mental Health Act, 1983 and the Mental Capacity Act, 2005 (Barber, Brown and Martin, 2009).

Mental health assessment involves a broad scope of information to collect. The Mental Health Act considers the mental disorder, the nature of the disorder, whether the person or others are at risk, the type of treatment necessary for example if the individual needs hospitalisation or if its possible to use community based mental health services and if it’s possible to give services without the individual being hospitalised (Barber et al, 2009). It’s much less intrusive to the individual if it is appropriate for them to receive care in their community rather than going into hospital and because of the stigma attached to using a section 2 or 3 of the Mental Health Act any social worker or professional in this setting would chose community care if they could.

Assessment with regard to the Mental Capacity Act draws upon information involving the impairment of the individual, the age of the individual, the individual’s capacity of making decisions and if the care they would receive would be a deprivation of liberty (Barber et al, 2009).

An assessment under the Mental Health Act can be done compulsorily when there is a mental disorder, or if it is in the patient’s safety or health and to protect others. Before the assessment takes place the social worker should look into previous history and liaise with other professionals involved in the case. Depending on whether you use a section 2 which last 28 days or a section 3 which lasts up to 6 months a team is needed to admit the individual. When assessing under these sections the social worker must ask questions regarding evidence of mental illness and the risk towards the individual or others, if the patient consents to informal admission or if there are alternatives to hospitalisation.

A Care programme approach assessment may be offered when an individual leaves an inpatient psychiatric unit or uses a community mental health team. This assessment is encouraged as all aspects of care are co-ordinated by one person. The assessment involves personal history, social situation, description of the illness and symptoms and length of treatment and what the individual’s needs are. The care programme approach incorporates four specific elements, as defined in Building Bridges: a guide to arrangements for inter-agency working for the care and protection of severely mentally ill people (DOH, 1995). These elements include the assessment of health care and social needs. The formed care plan, the appointment of a key worker who has a responsibility to monitor the care of the service user and the last element includes regular reviews of the care given and if needed how to adapt the care because of changes of need.

Mental health assessments are complicated because of individual’s complex situations assessing risk and needs as well as resources available. Social work practice must encompass a number of strategies when undertaking assessment for it to be effective. The care programme approach enables social workers to focus on the individual directing through all aspects of care and co-ordinating their care when the assessment process is finished.

The social worker is constantly receiving information including guidance from governments, evidence from research and literature. There is only vague guidance on how to undertake the assessment of the individual, even though assessment is so important because the results will undeniably affect the individual’s life for the upcoming future for a substantial amount of time. Social workers must balance risk, resources and the individual’s needs whilst undertaking the assessment, a process which can be very intricate and complicated when an individual has diverse needs and their risks are so great. However as social workers reflect on their previous assessments they will take away a strong idea of what works and this over time will help make assessments more effective.

Assessment is vital within social work and the features of assessment differ depending on the type of service the social worker is within. However within any service the assessment process still requires similar techniques including individualisation and citizenship and being open and honest. Many reports and papers have shown that when assessment is done correctly and uses an ecological approach which covers society and familial relationships as well as at an individual level then the assessment process will be more effective.

Elizabeth Flores

STUDY

Claireese Jones is a 16 year old African America teenager living in Harlem, New York. She is the only child of Mary Jones. Claireese has two children, one boy and one girl. Claireese daughter, Mango, is four years old and is diagnosed with Down syndrome but lives with Claireese grandmother. Her youngest son, Abdul is eight months old. Claireese is attending, Each One, Teach one, Alternative School and is currently in the eight grade. She is currently not working.

B. Setting

Harlem’s Women Center is a shelter for women who have children and were physically or mentally abuse. They work with women to reduce the physical, psychological and emotional trauma and the recurrence of domestic violence, sexual assault and incest experience by many of their clients. They work to secure their physical, emotional well being, individual freedom and economic equality. The agency offers counseling, legal services, childcare services, parenting classes, support groups and job readiness and job placement for their clients. The agency receive 97% of their revenues from government grants.

C. Reason for referral

Claireese was referred because she was recently homeless and was placed in a halfway house. She was referred by Ms. Rain, her teacher, who reported that she found Claireese in school, sleeping with her 3 day old son because her mother tried to kill her when she return home from the hospital. Claireese needs various services so she can eventually get her own place and support her children independently. She will need daycare services, so she can still continue to attend school, and earn her high school diploma. The social worker from the Welfare department reported that Claireese needs counseling to address experiences that were traumatic to her life. She will need extensive counseling. She needs to learn how to manage and care for her well being since she is already overweight and possible future health issues she will encounter in the future because of her diagnosis of HIV. Claireese has also experience episodes of blanking out and daydreaming.

D. Description and Functioning of Client

Claireese is considered overweight for her age. Her clothes are clean and she is always wearing cosmetic jewelry to match her outfits. She has her hair done and wears it differently. She can be verbal and nonverbal when talking to her at times. Client seems to be daydreaming when we discussed certain events in her life. She uses a lot of inappropriate language to describe how she feels.

E. Physical and economic environment

Claireese lives in a halfway house with her two children in Harlem, New York located in Manhattan. She receives a stipend while she attends school. She is also on welfare where she receives cash assistance and food stamps. She attends, Each One Teach One, Alternative school, Monday through Friday, in the day time.

F. Current Social Functioning (as reported by parents/caregivers or child/teen or obtained from written reports)

Claireese is estranged from her mother due to her abusive behavior towards her and her children. She has not seen her father since he last raped her, which is before she was pregnant. She knows that her grandmother would like to help her but is aware that she is also afraid of Mary. Client’s daughter, Mango, lived with great grandmother so client can attend school. Mary blames Claireese for being raped by her father and even accuses Claireese of stealing Mary’s boyfriend. Mary told her she is fat because she eats too much. Her mother never encourage her to attend school and told her it was a waste of time. Her mother is always telling Claireese, she is too stupid to learn anything. Claireese reported she never had a boyfriend but wish that she can have one in the future even though she feels she is too ugly and fat. She had two pregnancies that occur from her being raped by her father.

Claireese is a currently attending Each one, Teach One, alternative school, pursuing her High school Diploma so she can teach her children something. The client’s teacher, Ms. Rain, motivated Claireese to want read and write by encouraging her to do her best. She was surprised by her success in her ability to read and that she was actually beginning to write. Her sense of personal competence is in development; she states that she did not think that she was very smart, but that her class work and successes are changing that opinion of herself. She is grateful for having John, Ms. Rain, her friends for their support and encouragement. She never thought that there would people who would really care for her. The client’s primary social supports are her peers and her teacher in the school.

G. Personal and family history relevant to focus of assessment

Claireese was sexually abuse since the age of three by her biological father, which produced two children. She has also been mentally and physically abuse by her mother. There is also a possibility of sexual abuse by her mother. Claireese just recently learned that she contracted the HIV disease from her father who recently died of the disease. Claireese grandmother took cared of Mongo, so Claireese can go to school and Mary can still collect welfare based on fraud. Claireese has always depended on her mother up to now, even though moms have lived off of Claireese’s welfare check.

ASSESSMENT

Psychological functioning
Intellectual functioning- Client was not able to read or write but express interest in Math. Since attending the alternative school, client has been able to improve her reading and writing skills.
Reality testing- Poor, client seems to suffer from delusions. Whenever the client is dealing with stressful experiences, she is not listening and seems to be out of tune at the moment. She explains that she daydreams and imagines that she is someone else living a different lifestyle. She is not aware what is happening to her at the time of incident. She also images that the pictures in her photo album talks to her.
Coherence – Unimpaired, despite the client having delusions and has an imagination she can maintain on task whenever she is not dealing with stressful events.
Impulse control-Good, Client tries to control her behavior by not getting herself in any more trouble than she has to. She has gotten herself transfer from her old school not only because of her being pregnant again because she threaten the principal.
Judgment- Good; client have been able to make good judgments. She continues to go to school, so she can teach her children and earn her diploma.
Memory/recall- Poor: she can recall some but not all information that pertains to her traumatic experiences and whenever she addresses those experiences she goes into her fantasies.
Coping style- Poor; Client has never been able to deal with her traumatic experiences in a healthy way, even though she uses her imagination to forget what happened.
Defense mechanisms: Poor: Client daydreams and uses her imagination as a way to cope with stressful experiences.
Insight- Poor; Client has no idea how her traumatic experiences contributes to her mental issues.
Self-Perception-Fair; client has the confidence that she needs to complete school and even with her illness she is confident she can still provide for her children.
Emotional Functioning
Ability to express feelings- Good, she is able to express how she feels.
Rage of emotions-unimpaired: Client can express herself if she is more open to talking about how she feels. Once she sees that people care for her she can discuss how she is feeling.
Appropriate of affects-Impaired; Client seems to avoid talking about specific events, she will change the topic so the focus is not on her. This may be the client way of denying what happen.
Predominant mood- Poor; Client is depress and sad.
Social/behavior functioning

1. Ability to form relationships – Unimpaired; client demonstrates an ability to form relationships as evidenced by her ability to develop friendships with peers in her school. She also developed a friendship with one of the male nurses at the hospital.

2. Social skills/social competence – Poor; client demonstrates a lack of social skills.

3. Overall role performance – Improving; client’s role as mother is improving, she is now taking care of both her children and continues to attend school. Her role as a student is great; she continues to improve her grade level reading. She went from reading at a second grade level to an eighth grade level.

4. Other functional behaviors, if appropriate – Good; client has developed relationships through her school. Client has no other friends other than school.

D. Environmental issues and constraints affecting the situation.

1. Family – Poor; family is not supportive; mother is emotionally unstable and abusive towards Claireese. Her grandmother is too afraid of Mary, so she would not be able to assist Claireese.

2. Agency – Great; this agency is able to provide significant support in providing necessary services that Claireese needs. She has the availability of a daycare, so she can continue her education. She will receive housing assistance, so she can transition from the halfway house into her own place.

3. Community – Moderate; client’s neighborhood provides affordable housing and it is near public transportation and the school that she attends.

5. Physical Constraints, if appropriate – Poor; client recently discovered she is HIV positive and future health concerns associated with the illness will become a problem for her.

6. Economic Constraints, if appropriate – Fair; client has limited income from TANF and food stamps and she is currently living in a half way house.

E. Motivation and commitment to services

Claireese is very motivated in continuing her education. She wants to get her High School diploma. She wants to be able to learn how to read and write. She feels that if she continues to learns how to read and write, she can teach her children. Despite the fact that she has HIV, she clearly feels she still can be successful and do for her children, what her mother didn’t do for her. She wants to prove to her mother that she is wrong. Her motivation is influence by her wanting a better future for her children.

F. workers understanding of clients presenting situation/problem (person-in-environment)

Client seems to be experiencing symptoms of Dissociative Identity Disorder. These symptoms include flashback, amnesia and emotional numbness. When dealing with stress, client escapes reality by daydreaming. She may have developed this disorder due to her traumatic experiences, starting with her being raped by her father. Whenever the client experience stressful events, she has fantasies about her being famous and being someone else, she even sees herself as a white blond girl. Client has no control over her daydreaming. She seems to not remember how she was first raped.

Psychoanalytic theory help explains that client’s problems can be associated with painful childhood experiences that can sometimes be repressed. These repressed memories can shape the clients feelings, thoughts and behavior. These repress memories can be seen as defense mechanism (Robbins, Chatterjee, & Canda, 2012). The client uses her fantasies as a way of ignoring what is happening at the present time, which is not healthy as the client condition can worsen and create maladaptive behaviors. Client repressing these traumatic experiences may explain how the client coped with these experiences.

It is important to look at Erickson’s stage theory because it recognizes the importance of a person’s social location and the interaction between other individuals rather than just the family system. (Berzoff et al., 2011). Since, the client family system is not the strongest support system, the school staff and students are important people that provides positive feedback to the client. This will help the client learn to establish positive future relationships.

Strengths Perspective is an approach to understanding the client in terms of her strengths, abilities, motivations, knowledge and available resources. (Guo & Tsui, 2010) These qualities help the client the ability to solve their problems. This also can give you an idea how the client, who experienced many events in her life, overcame these obstacles and continues to attend school. (Robbins et al., 2012) They also talk about the courage an individual may have. She had the courage to confront her mother and finally leave the house in order to protect her children.

Strengths Perspective focuses on the social environment as having many resources that can help individuals overcome obstacles. People have the ability to learn, grow and change. Client has the abilities to continue to grow so she can provide for her children.

References

Berzoff, J., Flanagan, L. M., & Hertz, P. (2011). Inside Out And Outside In (3rd ed.). Maryland: Rowman & Littlefield.

Robbins, S., Chatterjee, P., & Canda, E. (2012). Contemporary Human Behavior Theory (3rd ed.). Saddle River, NJ: Pearson Education.

Guo, W., & Tsui, M. (2010). From resilience to resistance: A reconstruction of the strengths perspective in social work practice. International Social Work, 53(2) , 233-245. http://dx.doi.org/10.1177/0020872809355391

The essay will look at dispersal policy; a brief background and description of the dispersal policy. Critically analysing the policy in relation to asylum seekers, elaborate the role of NASS and arguments on welfare and asylum seekers in relation to Britain’s changing laws of seeking asylum. Outline how ideologies have used those policies and the impact they have caused. Critique the policy; explain the Implications and challenges for social work practice in relation to the policy.

A policy is a concept developed by government or political party to put down decisions 0r performance and matters that will prove advantageous to society in general. Dispersal is the process of moving asylum seekers to different areas of residence, to share the call on resources and public services amongst a wider range of local authorities across the UK instead of one particular area of the country. Under the immigration and Asylum Act 1999, any asylum seeker requiring support and accommodation may be dispersed anywhere in the UK while their applications are being considered (www.ind.homeoffice.gov.uk).

Asylum is protection given by a country to someone who is fleeing persecution in their own country. It is given under the 1951 United Nations Convention Relating to the Status of Refugees. To be recognised as a refugee, you must have left your country and be unable to go back because you have a well-founded fear of persecution. The person claiming for protection is an asylum seeker. If the claim go through the person becomes a refugee (ww.homeoffice.gov.uk).

In Britain, legislation and social policy in relation to asylum and refugees has been a priority for long. Britain gave attention to the refugees they had drafted in the1951 UN convention to provide protection to people who are at risk of persecution in their own countries. People from common wealth countries were invited to fill in gaps in the ‘labour market’ following the economic boom in 1960’sand thus settled in the Greater London.

Dispersal has a history in UK, though it is only in recent years that it has come to be used routinely for asylum seekers. Before the 1990s, it was used to distribute specific groups of refugees such as the polish resettlement in 1950s, the Ugandan Asians in 1972, the Chileans in 1974-1979, the Vietnamese as an attempt to de-concentrate ethnic minority families whose numbers had had been considered too high in relation to resources such as housing and schools. (Griffiths, Sigona and Zetter, 2005).

The concentration of asylum seekers in London and south east generated localised social and economic costs that those areas were not willing to accept. As a result of local tensions, the practical problems of housing, and supporting large and unexpected numbers of additional residents, some LA started to disperse asylum seekers. From 1996 on wards, London boroughs such as Harrow sent asylum seeker to Teignmouth in Devon (Robinson et al 2003 p: 122). This inspired dispersal and more local authorities were encouraged to do so voluntarily. More so, the policy was also inspired by dispersal of Bosnians in 1993, which was hailed as an example of effective settlement based up cluster areas and the principle of ethnic community formation (Griffiths et al 2005).

Initially the policy applied to asylum seekers who are destitute. If they asked for accommodation, they could only refuse to go if they have a medical support in London, risk of domestic violence and have relatives around. The main aims of the dispersal are to relieve pressure on councils in key areas of South East and London which have been over burdened with asylum seekers and to distribute the load more evenly around the count. Those requiring accommodation would be dispersed to areas with housing to spare (www.bbc.co.uk/news).

Dispersal was also seen as a means of improving the access of minority ethnic groups to improving life chances and a way of reducing prejudice through the deconstruction of stereotypes that these groups with areas characterised by overcrowding, poverty. The dispersal would encourage informal connection between neighbours of different races who might then begin to see each other as individuals rather than as stereotypes. The objectives of the policy were to control asylum seekers to enter the UK, increasing speed of the decision making for asylum seekers, refurbishing the financial support method of welfare benefits (Griffiths et al 2005).

However, to supporters of dispersal policy, the issue is one of costs and equity: “if society has made the democratic decision admit migrants, then the whole of society should bear the costs” (Robinson 2003, P: 163). When you look at dispersal, it is not about cutting costs, sharing the burden or addressing racism, but about soothing the fears of some voters who want to believe that immigration, and who is allowed to stay in their cities is under control. The government needs to embrace asylum seeking, shift in the tone of public debate away from illegal immigration and deterrence, using the educational system to change public perceptions, and promoting community involvement, active engagement and sponsorship (www.migrationyorkshire.org.uk).

Dispersal as a form of enforced population control is primarily a means of reducing the social visibility of asylum seekers and their potential ‘pollution’ of social space. If the concentration of asylum seekers in the community is constructed as a problem for ‘race relations’, then their social dispersal is both a valid and desirable outcome (Griffiths et al 2005).

By 1990’s the number of asylum seekers had increased sharply and public opinion had turned against them, racialising the issue and labelling them as ‘bogus’ and undeserving” (Robinson et al 2003 P: 122). They are perceived to be economically motivated. Today immigration is perceived by many in Britain as a problem for our society ‘which stems from a fear of unknown. Refugees and asylum seekers create an unwanted entity of the ‘otherness’ in the margins of UK. “From the moment they arrive they face an unpredictable and often aggressively hostile local public with ‘racist political’ sentiment openly engaging in intimidation and local press making accusations of ‘bogus claims’ and ‘a drain on national resources’ “(Pierson, 2002,p: 203, Dobrowolsky and Lister 2005).

This ‘othering’ resulted in discriminatory policies, which lead to the social exclusion, and discrimination of the asylum seekers, and refugee communities to the extent that their basic human rights have been challenged and their very existence has been criminalized (Dominelli 2002). I think devising strategies to prevent refugees coming to the country are a threat to the civilisation as it violates the basic human rights. The media could be partly to blame for this concept as they often wrongly imply that all asylum seekers for example, are criminals. Glasgow suspended its participation in the scheme in the wave of press hysteria. Media portrayals are often confusing and unreliable as they represent a gloomy impression about asylum seekers. The media blow up the insecurities of the public to sale more papers, as they are the only visible group in the local communities to blame for the ill health of the welfare system in the country. They have been an easy target for all as they are powerless, dislocated, silent, and ‘do not even having the right to be here’ (Robinson et al 2003).

Before 1996, asylum seekers were entitled to use the same social services as the rest of the population for example, if they had had been homeless, they would go to a homeless person unit, for support. The conservative Government introduced the asylum and immigration Act 1996, which meant that asylum seekers were cut off from mainstream welfare benefits. This left asylum seekers with no access to services. However, this was against the 1948 National Assistance Act which requires local authorities to provide welfare support to those destitute asylum seekers. Some local authorities started providing support to asylum seekers and their dependants if they appeared to be destitute. But, this was done on ad hoc basis and there were no clear guidelines of the local authorities’ responsibilities. In 1999, a new policy had been formulated for asylum seekers and refugees, which is called immigration and asylum Act 1999.

The immigration and asylum Act 1999 gave the National Asylum support service (NASS) the responsibility to provide services and meet needs of asylum seekers. This was due to the problems encountered by the social policy of UK regarding asylum and refugees, the policymakers have decided to establish the NASS in April 2000. NASS was set up to alleviate the pressure on the LA, and also to meet the government view that access to social security benefits creates a pull factor on economic migration. The major role of NASS was to provide support and accommodation for those asylum seekers who are poor while their claim is still being considered. Individual will be given accommodation in the UK, which is usually located and on a no choice basis. This meant that NASS has the sole right to decide for the asylum seekers will be moved (Griffiths et al 2005).

In 1999 the dispersal policy marked a fundamental change in British asylum approach by Introducing new procedures for the reception and accommodation of asylum seekers pending their claim for status determination in the UK (www.fmreview.org).

Failed asylum seekers are often destitute when support is cut off 21 days after a final claim for asylum is refused (Refugee Action 2006). The Red Cross estimate some 26,000 are living off food parcels although the figure could be far higher (www.rcn.org.uk/).

Dispersal failed to relieve pressure on London. It is possible that up to 2/3 of asylum seekers decided to remain in London and stay with friends and relatives rather than take up accommodation in other parts of UK while this does not add pressure to housing, it creates problems a with health and education www.school.gov.uk/policyhub/asylum_dispersal).

There were many draw backs, in the dispersal, as there was miscommunication between NASS and agencies concerned. There was no sufficient accommodation in the dispersal areas and the whole situation was in shambles as reported by the for example, councils did not know how many people were sent to them and what language they spoke so that they arrange translating services. In general, principles of the policy were not effectively adhered to. NASS should work closely with other agencies to coordinate action to ensure the presence of asylum seekers do not harm community relations.

NASS has been criticised by Fekete as being oppressive and institutionalised racism in her report ‘Crimes of NASS’: What is so alarming about the approach of NASS is that they do not consider it their duty to protect asylum seekers from racial violence, or ensure racial harmony, NASS is probably the only body in the country with no coherent policies against racial harassment and no apparent overall strategy to promote good race relations (Fekete, 2001). Since the year 2000, the NASS took the responsibility of asylum seekers to disperse them, wherever there is accommodation without considering their culture, language or any individual needs. Those who are vulnerable were left without support or information (Cohen, 2002, p: 119).

Ethnic minority people suffer from linguistic deprivation in areas they are dispersed to. Initially, the idea was to send asylum seekers to established communities who shared a common language and provided comfort and support. However, due to limited resources and scarcity of accommodation in some places, most asylum seekers were sent to places away from the communities. Breaking up families and then dumping asylum seekers in sub-standard accommodation in some of our poorest communities was always bound to backfire. It is a policy that was neither human nor practical (www.independent.co.uk/news).

From 1996 onwards, the responsibility of asylum seekers was given to voluntary organisations, for instance, NASS who dispersed refugees away from their countrymen and families. In so doing, their networks are sabotaged and left in isolation where they do not share any ownership or sense of belonging. They are unable to convey information or attain financial assistance from their communities, and that keeps them in a state of tension.

There are questions about the long-term impacts on social cohesion, because clustering can deprive these groups of people of integrating in the community. Also, clustering led to emergency of ‘Ghettos’ in deprived areas of asylum seekers. “This may in turn hinder refugees’ future integration into communities” (The Guardian 2005).

In addition to that, dispersal has led asylum seekers being sent to live in the very poorest areas where there were large numbers of people living on either benefits or in the lowest-paid jobs where they were not only more likely to face assaults but were also twice as likely to face racial harassment. More so, the accommodation of these dispersed people is made with no choice as to the location and anyone leaving the accommodation offered to them will lose the right to support. As a result, they are will be impoverishment, poverty, exploitation, ill health and sometimes death. Secondly; some of them whose claims are still pending are sometimes taken to detention centres where they are dealt with brutally with discrimination and abuse (Cohen, Humphries & Mynott, 2002).

In relation to housing some private landlords force asylum seekers to live as a family with people they do not even know. Overcrowding has become an issue for larger families, which are given smaller accommodation. Others return to their homeless charities after failing to cope with the situation (Audit Commission 2000, p: 3). NASS housed accommodation has no legal protection from eviction and the legislation of 1999 deteriorated in relation to housing conditions for asylum seekers and where by landlords growing richer on contracts in order to accommodate asylum seekers (Cohen et al, 2002).

One of the worst impacts of the Asylum and Immigration Act is the extension of immigration checks to housing and to all homeless applications. If the Home Office learns that a refuge has received public funds, he might lose the right to stay in the country or fail to renew their permission to stay (Cohen et al 2002).

Again, the vouchers are stigmatising, as they are used in fewer shops and less on public transport. Asylum seekers and Refugees who are skilled, experience high unemployment and low pay as there are not as many jobs in rural areas as the cities, and the policy sabotage them from their networks that would help them. As a result of this, asylum seekers are discriminated against instead of being offered opportunities and strategies for help (Ibid).

The government initiative towards asylum seekers preserved within the 2004 Asylum Act did not include the children welfare or to ensure that their human rights were thought of. On the contrary, children of asylum seekers whose claims failed are threatened to be removed from their families due to the powers of this act. “A government which sets out to make the children of failed asylum seekers destitute cannot seriously argue, ‘Every child matters” (Lavalette and Pratt, 2006, p. 200). It destabilizes the domestic and international human rights commitment and undermines the Third Way ambition of ‘every child matters’.

The detention centres, prisons and enforcement of dispersal programmes together with the 2002 Nationality Immigration and Asylum Seekers Act are all stereotyping asylum seekers as criminals, agree to be dispersed anywhere to get support, accommodation taken off them if they try to choose, taken in to isolation with high levels of crime directed to them, lack of legal representation. According to the Joint Council for the Welfare of Immigration: These policies are not only discriminatory against one of the most vulnerable sections of our community but also, of the worst kinds of social engineering which is destined to fail (www.lga.gov.uk).

More so, the Audit Commission has reported that asylum seekers and refugees get poor health care though they are entitled to free healthcare. Some of the GPs have taken their names off the lists as there is a tendency that it might impact on their surgeries. On the other hand, the examinations refugees take at ports of entry, have no follow ups due to poor health check ups. They are again registered temporary which does not allow keeping frequent medical records and cannot put their needs into account due to the rights and responsibilities of healthcare. For instance, most refugees experience post-traumatic stress disorder as they escape. (Audit commission 2000a).

The dispersal is reported to have improved recently, but this is down to the NASS working closely with other agencies like police, landlords, and local councils. They had all been included in the deciding in the area that was to be used, monitored the impact of the arrival of the asylum seekers on schools and other services and monitored community tension (guardian 2005). The policy has some success; this is evidenced by the larger number of refugees and asylum seekers in Birmingham, Liverpool and Manchester areas, and Birmingham hosts a sizeable refugee population in Wet midlands. There has been a corresponding growth of refugee community organisations (RCO) in these areas compared to before the dispersal policy of 1999 (Griffiths et al 2005).

In this section the will look at implications and challenges of social workers face in their work with asylum seekers and refugees in the context of dispersal policy in the UK are: Social workers tasks include giving assistance and proper attention to these individuals and ensuring that they receive the services which are included in the immigration and asylum Act. NASS is responsible for identifying who among the asylum seekers have the right to be given the services offered by such agency. The NASS should coordinate with the social workers, and the members of the enquiry lines to know if there are asylum seekers who need assistance of the government (Dominelli, 2008).

Hayes and Humphries (2006, p: 44) argue that “it is often the most vulnerable who suffer from lack of additional support; parents worry for the health and well-being of their children”. For example, a mother who can not breastfed her child because she is HIV positive and cannot afford to buy formula milk for her child. This puts social workers in a dilemma as they are forced to decide on eligibility based on immigration status, and the tension between social work values of providing for those in need and the requirement to exclude people from services. Social workers are forced to negotiate between this role of controlling access to support and that of providing care.

In addition to that, social workers working with asylum seekers experience a growing demand for the services as a result of new arrivals in a period of the budget constraint and their work tended to be dominated by assessing eligibility and providing for immediate needs rather than a broad social work role.

Social workers need to understand the impact of negative stereotyping on asylum seekers. Thompson (2009, P: 158) “the need to recognise the significance of discrimination and oppression in clients lives and circumstances has been emphasised”. As we have seen that asylum seekers will be subject to racist media portrayals and hostile views from members of the public, these factors will not help to integrate them into the community once an application has been successful. Thompson (2009, p: 18) argues that “the role of social work is to contribute to social stability, to ensure that the level of social discontent does not reach a point where the social order may be threatened”. Therefore, it is the role of social workers to help asylum seekers to integrate into local communities and adjust to a new culture. They will need to help asylum seekers to become more empowered as individuals and groups so that they can better represent themselves in the wider community. Empower involves practitioners having to reinvent their practice and their perceptions of particular problems and solutions (Trevithick, 2005, p: 219). Social workers were under pressure as Social Services are using their already over stretched budgets to provide for asylum seekers. Following the negative media portrayals; the local populations made the assumption that the social services budgets were drained, not as a result of government not providing enough money, but because of the asylum seekers. A discussion about who pays the taxes for public welfare and costs of migration devalues immigrant’s contributions to economic growth (Dominelli, 2008).

In some cases social workers were seen as supporting asylum seekers and neglecting the rest of the population. The role of a social worker is to address issues of oppression and discrimination on a daily basis yet their involvement is too little. Emphasis on the health and welfare of children allow social workers to become focused on specific issues such as safe case transfer of unaccompanied asylum seeking children, while not focusing on the needs of the vulnerable adult. (Hayes et al, 2006). Instead of the centralised NASS service provision, it would be better if asylum seekers could use local Social Services teams and benefits offices as these are more accessible. However, limited resources and staffing, the government should provide more support within the existing mainstream structures. Instead of training more social workers and community workers to support the asylum seekers, the government set up NASS, whose staff are not trained in anti-discriminatory principles, and had not got enough experience in housing and settlement issues. NASS’ work practices lead to more discrimination and social exclusion of the asylum seekers.

Social workers must seek clarification within their services concerning the issues related to asylum seekers. As the most asylum seekers do not speak English or cannot command the language well, social workers should make good use of interpretation services and make sure that these services are available for the asylum seekers and able to communicate appropriately. Patel and Kelly (2006, p:5) suggest that “ensuring access to interpreting services, and more equitable access to language learning opportunities, is essential for the appropriate provision of social care to Asylum seekers”.

It is my belief that all human beings deserve respect and dignity and should be treated will equal concern; however, looking at the media it is evident that the UK is struggling to sustain the support required for asylum seekers, which is becoming a growing problem within the UK today. The Human Rights Act 1998 applies to anyone living within the UK’s borders regardless of circumstances or nationality; until an asylum seeker receives refugee status they are often in a state of limbo and regularly their equal rights are denied. Therefore, anti discriminatory practice and humanitarianism is vital within Social Work practice.

Social workers should be involved in campaigning for the rights and ensure that they are observed (Dominelli 2008). The role of a social worker is to adhere to enhancing an atmosphere of acceptance, tolerance and equality for all individuals no matter what their background is. It is essential that Social Workers and those accountable for providing services and support to the most vulnerable in our society do not lose sight of the fact that asylum seekers, regardless of their immigration status, are human beings, with fundamental and basic human rights, needs and aspirations.

In conclusion, although dispersal policies are always understood as ways of temporarily accommodating asylum seekers as they wait for their decision on their asylum claims, the government needs to look at things on a long-term basis so that they are dispersed where they are able to integrate. Therefore, policy makers should also think of the future employment probability and service as they are most of the requirements for the future. NASS should work together with agencies concerned to make sure that asylum seekers are not put at risk. I have critically describe the policy, explained the implications of the policy into social work practice.

Being in the institution was bad. I got tied up and locked up. I didn’t have any clothes of my own, and no privacy. We got beat up at times but that wasn’t the worst. The real pain came from being a group. I was never a person. I was part of a group to eat, sleep and everything… it was sad. (As cited on Mencap.org)

Historically people with learning disabilities have suffered disempowerment by being excluded from mainstream society through segregation in large institutions. ( Wolfensberger, 1972) people were dismpowered by having little control over how they lived their lives. Although the Community Care Act 1990 has resulted in the closure and the resettlement of people with learning disabilities, people are still suffering disempowerment through exclusion by not being able to choose how to live their lives (Ramcharan,et al 1997).

Empowerment is: ‘aˆ¦”concerned with how people may gain collective control over their lives, so as to achieve their interests as a group, and a method by which social workers [and other care providers] seek to enhance the power of people who lack it’ (Thomas and Pierson 1996, p.134).

‘The Same As You? review’ is the Scottish Government’s strategy for learning disability services in Scotland. The review sets out the Scottish Government’s wider policies of social inclusion, equality and fairness to enable changes to happen for the better in the lives of people with learning disabilities. A key area identified within The Same As You? is Person Centred Planning. Person-centred planning means starting with the individual and putting the supports around them that will enable them to have the life that they want.

Person centred planning is a tool that can be used to plan with a person. This can be to help the person think about what is important in their life now and also to think about what what they would like in the future. Planning should include the persons circle of support and involve all the people who are important in the persons life. (Stalker and Campbell, 1998).

The idea behind person central planning was to respond to problems of social exclusion, disempowerment and de-evalution. Person centred planning was developed in the 1980’s by a small number of people including John O’ Brian and Michael Smull. As a way of enabling people with learning disabilities to move out segregated institutions and back into the main community. Person-centred planning is designed specifically to ’empower’ people, to directly support their social inclusion, and to directly challenge devaluation. By looking at what support is needed to allow the person included and involved in the community. (Magito-Mclaughlin et al., 2002).

Person centred approaches offer a different alternative to the traditional model of planning used for service provision. The traditional methods of service provision operated around the individual receiving the service, with health and social care professionals making all the decisions on the type of support the individual received. The traditional model was disempowering to people with learning disabilities as it focused on the persons medical problems, ignoring the qualities of the person as human being. (Sanderson, 2003)

Person centered planning places the individual at the center of the decision making process, allowing family members to become involved in the planning as Joynab, Mohammed’s mother states:

“Person-centred planning has given us hope and a vision for a better future for Mohammed. We feel now we can have a say in how and what service support he receives. We no longer believe that only professionals know best for our son. Mohammed’s faith and cultural needs are recognised and responded to.”(DoH, 2010)

Person centred planning looks at the persons qualities and is a way of listening to what is important in the persons life. People can direct their own services and supports, in a personalised way rather than attempting to fit within pre-existing service systems.

An area where person planning has helped the person by listening to what they want enabling them to direct their services and support is through training and employment. People with learning disabilities have been marginalised from gaining employement, through the employers lack of understanding about learning disabilities and stereotypical beliefs that they are incapable of working. As a mother states “

I have a son who has Down syndrome..I go to the supermarkets and ask if they could try my son outaˆ¦I explain that he has Down syndrome, then they change the subject and say they will give me an application form.I explain my son cannot write, and they tell me he cannot get an interview without an application form.Is this a way of eliminating the disabled?” (Anonymous contribution as cited by Williams,2009)

People with learning disabilities benefit from working as it helps them to gain fiancial independence and security, increases their self confidence and skills and allows them to socialise. Todd (2002) demonstrates this in his report ‘planning a new future’ where an agency worked with a young man with autism whose goal in life was to be an airline pilot, even though this goal was unrealistic. The support worker involved in his person-centered plan, suggested and arranged a visit to Heathrow airport once a week. The idea was to find out what interested the young man about being a pilot, was it the flying, planes or uniform? After visiting the airport for a couple of months it became apparent that the baggage carousels captivated him. The young man was then supported to get a part time job as a baggage handler. (Todd, 2002) enabling the person to become part of the community. In a way that values their human rights, gives them independence and choice.

Person centred planning has a particular approach that can be used for different individuals in different situations. The four main tools that can implemented include: McGill Action Planning System (MAPS), this process is a useful tool for gathering information in the early stages of planning, helping to identify the person talents and needs. ELP (Essential Lifestyle Planning) is more commonly used to plan for people who are moving out of instititionalised care. Personal Futures Planning is less service based, tending to be used for building relationships with family, friends and fitting into the wider community. PATHS (Planning Alternative Tomorrows and Hope) is used to develop an action plan for the individual. (Stalker and Campbell, 1998, Sanderson, 2000)

People with learning disabilities can have communication problems and should not be disregarded from having person centred planning for that reason. There are various techniques that can be used allow a person with a learning disability to communicate in their ideas for the plan, such as Makaton, talking mats, sign language and picture banks. (Grove, 2005) the plan can be done any format that is accessible to the person such as a written document, a drawing or mind map with images or an oral plan recorded on to a compact disc. Plans are the updated when the person wishes to make a change or when they have achieved their goal.

Person centred planning is for eveyone, not just for people who can communicate. As it can engage participants personally by allowing them to hear of deeply felt hopes and dreams and fears, even if the person feels they are silly. As the planning process allows the person to break free from the misconceptions and conventions that can harness their future. Some examples of peoples dreams were a young man wanted a trip to Mexico as part of his vision. Another is taking guitar lessons as a way to achieve his goal of being a country and western singer. An older woman, in her plan, decided to retire. Another is taking art classes and learning to paint watercolours. Starting a business, going to college or university, buying a house, these are all things that are possible through person centered planning. (ne-pdd.org)

Person centered planning has helped people achieve empowerment is their choice to form relationships, get married or have children. People with learning disabilities have the same need for love and relationships as do all human beings. However this need is not being met for people with a learning disability. Literature on the subject provides information about sexuality in regards to learning disabilities, however it seems to focus on disability and sexuality from the perspective of it being a problem. (Parritt, 2005.)

This negative view of people with learning disabilities and sexuality stems from the historical perspective of learning disabilities, where people with disabilities were placed in institutions and segregated (Potts and Fido,1991)

This level of control can still be seen today with professional’s and families trying to discourage intimacy and relationships, viewing the person with a disability as vulnerable, seen as the ‘eternal child’ (McCarthy, 1999)

Mrs Susan Hurst and Mr Frank Hurst tell their story of ‘Our Wedding, Our Dream’ where person centred planning enabled them to get married. Mrs Hurst states, “some people felt there wasn’t a need for us to get married but we wanted what every one else hadaˆ¦Getting married had always been our dreamaˆ¦.” (csrpcp.net)

Mr. and Mrs. Hurst describe how the tools of person centered planning enabled them to identify both their ‘hopes, goals and dreams for the future’ this enabled them both too make all the decisions in planning for their wedding. Mr and Mrs Hurst explain that they even planned their honeymoon and travelled to their honeymoon destination without the aide of support workers, as person centered planning had enabled them to plan ahead of the difficulties that might occur and how the couple would resolve them when on holiday. Without Person centered planning Mr and Mrs Hurst would never have been able to get married or go on honeymoon. Mr and Mrs Hurst felt that person centered planning helped them to achieve their goals enabling them to feel in control of their lives, allowing them to choose their human right to get married and respect for private and family life. (csrpcp.net)

There is legislation that supports the rights of people with learning disabilities to have fulfilling relationships and sex lives if that is their choice. (Article 8) states that every human being has a right to respect for private and family life. The Disability Discrimination Act (1995) gives people the right to access family planning clinics and advice centers. People with learning disabilities should be accepted as people who have the same capacity for loving as others in society.(Lesselliers, 1999)

Loneliness and isolation may occur through the lack of opportunity to have loving relationships. Therefore person centred planning can enable people with learning disabilities to be empowered by allowing them to make these decisions and choosing how they want to live their lives.

person centred planning improves the person quality of life. Increasing the persons right to empowerment through the right to work where they want, where they would like to live and increasing their social network by letting them choose how they would to socialise. (Whitney-Thomas et al., 1998).

Relationships improve for the person at the centre of the planning, as they became more motivated and goal oriented. As the participation process allows friends and family to join in the planning and help the person achieve their goals. Parents also reported that person centred planning had such an impact on their family’s lives, that they choose to become involved in training other families in the importance of person centered planning.

As person centred planning is designed to focus on one person at a time, it increases the potential to broaden opportunities for people with learning disabilities in gaining the life they choose. As Person centred planning allows the person to choose how, when and where they want support or services delivered rather than the standard ‘one size fits all’ approach. (O’Brien & Lovett, 1993).

However there are limitations to person centered planning for people with learning disabilities. Insufficient funding and resources can hinder the planning process persons and their opportunity to achieve their goals, leaving people disillusioned with the process.

Person centered planning requires trained and well equipped staff who are knowledgeable about inclusion, rights of people with learning disabilities and how to help empower people by directing them. As people can lose trust in centered planning if these values are not upheld. (Kinsella 2000),

Person centered planning can take time to achieve targets, it is not suitable for people who require emergency planning where action needs to take place in a few days. The process is not a “quick fix” (O’Brien & Lovett, 1993).

In conclusion people with learning disabilities have suffered from disempowerment in the past as a result of institutionalised care. However person centered planning has enabled people with disabilities to become empowered by allowing them to make their own choices and be fully supported about how they would like to live their life. By allowing people with learning disabilities to choose their right to employment through what job they would like to work, this in turn empowers them by gaining fiancial independence and increased self confidence, as well as learning skills and getting to meet new people. Person centred planning has allowed people to gain their right to family life and marriage, by allowing people to plan their own wedding and honeymoon giving them independence to start married life.

Therefore person centered planning creates positive effects that go beyond effective planning. In that it allows people to be listened to and what is important to them. However this is only effective if what is recorded on the plan is acted on, as people will lose faith in person centered planning if no action comes from their choices.

Traditionally, people experiencing mental health problems were removed from society and placed in asylums across the country, indefinitely (Thornicroft and Tansella, 2002, pp. 84-90). Patients within the mental health system were expected to take a compliant role in the management of their care and leave the decision making to the professionals. In today’s society that is not the case. In this assignment the writer will begin by exploring the publication ‘Vision for Change’ while discussing the main theme of this publication which is ‘the importance of service user involvement and the importance of empowering the service user in the mental health system of Ireland’ (Ireland, Dept of Health & Children, 2006). To empower the service user requires the control of power to be transferred from the professionals to the now known “Service User”. The writer will discuss the effect of this change and the importance of this change within the mental health system. The Mental Health Act 2001 requested the closure of many asylums and the move towards a community based model of care. The deinstitutionalisation of many patients and relocation back into the community required changes in the way the psychiatric nurse and service user operate.

Evidence has shown the importance of service user’s participation in research, education and in practice through out the mental health care system. The writer in this assignment will discuss the importance of service user participation in the delivery of psychiatric nursing care, focusing on the nursing assessment using a holistic approach.

Finally, the writer will discuss the importance of service user participation in the remaining stages of the nursing process; the nursing diagnosis, outcomes, planning, implementation and evaluation while exploring the need for a therapeutic relationship between service user and psychiatric nurse to complete the nursing process successfully.

With people experiencing mental health difficulties, who now reside in the community, it is vital that service users become involved in the development and delivery of mental health services, such as self-help services, drop-in centres, and in providing assistance with activities of daily living. The aim of this is to sensitise society to the need of integrating people with mental health difficulties back into community life.

As quoted in a Vision for Change;

“Service users must be at the centre of decision making at an individual level in terms of the services available to them, through to the strategic development of local services and national policy. To use a slogan of the disability rights movement: ‘nothing about us, without us’.

To reduce the stigma attached to people with mental health difficulties the term ‘patient’ was changed to service user, as most of the care they receive is provided in the community. The Mental Health Act, 2001 suggests ‘the term ‘patient’ is used to describe someone who is involuntarily admitted. Patient does not therefore refer to all individuals in an approved centre’. In the Vision for Change it states that ‘the correct way to describe someone with a mental health illness was to see the person before the illness, for example someone with anorexia nervosa was not to be described as ‘an anorexic’ rather than as a person with anorexia nervosa. Stereotyping in mental health is as damaging as any other stereotype (Ireland, Dept of Health & Children, 2006)’. People, who experience mental health difficulties, can be the experts through their own experience (Bee et al, 2008, pp. 442-447).

Psychiatric nurses remain the largest staff group involved in the provision of mental health care, (Bee et al, 2008, pp. 442-447). Therefore, to ensure the mental health care service abides by legislation, it is vital for psychiatric nurses to re-evaluate their role to ensure priority is given to including the service user. An Bord Altranais recommend that a holistic approach is adopted and it is listed as one of the requirements in nurse registration education programmes (An Bord Altranais, 2005). It is fundamental that the service user participates in the nursing assessment especially where the holistic model of assessment is used. The biopsychosocial model uses a holistic view, addressing the biological, psychological and social factors contributing to a person’s mental health problems. According to Boyd (2004, p.190) it proposes a person-centred treatment approach which addresses each of these elements through an integrated care plan agreed with service users and their carers and involves participation of the service user throughout the assessment. This assessment requires the service user to answer a series of questions, some being of intimate nature about themselves. This enables the assessor to obtain relevant information required in making a nursing diagnosis. To ensure accurate nursing diagnosis it is critical that the services user listens carefully to the questions asked and is completely honest when answering the questions. This process also requires the service user to be patient while the assessor records the data received. However, it is important to remember that an initial assessment can occur when a service user is first admitted into psychiatric care. According to Boyd (2004, p.194) the assessor must have empathy and an understanding of how difficult it is for a person to discuss intimate details of ones life’s to a complete stranger, even if it is in the person’s best interest.

Although the nursing assessment is the starting point of the nursing process, the writer feels that service user’s participation remains of equal importance throughout the nursing process. The freedom of information act 1997 requires that all services users can request access to any information stored about them. While, it is now a legal requirement for service users to be involved at all stages of the nursing process, the writer suggests that it is imperative that the service user is informed of the nursing diagnosis. This will empower the service user, by encouraging the service user to find relevant information regarding their diagnosis which can assist in them becoming experts of their own mental illness.

Following the diagnosis it is required by law that the psychiatric nurses discuss all details of the outcome with the service user. The psychiatric nurse needs to ensure that the service user’s values and beliefs are priority when planning the outcome. If any treatment is deemed necessary for the road to recovery, then it is compulsory that the service user is capable of understanding the effects of the treatment proposed, this requirement is stated Under the Mental Health Act, 2001:

“the service user must be capable of understanding the nature, purpose and likely effects of the proposed treatment and the consultant psychiatrist has given the patient adequate information in a form and language that the patient can understand, on the nature, purpose and likely effects of the proposed treatments (Section 56). Factors for consideration include the capacity to comprehend and decide, risks involved, patient’s wishes to be informed, the nature of the procedure and the effects of information on the service user.”

The service user must be informed of the benefits of taking the medication prescribed, for what duration the medication is to be taken and what side affects may occur when taking the prescribed medication. Forcing an unwilling inpatient to receive medication has been considered an unnecessarily coercive, traumatic, and even punitive assault on a person’s privacy. It has been stated that the patients’ refusal of medication is indicative of a gap between their experience and understanding of the medication and the intention of the prescribing physician. (Kaltiala-Heino et al, pp. 290-295) In today’s mental health care system, many service users receive treatment in the community; therefore, it is critical that services users listen to information regarding their prescribed medication while raising any concerns they may have.

Planning and the implementation stages of the nursing process are not possible without the involvement of the service user. Communication and agreement between the service user and the psychiatric nurse is necessary. Potential obstacles need to be pointed out, and methods of overcoming these obstacles, discussed. Potential risk areas for the service user needs to be discussed and a therapeutic risk assessment carried out by the psychiatric nurse to ensure the service user is not at risk or danger of harming themselves or others. Awareness of patients perceptions of their impaired quality of life gives psychiatric nurses important information for planning individually tailored interventions (Pitkanen, A. et al, 2008, pp. 1598-1606).

Finally, the evaluation stage evaluates client progress and reviews plans in accordance with evaluated data in consultation with the client. Evidence shows that the evaluation of a services users experience is of vital importance in shaping the future of service user’s outcomes within the mental health service. It also enables the psychiatric nurse to take the necessary steps required to ensure that the individual service user is satisfied with the service received. The Department of Mental Health, UK stated that the experience of service users, including those from black and minority ethnic groups, is a recognised national marker in the performance of the UK mental health services. In 2006, the UK National Service Framework (NSF) in line with the Mental Health Unit of the Regional Office for Europe carried out a systematic review of empirical service user views and expectations of UK-registered mental health nurses. Feedback from this review was both positive and negative, with service users holding mental health nurses in high regard. However; feedback also reveals that there was a strong need for nurses to be more effective in interpersonal communication and relationship building, whilst spending more time with the service user (Bee et al, 2008, pp. 442-447).

Throughout the nursing process it is necessary for a therapeutic relationship to exist between the service user and the psychiatric nurse to. Relationships are central in fostering and maintaining hope (Byrne et al 1994). Psychiatric nurses are required to have a genuine interest in services users, listening in a non judgemental way to what is being said. In a user-led study evidence has shown service users identified the importance of therapeutic relationships and how they inform patient experiences. Communication was highlighted by all participants as necessary. One participant in the survey quoted; “As soon as you come they can see that you are angry. Then someone will say, sit down, let’s talk about it, make a cup of tea.” Failure to establish a therapeutic relationship between the service user and the psychiatric nurse can result in negative patient experiences. Participants identified coercion as the main reason for failure to establish a therapeutic relationship (Gilburt, H. et al, 2008).

Conclusion:

The writer in this assignment briefly exposed the treatment of patients within the mental health care prior to the introduction of the Mental Health Act 2001 and the publication of ‘Vision for Change’. Then, the writer discussed the major changes within the Mental Health Services as a result of this act and publication. The Mental Health Act 2001, focused on the closure of many asylums and a community based model of care to be adopted, however, both the Mental Health Act and the Vision for Change also focus on the importance of service user involvement and empowering the service user. The writer demonstrates how a new psychiatric and service user role was required to adapt to policy changes within the Mental Health Service and to ensure all parties were adapting to policy requirements that aims at service user involvement at all stages, thus; empowering the service user. The writer reports how the publication ‘Vision for Change’ also hoped at reducing stigma by aiming to involve services users in developing and delivering mental health services. The writer mentioned the importance of service user involvement in research, education and practice, while focusing on the practice area by exploring the nursing process, starting with the assessment. Evidence is clear that it is not possible for a psychiatric nurse, even with the necessary skills required to proceed with the nursing process without the participation of the service user at all stages. The writer concluded this assignment by exploring evidence which reveals that service users regard a therapeutic relationship and good communication between the service user and the psychiatric nurse of high importance.

Personalisation is considered as a process that involves the usage of technology to accommodate the differences between the individuals. It is becoming an increasingly popular area within health and education sectors (Department of Health, 2008). When discussed in terms of Health care, Personalisation involves thinking in relation to care and support services in a completely different way, building care provisions around the person in a way as an individual with preferences, strengths and aspirations and combining them towards the center of the process of recognizing their needs and making choices about their living (Department of Health, 2008). It demands a significant transformation of social care so that all the processes, systems, staff and services are combined to put the people first. In addition, personalisation is indicated as offering people with much more choice and control over their lives within all social care settings. However, it is much of a wider concept than simply providing personal budgets to the people who are eligible for council funding. It also involves ensuring access to the universally determined services (transport, leisure, education, housing, health) and employment opportunities regardless of their age and disability characteristics (Department of Health, 2008). In a very short span of time, the personalisation concept has occupied its central place within the field of social work and adult care discourses in United Kingdom (Department of Health, 2008).

A study involving a consultation process was carried out by Department of Health (2006), it was observed that people showed much interest in accessing personalised approach and they demanded for its need and they expected it to be made available to them easily and quickly. In order to make better provisions relative to personalisation, various people who participated in this consultation process questioned their need about the availability of social care providers and their services (Department of Health, 2006). But in order to make it possible, the health care sector needs a clear vision with a direction to make personalisation a strategic shift towards the initial prevention and interventions of dreadful diseases (Department of Health, 2008). However, this seems to be a challenging agenda that cannot be possible by social work alone and it requires effective working away from the boundaries pertaining to social care like housing, benefits, leisure, health and transport. On the other hand, demographic variations show a significant impact upon the number of people who care and support the family members and this in turn influence the available care provisions (Department of Health, 2010). Although personalisation is the corner stone of public service modernisation, in terms of social care it can be meant that everyone who is receiving care (regardless of their need level, statutory services) should possess an equal choice and control over the way through which the support is delivered. Social care providers (involved in carrying out social work) will be potentially able to direct the use of resources, building on the technological support, family and the wider community in order to enable them in enjoying their role as citizens in their communities (Department of Health, 2008).

The document released by the Department of Health in 2010 on “Putting People First” offers a clear insight regarding personalisation along with the potential ways of its development when investments were made within the following aspects of support (in relation to the individual carers):

Universal Services: support that can be made available to everyone in the community in addition to transport, leisure, education, information and advice (Department of Health 2010).

Early interventions and preventions: helping people to live independently as long as possible and designing future cost efficiency systems.

Choice and control: helping people in understanding about the way of spending in relation to care and support and thus allowing them to choose in accordance to their needs.

Social capital: creating supportive communities that enable in determining the value of each and every contribution made by the citizens (Department of Health 2010).

Personalisation by Effective Participation

Personalisation through effective participation helps us in creating a better connection between the individuals and the group in a way by allowing users a direct, informed and creative rewriting in the script through which the service used can be designed, planned and evaluated (Houston 2010). This approach involves the following steps:

Expanded Choice: enables users in providing a greater choice over the various ways of mix through which the needs might be met and to combine the possible solutions around the user instead of limiting the provisions in relation to any institution in question like hospital, social service department to which the user seems to be much closer (Leadbeater, 2004; Lymbery 2010).

Intimate consultation: Here professionals work in an intimate relationship with the clients to help in opening up their needs, aspirations and preferences through an extended dialogue system (Houston 2010).

Enhanced voice: This is very difficult to follow through a white paper agenda and it involves the use of expanded choice in opening up the user’s voice. Making comparisons through the various possible alternatives can help in articulating the preferences.

Provision of Partnership: Generally, it can be possible to combine the solutions which are personalised to the individual if the services work in partnership. In instance, any organization – a secondary school can form a gateway for the learning services provided not only by the school but also to various other companies, colleges and distance learning programs (Houston 2010).

Advocacy: In this section, the professionals act as advocates to the users and help them to move their way through the system. This process can enable the clients in attaining a continual relationship with the professionals (Houston 2010).

Co-Production: Professionals who were found to be involved in shaping the service were expected to be more active and responsible in offering their help in relation to the service delivery. However, Personalisation aids in involving service users, creating more efficient, and responsible package of care services.

Funding: Within this, authorities need to follow the options or the choices made by the users and in certain cases-offering direct payments to the physically disabled people to assemble and obtain their own care packages. Funds should be left with the users for purchasing any good or commodity and this should be done with the advice of the professionals (Houston 2010).

Role of Personalisation

When considering the role of personalisation as an organizing principle with relation to the public service reforms, certain comparative studies need to be definitely performed with a broader emphasis on contracted services. Nevertheless, other public services do exist where in which personalisation fail in making a sensible approach (Duffy 2005). This can be exemplified by:

Someone who is entering in to an accident or emergency service department do not need a dialogue but instead he needs a quick and competent action (Leadbeater, 2004; Lymbery 2010).

Although in a public sector, defense is another area where in which personalisation principles cannot be applied and the people play a pivotal role in fighting against terrorism.

Thus it can be understood that, personalisation can be used only in certain public services which can be of face-face (like education, social services and non-emergency health care departments), those depending to establish a long term relationships (disease management) and the services involving a direct engagement between users and professionals through which the users can play a significant role in shaping the service (Leadbeater, 2004; Lymbery 2010).

Personalization- A Reality in 21st century

Making personalisation, a reality for the 21st century definitely requires huge cultural and transactional transformations within all the parts of the system (not only in social care but also in public sector, whole local government). Over the past ten years, direct payment option helped some people by providing an ability to design the services they need, but the potential impact was found to be very less. But in the recent years, figures indicated that about 54,000 people out of a million received help through direct payment (Department of Health 2010). Since personalisation describes the change within the whole system it needs the presence of strong leadership to communicate and convey its potential vision and values. To achieve a significant shift towards its cultural side and to construct a delivery model (Department of Health 2008), it demands all the stake holders to work in partnership with others.

Nevertheless, in future social care system allows individuals in undertaking their own choices with an appropriate support at the level they needed. It should be understood that personalisation need to be delivered in a cost effective manner. In addition, it must be recognized that personalisation with its early intervention and efficiency are not contrary and need to be strongly aligned in future to obtain better results (Department of Health 2010).

Personalisation in relation to the Mental Health Residential Care Homes

Personalisation in relation to the mental health can be defined as understanding and meeting the needs of the individuals in various ways that can seem to work best for them (Carr, 2009). Principles of personalisation can be applied in early interventions, prevention and other self directed approaches where in which the users are involved in maintaining and managing their own social support services (Lymbery 2004). However, it accommodates mental health promotion and its maintenance with a wider choice and control and thereby contributing to the improvement in well-being and quality of life.

The above mentioned principles pertaining to personalisation can be applied in Mental Health Residencies to direct payments and other internal budgets (Mc Donald, Postle, Dawson, 2008).

Direct payments: are in general, cash payments that are paid to the individual during which they can design and control the tailored support in order to meet the social care needs. Funding for this direct payments arrive from the respective local authorities (Fernandez et al., 2007). Though these were available from 1996, they are now-a-days considered to be as the only option for the people who are provided with the personal budget. Statistics indicate that direct payments users were found to be increased at a steady rate ranging from 50 in 2001 to 3373 in 2008 (Care Service improvement partnership, 2008). From the year of 2007 and 2008, the percentage of people using this option in order to meet their mental needs increased by 62% which was found to be one of the largest among all the care groups (Carmichael, Brown 2002; Ridley, Jones 2002; Spandler, 2004; Spandler, Vick 2004; Cestari et al, 2006; Taylor, 2008). But, when compared with the other impairment groups, the percentage of direct payment users in mental health is relatively low as a result of poor level of mental capacity, lack of awareness and non proactive attitude of managers towards the implementation of direct payment. This has been evidently noticed in my placement setting. Research studies indicate that, when offered with sufficient support people with the mental health condition will start to use direct payment option effectively and imaginatively (Carmichael, Brown 2002; Ridley, Jones 2002; Spandler, 2004; Spandler, Vick 2004; Cestari et al, 2006; Taylor, 2008). In a National Pilot Study of direct payments in mental health (2001 to 2003), around more than half of the people used a personal assistant in obtaining social, personal and mental support and they assisted the impaired ones in carrying out their daily activities and helping them in accessing community and leisure facilities (Spander, Vick 2004; 2006). Many barriers do exist for these direct payments in all the impairment groups and out of which many of them also apply within the mental field. They include lack of awareness, risk aversion and protectionism (Pearson, 2004; Fernandez et al, 2007; Hasler, Stewart 2004; Spandler, Vick 2005), potential difficulties in undertaking decisions pertaining to social care needs and other eligibility issues for the people whose condition changes within less time (Carmichael, Brown 2002; Ridley, Jones 2002; Spandler, 2004; Spandler, Vick 2004; Cestari et al, 2006; Taylor, 2008).

Personal Budgets: The cornerstone of the Government’s approach in creating transformations within social care especially mental health residential home care and relative support through personalisation is the allocation of Personal Budget (PB). My placement setting is a mental health residential home accommodating people with enduring mental health problems. I think individuals should be supported and assessed in conjunction with other agencies in order to meet users own needs, and by doing so a care provider can ultimately determine whether they are eligible for providing any social care funding. If individuals were found to be eligible, care providers can explain the amount of money they expected to receive in order to meet the needs (Department of Health 2006; Duffy, 2007).

Individual Budgets: On the other hand, individual budgets are quite similar to the Personal Budgets and these incorporate various other funding schemes along with social care funding (Glendinning et al., 2008). The funding schemes include: access to work, supporting people, living independently, disabled facilities and grants as well as integrated community equipment services. A National Pilot Study on Individual Budgets took place in the year of 2007- 2008, it was observed that around 14% of the people were found to be with mental health condition (Glendinning et al., 2008). The pilot study concluded that people who receive individual budgets experienced much higher levels of independence and were more likely to commission their valuable support from the main stream community services instead of specialist ones (Bamber, Flanagan 2008). This application offered a better mental health support need along with the flexibility in comparison to other conventional services or direct payments (Glendining et al., 2008; Manthrope et al., 2008). Many barriers were observed with Personal and Individual budgets in relation to the mental health field. The difference between the funding in relation to health and social care can also form a major barrier to the developing individual budgets in mental health (Glendinning et al., 2008). In addition, the following points need to be implemented within Residential care Homes in offering a personalised approach:

Person and relationship centered care and support at the heart of the service offered.

As the care home setting is considered to be as a community, the residents or the staff actively searches the various available opportunities to develop an effective relationship (Carey 2003; Bradley 2005).

The managers working in care homes need to be sure that the existing services respond to the needs and should look for the opportunities to diversify the offered services.

Staff should ensure that people has a live and breathe culture which is actively involved in promoting personalised services in a way by offering maximum choice and control for the people who are living in care homes (Cestari et al., 2006).

Residents need to possess the accessibility to all the information and advices as they need to make certain informed decisions including those pertaining to advocacy matters (Cestari et al., 2006).Team work and effective communication is needed with the people in care homes.

Staff development programs and the quality assurance systems must be introduced as they are considered to be crucial in offering a positive outcome.

Care home managers should be nicely placed in order to understand the potential needs of the local communities. Effective leadership work should be carried out in a collaborative manner with the people who are using these services along with their families and carers involved in design and delivery of services (Spandler 2004).

Assessing self directed approaches along with allocation of budgets (Cestari et al., 2006).

If a disabled person lacks capacity in choosing a direct payment or any other option, the local authorities must help them in undertaking a best interested solution and decisions (Ridley, Jones 2002).

Conclusion

The applications of principles of personalisation with the mental care residential homes share a lot of core values (Carmichael, Brown 2002; Ridley, Jones 2002; Spandler, 2004; Spandler, Vick 2004; Cestari et al, 2006; Taylor, 2008) The Mental Capacity Act (MCA) laid down in 2005 supports the practices and principles of personalisation by empowering many people in undertaking their own decisions. It also helps the mentally disabled people in taking their own decisions as much as possible (Spandler, Vick 2004). But in principle, this may not seem to be possible as the people lack mental ability and the individuals need play a very big role in decision making processes that can only directly detect them. The first research study underpinning this approach was carried out by Norah Fry Research Centre at the Bristol University in 2008-2009 (Philips, Waterson 2002). The study suggested that people experiencing mental health problems and distress need to possess a better choice and control over their care (Carey 2003; Bradley 2005).

The Personalisation Agenda in United Kingdom has more to offer in the field of mental health as it challenges the way through which health condition is perceived (Payne 2000). To implement the principles, the country need to support a social model in understanding the mental health condition and must recognize the important social factors that play a key role in contributing to that condition (Beresford, Wallcraft, 1997; Brewis, 2007).

Thus effective and proactive leadership from the managers in senior position along with the direct payment support agencies could help in creating awareness within the general public and thereby aid in developing expertise (Newbigging, Lowe 2005). Therefore, in the context of mental health, it can be understood that a move towards the direction of personalisation indicates a move towards a feeling of independent living philosophy (Vick, Spandler 2006). Various projects need to be developed to support that move and various practical tools must be designed to effectively meet the challenges associated to the mental health field. In particular we need to aim in developing strategies that encourage champions amongst various other service users, forums for discussions and networking in a way that progress can be made in overcoming the challenges to personalisation in mental health field. In addition issues of negligence pertaining to poverty and inequality, its weak conception regarding individuals utilizing social care work services, its view on welfare dependency and its potential for promotion as an alternative of challenging the depersonalisation in relation to social work, need to be tackled effectively in order to meet its future aims and objectives.

In the following I will be discussing the quotation “Social Work is an ethical and political activity made necessary by the consequences of social and economic disadvantage and inequalities”. I will be critically evaluating the statement by expressing my view of Social work role and what Social Services are there to do. I will be addressing the role of politics within Social Work and the effects it may have on service provision. I will also be highlighting the some of the ethical dilemmas and constraints social work services face. By discussing these issues I will be able to evaluate the statement and highlight the way in which service users may be discriminated against within Social Work.

Social Work in the 21st Century has changed and improved throughout the years. Within Social Work today great emphasis is put upon the service user and working in partnership. Thompson, 2005 highlights that partnership is a highly skilled activity, being able to work in partnership also demonstrates so many other skills necessary within social work. This approach is aimed at empowering the service user as so many of the individuals that we work with are discriminated against within society. However this has not always been the main focus as service provision was very different at the beginning of the welfare state when the Poor Law was implemented. The focus at that time was labeling people as deserving and undeserving which then oppressed those labeled undeserving as this reduced the opportunities available to them as they were often sent to the workhouse with poor conditions. The “underclass” where described by the middle class as “Dangerous” and ” dark” Mooney,1998 as they thought the increase in urbanisation would cause overcrowding leading to disease which would spread onto the middle class. Therefore along with the new poor law philanthropic woman were introduced to contain and reduce disease. It has been highlighted by Forsythe, 1995 that philanthropic agencies did not wish to reduce deprivation for everyone but only for those who were seen as worthy. The wealthy middle class woman viewed themselves as superior to the working class therefore discriminating against them. The main focus of the support was to limit and contain the spread of disease from those that were poor onto the middle classes. This again discriminated against those who were experiencing great levels of poverty and deprivation. In the years that followed the Beveridge Report in 1942, legislation was implement by the Government to tackle the five giants that were highlighted within the report. By concentrating on these issues the Government aimed to tackle the difficulties which society was facing at that time. Unfortunately the same five giants continue to be problematic today’s society although these difficulties are now approached with a different manner.

Today’s approach has been influenced by many reports highlighting various ways in which service provision could improve including social work. Today social work takes on so many different meaning and cannot be explained with a single definition. Social Works mission is to support and empower individuals to reach their full potential by addressing the difficulties they may be experiencing which then prevents dysfunction cited by IFSW, 1982. We do this by applying our social work skills and values and relating the knowledge and theory to our practice. By doing this we are then able to communicate and engage with the services user and gain knowledge of their environment which then enables the social worker to work in Partnership with the service user to address the difficulties that have been identified. This is done by applying the Social Work Process of Assessment cited by Coulshed & Orme, 1996. Many of the service users that require the support of a social worker often are experiencing discrimination or oppression at some level within society due to social and economical constraints. It is the social worker’s role to work in a non discriminatory and anti oppressive manner to empower and encourage the service user to address their issues and minimize the level of disadvantage they they may be experiencing

Social Work knowledge enables us to gain a greater understanding of the service users by applying a holistic view. One way this can be applied within the social work process is with the use of systems theory. When carrying out the assessment process with a service user it is important to gain a holistic view of the individual which will then enable an accurate assessment of the individuals needs and level of risk. By apply theory to practice you are able to adopt a holistic approach effectively. Systems within an individual’s life are symbols for the different relationships which they are connected to. As all systems are interlinked they will then all impact on the individual therefore all systems need to be considered for the service user. Parker & Bradley, 2007 highlight that this approach demonstrates that social workers commitment to work in an anti oppressive manner as this approach will enable the discrimination to be addressed and challenged. This is because systems take into consideration and social structures which may affect the service user.

When carry out an assessment there are many skills that need to be implemented in order for the assessment to be accurate. One that I have already highlighted was the need for a partnership between the service user and social worker. However before this can form there is basic skills such as communication and engagement. As this takes place at the beginning of the assessment it is important that this is effective. By using communication this does not just mean to speak or inform but can also mean non verbal communication such as eye contact, facial expression or gesturing. It important to use effective non verbal communication as Thompson, 2002, highlights, non verbal communication can enable us to communicate our emotions and illustrate our reaction to what we have been told. When communicating, it is important to use the communication appropriately and in a non discriminatory or oppressive manner an example of this may include the use of jargon. Many people within Social Work can at times forget that they are using jargon with service users as they are so comfortable with it this. However this can present a barrier between the social worker and service user as the service user may not understand what they are being told. This can then lead to oppression as the social worker is discriminating against the service user by using inappropriate language and therefore the service user is being oppressed as s/he is not receive the support required cited in Thompson, 2003. This can then lead to relationship breakdown as the service user may not wish to full engage as a result.

Lastly values are also crucial when applying the skills required to address discrimination and disadvantage when working with service users. The values that we apply within our practice then enable us to work in a non discriminatory and oppressive manner. One of the main social work values includes approaching with a non judgmental attitude. It is important to remember that so many of the service users that we support are already being disadvantaged or discriminated against within society this could be a form of sexism, racism or classicism as so many service users are experiencing poverty and disadvantage which is often why social services are implemented. By applying a non judgmental attitude you are then able to engage and form a positive relationship which will then allow for a more holistic assessment to be carried out in order to identify the services user’s needs and level of risk. By doing this we are able to identify ways in which the service user’s needs can be met effectively and therefore minimse the level or oppression which they experience as a result of discrimination within society for example stigmatization.

Within Social Work practicing in an anti discriminatory and anti oppressive manner is highlighted as being crucial from the beginning of the social work training and has always been a focus throughout the work carried out by students. Forsythe, 1995 stated all students had to demonstrate a level of competence in anti discriminatory practice when completing the Social Work Diploma. This is an area and a requirement that is emphasised in today’s training with an emphasis on applying anti discriminatory practice. With recent literature such as Thompson, 2003 discrimination can be explained in a clear manner. Thompson’s P.C.S. Model helps to prevent discrimination and oppression of the client and aids the Social Worker to work in an anti oppressive and anti discriminatory way. It explains how discrimination and oppression affects individual on three different levels these being Personal, Culturally and Structurally. This allows the Social Worker to become aware of these levels in working in and anti Discriminatory way. “Each of these levels is important in its own right, but so too are the interactions between them” Thompson,2003, pg,13 Each level is linked therefore by understanding how discrimination effects individuals at a personal level you can then relate it in the wider context of Cultural and Structural. By understanding the model you can promote good anti discriminatory practice and work with the client in an empowering manner.

The Scottish Government has highlighted that they are now providing the largest budget for social work than ever before with an increase to all services as highlighted by Scottish Executive, 2001. This budget has been used for services provision, training for staff etc this money should enable better service provision and reduce the inequality that many of the service users are currently experiencing within society as a result of a disability or mental health. The funding and support can then be offered to empower and enable the service user to progress with their lifes. However this money is not always evident within the social work services as many service users are being denied service provision. It has been highlighted that in the 21st century families are not having as many children therefore the birth rate has fallen while the elderly appear to be living for longer and requiring more support as cited by Hill, 1996. So much of the time social worker are having to negotiate with managers or services to enable their service user to gain a service as highlighted by Trevithick, 2005. When thinking back to the quotation social work can be viewed as a political activity with regards to budgeting. So much of the time resources are limited when service provision is higher than average e.g. high levels of unemployment. With the recession which is currently taking place more people are attempting to access services due to poverty, mental health and increased crime rates, all of these negatives will increase with the condition that society now faces. With the same budget in place this will then impact on the services available. This then causes disadvantage within social work services due to high numbers and low service provision. Social work aims to tackle discrimination but due to political restriction can often disadvantage and discriminate their service users.

Nevertheless there have been positive influences by the government to improve social work provision to and promote an anti discriminatory practice. One of which includes the introduction of the care commission which was implemented with the Regulation of care (Scotland) act 2001. This was set up to regulate the care provision of social services including elderly care homes. By regulating the care the service user is then ensured that they will be provided with a consistent level of care which can minimise people being discriminated against due to a disability for example as their care will be regulated as cited by Care Commission, 2009

Another way in which the government has impacted on service provision within social work includes the introduction of the SSSC which was also introduced also under the Regulations of care (Scotland) act 2001. Their aim is to increase the protection of vulnerable people by regulating the training and registration of those working in social services and highlight the codes of practice. By doing this they are able to limit the discrimination and disadvantage that the service users may encounter as all people working in social services are registered. They highlight that they encourage equality by delivering a high level of competence in their work which can then enable and empower the service user to take up the opportunities available to them which will then prevent them from feeling oppressed within society.

Within Social work ethical dilemmas are evident throughout practice. At time this can be due to challenging discrimination appropriately or being in conflict with your personal and professional values. As highlighted within the quote social work should be approached in an ethical manner by demonstrating the social work values. However at times social workers may experience ethical dilemmas in the work that they are carrying out in order to do the best for the service user. At times due to low levels of service provision which was highlighted earlier this can then impact on the service user and whether their needs are being meet in an effective way. If needs are assessed and identified then it is the role of the social worker to encourage the service user to meet their needs effectively. However if the service provision is not available this can then impact on the service user. Banks, 1995 highlights that the welfare state is benefiting and embracing those in need as it will increase the budget received from the government, although they are also seeking to limit and control poverty. However while the welfare state may be benefiting from those in “need” social workers cannot help but feel guilty when those needs cannot be met due to lack of resources. Social workers are accountable and answerable to their actions. At time it is not the social workers fault as Trevithick, 2005 advises that often social worker negotiate to the best of their ability for service provision but at times the resources and not available. This is similar to what was carried out regarding the deserving and undeserving as shows that at times services users do need to be prioritised due to lack of resources. This may then mean that they are oppressed by this as their needs cannot effectively be met.

Another ethical dilemma which I have became aware of is Care vs. Control as it demonstrate the level of power that you as the social worker has although by informing the service user of your duty as a social worker, to pass relevant information on, you are also limiting the control as the service user may then withdraw or hold back in what is being said. This can have a great impact upon the relationship that has been built between the social worker and the service user. Thompson, 2005 advised that the basis of a positive working relationship is trust and respect. With this in mind it is possible that you may need to pass on information to the police etc regarding your service user. This may be difficult as the service user may then become disempowered and let down by social services. Lishman, 2007 states social workers are there to empower and encourage the service user to address their needs effectively. However if information was required to be passed on from what a service user had disclosed this would then demonstrate the power imbalance within your relationship. However this should be fully explained at the beginning of the working relationship and an appropriate connection should be made. This service user and social worker relationship is determined by confidentiality, accountability as the social worker has the responsibility as a professional personal to uphold the two were appropriate as cited by Hugman & Smith, 1995.

When working within social work there can be constraints that impact upon how we are able to fulfill our role to encourage and empower and this may then lead to further discrimination or disadvantage out with our control. One of which includes the legislation such as the Children’s Scotland Act 1995. The legislation highlights that the welfare of the child is paramount cited in Anderson et al, 2008. Therefore within child protection any referral that is made will be looked into which enables an assessment of the child to take place. This legislation enables better and more efficient child protection procedures; although the legislation states that a minimalist approach should be taken with the child. This may mean that the child continues to stay in the home as there may not be clear evidence of abuse or neglect. This can impact greatly upon the child and can cause the child to feel let down by the system and oppressed. This is due to the constraint of legislation and is put in place for the best interest of the child however this can lead to the oppression amongst young people who do not want to speak out and therefore their needs may go undetected.

Another constraint that has been considered is in relation to service provision. I have previously discussed that at times service provision can be limited and what is available to that service user may be restricted. As a result the criteria for the service may then increase to reduce the level of service users who require the service. If this happens their need will not be met effectively and this will not be addressed. However the role of a social worker is to identify needs and risk and ways in which these could be met. Therefore this may then raise questions regarding the accuracy of the assessment. Social workers may alter the truth to ensure that their service user will be provided with the appropriate support. The focus for assessments should be needs led and the services should fit around the service user. However this is not always the case as Parker & Bradley, 2007 state that at times due to limited service provision the services users have been placed wherever has been available.

To conclude I agree with the quotation as I feel that at times social workers are providing services for those who are socially and economically disadvantaged within society for various reasons. If these people were not experiencing inequality there may then be no role for social work. It is important to remember that social work is informed by the knowledge skills and values which then enable us to practice and approach with a non discriminatory attitude this encourages and empowers the services user to reduce the inequalities which they be facing. However at times due to the constraints within social work e.g. resources services user continues to experience inequality.

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There are various drugs which are abused by teenagers and adults. Most of these are addictive and have adverse health effects to users. The common drugs of choice are alcohol, cigarettes, speed, prescription drugs, heroin, cocaine and marijuana. Alcohol is the most abused drug, and it inhibits judgment among users (Stimson 34-48). Long term use leads to liver and kidney failure. Tobacco, or cigarettes are one of the most addictive drugs and their long term use leads to development of cancer, impotency, lung collapse and others. Cocaine and heroine are drugs which are injected, smoked or taken orally. They are very addictive and they distort reality among users. Long term use may lead to heart problems, mental disorders and high blood pressure. Sharing of needles may transmit STDs while drug overdose may be fatal. Marijuana is another common drug abused and it distorts reality among users. Long term use may lead to mental damage, and some researchers have linked it to development of schizophrenia. Prescription drugs are also commonly abused by the old and young alike. Although done innocently, these drugs may cause sudden death due to overdose or fatal combination of drugs, as has been witnessed among many celebrities who have died early due to use of prescription drugs (Isralowitz 122-123).

Causes of drug abuse

There are various causes of drug abuse. Drug abuse can be blamed on parents, friends, individuals and society at large. These causes will be briefly discussed to show how everyone is responsible for the problem of drug abuse.

Lack of parental supervision

Parents have an important role in their child’s upbringing. They serve an important purpose of instilling values in their children through socialization at early age. Parents should ensure that their children are morally upright and that they do not engage in social vices. However, in the modern world, parents have put professional lives ahead of their families and delegated the role of raising children to nannies and teachers. As a result, the children do not acquire much needed guidance on life’s issues, and many end up taking drugs through peer influence. Lack of supervision from parents, who pursue their careers at the expense of their families, can therefore be blamed for the high number of drug abuse cases among teenagers. Parents should supervise their children at all times to avoid negative influence from peers.

Poor communication between parents and teens

Lack of communication between children and parents, especially during teenage years is also another causality of drug use. Many teenagers are unable to effectively communicate with their parents since neither group understands the other’s needs. Parents appear too harsh to teenagers while teenagers appear to demanding to parents. When parents and teenagers are unable to effectively communicate about issues teenagers face, teenagers are left to seek advice from peers, who may influence them to take drugs. Parents should understand children’s needs and vice verse, if drug abuse is to be eliminated.

Mental & Physical abuse

Domestic violence and abuse has been one of the most common triggers of drug abuse. When people are emotionally or physically abused, and they do not seek help, they may engage in drugs to forget their problems. Since most abuse cases are perpetrated by close family members, this makes it harder for victims to overcome, and many opt to try out drugs, which they perceive will distort reality and make them forget their concerns (United States Department of Justice Website 2000). Drugs of choice in such circumstances include alcohol, tobacco and marijuana. However, victims are unaware that use of drugs increases their problems since it leads to addiction, which needs to be treated. Publicizing abuse, passing tough laws and offering free help to victims will help reduce abuse cases and thereby reduce drug use cases.

Media influence

Media influence is a major causality of drug abuse, especially regarding drugs such as alcohol and tobacco. The media makes it appear “cool” to use such drugs through flashy advertisements in the media. However, less emphasis is placed on adverse effects of such drugs; hence teenagers are influenced to use them without enough information on repercussions faced due to drug use. This leads to addiction, and by the time victims realize, they cannot do without drugs. This influence from media can be stemmed through use of warning labels and bans on certain forms of drug advertising which targets the youth.

Warning signs

There are various symptoms and warning signs which are associated with drug use. These symptoms vary according to drugs used, genetic make up of users, quantity used, personality and other aspects. It is important to note that presence of a particular symptom does not automatically means that the individual abuses drugs, rather that it shows that further investigation should be done to ascertain drug use by the individual. Some of these signs are discussed below;

Dropping Grades

Sudden drop of grades without clear reasons may indicate drug use. This may be linked to missing of classes when taking drugs, or harmful effects of drugs which affect the brain and cause poor academic performance. This behavior is usually accompanied by disrespect for school authorities and fellow students.

Missing Curfew

Missing curfews without adequate explanation of one’s whereabouts may also indicate drug use. When teenagers are unable to explain their movements, this shows that they are secretive, and drug use may explain this situation. However, teenagers’ movements should be established before accusing them of drug use.

Disrespectful to parents

Drug users are usually disrespectful to other people. This is due to the label which society gives them of “drug addicts”, which makes them harbor hatred towards society. Teenagers who use drugs are unable to explain their “odd” behavior to parents and much resort to disrespect as a means of covering up drug use (Giannini 69-73). Others are influenced by drugs to make irrational choices leading to disrespect of family, friends and the community.

Stealing & lying

Stealing is a common trait amongst drug users and it emanates from the need to purchase drugs. Drugs are expensive to purchase and drug users may be forced to steal from family and friends to maintain the vice. When questioned about it, they are likely to lie about it. This makes it a symptom of drug abuse, and parents should be careful to note such behavior from their children.

Who to blame

Various discussions have centered on who is to blame for the problem of drug abuse. However, there is consensus that everyone is to blame for the problem. Parents have neglected their children and left nannies and teachers to raise them, as they pursue professional goals. Teachers have also neglected students since they focus on academic curriculum at the expense of social development. The society has tolerated drug abuse and perceived it as “normal” behavior without taking action against drug users (Roleff 39-44). This has left adolescents to seek advice from peers, who may influence them to abuse drugs. Teachers and parents ought to give attention to teenagers and advice them on harmful effects of drug use. The society should also condemn and punish drug users, since this will deter them from practicing the same.

Risks involved

There are many risks which are involved in drug use. These risks affect the health of the user, their relationships with family, society and friends, and their ability to achieve full potential in later life. In addition to this, some risks may be potentially fatal to users. Risks associated with drug abuse include addiction, health problems, transmission of STDs, accidents, mental disorders and problems with law enforcers. These risks will be discussed below in more detail;

Addiction

Most drugs are addictive to users. The degree of addiction varies according to several factors including specific drug used, genetic make up of user, quantities used and other factors. However, since most drugs are addictive, users become dependent on the drugs for performance of everyday activities. Drug addiction is the most harmful effect of drugs since it ensures that users are unable to quit drugs, and instead use more quantities of drugs to achieve the state of intoxication over time. Some of the most addictive drugs include cocaine, heroine and tobacco. However, other drugs such as alcohol, prescription drugs and marijuana are also addictive and may make users dependent on them. This makes it expensive to sustain abuse, and users may use illegal means of getting money to satisfy the addiction. Drug manufacturers use the aspect of addiction to ensure they have a steady supply of cash from addicts.

STDS

Many drugs affect the ability to make reasonable judgments by users. Some drugs, especially alcohol, marijuana, cocaine and other hard drugs interfere with decision making abilities of users and may allow them to engage in irresponsible sexual behavior. This behavior may lead to transmission of STDs among people who engage in this behavior after drug abuse. In addiction, users who share needles when injecting themselves may acquire STDs as a result. Some STDs such as HIV are incurable and developing them leads to fatalities after a period of time. Others which are curable are expensive to treat, which leads to financial burdens on families of such drug users.

Health problems

Several health problems are linked to drug use. In fact, all drugs have a side effect or health problem associated with it. Drugs such as alcohol lead to kidney and liver failure while others such as tobacco may lead to development of cancer or lung damage (Learn about alcoholism website 2009). Hard drugs such as cocaine and heroin may lead to high blood pressure and heart problems. As earlier stated, sharing of needles may transmit STDs. It is clear that all drugs have adverse health repercussions. This leads to high medical costs to victims, and these problems may also lead to fatalities. This is an economic cost to families and governments around the world. Drug overdose may lead to instant death to users.

Mental disorders

There are various drugs which may lead to the development of mental disorders amongst users. These drugs adversely affect the brain leading to distortion of reality, leading to mental disorders. Drugs such as marijuana, cocaine, heroin and others have been known to cause psychosis and illusions, which may develop into mental disorders. People with such disorders may perform unreasonable acts as they perceive themselves as normal and the rest as abnormal. These disorders are expensive to treat, and may at times be incurable to victims.

Accidents

Many accidents are caused by drivers or pedestrians who have taken drugs. Alcohol is the most common drug linked to accidents, although others also lead to accidents in our roads. In the US, over 37,000 people died as a result of accidents caused by drink-driving, while this figure exceeded 41,000 in the previous year. These figures show the severity of the matter. This is a matter of great concern especially when sober drivers are exposed to accidents caused by drunk drivers, which end up taking their lives. There are also other accidents at the workplace which are caused by working while intoxicated, especially in industrial plants where there is dangerous machinery. Accidents cause serious injuries or fatalities to victims.

Trouble with the law

Many drug users are arrested at some point in their lives due to drug use. Drug use causes addiction, which forces users to seek more. Since most drugs are illegal, law enforcers arrest drug users through elaborate schemes and plans put in place to deter drug use. Arrests over drug use have adverse repercussions including heavy fines and prison sentences. It also leaves a record which may affect future employment opportunities. Families suffer when breadwinners are arrested, and one loses employment when arrest over drugs is publicized. This creates a large population of social deviants who are a liability to society.

Solutions

In order to solve the problem of drug abuse, each society stakeholder should join efforts to fight the vice. The problem of drug abuse needs to be publicized and help given to drug users. In addition, stiffer punishment should be given to traffickers. These and more interventions will be discussed below;

Family Counseling

Counseling is the first step in solving the drug abuse problem. Users need to accept that they face a problem and counseling will enable them see the effects of drugs to themselves and their families. Family counseling also teaches families to be supportive of drug users in attempts to stop drugs (Evans & Sullivan 75-76). This is important as drug users have families as primary socialization units. Family counseling should also address problems such as domestic violence which are causalities of drug abuse.

Community and youth programs

Community and youth programs educate youth on harmful effects of drugs. These programs also offer youth alternative activities to do with leisure time such as sports activities. When youth are aware of harmful effects of drugs, they are likely to avoid using them, thereby reducing the problem of drug abuse.

Harsher punishment

In order to deter trafficking and sale of drugs, laws which heavily punish drug use and trafficking ought to be passed. These should involve heavy fines and long prison sentences. When such laws are passed, they will deter drug traffickers, and when drugs are unavailable, the problem of drug abuse will reduce, if not completely eradicated. Harsh laws are very effective in deterring commission of crime.

Communication

In order to solve the drug problem, better communication between teenagers, teachers and parents should be developed. This will enable teenagers to share their concerns with parents and guardians, who will advice them on choices to make as opposed to peers, who may give wrong guidance and direction. Communication will also provide opportunities to teenagers to be aware of adverse effects of drug use.

Summary

The problem of drug use has been discussed in detail. Common drugs abused have also been discussed. Drugs have been seen to be harmful not only to users but also to their friends and families. Their harmful effects include health complications, fatalities, loss of employment, and economic burdens amongst other effects. Every member of the society is responsible for the problem of drug abuse and appropriate interventions should be implemented to discourage the vice. These include communication with teenagers, stricter laws against drug trafficking, family counseling and community programs which publicize the problem of drug use. This will ensure that teenagers are safe and free from drug abuse.

Pregnancy and motherhood is a significant part of womens lives. In fact, motherhood is a privilege that only women can experience. However, not all women feel privileged about becoming a mother. Knowles and Cole (1990) suggest that there is an increasing number of cases wherein soon-to-be mothers are not happy about their pregnancy either because of their current marital relationship, the biological father of the baby is not responsible enough to give emotional and financial support, or simply because they have negative past experiences such as being sexually or physically abused by their own parents, brothers, or relatives (Knowles and Cole 1990). Due to high incidence of unhappy pregnant women and mothers, the number of female perversion also increases.

Sexual abuse towards children or the act of inflicting harm towards her own body or the child’s body is considered as female perversion in the sense that sexually abusing her own children, inflicting harm towards one’s own body or her child’s body is totally the opposite of the true concept of motherhood and femininity. Welldon (2008) argues that female perversion is often expressed by inflicting self-destructive harm caused by biological or hormonal disorders that normally affects their reproductive meaning (Welldon 2008). Unlike male perversion, researchers highlight that female perversion aims at causing physical harm against their own body or against the objects that they created, including their babies (Welldon 2008; Springer-Kremser et al. 2003; Richards 1990). Motz (2001) acknowledges that there are many ways in which female perversion could cause physical harm towards her own body. Since perverse women identify their own body as their mothers’ body, perverse women is capable of attacking their own body through self-mutilation or self-starvation (Motz 2001). Other signs of perverse women include, as Balsam (2008) and Somers and Block (2005) note are: the act of exhibitionism wherein the woman shows off her body as a way of showing her active sex life and pleasure they get during procreation and sexual promiscuity ( Balsam 2008; Somers and Block 2005). In the case of perverse mothers, Banning (1989) explains that they attack their own children as a way of expressing their violent revenge (Banning 1989). Various researchers note that perverse mothers are often guilty of infanticide, unlawful abortion, and concealing a birth (Fraser 2008; Spinelli 2004; Tekell 2001; Boswell 1984).

Boswell (1984) suggest that infanticide cases normally occurs when the mother abandon their infant in outdoor places in order him or her to die from hypothermia, animal attack, hunger, or dehydration (Boswell 1984). In some cases, as Spinelli (2004) highlights, infanticide can also happen by intentionally suffocating the infant using a pillow or drowning the infant in a bathtub (Spinelli 2004). Spinelli (2004) and Tekell (2001) argue that that regardless of whether maternal infanticide cases happened because of postpartum mental illness or psychosis, schizophrenia, or purely because of neglect on the part of the mother or carer ,infanticide outside the concept of mental illness is clearly a crime under the law (Spinelli 2004; Tekell 2001).

Postpartum mental illness or psychosis is a kind of mental illness that can occur because of too much blood flow that passes through the brain (Meyer, Proano and Franz 1999;Cox 1988). In some cases, as Rapaport (2006) highlights, the practice of lactation could become a ground for mental disturbances among mothers who has just given birth to a baby (Rapaport 2006). Fraser (2008) also argues that biological and hormonal imbalances cause significant changes in the mood such as agitation, delirium, and delusions on the part of the mothers (Fraser 2008). Aside from biological or hormonal disorders, other common factors that can trigger female perversion, as researchers suggest, include the early exposure to maternal abuse and neglect, alcoholism, the use of illegal drugs, and stress related to socio-economic problems (Barnett 2006; Motz 2001).

Peter (2008) suggests that when a young girl is physically or sexually abused or neglected in the past, the future relationship of the abused might lead to confusion between the appropriate and inappropriate sexual activity, especially if the relationship is an abusive one. Since the negative experience with man could further damage their self-image and psychological functioning, the victim’s ability to become good mother will also negatively affected (Peter 2008). Barnett (2006) also notes that childhood experiences such as a young girl who failed to receive emotional support from mothers and fathers could grow up feeling devastated about their life. Because of their strong desire to rebel, some women may end up becoming unwed mothers only to prove their femininity or their ability to become more superior than another person – in this case, their own children (Barnett 2006). In line with this, other studies, Barnett (2006) and Welldon (1991), highlight that young girls who were sexually abused or emotionally deprived by their mothers often end up as prostitutes as a way of revenge. Authors also suggest that such mothers with psychological imbalance will intentionally inflict physical harm on their children (Barnett 2006; Welldon 1991). Welldon (1991) also explains that perverse mothers can either be a facilitator – someone who is capable of adapting to the child’s needs; or regulator – the type of mother who anticipate that their baby is capable of adapting to their own needs , which the second type leading more to physical abuse of children (Welldon 1991).

Society in general perceves mothers as a role models to their children, loving, nurturing. As part of being a role model, ideal mothers should refrain from the use of illegal substances,alcohol and smoking addictions. Aside from molding, educating, and nurturing their children to become good citizens, ideal mothers are expected to make their children happy and confident by instilling only good values in their minds. In other words, the role of ideal mothers are not limited in feeding their children but also to make them feel that they are loved by not being selfish. Every woman, on other hand, desires to be accepted socially as a good mother.In line with the strong desire to be accepted in public, the act of idealizing motherhood may lead to denial of female perversion. As it was highlighted previuosly, perverse mothers are capable of sexually abusing or physically harming their own children due of their negative childhood experiences. By strictly idealizing the concept of motherhood in our society, there is a strong possibility for perverse mothers will deny participating in any forms of such actions.

As mentioned in the previous statement, various researchers suggest that female perversion can be noted when there is alarmingly disturbed relationship between the mother and her infant, mother and son, or mother and daughter (Peter 2008; Hetherton 1999; Banning 1989). In line with this, women who have been neglected or deprived of love in the past or were sexually abused, could make them capable of sexually abusing their own children. Although the possibility wherein perverse mothers could sexually abuse their children is high, Motz (2001) highlights that these type of cases are often under-reported because of the complex relationship or emotional attachment that is present between the mothers and children. The absence of concrete evidences, it would be difficult to prove that a perverse mother is indeed punishing their children physically or sexually especially when the child is too young to talk and defend themselves against their abusive mothers (Motz 2001). As a part of idealizing motherhood and femininity, the idea wherein perverse mothers are abusing their own children physically or sexually is totally not acceptable within our society. As a result of idealizing motherhood and femininity, there is a strong possibility wherein perverse women are more likely to deny their act of perversion in order to protect themselves from being humiliated and judged by the public as irresponsible, immoral, and/or cruel mothers. For this reason, Hetherton (1999) and Banning (1989) argue that idealization of women could result to more under-reported cases especially with regards to criminal issues wherein female perpetrators would sexually abuse a child (Hetherton 1999; Banning 1989).

Researchers studies suggest that women’s past and unresolved experiences of being sexually abused during her childhood days can make them prone to inferiority complex which makes her an easy victim of abusive men (Balsam 2008; Springer-Kremser et al. 2003). In line with this, a good example is drawn by Motz (2001) where a perverse mother wherein becomes as an accessory of sexually abusing her own children, when the husband coerced the wife to encourage 7 and 10 year-olds, sexually abused victims, to masturbate the husband while the wife was taking pictures (Motz 2001). We can suggest that in case these two children refused to participate in the sexual activity with the father, either the mother or the father would physically harm the children for disobedience. There is also a strong tendency for both parents to threaten these children not to inform other people about the sexual activity that happened between them. Given that the society strictly idealizes the concept of motherhood, perverse mothers will continuously deny their willingness to abuse their children physically or sexually as a way of protecting themselves from becoming involved in child abuse cases. Based on the given example, it is possible on the part of the perverse mother to claim that it was the husband who made her encourage children to perform illicit sexual activities with the couple. For this reason, as we may suggest, it is the husband who is more likely to face the legal consequences or punishment for engaging children to participate in illegal sexual activities as compared to the perverse mother.

According to Welldon (1991), perversion in motherhood is possible when society denies mother’s perversion and idealises being a mother. Author further agrues that due to sexual or social politics, some women are not treated as a complete human beings because they were not born as men. By not allowing women to feel completely as human beings, there is a greater chance wherein of emotional instability leading mother to result in perverse motherhood (Welldon 1991).

Considering the cases of maternal infanticide, Rapaport (2006) explained that the law in UK has a distinctive legislation with regards to the act of killing infants and young children by their own mothers. In line with this, women who are proven victims of biological or hormonal disturbance caused by immaturity or unfavorable circumstances such as rape cases are qualified for settled law. For this reason, women who are guilty of maternal infanticide are free from death penalty. Under the British’s infanticide statute of 1922 and 1938, mothers who are guilty of killing their infant or children because of postpartum mental illnesses or psychosis are exempted from capital punishment related to murder. Author further acknowledge us the legal charges that are most likely to be imposed on the accused mothers will be reduced to manslaughter provided that there are enough biological evidence to prove that the accused mothers are going through postpartum-related mental disorder. Instead of sending the accused mothers to prison, perverse mothers who happened to be convicted of killing their infants due to post-partum syndromes are mandated to undergo hospitalization for necessary treatments (Rapaport 2006). In relation to the case of maternal infanticide, Card (2002) explained that evil actions can be classified as either “intolerable harm” or “culpable wrongdoing” (Card 2002:4). Since conscience plays a significant factor which enables us to act good deeds and avoid those that are evil, each person should be free from mental illnesses when judging whether a human action is morally good or bad (Card 2002). Card (2002) suggest that those women who are suffering from postpartum mental illness or psychosis, should not be classified as perverse female simply because they are not mentally capable of determining what is right from wrong at the time they had committed a crime. Infanticide caused by postpartum mental illness and psychosis should never be considered as an intentional crime. For this reason, the level of legal punishment imposed on postpartum mothers who are accused of infanticide should be different from perverse mothers who are guilty of intentionally inflicting physical or sexual harm on their children (Card 2002). West and Lichtenstein (2006) also draw a good exaple of criminalization of Andrea Yates case who drowned her five children in the bathtub and was inicially convinced for capital murder, who later on was found guilty of insanity and eventually was moved to state mental hospital. Authors argue that society’s myths and perceptions about perfect mothehood plays a great role in womens lives and stigmatizes those who’s behavoir is unnatural and deviant. Aside from taboo and stigma, society also don’t take into account the role of women;s daily activities, which as authors argue, lead to “double shift” both at home and at work which often result in emotional and physical stress and therefore could escallate to murder of a child (West and Lichtenstein 2006). Although it is possible that the act of idealizing motherhood could lead to denial of female perversion, it is by no doubt that justice will always prevail. Even though perverse mothers are capable of denying the act of harming their children physically or sexually, the local authorities can still gather concrete evidences from the victims of child abuse in order to convict preserve mothers who are guilty of committing a crime. Perverse mothers may continuously deny their act of female perversion, as in Andrea Yates case due to delusional thoughts about Satan, but they are not free from being legally punished for their socially unacceptable behaviour.

Rapaport (2006) suggests that when maternal infanticide is classified by psychiatrists as a form of postpartum mental illness or psychosis, suspected mothers who are positive for postpartum mental illness or psychosis should be given the privilege to receive psychiatric treatment (Rapaport 2006). In line with this, Spinelli (2004) highly recommended the need to make use of formal DSM-IV diagnostic criteria when scrutinizing a suspected mother for killing her infant and deciding for the level of punishment to be imposed on mentally ill person (Spinelli 2004). Considering the fact, as Hetherton (1999) highlights, that idealization of women could result to more under-reported cases particularly with regards to criminal issues wherein female perpetrators would sexually abuse a child, criminologists together with the assistance of social workers and school teachers should continuously educate children concerning ways on how they can protect themselves from abusive parents including issues related to perverse mothers. By teaching the victims of sexually and physically abusive parents on how they can report such cases to the authorities, the number of victimization caused by perverse women is more likely to decrease over time (Hhetherton 1999).

Barnett (2006) and Motz (2001) , as noted previously, suggest that the factors which can trigger female perversion include hormonal imbalances causing mental illness, the early exposure to maternal abuse and neglect, alcoholism, the use of illegal drugs, and stress related to socio-economic problems (Barnett 2006; Motz 2001). For this reasons, the kind of punishment imposed on women who are convicted of murdering their children varies on case to case basis. Wilczynski (1997) notes that unlike men, the universal characteristic of ideal women is passive by nature. Since the public’s perception of women is characterized by femininity, there is a lesser chance wherein perverse women and mothers will be accused of inflicting physical and emotional harm on their children. This is one of the main reasons why it has been a common legal practice in the United Kingdom that women who are found guilty of killing their own children are most likely to receive lesser punishment as compared to men (Wilczynski 1997). Up to the present time, there is on-going situation wherein perverse women and mothers are sexually abusing both male and female children. Since the cases of female perpetrators are often left unreported and considered by society as rare, there is a risk that the number of perverse female and mothers who are on the loose will continuously abuse children either sexually or physically (Peter 2008).

The legal system in the United Kingdom strongly recognizes the possible link between maternal mental illness with maternal infanticide and child homicide. Since there are cases wherein perverse mothers and young women who are convicted of murdering their children are using insanity as a defence for murder or child abuse, criminologists in UK should be able to learn more ways on how they can improve their ability to differentiate perverse mothers from those mothers who are suffering from mental illnesses caused by postpartum. By psychiatrists to strengthen their ability to detect postpartum-related mental disorder and psychosis, there is a higher chance wherein the accused perverse mothers will be able to receive proper medical treatment and free themselves from the punishment of life-time imprisonment.

As Raitt and Zeedyk (2004) suggest there is a very thin line that separates innocent women from perverse women who are guilty of murdering or physically harming their own children. Considering the fact that idealization of motherhood can enable perverse women and mothers who has just given birth to a baby to mislead the authorities by acting similar to mothers with postpartum mental disorders, criminologists should take it as a challenge to focus on determining the truth by gathering concrete evidences that will prove whether or not perverse women or perverse mothers are guilty of a crime. To prevent false accusations or wrong judgment, it is important on the part of criminologists to make use of medication intervention such as autopsy in order to determine whether the death of an infant was intention or merely caused by unexplainable infant death syndrome (Raitt and Zeedyk 2004).

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