Category: Free Essays

Weizhi You (Peter)

Alternative care placement for BD

Workplace: hoani waititi social services

1 Outline the information and issues relevant to the decisions about the alternative placement for this individual.

BD is a 13years old boy. The boy’s parent are both not working and they are drug and drunk everyday. The boy couldn’t receive the good care from the family, not enough food, always wear on dirty clothes. He’s suffered from abuse in verbal and physical. The grandparents called the social services for some help because they are old and could not look after BD, and they would like BD to be placed in foster care. After discuss with grandparents, the social workers decide to remove BD from the parents care to another family which is full of love and willing to look after DB. The social worker concerned the parents of DB and told them that their children will leave them until they change them self and find themselves.

2 What other information did you need to obtain?

Safety: The person is safe from any kind of harm that comes from themselves, or any other person. Make sure he won’t be abused in foster care. Check if he is at risk of running away from foster are.

Wellbeing: We need to check the boy’s health situation and the psychology health situations.

The person’s wellbeing is looked after – for Maori people wellbeing should be considered in the holistic sense. We need concerned the family members and have a family meeting to discuss about it.

Arrange the visit for grandparents.

3 Key points of information provided to the parties involved or other observations

The boy is so silent and don’t want to talk with others and hide on the back of grandparents. So we spend the tie with BD and build the trust.

The grandparents have pain legs and sore back who need take medications every day and no family members can take BD, so foster family is necessary.

4 Outline how decision making was facilitated in accordance with the service provider’s standard

Gain information that is relevant to the decision making process. Before an Alternative Placement happens, the families including SW, BD, BD’ parents and BD’ grandparents may meet several times to discuss and share relevant information, issues and needs of the client for their safety and wellbeing.

The safety and wellbeing of BD is the subject of an alternative care placement is the first consideration

Social workers use verbal and non-verbal communications to obtain information relevant to decision making

Obtaining sufficient information to facilitate decision making about the alternative care placement includes all information and issues relevant to all parties involved in the decision about the alternative care placement

Keep the information confidential, and get family consent to discuss family concerns with outside agencies e.g drug agency.

5 other notes which reflect on the decision making process

The boy and the whanau will have the different preferences for the placement, perhaps related to the ease of access for visiting etc.

Cultural issues are an important consideration for social workers, particularly when dealing with Maori.

Some information may reflect on the decision making process including Health needs, Language, safety, client’s privacy,spiritual needs, Dietary needs, Medication needs, Physical comfort

Task 2

Student name: weizhi you(peter)

Alternative care placement for BD

Workplace: hoani waititi social services

1 Outline any further or additional information or issues relevant to the decisions about the alternative placement for this individual.

DB is more shy and silent at first week, but with the help of social workers and new families, he becomes improved both in physical and psychology health. For the spiritual support, the social worker bring him to the marae to join in maori activities and practice maori culture. DB made friend with them and develop his social network. But from the feedback of school, he is not focus on study and seldom do the homework.

BD will go to the same school so he won’t need to involved at another school. He always walk to school.

BD is happy to live in the foster family, the risk of running away is low.

2How did you plan the placement in line with the decisions of the parties involved and any other key people?

The social workers keep contact with family members involved. They keep contact with the fostr family and BD, gain feedbacks and make plan to help BD get used in the new family. They also contact with BD’s parents and grandparents. Helping BD’s parents stop drug and find a job to earn some money. They have a talk with the school and the teacher of BD then the school decide to spend extra hours to help BD study.

3 how did you plan the placement in line with ethical practice?

Followed agency’s policies/protocols.

Ethical practice, the ethics of social work practice also need to apply to decisions about alternative care placements. For example, it will be unethical to tell the person’s family the only place available was one a long distance away, because it had a vacancy and social worker can end their involvement quickly and move on to another case. A place was found nearly to garandparents’s home and easy to visit, families kept informed at all times of all the decision making.

4 how did you make sure that everything you did was focused on the current and future safety of the person who needed the alternative care placement?

BD need to moved from home because he couldn’t receive the properly care from parents which is bad for his well beings. The social worker together with relevant people needs to determine the best alternative care placement for BD, with the safety and wellbeing of the person as the first consideration.

5 key points of information provided or other obeservations

The parents of BD have agree to receive the help from the community and local organizations to stop drug.

BD is happy living in the foster home.

6 outline how planning was facilitated in accordance with the service provider’s standards. Give examples

Followed agency’s policies.

Family Group Conference (FGC) lead by Youth Justice Co-ordinator and Social Work.

Family group conference (FGC) supported CYF care as an interim measure.

completion of checklists: all the paper should be done and checked, it need to be sign by social worker, care provider and families.

security of information: make sure that all the information through inside the person who is involved.

Confidentiality and keeping accurate records of conversations or meetings

Social workers acknowledging the needs and issues of parties to the alternative care placement, use the interpersonal skills to work with the different parties and make sure everything goes on line.

7other notes reflect on the planning process

Home environment: low risk – high risk safety issues. Always consider person’s safety and well being first.

Family visit provide spiritual support.

Task 3

Student name: weizhi you(peter)

Alternative care placement for BD

Workplace: hoani waititi social services

1how did you encourage self-determination of the person who is the subject of the alternative care placement?

To encourage self-determination means encouraging families members to the plan to fulfil their identified roles, and to take ownership of these roles. Dependency on the social worker or social service provider needs to be discouraged. Encourage grandparents to visit. Provide BD’s parents 2or 3 councilling agencies to choose to solve their problems.

Outlined agency’s objectives and appropriate legislation, backing up agencies mandate/kaupapa.

Fully informed BD and whA?nau/family of the parameters and scope of the meeting, and allowed them to define the best options. Informed all the decision making at all times before it satarts.

Where possible I (agency) worked collaboratively with the family to find a middle ground where agency mandate and whA?nau choices weren’t aligned.

2how did you discourage dependency on you as the social worker and the social service provider?

Gave space (and resourced where necessary) so the whA?nau/family could define their own possible solutions. Give them 2to3 useful local agencies and let BD’s parents choose the way to help themselves.

Where possible the agency would step aside, so the family/whA?nau could step up.

3how did you assist key people in the implementation of the plan to identify progress?

I will provide key people with a care-plan that included key indicators of progress, such as attending school regularly, keeping curfew, behavioural contract etc and informed all decision making at all times.

4how did you assist parties to the plan to review the plan? What if any further options were identified? If the plan was amended, how was it amended?

Regular meetings to review progress were held between social service provider,BD , whA?nau and care giver(s). to check the which task has been achived so far and what to improve.

When implementation of the plan is complete, the plan (in its entirety) needs to be reviewed. In some cases the review will result in further options being identified. The review may also determine some different outcomes in terms of achievement of objectives and these also need to be recorded in the plan

5 key points of information provided or other observations

Parents have enrolled the drug councilling center

6outline the implementation was in accordance with the service provider’s standards

Cultural practices were followed eg a karakia/blessing was arranged for BD when he arrived at the home.

The checking in processes was completed fully, including areas such as health and safety, and rules for behaviour etc were explained to BD.

7other notes reflect on the implementation process

His study in school have a big improve under the help of teacher.

Task 4

Student name: weizhi you(peter)

Alternative care placement for BD

Workplace: hoani waititi social services

1how you know you had completed your required tasks or involvement in the plan?

DB is now in foster care family and the parents were enrolled in drug councilling. BD attend the school regular and make new friends. When the implementation of the alternative care placement is complete, it is time for the social worker to complete their involvement in the plan. Always first consider the safety and wellbeing of the person who is the subject of the alternative care placement.

2what possible future involvement might be required from the social service provider in this case? Think about factors that may lead to further contact being needed, what functions or services a social service provider might offer the person in the future, and how the person could go about re-establishing contact with social service provider

The parents may need parenting program to help them learn how to take care of BD. If the parents could not stop drug and abuse on BD, in this situation, BD have to move to another home. The social workers will provide many suggestions and some useful organizations for them. If they need services in the future, they can ring the organizations again.

3notesor key points of information received or other obeservatons made

Social worker’s tasks were clearly finished on the care plan, and the plan was updated to show they were completed.

Transition from home to residential care completed.

4outline how the closure was in accordance with the service provider’s standards

Review the items that were part of your role or responsibility in the plan. Check you have completed them all, and completed all related documentation etc.

Consult with the other parties to the plan. Check that they consider you have completed your responsibilities, or whether there is something else they were expecting you to do.

Handover meeting with host home family, BD and whA?nau.

5outline how you made sure information was kept confidential

Followed agency privacy policy. For example, consent from whA?nau to share information with alternative education provider was received.

6provide two examples of how your actions were in accordance with relevant legislation. Name the legislation in the example.

Privacy Act – I (agency) only kept information that was necessary for the purpose of facilitating BD’s placement in the host home.

CYPF Act – both BD and whA?nau were kept informed of decisions made, and wherever possible involved in the decision making process.

7other notes reflect on the closure process

All parties updated and keep contacting with them.

Provider policy followed, case file checked and updated, renew the information and regular check visit BD.

Task5

How tiriti o Waitangi in social services? Give 3 examples how your actions on placement were guided by the tiriti.

There are four principles in the Te Tiriti o Waitangi to ensure that maori’s rights were covered including partnership, protection, participation and permission.

A partnership in good faith between two Maori and Crown, for that principle, when engaging with Maori or creating policy that could affect Maori, the Social Service organisations ensure needs of Maori are prioritised. In order to make ensure Maori have rangatiratanga rights over their taonga, always consultation with Maori leadership and management when organisational policies are being discussed. Te Tiriti o Waitangi applies in social services including ensure that all social services have a bi-cultural perspective. For example, we respect our maori client, maori way to deal with things, our maori workmates and client’s families, keep good relationship with them.

Protection: for that principle, it allowed maori to exercise their Tino Rangatiratanga (absolute sovereignty) over all of their taonga(land), and benefit from these. Taonga in Maori language means land, resources, language, knowledge, and other aspects of the Maori way of life. Maori have the rights to enjoy their taonga in social service settings, and social service organisations must respect their way of life. It protect Maori’s rights to make choices that best serve their culture, that line with tika and kawa, suit their traditions and practices customary. For example, we working in the maori marae, we follow their traditional cultures and their process in the marae, we are not allowed to bring the food into marae and turn off the phone, no noisy when join the formal welcome.

Participation: it ensure that maori take part in the social counseling and have the equal rights with crown. Consultation at all levels with Maori. It must be service accessibility for MA?ori. Allowed Maori choose their models of health i.e (Te Whare Tapa Wha) rather than western models when working with MA?ori. So when we working with maori, we should knowing their needs and their culture respect, provide their prefer ways to help them.

Task6

How your actions throughout the process of contributing to the facilitation? At least 3 examples and include your inflections from your activities in this assessment all linked to theory for social service practice.

respect my client, always ask their permission, I always collect the family agreement before the action and listen to my client, respect their choices and their maori way to do things. And I respect their culture, when enter Maura, I will follow their traditional approach and customs.

Gain information that is relevant to the decision making process. Before an Alternative Placement happens, the families including SW, BD, BD’ parents and BD’ grandparents may meet several times to discuss and share relevant information, issues and needs of the client for their safety and wellbeing.

We keep contact with family members involved. Keeping contact with the fostr family and BD, gain feedbacks and make plan to help BD get used in the new family. Contacting with BD’s parents and grandparents. Helping BD’s parents stop drug and find a job to earn some money.

Weizhi you 13010121[e”®a…??-‡a­-] 1

Abuse can be defined as “to treat wrongfully or harmfully”. There are different categories of abuse that have been recognized and within our case study there appears to be two distinct forms of abuse, domestic abuse and child abuse. These can be sub divided into terms of physical abuse, emotional /psychological abuse, and non-organic failure to thrive. Physical abuse is the intentional inflicting of physical injury or harm or deliberately not preventing harm occurring.

The minimum physical signs seen in our study to both Mrs Black and James are bruising with suspect excuses for their appearance. Emotional abuse is the continual failure to meet basic emotional needs. Emotional development is stunted and well- being impaired. The emotional signs in our case study can be seen in James by his actions of being withdrawn and non-communicative. The behavioural sign to abuse taking place to James is his aggressive behaviour.

The short term effects of physical abuse to James are bruising and pain. In the long term recurring injuries can result in secondary illness and complications, permanent scarring and disfigurement. His emotional effects in the short term are a fear of adults or others, withdrawal, poor relationship with his peers. The long term emotional effects for James could be low self esteem, depression, inability to form relationships.

Abuse can arise for many reasons and there are a number of theoretical perspectives which may be useful in clarifying why the abuse has taken place. The Feminist perspective believes that gender and family roles gives approval to a culture of abuse. Consider the historical and stereotypical ideas of the family, with men, women and children having definite roles. With the men having power and control in the perspective of abuse. In James case he lives in a reconstituted family with the father figure being dominant and a heavy drinker. From a psychological perspective, alcohol misuse can bring mental health problems which may increase aggression in the person and so James is more at risk from abuse by his step father. The family dysfunction theory suggests that the family is not functioning due to family dynamics. The dysfunctioning family attempts to find alternative ways of coping. The relationship between the mother and James, involves a dependency of James on his mother. With other problems in James mothers life, this leads to increasing stress and the inability of his mother to cope and manage the situation within the relationship. The attachment theory state that significant separations of a child from the carer in the early years can have an effect on their emotional development and can lead to psychological and social difficulties in later life. With the loss of both his father and his sisters` father with whom he was close, may have contributed to his deterioration of his behaviour

If a client begins to make a disclosure of abuse it is important to ensure privacy and confidentiality. It is necessary to show that listening skills are employed and that I remain calm and receptive. I must listen without interruption and make it clear that I am taking their disclosure seriously. I must only ask questions of clarification if I am unclear as to what the vulnerable adult is saying. It is important that I acknowledge their courage in coming forward and tell them that they are not responsible for the abuse. I must let it be known to them what I will do to help them and where possible get their consent to inform my line manager. I must speak to my client in comfortable and quiet surroundings. I would ask my client to sit down where I shall use SOLER techniques to aid in communication. Using the SOLER theory I would use the five basic components used in communication. I would sit squarely on at the table turned towards one another. I would adopt an open posture. I would sit so that we have regular but varied eye contact and that my client could see my facial expressions and gestures to aid in communication. This would also let him know that I am involved in the situation. I would lean forward slightly to convey to him that I am interested and committed to actively listen to him. This adhered to our organizations policy on Confidentiality and the Data Protection Act of 1998 allowing my client to voice his concerns without worry and protected his privacy. I would inform him that they are not responsible for the abuse. I must let it be known to him what I will do to help him and where possible get his consent to inform my line manager. It is important that I make an immediate record of what the vulnerable adult has said, using only their own words. This should be recorded in the Incident Book, clearly, accurately and legibly, and then reported to the Line Manager who is responsible for any further action.

As we do not supply a care service, we are not required to register with the Care Commission, but we ensure all our policies and procedures meet their standards. As all clients under these standards are legally allowed an individualized care plan, we instead have an activity plan. The policy and procedures on abuse of our organisation are underpinned by the National Care Standards which were set up under the Regulation of Care (Scotland) Act 2001. This Act came about to regulate the care and social work force and set out the principals of good care practice. The Care Commission was set up under this Act to register, regulate and inspect all care services listed in the Act. It also established The Scottish Social Services Council (SSSC). (ref1)The SSSC has aims and objectives to protect the service users, raise standards, strengthen and support workforce professionalism. An example of the code of practice on abuse, of the SSSC is `to protect the rights and promote the interests of the service users and carers. Strive to establish and maintain trust and confidence of service users and carers. Promote the independence of service users while protecting them as far as possible from danger or harm. Respect the rights of service users and ensure that their behaviour does not harm themselves or others.` The policy for protecting vulnerable people within our organisation is achieved through the careful selection, screening, training and supervision of staff and volunteers. Under The Protection of Vulnerable Groups (Scotland) Act 2007 a code of good practice for vulnerable adults within our organisation has been developed which expects staff or volunteers suspecting or have had abuse disclosed must immediately report the concerns to their line manager and write up an incident report. The line manager will discuss the concerns with the person reporting the abuse; she will clarify the concerns and obtain all known relevant information. This will then be forwarded to the appropriate local Social Work Department stating that it concerns vulnerable adult protection. In the absence of a line manager the concerns should be reported directly to the local Social work department and then inform the line manager as soon as possible. The social work department after investigation may have to inform the police to investigate further.(ref2)” the primary role of Registered Social Workers is the protection and promotion of the welfare of children, vulnerable adults and the promotion of the welfare of communities in accordance with the Scottish Social Services Council’s Code of Practice for Social Service Workers.” (ref3)”The social work department will work with the police to carry out joint enquires if necessary and organise case reviews and protection conferences. The police will keep safe from harm the individual who has been subjected to abuse and may call for a medical examination. They will examine and collect evidence, interview suspects, identify offenders and arrange cases for prosecution.” The GP or hospital Doctor maybe involved giving medical evidence of abuse and treating the individual.

Under our code of good practice in preventing abuse it is important that I avoid unobserved situations of one -to-one contact with a vulnerable adult. I must never invite a vulnerable adult to my home; I must never offer to take a vulnerable adult alone in my own vehicle, if it is necessary to do things of a “personal “nature e.g. toileting, I must have the consent and knowledge of the carers and my line manager, before doing any of the above. I must not engage or allow any sexually provocative games involving or observed by vulnerable adults. I must never make or allow suggestive remarks or discrimatory comments to be made to a vulnerable adult. I must not engage in or tolerate bullying, or inappropriate physical behaviour. I must respect all vulnerable adults regardless of age, gender, ethnicity, disability or sexual identity. I must avoid “favouritism” and singling out “troublemakers”. I must never trivialise abuse and never let allegations of abuse go unreported, including any made against myself. The policy and procedures of our organisation adhere to the Protection of Vulnerable Groups Act (Scotland) 2007 by ensuring as a way of vetting and barring every volunteer and employee has undergone a Disclosure which shows any convictions. If any convictions suggest that abuse of our clients is a possibility then they would not be allowed to volunteer or be employed.

Sources of support for workers in the field of preventing abuse can be provided by statutory, voluntary, and private or independent organisations. Statutory services have a distinct concern laid down by legislation e.g. social services and NHS. The voluntary sector is run on a non profit making basis and have arisen through a recognised need and reflect society`s feelings. E.g. Advocacy, Mencap. Private organisations make a profit but I am not aware of any private local organisation that supports vulnerable adults suffering abuse. Support can consist of Casework, by working on a one to one basis, by counselling again one to one, and by group work bring people together with shared issues to resolve problems together.

(Ref4) Cultural values play a part in defining what is considered abusive conduct .What we in the UK consider abuse may not be considered abuse in another culture. For example, domestic abuse has only recently become abhorrent in the UK. As up until the 1970s/80s, domestic abuse was considered a marital problem and to be accepted, but today we have little tolerance for domestic abuse. But, today, ethnic minority women still run the risk of long periods of abuse and find it difficult to report, families expect women to put up with it, as ethnic women are considered their husbands property. ‘Honour killings` are not unknown amongst ethnic minorities using religious text as justification. (Ref5)Female circumcision is another culturally accepted form of abuse, still practised in 28 countries in Africa. It is seen to control female sexuality and sex outside marriage. This is done to girl’s age range from 4 to 12. It usually takes place in un- hygienic conditions with potentially fatal consequences.

Sometimes, workers may have trouble accepting the motives of people who are involved in abuse. There may be the need to ask why and how can they have abused? Where they just bad or mad? Perhaps the workers values and beliefs make working with an abuser distasteful. However, a professional approach to working with an abuser must be taken. For those who work with abusers there is a need to understand why people abuse.

Abusive behaviour can sometimes be the result of mental health problems, empathy deficit, brain damage or being abused themselves. By becoming the abuser they believe they are taking control, some even believe that they are not doing anything wrong and cannot stop themselves. When working with individuals who have abused it is important to be aware that they may go on to abuse again and as well as trying to treat the underlying cause for abuse their is a need to protect the community from the abuser. So, the use of risk assessments are important to keep safe when working with an abuser. ( Ref7) It is important to be able to understand probable risks and take appropriate action to reduce them. Effective communication and personal skills are useful to understand and reduce potential conflicts. Reflection on my own values and how they may affect my practice and awareness and understanding of the abusers cultural values and background is required to ensure awareness and intervention is employed when required.

References.
SSSC. (2009). Codes of Practice. Available: http://www.arcuk.org.uk/silo/files/791.pdf. Last accessed 09/02/2010.
Stephen Smellie. (2005). Role of the Social Worker: Protection of Title. Available: http://www.unison-scotland.org.uk/response/swrole2.html. Last accessed 09/02/2010
Elizabeth Bingham +. (2009). Protection including safeguarding and management of risk.. In: HNC in Social Care. Edinburgh: Heinemann. 229.
Mary Barnish. (2004). Domestic Violence: A Literature Review. Available: http://www.domestic-violence-and-abuse.co.uk/information/Cultural-Differences-in-the-UK.php. Last accessed 13/02/2010.
Frances A. Althaus . (1997). Female Circumcision: Rite of Passage or Violation of Rights? Available: http://www.guttmacher.org/pubs/journals/2313097.html. Last accessed 13/02/2010.
Kathryn Patricelli. (2005). Why do people abuse?. Available: http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=8482. Last accessed 13/02/2010.
Elizabeth Bingham +. (2009). Issues involved in protection from abuse. In: HNC in Social Care. Edinburgh: Heinemann. 217.

In 1992 the Department of Health (DH) and the then, Social Services Inspectorate, in England, published the findings of a survey of two social services Departments in relation to abuse. This publication found there to be a lack of assessments in large numbers of ‘elder abuse’ cases and little evidence of inter-agency cooperation. The report recommended guidelines to assist social services in their work with older people (DH/SSI 1992).

During the 1990’s concerns had been raised throughout the UK regarding the abuse of vulnerable adults. The social services inspectorate published Confronting elder abuse (SSI 1992) and following this, practice guidelines No longer afraid (SSI 1993). ‘No longer afraid’ provided practice guidelines for responding to, what was acknowledged at that time, as ‘elder abuse’. It was aimed at professionals in England, Wales and Northern Ireland and emphasised clear expectations that policies should be multi-agency and also include ownership and operational responsibilities (Bennett et al 1997).

This guidance was issued under section 7 of the Local Authority Social Services Act 1970 and gives local authority Social Service departments a co-ordinating role in the development and implementation of local vulnerable adult policies and procedures.

In 2000, the department of Health published the guidance No Secrets. The purpose of No Secrets was aimed primarily at local authority social services departments, but also gave the local authority the lead in co-ordinating other agencies i.e. police, NHS, housing providers (DOH 2000).

The guidance does not have the full force of statute, but should be complied with unless local circumstances indicate exceptional reasons which justify a variation (No Secrets, 2000)

The aim of No Secrets was to provide a coherent framework for all responsible organisations to devise a clear policy for the protection of vulnerable adults at risk of abuse and to provide appropriate responses to concerns, anxieties and complaints of abuse /neglect (DOH 2000).

Scotland Historical

In December 2001, the Scottish Executive published Vulnerable Adults: Consultation Paper (2001 consultation) (Scottish Executive, 2001). This sought views on the extension of the vulnerable adult’s provisions to groups other than persons with mental disorder and the possible introduction of provisions to exclude persons living with a vulnerable adult, where the adult’s health is at risk.

A joint inquiry was conducted by the Social Work Services Inspectorate and the Mental Welfare Commission for Scotland. Both of these agencies were linked with the central government of Scotland who had responsibility for the oversight of social work services and care and treatment for persons with mental health problems.

In the report by the Scottish Executive (2004), a case of a woman who was admitted to a general hospital with multiple injuries from physical and sexual assault and who had a learning disability became the focus for change for Scotland in terms of adults who have been abused. The police investigation identified a catalogue of abuse and assaults ranging back weeks and possibly longer.

In June 2003 the Minister for Education and Young People, Peter Peacock MSP, asked the Social Work Services Inspectorate (SWSI) to carry out an inspection of the social work services provided to people with learning disabilities by Scottish Borders Council. At the same time, the Mental Welfare Commission for Scotland (MWC) also undertook an inquiry into the involvement of health services, though worked closely with SWSI during its inquiry. The two bodies produced separate reports, but also published a joint statement (MWC and SWSI, 2004), which summarised their findings and stated their recommendations. The findings included:

aˆ? a failure to investigate appropriately very serious allegations of abuse

aˆ? a lack of information-sharing and co-ordination within and between key agencies (social work, health, education, housing, police)

aˆ? a lack of risk assessment and failure to consider allegations of sexual abuse

a lack of understanding of the legislative framework for intervention and its capacity to provide protection

aˆ? a failure to consider statutory intervention at appropriate stages

The Adult Support and Protection (Scotland) Act 2007 (ASPA) is a result of the events that were known as the Scottish Borders Enquiry.

Following the various police investigations, it was identified that there were historical links between the client and the offenders who were later prosecuted in terms of statements held by social services department detailing the offender’s behaviour towards the woman and that this information was held on file.

The Scottish Executive (2004) described the case as “extremely disturbing but even more shocking to many that so many concerns about this woman had been made known and not acted on”. As a consequence, 42 recommendations from the inquiry were made and there was a specific recommendation which was taken to the Scottish Executive and involved the provision of comprehensive adult protection legislation as a matter of urgency as there had been concerns raised from political groups and high profile enquiries to provide statute for the protection of adults at risk of abuse in Scotland (Mackay 2008).

The Scottish framework links with three pieces of legislation. In 2000, the Adults with Incapacity (Scotland) Act [AWISA 2000] was passed and focused on protecting those without capacity with financial and welfare interventions for those unable to make a decisions.

Second, the Mental Health (Care and Treatment) (Scotland) Act (2003) [MHSA (2003)] modernised the way in which care and treatment could be delivered both in hospital and the community and improved patients’ rights.

Finally, the Adult Support and Protection (Scotland) Act (2007) [ASPSA (2007)] widened the range of community care service user groups who could be subject to assessment, and mainly short-term intervention, if they were deemed to be adults at risk of harm.

Mackay (2008) argues that the Scottish arrangements both mirror and differ from those of England and Wales. She maps out the intervention powers for adults at ‘risk of harm’ into a type of hierarchical structure known as a ‘pyramid of intervention’ which aims to reflect the framework of the various pieces of Scottish legislation and goes onto say that the principle underlying all of the legislation is “minimum intervention to achieve the desired outcome”.

Critique of definitions.

In England, the No Secrets (2000) guidance defines a vulnerable adult as ‘a person aged 18 or over’ and ‘who is or may be in need of community care services by reason of mental or other disability, age or illness; and who is or may be unable to take care of him or herself, or unable to protect him or herself against significant harm or exploitation’ (DOH 2000 Section 2.3)

The groups of adults targeted by ‘No Secrets’ were those “who is or may be eligible for community care services”. And within that group, those who “were unable to protect themselves from significant harm” were referred to as “vulnerable adults”. Whilst the phrase “vulnerable adults” names the high prevalence of abuse experienced by the group, there is a ‘recognition that this definition is contentious.’ ADSS (2005).

The definition of a vulnerable adult referred to in the 1997 consultation paper “Who Decides” issued by the Lord Chancellors Department is a person: “who is, or may be in need of Community Care Services by reason of mental or other disability, age or illness: and who Is, or may be unable to take care of him or herself, or unable to protect him or herself against significant harm or exploitation” (Law Commission Report

231, 1995)

There are however broader definitions of vulnerability which are used in different guidance and in the more recent Crime and Disorder Act (1998) it refers to ‘vulnerable sections of the community and embraces ethnic minority communities and people rendered vulnerable by social exclusion and poverty’ rather than service led definitions.

There is concern, however, that the current England framework is more restricted than it should be, and that the problem is one of definition.

The House of Commons Health Committee, says that No secrets should not be confined to ‘people requiring community care services’, and that it should ‘also apply to old people living in their own homes without professional support and anyone who can take care of themselves’ (House of Commons Health Committee, 2007).

Even within the ADASS National Framework (2005) it has been argued that ‘vulnerability’ “seems to locate the cause of abuse with the victim, rather than placing responsibility with the acts or omissions of others” (ADASS, 2005)

The Law Commission speaks favourably of the Safeguarding Vulnerable Groups Act 2006, which, it says, understands vulnerability “purely through the situation an adult is placed [in]” (Law Commission, 2008). It is now becoming questionable whether the term ‘vulnerable’ be replaced with the term ‘at risk’.

If we were to look at the current legislation in England surrounding the investigations of abuse to adults, there are none, however there are underpinning pieces of legislation which whilst not in its entirety focus specifically on the adult abuse remit, but can be drawn upon to protect those most vulnerable. There are many duties underpinning investigations of adult abuse, but no specific legislation.

The NHS and Community Care Act 1990, section 47 assessments can be implemented in order to consider an adults need for services and can therefore consider any risk factors present at the time of the assessment. From this, assessment and commissioned services can support people who have been abused or can prevent abuse from occurring.

The National Assistance Act (1948) deals with the welfare of people with disabilities and states that the: ‘local authority shall make arrangements for promoting the welfare of person who…suffers from a mental disorder……who are substantially and permanently handicapped by illness, injury or congenital deformity or other disabilities’ and gives power to provide services arising out of an investigation out of the NHS & Community care Act 1990. (Mantell 2009).

The Fair Access to Care Services 2003 (FACS) recognises that community care services will be a vital aspect of adult protection work (Spencer- Lane, 2010). Interestingly the eligibility criteria that superseded Fair Access to Care from April 2010 (‘Prioritising Need in the context of Putting People First: A whole systems approach to eligibility for Social Care’), continues to place adults who are experiencing, or at risk of experiencing abuse or neglect, in Critical and substantial needs criteria banding, as FACS did.

Another definition of a vulnerable adult is cited within The Safeguarding Vulnerable Groups Act (2006), (SVG Act 2006), and defines a vulnerable adult as:

A person is a vulnerable adult if he has attained the age of 18 and:

(a)he is in residential accommodation,

(b)he is in sheltered housing,

(c)he receives domiciliary care,

(d)he receives any form of health care,

(e)he is detained in lawful custody,

(f)he is by virtue of an order of a court under supervision by a person exercising functions for the purposes of Part 1 of the Criminal Justice and Court Services Act 2000 (c. 43),

(g)he receives a welfare service of a prescribed description,

(h)he receives any service or participates in any activity provided specifically for persons who fall within subsection (9),

(i)payments are made to him (or to another on his behalf) in pursuance of arrangements under section 57 of the Health and Social Care Act 2001 (c. 15), or

(j)he requires assistance in the conduct of his own affairs.

This particular act appears to take an alternative approach to the term ‘vulnerability.’ It refers to places where a person is placed and is situational. (Law Commission, 2008).

Following the consultation of No Secrets, one of the key findings of the consultation was the role that the National Health Service played in relation to Safeguarding Vulnerable adults and their systems. The Department of Health produced a document titled ‘Clinical Governance and Adult Safeguarding- An Integrated Process’ (DOH 2010). The aim of the guidance is to encourage organisations to develop processes and systems which focused on complaints, healthcare incidents and how these aspects fall within the remit of Safeguarding processes and to empower reporting of such as it identified that clinical governance systems did not formally recognise the need to ‘work in collaboration with Local Authorities when concerns arise during healthcare delivery.’ The definition of who is ‘vulnerable’ in this NHS guidance, refers to the Safeguarding Vulnerable Groups Act (2006) and states that ‘any adult receiving any form of healthcare is vulnerable’ and that there is ‘no formal definition of vulnerability within health care’ but those receiving healthcare ‘may be at greater risk from harm than others’ (DOH 2010).

In the Care Standards Act 2000 it describes a “Vulnerable adult” as:

(a) an adult to whom accommodation and nursing or personal care are provided in a care home;

(b) an adult to whom personal care is provided in their own home under arrangements made by a domiciliary care agency; or

(c) an adult to whom prescribed services are provided by an independent hospital, independent clinic, independent medical agency or National Health Service body.

Similar to the Safeguarding Vulnerable Groups Act, the Care Standards Act 2000 classifies the term ‘vulnerable adult’ as situational and circumstantial rather than specific and relevant to a person’s individual circumstance.

Spencer-Lane (2010) says that these definitions of vulnerability in England have been the subject of increasing criticism. He states that the location of the cause of the abuse rests with the ‘victim’ rather than the acts of others; that vulnerability is an inherent characteristic of the person and that no recognition is given that it might be contextual, by setting or place that makes the person vulnerable.

Interestingly Spencer -Lane (2010) prefers the concept of ‘adults at risk’. He goes on to suggest a new definition that ‘adults at risk’ are based on two approaches as the Law Commission feel that the term vulnerable adults should be replaced by adults at risk to reflect these two concerns:

To reflect the person’s social care needs rather than the receipt of services or a particular diagnosis

What the person is at risk from – whether or not the term significant harm should be used – but would include ill treatment or the impairment of health or development or unlawful conduct which would include financial abuse

Spencer-Lane (2010) also argues that with the two approaches above, concerns remain regarding the term ‘significant harm’ as he feels the threshold for this type of risk is too high and whether the term in its entirety ‘at risk of harm’ be used whilst encompassing the following examples: ill treatment; impairment of health or development; unlawful conduct.

Unlike in Scotland, there are no specific statutory provisions for adult protection; the legal framework is provided through a combination of the common law, local authority guidance and general statute law (Spencer-Lane 2010).

Whereby in England the term ‘vulnerable adult’ is used, in Scotland the term in the Adult Support and Protection (Scotland) Act 2007 uses the term ‘adults at risk’. This term was derived by the Scottish Executive following their 2005 consultation were respondents criticised the word ‘vulnerable’ as they believed it focussed on a person disability rather than their abilities, hence the Scottish executive adopted the term ‘at risk’ (Payne, 2006).

Martin (2007) questions the definition of vulnerability and highlights how the vulnerability focus in England leaves the deficit with the adult, as opposed to their environment. She uses the parallel argument to that idea of ‘disabling environments’, rather than the disabled person, within the social model of disability. She goes on to comment that processes within society can create ‘vulnerability’. People, referred to as vulnerable adults, may well be in need of community care services to enjoy independence, but what makes people vulnerable is that way in which they are treated by society and those who support them. It could be argues that vulnerability and defining a person as vulnerable could be construed as being oppressive.

This act states that an ‘adult at risk’ is unable to safeguard their own well-being, property, rights or other interests; at risk of harm and more vulnerable because they have a disability, mental disorder, illness or physical or mental infirmity. It also details that the act applies to those over 16 years of age, where in England the term vulnerable adult is defined for those over the age of 18 and for the requirement under the statute is that all of the three elements are met for a person to be deemed ‘at risk’.

ADASS too supports the use of ‘risk’ as the basis of adult protection, although its definition differs from the one used in Scotland. It states that an adult at risk is one “who is or may be eligible for community care services” and whose independence and wellbeing are at risk due to abuse or neglect (ADASS, 2005)

The ASPSA (2007) act

The Scottish Code of Practice states that ‘no category of harm is excluded simply because it is not explicitly listed. In general terms, behaviours that constitute “harm” to others can be physical (including neglect), emotional, financial, sexual or a combination of these. Also, what constitutes serious harm will be different for different persons’. (Scottish Government, 2008a p13).

In defining what constitutes significant harm, No Secret’s (2000) uses the definition of significant harm in who decides? No Secrets defines significant harm as:-

‘harm should be taken to include not only ill treatment (including sexual abuse and forms of ill treatment which are not physical), but also the impairment of, or an unavoidable deterioration in, physical or mental health; and the impairment of physical, intellectual, emotional, social or behavioural developments’ (No Secrets, 2000.

The ASPA (2007) act also goes onto detail that “any intervention in an individual’s affairs should provide benefit to the individual, and should be the least restrictive option of those that are available” thus providing a safety net on the principles of the act (ASPA, 2007).

The Adult Support and Protection (Scotland) Act 2007 says:

“harm” includes all harmful conduct and, in particular, includes:

conduct which causes physical harm;

conduct which causes psychological harm (e.g. by causing fear, alarm or distress)

unlawful conduct which appropriates or adversely affects property, rights or interests (e.g. theft, fraud, embezzlement or extortion)

conduct which causes self-harm

N.B – “conduct” includes neglect and other failures to act, which includes actions which are not planned or deliberate, but have harmful consequences

Interestingly the Mental Capacity Act 2005 (section 44) introduced a new criminal offence of ill treatment and wilful neglect of a person who lacks capacity to make a relevant decision. It does not matter whether the behaviour toward the person was likely to cause or actually caused harm or damage to the victim’s health. Although the Mental Capacity Act mainly relates to adults 16 and over, Section 44 can apply to all age groups including children (Code of Practice Mental Capacity Act 2005).

The Association of Directors of Social Services (ADSS) published a National Framework of Standards to attempt to reduce variation across the country (ADSS 2005). In this document the ADSS 2005 updated this definition above to :-

‘every adult “who is or may be eligible for community care services, facing a risk to their independence” (ADSS 2005 para 1.14).

England and Scotland – differences with policy/legislation
Definition of vulnerability

Three part definition to definition of ‘at risk of harm’

Harm might be caused by another person or the person may be causing the harm themselves

‘no category of harm is excluded simply because it is not explicitly listed. In general terms, behaviours that constitute ‘harm’ to others can be physical (including neglect), emotional, financial, sexual, or a combination of these. Also, what constitutes serious harm will be different for different persons.’

Code of Practice, Scottish Government (2008)

Defining vulnerable: adult safeguarding in England and Wales

Greater level of contestation in defining VA in adults than children.

Doucuments in wales and England are very similar. In safe hands document is greater but both are issued under the provision of section 7.

Whilst they are guidance, there is a statutory footing behind them.

‘No Secrets (DH2000) defines vulnerable in a particular way: Is a person who ‘is or may be in need of community care services by reason of mental or other disability, age or illness; and who is or may be unable to take care of him or herself, or unable to protect him or herself against significant harm or exploitation.’ No Secrets paragraph 2.3 Lord Chancellor’s Department, Who Decides (1995)

The ASP Act introduces new adult protection duties and powers, including:
Councils duty to inquire and investigate
Duty to co-operate
Duty to consider support services such as independent advocacy

Other duties and powers – visits, interviews, examinations

Protection Orders: assessment, removal, banning and temporary banning

Warrants for Entry, Powers of Arrest and Offences
Duty to establish Adult Protection Committees across Scotland
Harm includes all harmful conduct and, in particular, includes:
a) conduct which causes physical harm;
b) conduct which causes psychological harm (for example: by causing fear, alarm or distress);
c) unlawful conduct which appropriates or adversely affects property, rights or interests (for example: theft, fraud; embezzlement or extortion); and
d) conduct which causes self-harm.
An adult is at risk of harm if:
another person’s conduct is causing (or is likely to cause) the adult to be harmed, or
the adult is engaging (or is likely to engage) in conduct which causes (or is likely to cause) self-harm
N.B “conduct” includes neglect and other failures to act (Section 53)

Homelessness is a social problem that relates to the condition of people without a regular private house and shelter. People passing through social issue of homelessness are most often not capable to obtain and preserve standard, harmless, protected, and satisfactory accommodation, or lack “fixed, regular, and adequate night-time residence.” There is no standard definition of homelessness and it differs from region to region, or among different entities or institutions in the same country or region. The scope of homeless is vary vast and it also comprise people whose prime night-time dwelling is in a homeless shelter, a warming center, a domestic violence shelter, cardboard boxes or other informal housing situation. In USA people also are covered under homeless record and are included in research studies who sleep in a public or private place not intended for use as an expected sleeping place for human beings. From different researches it’s predicted that almost 100 million people across globe were homeless in 2005. In western regions and areas of world the large majority of homeless are men (75-80%) (Culhane and Associates, 2012).

History of Homelessness in America:

Homelessness is not a contemporary issue it is predicted that it is found in American society in the early ages of 1640. In early history the homelessness was related to moral issue and obligation and people who were homeless visit town to town to prove their worth but in recent era it is more related to a social problem. People who are homeless are facing severe issue is contemporary world related to health and social initiatives. Homelessness can be caused from several perspectives. From different researches it is depicted that the most common caused behind homelessness are industrialization, wars, natural disasters, racial inequalities, medical problems, character flaws, etc. industrial revolution started in 1820s. This gives rise to migrations of people from rural areas to urban areas that give rise to the main causes of homelessness because of job searches and earn living standard. Violent crimes also started because of this migration and sudden rise in population. The policies at that time also lead to devastating issues relating death and mental illness because of homelessness. The major rise was faced in 1850s when most parents send their young children to remain independent because of rise in cost of living, this give rise to adults’ homelessness. The civil wars also give rise to homelessness in 1890s most people were homeless because of several causes from the civil war destructions. Another most important cause relates back to natural disasters i.e. Earthquake, fires, and Droughts caused in 1920s and 30s. The causes give rise to poverty and thus people lack support to build their houses. The income level drops because of increased population and unemployment which also moved society towards increase rate of homeless people. The financial crisis recently gives rise to more destructive situation that leads towards enhanced homelessness problem. The contemporary homelessness can be seen in surrounding that many children, youth, and old age people are homeless (Culhane, 2008).

Causes of Homelessness:

Different researches are done to find the main causes that lead to homelessness. The causes can be categorized into three areas that are personal, structural, and homeless peoples own causes.

Personal Issues:

There are several personal and social factors that lead to homelessness. The common factors are outlined below:

Individual factors: like drug abuse, character flaws, lacking qualifications, debts, no social support, poor health regarding mental and physical conditions, peer relations of bad company.

Family factors: disputes and family conflicts, physical and sexual abuse while adulthood and family background of homelessness.

Institutional factors: living in foster care, as prisoner, and employed in armed forces.

Structural Issues:

There are several social and economic problems that cause this homelessness. Some common causes are outlined below:

Unemployment

Poverty

Lack of affordability

Policies relating housing

Structure of housing benefits

Wide policy development relating hospitality and criminal issues

Homeless People Views:

The three main reasons identified through reviewing opinions of homeless people about their reasons of leaving home are family and peers pressures to leave them, relationship disputes and violence at home, loss of temporary dwelling (Dr. Lynn et al., 2006).

Problems faced by Homeless People:

There are several risks that are associated with people who are passing through state of homelessness. The problems can be categorized as basic and devastating. The problems are outlined below:

Lacking personal security, silence, and privacy, especially for sleeping

Lacking safekeeping of bedding, clothing and possessions, which may have to be carried at all times

Lacking facilities for hygiene

No place for cleaning and drying clothes

Lacking affordability to acquire, prepare, and store food

No social contacts because of no permanent location or mailing address

Antagonism and lawful authorities against metropolitan poverty.

Compact admittance to health care and dental services.

Little or no access to education.

Increased jeopardy of affliction from violence and abuse.

Common denial or intolerance from other people.

Loss of accustomed relationships and association with the mainstream

Lacking qualification for employment.

Reduced access to banking services because of lacking collateral

Reduced access to communications technology (Echenberg & Jensen, 2009).

Assistance and Resources for Homeless People:

Many researches relating homelessness and homeless people have diverted the attention of government and other institutions to support and fund the needs of the homeless people. Many countries run the assistance programs for the homeless people and provide them with food, shelter, and clothing and sometimes most augmented services. Many non-government organizations also run support programs with help of funding from volunteers. Social support is provided by homeless people to other homeless people. They run their own community and support one another in different needs. Formal assistant is also provided through government, religious organizations, charities, other ministries. Many organizations are working to provide income support through employment opportunities like street newspapers selling. Other income sources are through employing little works like playing music, performing magic and other arts. Many homeless people commit little crimes to be jailed to have food and shelter for some days (Foweler et al., 2009).

Refuges for Homeless:

There are many refuges that are used by homeless people to be used as temporary place for shelter and sleep. Some common refuges are outlined below:

Sleeping bags

Tent

Cardboard box

Abandoned buildings

Cars and trucks

Wagons and other public vehicles

Parks, pavement, and bus stations

Train tunnels etc.

Proposed Solutions for Homeless:
Housing First / Rapid Re-housing:

Many governments are taking steps to eliminate the homelessness. The USA government asked almost every state and city to enhance the standard of living of homeless people. the 10 years plans are planned and are in process to be implemented to eliminate the homelessness and one of the results of this was a “Housing first” solution, also known as “rapid re-housing”. These policies facilitate quickly to get a homeless person permanent housing of some sort and the necessary support services to maintain and hold a new home. There are many impediments of this kind of program and there must be solutions to augment these programs to make such an initiative work successfully in the middle to long term.

Supportive housing:

Supportive housing is a related to provide the basic necessities to the homeless people. It is the combination of housing and services proposed in a cost-effective way to facilitate and support needy people live more stable and productive lives. Supportive housing provides special programs for those who are in most challenging situations. The audiences for this program are individuals and families confronted with homelessness and who also have very low incomes. It also has increases coverage and scope and therefore incorporates substance abuse, addiction or alcoholism, mental illness, HIV/AIDS, or other serious challenges to a standard and productive life.

Pedestrian Villages:

Many researchers are proposed several solutions to enhance the lives of homeless people. The most common solution proposed is relating notorious national solution for homelessness that would engross building nearly carefree Pedestrian Villages. This policy and solution is termed as “the current Band-Aid approach to the problem.” Example of this policy is Tiger Bay Village that was proposed to create caring society for homeless people. This policy states that this program and support would be better-quality for indulgence the psychological as well as psychiatric needs of both temporarily and permanently homeless adults. This policy was based on the cost-effective solution thus aimed to provide opportunities and support and cost less than the current approach. This policy also enhanced the homeless people living by moving them away from criminal acts to take shelter in prisons. Work opportunities are also provided and constitute construction and maintenance of the villages. It also focuses on the creation of work force agencies that help to make the villages financially and socially feasible and practical.

Transitional housing:

Transitional Housing endows with impermanent housing for the certain audience of the homeless population. The target group constitutes of working class of homeless people who are on verge of setting up to changeover their residents into enduring and inexpensive housing. It is not a temporary shelter house for homeless but typically a room or apartment in a habitation with support services. The intermediary time can be short ranging from 1 to 2 years and in that time the person must file for and get permanent housing and usually some gainful employment or income, even if Social Security or assistance. From time to time the transitional housing habitation program incriminates a room and board fee that can be a standard percentage of an individual’s income. This fee is sometimes partially or fully refunded after the person acquires a permanent place to live in. In the USA centralized financial support for transitional housing programs was originally allocated in the McKinney act (Cohelen, 1997).

Conclusions:

The above study is based on the research work of other authors. The report started with the introduction to the homelessness relative to its broad meanings and is then proceed to the history, causes and underlying factors. The solutions are also provided to help states and countries to make remediation for the enhanced livings of homeless people and move them to productive life.

The problem of homelessness is traced back to late history and is not a contemporary issue. There are several factors and underlying causes of homelessness out of which family conflicts and disruptions are rated as high. The issues that are faced by homeless people vary in range from more basic lacking facilities to higher levels of physical and mental destructions and illness. Many organizations along with governments are working to provide facilities and support the homeless people. Many volunteers are also working to augment the lives of homeless people by proving them with food, shelter, and clothing along with health facilities. Many support programs are also planned to support and facilitate the homeless people. Some common programs processed are housing fund and re-housing, transition housing support, and pedestrian villages.

In this essay, based on a case study and ethical dilemma (see appendix); I will demonstrate the process of ethical decision making and justify a course of action. I will discuss the ethical issues from the dilemma; critically examine competing BACP ethical principles and guidelines, issues of difference, organisational issues and legal implications and evaluating the outcome. To conclude I will discuss the therapeutic relationship. To maintain confidentiality and client anonymity, all personal details have been amended within this academic essay and case study.

Impacts upon the problem and issues to consider

An impact upon the problem is, if I breach confidentiality, I will be damaging the trusting relationship formed with Raj, leaving her feeling isolated, further vulnerable and let down. This could affect not only her trust in future relationships and prevent her from seeking help in the future but also her therapeutic progress.

If I breached confidentiality it could lead to my client experiencing further threats from her husband. Raj is fearful of going to the police when this happens as in the past he manipulated the police into believing she was abusing her husband which led to him having custody of their son. Furthermore, it could cause the father to be angry with Aaron and could lead to him experiencing further abuse.

However, as a member of the BACP I have a duty of care towards my client and a statutory and common law duty to safeguard vulnerable children as recognised by the Children’s Act (2004) (Jenkins, 2004). Further impacting the situation is the organisations policies regarding confidentiality and child protection, which require me to breach confidentiality and report such concerns to my line manager and make a safeguarding alert to social services. Additionally, when contracting in our initial counselling session, I explained that in circumstances of child protection and where my client or others are at risk of harm, confidentiality would be breached, which Raj agreed too, thus she was aware of this when she disclosed child abuse to me.

Furthermore, if I was to breach confidentiality without Raj’s consent, she would not want to continue our counselling sessions due to trust being broken. It could also seem disrespectful of Raj’s choices and concerns and that I do not understand her frame of reference.

Further issues to consider include the client’s culture, my own morals and standpoint, what action needs to be taken to ensure a good quality of practice, the ethical, legal and professional implications for any decision made as well as considering will breaching confidentiality be for the greater good and whose interests will be met. While also considering Raj’s interests and rights to be free of harm, autonomous living, justice and good quality of therapy, I must also consider the consequences for myself and my own self-respect and needs (BACP, 2010).

Whose dilemma is it?

It is Raj’s dilemma as she is fearful of her ex-husband finding out that Aaron told her about the incident, fearing this will lead to Aaron being further abused. The decision affects Raj as I have been trusted with personal, confidential information, therefore Raj will feel neglected and betrayed if confidentiality is breached, leaving her isolated (Welfel, 2006, pp 67). Her vulnerability will further due to feelings of abandonment as presently I am her only support besides the collectivist family unit.

It is also my problem as I am being asked to keep confidence despite feeling wary and uncomfortable in doing so. While I have no legal obligation to report child abuse, I have an ethical obligation to report the disclosure as I have a duty of care towards protecting a child at risk and a vulnerable adult as well as acting in the best interests of the client. Furthermore it would be morally wrong of me to not report the incident and especially if something else happens causing further harm to Aaron and/or Raj, which seems likely as the ex-husband has a history of abuse and aggressive behaviour. I will need to act quickly in order to prevent possible further harm to Aaron.

Raj has specifically asked for confidentiality to be maintained, so if I breached confidentiality, this will be untrustworthy and going against my client’s wishes. However, confidentiality can be breached in cases of child protection and if someone is at risk of harm; in this case Aaron. Due to Raj’s vulnerability and fear resulting from domestic violence, her thought process may be irrational and anxiety provoked. As a counsellor I need to act in the best interests of my client and to protect her from harm.

By breaching confidence, I do not want to create further problems for my client or do anything that will cause harm to her or her son. I have an obligation to Raj, BACP and the organisation to put my own feelings aside in order to follow the best interests of my client and what causes the least harm to her whilst also having an ethical obligation to protect Aaron against harm.

In my job description, it is not stated that I will solely liable for damages; therefore, it is the organisations problem because as my employer they could face legal implications if confidentiality is breached, i.e. if Raj sued the organisation. BACP (2010) state “respecting client confidentiality is a fundamental requirement for keeping trust”. I am a member of the BACP so I would be going against their guidelines by breaching confidence without consent.

Ethical Principles and Values, Organisation Policies and Legal Issues

By law, I am required to maintain confidentiality so long as the client or anyone else is not at risk of harm and when confidentiality is assumed or requested, , I would be lying to Raj and betraying her trust and their relationship is this information was disclosed to a third party (Welfel, 2006). However, while in cases of child protection informed consent is not required due to having a statutory duty to report, I can be honest and open with Raj about what I plan on doing to ensure congruence and maintain the therapeutic relationship.

There are many possible conflicts between ethical principles and the law. The law states confidentiality must be abided so long as no one is at harm, however the BACP ethical principles of justice and self-respect ensure that not only does the professional consider the clients best interest, without causing harm to themselves. However, by adhering to confidentiality about something I am morally against I would not be appropriately applying the ethical principles as entitlements for myself. While I have a main responsibility to keep Raj from harm, I also must consider the Aarons right for safety. While Raj has a human right to choice, I have an ethical and professional obligation to ensure I provide Raj with necessary information to ensure the decision made is the best possible decision for Raj and Aaron and would cause the least harm.

By attending clinical supervision and line management supervision I will be able to receive guidance on dealing with dilemma, gain a differing perspective on the situation. Reflection will also help me understand the situation more clearly.

Fidelity

I have established an effective therapeutic relationship based on trust, congruence, safety, UPR and warmth with Raj. It would be untrustworthy of me to breach confidentiality as Raj trusts me. However as I am required by the BACP and organisation to report child protection, I will need to be honest with Raj and explain that I will need to report the incident however it would be better if she gave her consent and explaining why this matter needs to be reported.

Autonomy

Throughout the counselling process, I have valued Raj’s autonomy through choice and offering power to make decisions within therapy. I must respect her decision by keeping her material confidential and her right to be self-governing and make choices independently without hindrance (Gillon, 1985). However by helping Raj consider the situation and consequences thoroughly, through all perspectives, she will be able to make an informed decision. By gaining informed consent I will be abiding by BACP guidelines as well as respecting my client’s right to choice and accurate information and being client-centred. By explaining my ethical obligations in the contracting process and reiterating this and my requirements in safeguarding children when Raj made the disclosure, I am informing her of foreseeable conflicts as soon as possible.

Beneficence

Raj is vulnerable, confused, scared and distressed, therefore is it not sure if she is able to recognise her best interest. She may not be acting rationally due to her fear of her ex-husband and worry over her son. By explaining why it would be in her best interests and Aarons best interests to disclose child abuse, I am showing a commitment to promoting her well-being as well as being concrete and honest.

Non-maleficence

The action that would cause the least amount of harm to Raj is to make the safeguarding alert without disclosing where I gained the information. While this will limit the action social services can take against her husband and to protect her son, it will ensure that her husband will not find out that she or Aaron disclosed the abuse. If I was to not make the safeguarding alert, Raj would remain distressed and fearing for her son’s safety which would cause her further emotional harm.

Justice

Raj has human rights to freedom and choice over her decision and the support she receives and the right to respect for private and family life, however she and Aaron have a right to prohibition of torture. The fairest decision for both Raj and Aaron is to make the safeguarding alert with informed consent. By honouring her right to information I am being fair by assisting her to make an informed decision. I am also being fair to myself in abiding by BACP ethics, the law and organisational policies.

Self-Respect

I am being asked to go against my own beliefs and morals as well statutory law and BACP ethical guidelines, thus conflicting with my right to beneficence, autonomy, non-maleficence, justice and my human rights.

BACP state informed consent should be sought before breaching confidentiality, however the organisations policies state that clients do not need to be informed when breaching confidentiality for child protection matters, which would be dishonest of me and affect the therapeutic relationship. This causes conflicts within what is being asked of me, professionally, ethically, legally and morally what I feel is right. To work through these conflicts I attended clinical supervision and discussed the dilemma with my line manager.

Possible Courses of Action

As a member of the BACP I am required to maintain confidence at Raj’s request. By providing a rationale as to why confidentiality needs to be breached, I could work within the boundaries of my job and BACP ethical guidelines by helping Raj to understand that this disclosure would assist in ensuring Aarons safety in the future as procedures would be put into place to prevent further harm to Aaron and a safety plan can be formed to ensure Raj is safe from harm from her ex-husband. I could explain to her that when I make the disclosure to social services, I don’t have to disclose her personal details and she can remain anonymous thus her ex-husband will not know that she has reported the incident. I can also explain to social services that Aaron is at risk of further harm so procedures will be put into place to protect him should the incident be investigated. This will hopefully put Raj at ease. Raj would need to give written informed consent for me to share her information with a third party (Welfel, 2006), providing she is “fully informed of all the facts to make that choice” (Gerch and Dhomhnaill (2005). This would ensure I am abiding by the Data Protection Act (1998). By giving a rationale, offering a different perspective and accurate and necessary information, Raj will be able to make an informed decision. Raj is more likely to give me informed consent to make the disclosure if I show her that she can trust me to consider her best interests and ensure her safety as far as possible. I will allow Raj time to make up her mind, and ask questions to ensure she does not feel pressured (McLeod, 2010).

The other option is to breach confidentiality without Raj’s consent as a child is at risk of harm. This would mean the disclosure could be made sooner as I would not need to speak to Raj thus action to ensure Aaron’s safety could be taken sooner. However, in doing so I will damage the therapeutic relationship, breaking her trust and causing more psychological harm as she I would then be another person in her life whom she trusted but let her down, which will then make her more vulnerable and cause trust issues within future relationships. Furthermore, Raj could take legal action against me or the organisation (Jenkins, 2007). By choosing this course of action I will be going against BACP ethical guidelines, the organisations ethos and my own values and morals as an integrative practitioner as well as safeguarding legislations. To ensure Raj’s safety I still could keep Raj’s personal details confidential when making the safeguarding alert.

Course of Action

Having referred to the Children’s Act (1989, 2004) and it’s supporting guidance for safeguarding children (HM Government, 2006, 2010). I will explain to Raj that due to ethical guidelines, the organisations policies regarding child protection and statutory and common law as well as my moral duty of care towards Aaron, I need to breach confidentiality as stated in the counselling contract. I will explain to her that this safeguarding alert will assist in ensuring her son’s safety in the future as there will be a record made and that social services will do whatever they can to prevent further harm to Aaron. I will explain to Raj that when I raise this alert to social services, if she prefers, I will not disclose her personal details, I will maintain her anonymity in accordance to the data protection act (1998) (Jenkins, 2007) and I will not disclose where I got this information from thus her husband will not know that she has reported the incident. However I will also explain to Raj that should she give me permission to disclose where I got this information from it will be further help as the more evidence I can provide, the better chance there is of social services acting upon the disclosure. I will explain that this is completely her choice and I will respect whatever decision she make, but I am professionally, ethically and legally required to breach confidentiality, thus enabling her to make an informed choice. Thus Raj would feel more confident and knowledgeable about her decision and she will have a choice in her decision (BMAED, 2004, pp. 74), thus respecting her autonomy and Human Rights (Bond, 2010).

I will also explain that due to my respect for Raj I would like her permission to make this disclosure and to agree upon what information will be shared as well as abiding by BACP guidelines and the law. By explaining to Raj why this action must be taken, how I will ensure her and Aarons safety is maintained as much as possible and explaining each step I will take and the information to be shared, I am showing Raj that I value her and her opinion, I have her best interests at heart and that protecting Aaron and maintaining her safety is key within the work that I am doing. Ultimately I am exemplifying she can trust me and providing her with a safe environment, free from punishment.

By also offering alternative perspectives such as explaining the possible consequences of not making the safeguarding alert would also allow Raj to make an informed choice (BACP, 2010). It is important that I am honest with Raj and that I give her the necessary information as this would exemplify fidelity, client autonomy, respect, and equality. I will reassure Raj that I will support her, listen to her and that as an Asian counsellor I can understand her concerns regarding family honour and confidentiality thus I will maintain her anonymity it she feels that it what she wants to do.

By choosing this course of action I show that I have considered universality, publicity and justice (Bond, 2010, Gabriel and Casemore, 2010) and the ethical, legal and professional implications, whereby I am abiding by the BACP ethical framework, the organisations policies on child protection and statutory law regarding data protection, confidentiality, and child protection and safeguarding vulnerable adults. Furthermore, I have considered the consequences of this action within supervision, considering the effect on the therapeutic relationship, my own rights and legal implications if informed consent is not sought.

Evaluation of the outcome

The outcome was that after the fourth session, with informed consent I made a safeguarding alert whilst also maintaining Raj’s anonymity, which led to social services checking on Aaron and a record being made. Raj attended a further where she reflected upon her therapeutic progress, her self-esteem and shared her decision to apply for sole custody of Aaron.

I would take this action again for other clients and feel I made the right decision as I was honest, gave the necessary information, respected Raj’s autonomy, beneficence, maleficence and ensured that the decision was fair for everyone involved, prevented further harm to Raj, Aaron and abided by ethical and legal guidelines (Bond, 2010, Gabriel and Casemore, 2010). Furthermore, I considered the client’s culture and presenting issues which were relevant to ensuring her safety. Over all, I promoted the clients well-being and protected her from harm.

Therapeutic Relationship

When clients are able to see us as genuinely concerned for them, that we are not putting on a professional facade, they will feel safe with us because we are reliable (Merry, 2002). By being honest about what I was intending to do and explaining I was congruent yet mindful of the client’s frame of reference and experience I highlighted I was sincere in offering help.

Beyond the physical scars, domestic violence has profound effects on a women’s self-worth. Lewis (2003) stated an abused woman needs to regain power and control over her life by making independent choices and decisions. Carl Rogers (1951) highlighted that we all have the capacity to be fully functioning if our power is given recognition. Through a client centred approach based on respect, acceptance and choice, I helped Raj to recognise her worth and power within the therapeutic relationship and thus empowering her. Roger’s core conditions (1951) encourage women to develop power from inside them in order to attain improved self-awareness and to take control. Thus by allowing Raj to take control over what was happening in therapy, I was helping her become autonomous, and take control over the choices she wanted in life, whilst also protecting her from harm and understanding her cultural needs through empathy and UPR. The increase in self-esteem would enable further self-awareness, which would later help achieve successful therapy outcomes from changes in personality and behaviour (Rogers, 1951). These points highlight that I had provided a good quality of care and maintained a good therapeutic relationship (BACP, 2010). It must be considered, it is due to the effective relationship that Raj felt comfortable to make the disclosure and through offering her power and autonomy and being honest, she felt comfortable with giving her consent as I was able to exemplify that her and Aaron’s safety was paramount.

This essay will analyse the child benefit scheme from both a historical and political perspective in which it will examine the debates on child benefit in the 1970’s when the scheme was first introduced and compare them to the current debates and reforms the coalition government have proposed to introduce.

The child benefit scheme was fully introduced in 1977 through the Child Benefit Act 1975 proposed by the Labour government coming from a socialist perspective. Child benefit merged Family Allowances, which were paid to those with more than one child, and Child Tax Allowances into one single payment. These were both previous welfare benefits specifically for children. Child benefit is a universal, tax free benefit paid to all children in the household. It did not exclude those on higher incomes or was any different for single parent families as it was paid to every child (Greener & Cracknell, 1998). Child benefit was a recognition by government that there are extra costs when parents have children. Child benefits have been increased by the successive governments over the years in relation to inflation and the needs of children and families. It is regarded as a positive benefit, helping relieve child poverty and social exclusion. It is recognised as a fair and worthy way of spending public money and an investment for the future (Greener & Cracknell, 1998).

There were a number of positive and negative arguments for and against the introduction of child benefit. One of the main causes for an improved system of child support was the rising levels of child poverty in Britain in the 1960’s and 1970’s (Hendrick, 2008). Child Benefit was seen as a way of protecting and preventing a child against poverty (Bennett & Dornan, 2006). Poverty had increased as of the deprivation caused by the likes of inflation and the rise in food prices (McCarthy, 1983). There were a number of reports highlighting the decline in living standards of children such as those by 1960’s scholars Margaret Wynn and Della Nevitt questioning whether support for children in the 1960’s matched the needs of children (Field, 1982). Further, the social researcher Richard Titmuss expressed that child support in Britain was badly designed and had to be improved as only those with more than one child received Family allowances (Field, 1982). Additionally a report on Circumstances of Families (1966) presented to us that half a million families who have one and a quarter children live on or below the official poverty line (Field, 1982). Therefore these reports show that child poverty was an ongoing issue at the time and a valid reason as to why a new child policy such as child benefit would be a beneficial action for children’s future. It provides a form of stability as it does not depend on income (Bennett & Dornan, 2006).

The Child Poverty Action Group (CPAG) were highly influential in the introduction of Child Benefit. They campaigned for the protection of children since their establishment in 1965. The CPAG’s main aim was to persuade Harold Wilson’s Labour government to increase Family Allowances and therefore brought child benefit into the public eye (Field, 1982). When it came to the child benefit campaign The CPAG had been claimed as the ‘main stimulus’ for its introduction (Field, 1982). They even used threats to the government to demand better welfare for children. They were a Group who represented the poor, acting as an agent of those in poverty. Their purpose was to help poor families and not only focus on changing the structures in society (Field, 1982). CPAG campaigners tried to convince poor people that it was not their fault they were in poverty but was structures within society that did not fairly redistribute resources (Field, 1982). According to Field (1982) the Group had strong support for an appropriate form of child support to be put in place as they believe it was needed to eradicate child poverty. The Group recognised raising a child costs more money and sharing the cost through the redistribution of income was thought to be the best way of improving children’s welfare (McCarthy, 1983). Therefore looking at the political issues in the history of child benefits are important to examine the evolution of child benefit. The CPAG’s influence in child benefit shows the large impact pressure groups can have on political issues and how they raise public awareness. McCarthy (1983) also claims if the CPAG had not became involved in the cause the issue may not have been discussed at all. It also shows that government are not the only protagonists in the policy process as the Group had such a peripheral role on child benefit.

Trade Unions also had a large contribution to the introduction of child benefit and supported the change from wallet to purse. The TUC/Labour party committee in the early 1970’s stated the benefit scheme must tackle the problem of poverty and provide enough to do this (McCarthy, 1983). According to the CPAG policy briefing (Bennett & Dornan. 2006) the scheme was going to cost too much money and the Labour government claimed the benefits introduction would be postponed as of administrative and legislative problems. In May 1976 suspicions grew that the Labour government was abandoning the scheme as they introduced the Child Interim Benefit to single parents which was thought to be a temporary provision until the government had enough funds to fully introduce child benefit (McCarthy, 1983). It has been claimed the shelving of child benefit could have been due to James Callaghan succeeding as Prime Minister from Harold Wilson. According to Field (1982) Callaghan did not support an increase in family allowances in the 1960’s. Callaghan believed the public were against the benefit scheme as it meant a decrease in take home pay for men (Field, 1982). The Cabinet leaks by the CPAG however seemed to have one of the largest impacts on the child benefit scheme as it revived the political debates on child benefits. It revealed that the TUC had reacted badly to the fact that child benefit implementation would reduce take home pay for men and they therefore became completely against its introduction despite the fact child benefit would bring income back up again (Field, 1982). The Labour government decided to abolish the scheme and were reluctant to go against the TUC. Therefore the lead up to the implementation of child benefit has shown the way government ministers make decisions on social policies. We can see from the literature that the government did not necessarily make a decision on the needs of the public but was the opinions of the TUC dominated their decision. The leaks led to government embarrassment and a swift change of mind to implement child benefit. This shows Labour may have introduced child benefit to keep the public happy and to avoid being voted out.

It appeared in the 1970’s that there was a wide support for reforms of the Family allowance as the Labour and Conservative governments supported change as well as the trade union movement. The proposal for the introduction of child benefit raised the subject of whether the monthly payment should be paid into the purse (mother) or wallet (father). With the previous system men received all welfare benefits for the family. The argument that the benefit should go to the purse was so that the person who primarily cared for the children could organise the family budget for the likes of food and clothes (McCarthy, 1983). This can also make sure that the money is spent on the child and on items the child needs (Bennett & Dornan, 2006). Recent evidence from CPAG (Bennett & Dornan, 2006) claimed that child benefit is regarded as highly valuable to mothers. The benefit may also be the only formal income the mother receives and is regarded as an ‘independent income’ for some mothers. It appears the shift from wallet to purse was significant argument in the introduction of child benefits and was one of the main reasons for change. The transfer was also an issue for the trade unions where the majority of members were male at this time. There were sexist attitudes towards this move as men would lose out on their tax allowances and therefore became against child benefits. However the change from wallet to purse did make sense and became implemented. Therefore this was an argument that welfare for children had to be improved and changed.

Since the introduction of child benefit in 1977 there have been a number of increases and changes depending on the government in power. The largest change however since its introduction will be the Conservative – Liberal Democrat coalition reforms pledged in October 2010 and is an issue both parties seem to agree on. According to Roberts (2010) {online}, the Liberals Democrats believe this move has been long overdue. The policy proposes that if at least one person in the household is paying the higher tax rate earning more than ?43,875 per year then that household will no longer be eligible to receive the benefit. These cuts have caused public uproar. The coalitions aims are to cut public spending by an average of 25% across all departments excluding health and overseas developmental (AVECO, 2010) {online}.

An ongoing argument against the withdrawal of child benefits from higher rate taxpayers is that it is unfair, and the design of the policy is unclear. The media highlight this showing how unjust the policy proposal is and will hit the middle classes most. Ed Miliband in Labour opposition states how it is unreasonable that a person earning two salaries just under ?43,875 can keep their monthly payment but those earning over this threshold when the other parent is not working will not receive their benefit (Prince, 2010) {online}. According to the Comprehensive Spending Review by 2014-15 the cut in child benefit will be saving ?2.5 billion a year preventing those on a lower income from subsidising higher earners (Spending Review, 2010). It has been argued Child benefit is in some cases wasted as of its universalism and payment for every child. For instance even those who do not need the extra income still receive it. Further, it is argued it is ill-targeted across the board and wasted on those at the top end of the income scale rather than targeting those who are really in dire need of that extra piece of income which the Conservative government believe are good enough reasons to remove Child benefit from higher earners. Therefore the policy reform comes from a right wing background which believes that the state should not be relied on by its citizens such as those who are better off and are able to provide for themselves. Whereas in 1977 child benefit was seen as a collective investment.

The Labour party challenge the coalition cuts by informing that stay at home mothers will be the worst affected under this move. It is viewed as unfair as for example if a family has the main breadwinner on a ?45,00 wage and a female carer staying at home to look after their children, they will lose out on thousands of pounds a year for their family. Single earner families lose out the most (Prince, 2010) {online}. The media claim 15% of tax payers will be affected by this change (Prince, 2010) {online}. A further argument agreeing that women will be the most affected by this is the fact that for some females child benefit is the only form of income the mother receives. Katherine Rake of the Family and Parenting Institute states that for some handling the family budget is the only form of independence some mothers have (Collins, 2010) {online}. With these reforms it seems the Coalition government are reverting back to old ways, favouring male income which the old style family allowances did.

Undoubtedly the policy is designed to save on public expenditure and target those who need it most. The policy however could create problems within the family. It could cost families thousands as it could prevent those on a wage below the cut off from taking employment promotions which take them above the line (Prince, 2010) {online}. When single mothers enter a new relationship with a person who is on the higher tax rate wage which would remove the eligibility for child benefit. Additionally the Labour MP Parmjit Dhanda commented on the reform saying couples may claim they are separated to avoid losing the payment as they feel they should be entitled to it. Checks on this neo-liberalist reform would be difficult and expensive and therefore implementation could become difficult as of the removal of its universalism (Chapman, 2010) {online}.

It is valuable to look at the policy from a historical and political perspective as it has shown how the policy has evolved and why the policy was implemented with the rise of child poverty and a need for a satisfactory form of child support. Cost is obviously a key factor in the cuts however whether this cut is affordable for the future of children remains to be seen. The reforms have brought about controversy politically and publicly as it has raised the subject of who is deserving of child benefit as it has now decided who receives it.

In conclusion child benefit has therefore become a success in Britain and has become relied on by many. The fact that child benefit has lasted over 40 years shows this significance as well as the fact that it has angered many who will be losing out after the proposed coalition reforms.

INTRODUCTION

Social work is concerned with people and their environment and seeks to intervene to assist in dealing with complex problems and difficulties people face in their lives. It focused on assisting the individual to reach their full potential and engages in problem solving and social change (Graham, 2007, p. 8). Social work emerged in the industrialised countries during the late nineteenth century and played an important role in Victorian society. In 1869, the Charity Organisation Society (COS) in London came together to form a charitable good works to eliminate poverty by increasing co-operation with other charities and the Poor Law, to eliminate the unequal distribution of the poor relief. Women volunteered to give assist and advice to those in need. The Beveridge report which advocated for family allowances, free health and employment services, flat rate social insurance, served as a foundation and shaped social work role in the post-war Britain (Abel-Smith, 2007). In 1954, the first generic social work course was introduced at London School of Economics (Denney, 1998, p. 18).

This eassy discusses the political relevance of social work provision for adults with learning disabilities (LD) who live in the community. It will further examine the impact of discrimination and oppression on service users and need to promote anti-oppressive practice in social work for the benefit of those with (LD). Thereafter the eassy will explore the importance of service user participation and how it informs social work practice.

The White Paper, Valuing People, defines a learning disability as ‘a significantly reduced ability to understand new or complex information (impaired intelligence) with reduced ability to cope independently (impaired social functioning) which started before adulthood, with a lasting effect on development’. Department of Health, (DoH, 2001, p. 14), discussed in Galpin and Bates, (2009, p. 50). Social work services concerned with the disabled people developed in the health and the voluntary sectors (Graham, 2007, p.127).

Before the 1960s, disability was often invisible and has always been discussed in the context of medical model on which it concerned on the individuals’ disability. Social work practice with disability was mainly influenced by the medical model as it encouraged paternalism and dependency on State Welfare benefits (Oliver, 1996). However, the social model of disability was influenced by disability movements such as MENCAP and MIND organisations, who campaigned to bring awareness to the able-bodied professionals and policy makers to focus on the social environment and participation in the management of services for people with learning disability (Oliver, 1990). The social model has gain influence and been adopted as the best way to work with disabled people, because of it influence on social barriers and attitudes of the society (Graham, 2007).

People with (LD) did not have the opportunity to access mainstream resources in the society as they were either shut away in hospitals and large institutions, and often isolated from the society. However in the 1960’s the poor physical conditions and the misconduct of staff brought to the attention of political and public perception of long stay in hospitals and institutions (Shardlow and Nelson, 2005). The Community Care came about when the newly created National Health Service wanted to rid itself of the old workhouses. However, people who needed nursing care, had no where to go so a smaller units in the community was recommended. For people with (LD), the publication of the White Paper Better Services for the Mentally Handicapped in 1971 was a landmark change Social Policy. One of the main recommendations of the White Paper was the replacement of 27,000 of 52,100 hospital places in England and Wales with residential homes in the community (Stevens, 2004) discussed in (Galpin and Bates, 2009). The community Care served as the cheaper option to deliver a high quality of services for people with (LD). This made a way for them to move into the community, for example some owned their own tenancies, some in houses with twenty four hour staff support. This promoted choice and inclusion and enabled people with learning disability to live in the mainstream of life (Thomas and woods, 2003,).

The National Health Services and Community Care Act, (1990) and White Paper Caring for People (DoH, 1989) reduced the interference and dependency through managerialism, and introduced care managers into local authorities social work and social services departments. Their role was to take assessment of the individual disabled needs and then purchase social care packages for them. In this way, local authorities became enabling authorities rather than direct care providers for people with disability (Graham, 2007, p.127; Oliver and Sapey, 2006, p. 1).

People with (LD) are discriminated against in terms of disability and other social divisions and their environment. Most often when the above occurs, the resulting experience is generally one of oppression (Thompson, 2006).The Disability Discrimination Act, states that ‘disabled people should have fair access to the mainstream society in relation to employment, access to goods, facilities or services and renting or buying property (Graham, 2007, p.130). A number of organisational practices, society and professionals view impairments as personal tragedy. People with (LD) face discrimination when seeking for employment, as most jobs are tailored to suit the able-bodied. numerous employers do not make available resources to recruit disabled people, most often this throws them to dependant roles of policies, and restrict people with ( LD) living in the community to meet the demands of independent living (Booth, 2002). Lack of confidence, disempowerment and social exclusion also sets in and the end result is oppressive. Although Social workers, cannot single handledly change the attitudes of the society and employment limitations towards people with (LD), however ‘social workers can act as resource to be used by disabled people, rather than providers of care’ (French, 1994) to effectively be involved in promoting and supporting their rights and aspirations. Social work provision should enable disabled people to overcome the barriers by assisting service users with (LD) to seek employment, to receive welfare benefits due to them and gain access to adaptation, equipment and personal support to participate fully in the mainstream social and economic life (Barnes,1991). This will lead them to dependence, self-determination and inclusion (Shardlow and Nelson, 2005).

Another major barrier that people with (LD) faces is stereotypes and negative attitudes from the society. I recall an incident during a four day holiday to Norfolk with adult with learning disability. It was a warm day so we decided to go swimming. We got to the pool and some of the holiday makers protested that service users should not enter because they might spit or urinate inside the water. The team explained that they have same rights as everyone to use the facilities. After much discussion the manager was informed and allowed us into the pool. It was very intimidating. This attitude often leads to social exclusion for service users with (LD) which often results in oppression. Even though presently there are a lot of special facilities that are in place for people with (LD), there is still stigma attached to them by organisations and accessibility to some buildings is still limited.

The introduction of the Community Care (Direct Payments, Acts, 1996) has been a significant step forward in assisting people with (LD) to achieve independent living. The Act requires the local authority to offer the payment to the individual who are eligible, enabling them to live a quality and have control over their own independence and have self determination. The policy also supports social living for people with learning disability (Hasler, 2004) discussed in (Graham 2007). People with (LD) may have their payment made to a trust fund or families to manage for them.

The Concept of Normalisation has been a great tool for people with (LD). Normalisation originated from Scandinavia and practiced in America and later came to Britain (Denney, 1998, p.88). Though time has moved, normalisation still provides insight in a variety of services development. The concept emphasise the importance of people with learning disability to live and have the same rights and social roles as the able-bodied to live within society and be part of it (Thomas and Wood, 2003). The work of John O’Brien (1987) set out ‘five accomplishments’ target to serve as a guideline for community services development and support in other to realise the principles of normalisation. The accomplishments are; community presence, choice, competence, (giving disabled people the opportunity to develop a range of skills), respect and community participation (Sharldow and Nelson, 2005, p.64).

The Valuing People White Paper, published in 2001, came as a major breakthrough for people with (LD) after thirty years of segregation. The Paper is to promote rights, independence, choice, inclusion and modernising day services now and the future for people with learning disability (Community Care Magazine, 2008,). Some local councils has come a long way to put services and support for people with (LD) such as short breaks, daytime opportunities, supported living services and adult placements. The young adult receives advice on education, healthy lifestyles and sexual relationships (www.kent.gov.uk).

From experience, service users participation promotes inclusion, enhances respect and empowerment. Learning disability ranges from mild to profound, some do have sensory and physical impairments, speech and communication impairments, and others do have challenging behaviours which sometimes affect service users with learning disability involvement in decision making (Parrott, 1999). Social work practioners may use other tools of communication to involve them in decision making. This will enable them to contribute towards their care needs and encourage them in choosing appropriate service provision through advocacy. This will challenge people with (LD) to become independent and take active part in the mainstream community (Sharldlow and Nelson, 2005).

Person-centred planning (PCP) is one of the ways forward in involving service users with (LD). A process of ‘continual listening and learning: focused on what is important to someone now, and for the future; and acting upon this in alliance with their family and friends’ (Sanderson, 2000, p.2) quoted from (Galpin, and Bates, 2009, p. 67). The listening aspect is a good social work practice and care management skill to understand the individual’s with learning disabilities choices and abilities. PCP assist social work practioners to work in such a way that, they see the individual with learning disability in context of family and community connections, friendships, their race, ethnicity and religion, gender and sexuality, their previous experiences and other factors that makes them who they are

(Galpin and Bates, 2009; Sharldlow and Nelson, 2005).

CONCLUSION

This essay has highlighted the significance areas of the historical and political context of social work provision, and it has spearheaded a reform in social work practice. It has evaluated the different ways in tackling social exclusion and suggested avenues that can be explored to promote inclusion for people with (LD). The eassy has also examined the impact of oppression on service users, and how oppressive practice has hindered professional relationship with service users, and in this context people living with learning disabilities. Drawing from analysis on various literatures, it appears that there is a gap for social work professionals to identify any development delays in promoting individuality, equality in areas like employment and accessibility to buildings. Therefore, social care services can make a real difference to people with learning disability lives, their development, opportunities and achievement.

In this research paper I will be discussing how to identify high risk youth and the treatment for drug abuse. First I will cover which teenagers are likely to be at high risk for drug use and abuse. Second I will discuss some of the causes of drug abuse amongst our teenagers. Third I will discuss the symptoms of teenage drug use. Fourth I will discuss preventative measures with high risk teenagers. Last I will talk about the different types of treatment for teenagers who are abusing drugs.

There are teenagers throughout the world that are considered high risk for drug abuse. Some of the teenagers have been labeled as gang members, homeless, and throwaway teenagers. (Newcomb, 1995) Socioeconomic status may also be a variable with our high risk teenagers. The lower the economic status the higher the risk the teenager is to try drugs. According to a report in 2007 up to 50% of youth who used substances, had some sort of mental disorder such as anxiety or depression. (Leslie, 2008)

There are a few other risk factors that have to be taken into consideration. Family risk factors for teenagers is such a huge factor; family conflicts, poor parenting skills, lack of attention, severe parental discipline, and history of alcohol or drug abuse. (Newcomb, 1995) Other risk factors that are more individual would be history of physical or sexual abuse, learning problems, and difficulty with handling impulsive behavior. (Newcomb, 1995)

Some of the causes of this disorder (drug use and abuse) can be broken down into several areas of concerns. The first area would be cultural/ social environment. (Newcomb, 1995) This consists of the availability of substances for a teenager within their community. How extreme is the living conditions for the teenager; meaning is this teenager living in poverty. Teenagers who don’t have access to certain resources are at a higher risk. The community that the teenager resides in can be a cause of drug use. If that individual teenager is custom to seeing drug use, drug selling, or drug addicts this can be a cause of drug use as well. (Newcomb, 1995)

An interpersonal factor is another area that can be a cause of drug use for teenagers. Teenagers who live in a home where there are inconsistent family practices, family conflict, or poor parental supervision typically are at higher risk. (Newcomb, 1995) Where there is family conflict in the home such as arguing and fighting this can be a cause for a teenager to want to use drugs to escape the conflict. If a teenager is in a home were drugs are not frowned upon they could feel its o.k. and are comfortable with using. When a teenager is rejected among its peers this may a reason for a teenager to find new friends whom may be drug users and they will begin to experiment with drugs with these new friends because they feel accepted. (Newcomb, 1995)

Psycho behavioral is an area which deals more with a teenager who has always had problems academically. They have rebellious behavior toward adults such as teachers, school counselors, or administration. They probably started drug use at an early age; as early as eleven years old. They have always looked at drugs as a good thing. (Newcomb, 1995)

Lack of communication is a cause of drug use that many people, mainly parents don’t consider. When parents and community leaders don’t discuss drug use with teenagers this leads to many teenagers being ignorant about the effects of drug use. (Accornero, Crum, & Storr, 2007) Many teenagers who participate in high-level sports may feel the competition is a lot of pressure and this can cause drug use as well. (Accornero et al., 2007)

There are many symptoms and warning signs of drug use with teenagers. Many of the symptoms are noticeable and some are not. Some of the symptoms of an individual who may be smoking marijuana could be: reddened whites of the eyes, a larger appetite than normal, not motivated to do anything productive, always happy, or paranoid. (Leslie, 2008) Some teenagers may start out by using over the counter cold medications. Symptoms for cold medicine use would be: sleepiness, a rapid or slow heart rate. (Shiel, 2010)

Symptoms of a teenager using inhalants are: runny nose, confusion, moody, smell of gasoline, or the smell of paint. (Shiel, 2010) Teenagers who are using heroin, morphine, codeine, and other depressant drugs normally show signs of sleepiness, poor coordination, dizzy, or low inhibitions. (Shiel, 2010) Ecstasy is known as the “club drug” and is popular among teenagers. Warning signs that your teenager may be using this drug would be: feverish child who does not sweat, finding lollipops around the house or in their room, the teen may seem to love everyone or is always in an excessive happy mood. (Shiel, 2010)

General behavior changes among teenagers who are using drugs would be grades dropping all of a sudden, parent(s) receiving phone calls of child missing or skipping school regularly, and dropping out of regular school activities. (Leslie, 2010) Some teenagers physical appearance may change; such as their attire, loss of weight, and poor hygiene. A teenager who was once jovial, happy, and easy to get along with may become hostile or easily agitated. They may become more secretive such as coming in and going straight to their bedroom without speaking. Locking their bedroom door when they leave the house and simply some parents may feel their child just doesn’t seem like their normal selves. As you can see there are so many warning signs and symptoms of drug use.

Now that I have discussed the risk, causes, and symptoms; I will now discuss some preventative measures. Not very many preventative programs have been completed among teenagers who are emerging into adulthood. This would be teenagers from the ages of 16 to 19 of age. Some of the preventative programs out there for teenagers consist of helping teenagers change their drug use motivations, teach them new communications skills, how to have self-control, and job seeking skills. For 17 and 18 year olds these programs may work on showing them how to make good decisions, and how to obtain new environmental resources. (Pumpuang, Skara, & Sussman, 2006)

One preventative program that could be used within the schools would be providing resources to teenagers who normally wouldn’t have access to these. Some of these resources would be providing transportation to and from drug counseling services within their community. Providing job training for students who may be struggling academically and helping them find a trade or skill that they would enjoy would be motivation for them to avoid using drugs. Some of these teenagers have never been introduced to recreational activities by their parents; by providing them with these different recreational activities this will give them something to do besides hanging out and doing drugs. (Pumpuang et al., 2006) Also providing drug prevention classes within the middle and high schools would be an opportunity for teenagers to communicate and learn more about the consequences of drug use. Research has shown that school-based prevention programs have had long-term success especially with current teenage drug users. (Pumpuang et al., 2006)

Telephone drug prevention education is becoming more popular. Some researchers suggest using the telephone prevention in conjunction with the school-based programs. (Pumuang et al., 2006) Telephone education is a great tool for teenagers to use when trying to find out about social-environmental resources in their communities.

There is a group of social workers who are trying to start a social service telephone program (SSRTP) that youth can use to get information that will help them within their surrounding community. (Pumuang et al., 2006) This program will consist of four elements: Mastery, attachment, cue, and hope. This will be known as the MACH model; which will help with early intervention for teenagers who are transitioning into adulthood. (Pumuang et al., 2006) In the mastery stage individuals would be able to receive educational lessons that would help them to master a skill and feel a sense of autonomy. They would show them how to plan and receive assistance as they transition to live by themselves. In the attachment stage they would receive information on jobs, continuing education, how to use public transportation, and how to access free or low cost counseling services. These teenagers who are getting ready to live on their own will need these services so that they will have healthy development and a sense of knowing there is resources out there for them to be successful. (Pumuang et al., 2006) The third stage is the cue stage. This stage gives awareness to participants that there are programs that will direct them to learning more about the risk of drug use/abuse. The last stage is the hope stage; this stage gives teenagers a positive outlook on their current circumstance. This allows teenagers to have the knowledge to know that there are so many other options out their besides drugs. (Pumuang is et al., 2006)

There are many different types of preventative programs out there. One program that is popular in the Santa Barbara area is ADAP Teen coalition. This program is headed up by teenagers who work together to reduce the amount of underage teenagers who use drugs and drink alcohol. This program has been around for over six years. They consider themselves to be more about the community and using community resources. They look at how the environment effects teenagers’ decisions, they look at solutions on public policy when dealing with underage drug use, and they study how culture, social, and political factors play an important role. (2009)

There are also two programs that are headed up in Portland, OR. These preventative programs teach teen athletes other alternatives to steroids, sports supplements, alcohol, and other drugs. (Bradley, 2010) This program has won several achievement awards. This is the first program and the only program in the world that has effectively reduced the need of using drugs that promote athletic performance. This program provides mentors to teenage athletes throughout the high schools. (Bradley, 2010)

As we know with teenage drug use delinquent behavior comes along. Many teenagers who are using substances find themselves in trouble with the law. The juvenile system has become a haven for many of these teenagers who have numerous challenges with drug and alcohol abuse, mental health issues, and lack of resources for other assistance. (Nissen, 2006) The juvenile system is trying to come up with new ways to effectively treat these juvenile delinquents. Many teenagers who need assistance rarely ever receive it, studies show less than 10% will receive proper assistance. (Nissen, 2006) Only 36% of the juvenile justice centers offer drug abuse treatment. Many teenagers who are in juvenile detention centers come from different walks of life; this makes it tough when trying to do assessment and matching. Many juvenile detention centers will use family involvement in treatment. They have found that this is the key to long-term success with these teenagers. They work with these families while the teenager is in custody and once they are released they help the family find the resources so they can receive proper treatment. (Nissen, 2006)

Many family practitioners do not test youth for drug use. There are many screening assessments out there that can be used with teenagers. One of these is called the HEADSS assessment; this is a mnemonic that forms the basis for a psychosocial assessment. (Leslie, 2008) GAPS is another assessment it stands for Guidelines for adolescent prevention services. CRAFT is an assessment tool that identifies substance use, which has been known to be successful with teenagers. (Leslie, 2008)

In the past there have not been very many successful treatment programs for teenagers. Many of these programs went for an abstinence-based approach; meaning don’t use alcohol or drugs period. (Leslie, 2008) Evidence has shown that these programs have not been successful. There is a rise of harm-reduction treatment programs that have been successful. This program accepts teenage drug and alcohol use but shows the long term effect of drug and alcohol use. These programs aim to reduce the risks that are related to drug abuse. (Leslie, 2008)

Treatment also depends on the types of drugs that the individual teenager is using. There are short-term substance abuse treatment programs specifically for teenagers. Many of the programs will last less than six months. There are residential therapy centers that are designed for teenagers to stay in a facility for three to six weeks. They will detox and hopefully overcome their addictions. After the residential program has ended the teenager will begin to do go to twelve step meetings. There is also medication therapy; these medications will help the teenager overcome their addictions. These medications will help with withdrawal symptoms and craving which normally cause teenagers to relapse. (Shiel, 2010) There are also long term substance abuse treatment programs. These programs will last more than six months; typically these programs are designed for teenagers who are using opiates, or have been addicted for a long time. Therapeutic communities are a residential drug abuse treatment. Typically a teenager will stay here for six to twelve months. (Shiel, 2010)

As we can see there are so many factors that go into drug abuse and high risk teenagers. There is still so much research and work to be done to effectively prevent and treat these teenagers. There have been strides in our juvenile detention centers with teenagers who have been court mandated. Many of these teenagers will receive he treatment that is needed, but what happens when the teenager is released back into their environment. More community involvement is needed when working with teenagers who lack the resources to get the counseling and treatment that is necessary for them to recover from drug abuse. Hopefully we will see more community involvement and more research done on treatment for teenage drug abuse.

Abstract:

The term Social Problems is a misnomer and is an admission of the fact that the actual nature and constitution of the situation has not been deliberated at depth. When senior people see that the rules and behavioural patterns they have held so dear are getting challenged they term it as creation of problems.

Criticising the social order that is emerging is the easiest way to admit defeat. The brave and sensible way is to accept the challenges and find ways and means of retaining the value system – may be with certain modifications – that has been followed for generations. In this way the young generation can adjust to the social changes and yet remain healthy and flourish in life.

Introduction:

The present day health issues are very closely related to the current social set up and coming into existence of a new set of social norms and values. While most of the social norms and values are traceable to and intimately related to the economic factors yet there is a trend of getting carried away by foreign cultures and their different social bearings. The pressure on the present day youth for being economically successful is very high and this gives a peculiar dimension to these ‘youngsters’ way of life which is enormously different to the type of pressures felt by the previous generations.

While on one hand parents expect their children to become successful – which is a decent way of saying that they earn pots and pots of money – on the other the boys and girls are expected to follow the same set of social rules which has been followed by the ‘elders’ for generations. Thus the social problems have many causes but one significant reason is the inability of the older generations to accept and adjust to the changes in the society which is inevitable.

The main problem that surfaced is that previous generation weighed the social structure of today by the norms and values that were taught to them quite a few decades back. The ground reality has changed rapidly and the senior generations are still getting guided by the rules of the game of yesteryears. The world is changing faster than it ever did before and the changes are not only very wide and rapid but are also very deep penetrating. Thus the changes are in effect causing social ‘evils’ as seen by the previous outlook but in reality the developments of the world is going on for centuries and what is being called as social problems is a manifestation of the inability to change and adjust to the new life order.

Discussion:

As stated in the introduction above, it is evident that there is need to face the societal changes that are coming up every day. In order to examine the situation in depth, three generation of society were interviewed to get to the bottom of the problem. The first were the generation of grandparents – who learned their ways of life some fifty to sixty years back.

The next set consisted of parents i.e. father and mother group of today’s youngsters and they learned what they believe to be correct social norms some twenty-five to thirty year back. The final subset consisted of growing boys and girls of today and consisted of college and university students. These are the people who are bearing the brunt of the social problems which in turn is having a serious effect on their health.

The first set of people consisting of grandparents carried fixed and set ideas about what the societal norms and beliefs are supposed to be. They saw no reason for changing those norms and beliefs. The behavioral norms were very strictly defined and centered around simple living and high thinking with very little emphasis and importance – if any at all – being paid to the economic progress and well being.

They had lived their life in a very definite way and firmly believed that what was good for them is also god for their grandchildren today. Above all, their firm belief that ‘one size fits all’ concept as far as social behavior is concerned was much too firm for accommodating any updating necessitated by the present day life style. This brought about the severe view of the present day social interactions and the resultant problems. They knew that they had lived their life and were in no mood to accommodate or even tolerate the changing pattern of social values and norms. The best thing is that – in fact it should be called the worst thing – is that his set of people failed to see the few very good aspects of the changing patterns of social behavior. They invariably were quick to point out the drawbacks without for a moment acknowledging the good and beneficial aspects of the emerging new social order.

The second set of people who were interviewed represented the parents. This group had its own problems. They fully appreciated the beneficial aspects of the change but were hesitant to admit the same since it clashed with what they were taught as the ideal way of social behavior. They too saw the problems of the present social setups and behavioral patterns but at the same time knew that there is no stopping of the changes coming about.

Further they saw the new order did bring new problems but at the same time it encouraged the democratic institutions so very necessary for the well being of the future generations. They wanted to break away from the traditional social order and get into the flow of development of the new order. However, they had reached an age where they were unable to be adventurous and were cautious about accepting the changes.

This gave rise to a very unbalanced state since while in their heart of hearts they knew that what was seen as social problems were more of aberrations of their viewing the outcomes than causing difficulties for the new generations.

Yes, they wanted their children to bag high-pay job offers but at the same time wanted their children to stick to the ‘five prayers a day’ schedule despite the demands of their job conditions. This kind of situation is prevalent not only in the Middle East but such situation also exists in most of the emerging economies like Brazil, India, China, Pakistan etc.

This group, like the previous group of grandparents, also quickly saw the social problems – but with a difference. This group simultaneously tried to find a solution which would accommodate the social change and at the same time keep a balance with the past so that the health (both mental as well as physical) hazards were contained. This is a very healthy indicator of the changes in social order being slowly accepted and though it is a slow process but it is a sure process. The present social norms have taken centuries to develop; it is very likely that the new social order will take some time to settle down.

The last group consisted of the people of the below twenty-five age group. The first priority for this group was a better and more comfortable way of life. They valued democracy in all walks of life. They carried no negative feelings for the age old systems and gave full credit to the social order which has seen their predecessors to reach the current state.

Yet when any of the social behavioral patterns got into the way of their achieving the goal they so cherished they did not hesitate to set aside the existing social norms. They were ready to burn the midnight lamp if that meant getting higher grades which would translate into their landing better jobs. Yes this was a potential health hazard but it also promised attainment of their dream goals. These groups wanted to make it big and for achieving this they were ready to take on with a ‘no-holds-barred’ situation.

Good health is basic pre- requisite of good life. Without having good heath one will lose the very capacity for any human pursuit – from the grossest to the subtlest. He will not be able to enjoy the fruits of his toil. Health does not mean absence of diseases but it implies the possession and cultivation of a physically fit, morally strong and mentally alert individual who is able to meet the physical demands of life pursuits with full vigour and enthusiasm.

The present day society seeks comforts, conveniences and freedom from drudgeries and wants to avoid working on monotonous, back-breaking and tedious chores from dawn to dusk – except out of compulsion. They prefer freedom from all hindrances and choose democratic way of life. Democracy for them is not just a merely form of government but it is a foundational societal value and hence they prefer a democratic society. In such a preferred democratic society values of freedom, equality, respect for the individual, collective decision making and the right to dissent should be inbuilt into the social arrangements and transactions. The young people with a democratic bent of mind respected the rights and freedoms of other people.

They treated people at the level of equality and were tolerant of the views and opinions which were different from their own. When they were invested with authority they would use it with care and that too for the common benefit of people. Instead of imposing their views on others they would look for a consensus solution for making any collective decision. While the first group (grandparents) stood out by their intolerant attitude, this group of young citizens were endowed with refined, liberal and humanistic values.

Though the members of the first group found the young people as creators of all trouble and labelled them as ‘rebels’ the younger generation were accepting their new found status of that of a rebel with alarming ease and comfort.

They knew that if they stuck to the ways of the senior citizens then the possibilities of their realising their dreams of making it big would never materialise. There is ample historical evidence which go to prove that change – be it social, economic, technological or even environment – are all here to stay. Either one makes himself capable to adjust to the change or the process of change will eliminate them for good.

Now, SOCIETY is an organisation for cooperative working to ensure human development, through production and distribution of sharable social goods. Society is made up of various constituents like individuals, different classes and groups, social, economic institutions and many more. In UAE and other Middle East countries the individual goals and the collective goals are often in conflict with each other.

Yet the main objective of any developing and healthy society is to ensure human development which is not restricted to social, political, economic issues but also the development of the members on a total basis which would include health, formality and above all the value system of life.

As stated earlier, one of the major aim of any society is to ensure production and distribution of sharable social goods like roads, transportation, water, electricity, health care and a host of other facilities. Opportunities and means of gainful employment, jobs, career and other rightful and legitimate means of seeking personal economic betterment are also to be treated as part of sharable social goods.

Thus, the social changes taking place in every country and in every society aim at providing better opportunities and means of gainful employment and suitable jobs to the members of the society. There is no harm if the young people of today seek better standards of living and are prepared to dissociate themselves from the social norms which prevent their advancement in life.

Conclusion:

To sum up the entire picture it is necessary to understand that the so called Social problems are the result of the failure to appreciate the wisdom behind each and every change that is taking place in the world around.

Older people who have lived their lives may conveniently call such changes as resulting in problems causing health hazards but such changes are for ‘GREATER GOOD’ and hence should be accepted if not welcomed. The budding Engineer or Manager or Professor faces an uphill task and shying away from sharing the gains available today is certainly not wise. Though the severe challenges may prove to be a health hazard in the short run but over time people will learn to cope with it and emerge the winner.

Thus finding faults with the social problems is the weak person’s way of handling the changes taking place in the milieu. A strong and healthy individual will take the bull by its horns and will certainly succeed in controlling the social changes to his advantage.

INEQUALITIES IN MENTAL HEALTHIntroduction and definitions:

Mental health is described by the World Health Organization (WHO) as:

“a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community” (WHO 2001a, p.1).

According to NHS website every year in the UK, more than 250,000 people are admitted to psychiatric hospitals and over 4,000 people commit suicide

(http://www.nhs.uk/conditions/mental-health/Pages/Introduction.aspx , accessed 20-4-2010)

Mental health inequality is a long standing problem that has been tackled for decades by epidemiologists, sociologists and health professionals.

And because this problem has both strong social and health aspect there is no unified approach to identification and resolution.

From Sociologists viewpoint inequality with mental health is a problem that has two main explanations: people are poor because they have mentally illness that makes them unable to keep work probably (social selection), or they become mentally ill under the stress of being poor (social causation). However, in modern psychiatry other factors are believed to involve in the etiology such as genetic factors, diet, and hormonal disturbance which interact with personality disorders or emotional state to produce mental illness.

The problem of inequality is not only about serious mental illness but we can expand the definition of mental health inequality to include everyday feelings which is considered by United Kingdom Department of Health to be public health indicator:

“How people feel is not an elusive or abstract concept, but a significant public health indicator; as significant as rates of smoking, obesity and physical activity” (Mental Well-being Impact Assessment ,2009)

The table below gives examples of those factors that promote or reduce opportunities for good mental health (DOH 2001):

MENTAL HEALTH – PROTECTIVE FACTORS
INTERNAL PROTECTIVE FACTORS
EXTERNAL PROTECTIVE FACTORS
EMOTIONAL RESILIENCE

physical health

self esteem/positive sense of self

ability to manage conflict

ability to learn

CITIZENSHIP

a positive experience of early bonding

positive experience of attachment

ability to make, maintain and break relationships

communication skills

feeling of acceptance

EMOTIONAL RESILIENCE

basic needs met – food, warmth, shelter

CITIZENSHIP

societal or community validation

supportive social network

positive role models

employment

HEALTHY STRUCTURES

positive educational experiences

safe and secure environment in which to live

supportive political infrastructure

live within time of peace (absence of conflict)

MENTAL HEALTH – DEMOTING/VULNERABILITY FACTORS
INTERNAL VULNERABLE FACTORS
EXTERNAL VULNERABLE FACTORS
EMOTIONAL RESILIENCE

congenital illness, infirmity or disability

lack of self esteem and social status

feeling of helplessness

problems with sexuality or sexual orientation

CITIZENSHIP

poor quality of relationships

feeling of isolation

feeling of institutionalisation

experience of dissonance, conflict, or alienation

EMOTIONAL RESILIENCE

needs not being met – hunger, cold, homelessness/poor housing conditions etc.

experience separation and loss

experience of abuse or violence

substance misuse

family history of psychiatric disorder

CITIZENSHIP

cultural conflict – experience of alienation

discrimination – the negative experience of being stigmatised

lack of autonomy

the negative experience of peer pressure unemployment

HEALTHY STRUCTURES

value systems

effects of poverty

negative physical environment

Table 1: factors that promote or reduce opportunities for good mental health
What is the evidence on mental health inequalities?
Socio-economic status:

Community-based epidemiological studies across countries and over time have consistently identified an inverse relationship between Socio-economic status and prevalence rates of schizophrenia .The ratio between the current prevalence (defined as period prevalence up to one-year prevalence) of the disorder among low-SES and high-SES people was 3.4, whereas the ratio for lifetime prevalence was 2.4? (Saraceno et al,2005), and in Britain, twice as many suicides occur among people from the most lower SES (Blamey A et al ,2002).

There are five hypotheses to explain this relation (Hudson 2005):

Hypothesis 1: Economic stress. The inverse SES-mental illness correlation is a speci¬?c outcome of stressful economic conditions, such as poverty, unemployment, and housing unaffordability.

Hypothesis 2: Family fragmentation. The inverse SES-mental illness correlation is a function of the fragmentation of family structure and lack of family supports.

Hypothesis 3: Geographic drift. The inverse SES-mental illness correlation results from the movement of individuals from higher to lower SES communities subsequent to their initial hospitalization.

Hypothesis 4: Socioeconomic drift. The inverse SES-mental illness correlation results from declining employment subsequent to initial hospitalization.

Hypothesis 5: Intergenerational drift. The inverse SES-mental illness correlation is a function of declines in community SES levels of hospitalized adolescents between their ¬?rst hospitalization and their most recent hospitalization after turning 18

Age:
In elderly:

National Institute for Mental Health in England (NIMHE) has reported the following point regarding mental health problems in elderly :

3million older people in the UK experience symptoms of mental health problems

the annual economic burden of late onset dementia is ?4.3 billion which is greater than that for stroke, cancer and heart disease combined

dementia affects 5% of those aged over 65 and 20% over 80

10-15% of all older people meet the clinical criteria for a diagnosis of depression

these numbers are set to increase by a third over the next 15 years

(NIMHE, 2009).

Mental health problems in elderly often go unrecognised. Even where they are acknowledged, they are often inadequately or inappropriately managed (DH 2005c).

The UK inquiry into mental health and well-being in later life (2006) identified five factors that influence the mental health of older people: discrimination (for example, by age or culture); participation in meaningful activity; relationships; physical health (including physical capability to undertake everyday tasks); and poverty.

in children :

WHO states, that the aˆzdevelopment of a child and adolescent mental health policy requires an understanding of well-being and the prevalence of mental health problems among children and adolescents”(child and adolescent mental health policy, 2006)

However, there is an evidence that levels of distress and dysfunction during childhood are considerably high between 11 per cent and 26 per cent, while the severe cases that require interventions are around 3-6 per cent of people under 16 years of age (Bird et al.1988; Costello et al. 1988).

Emotionally disturbed children are exposed to abuse or neglect in their family of origin, with estimates up to 65 per cent (Zeigler-Dendy,1989).

Gender:
Women and Mental Health

Mental health problems are more common among women than men with higher incidence rates of depressive disorder than men (Palmer, 2003).

There are many factors to explain this, first: Socio-economic factors such as poverty and poor housing conditions cause greater stress and fear of future amongst women. lack of confidence and self-esteem may be the results of educational factors such negative school experiences , Living in unsafe neighbourhoods cause stress and anxiety amongst women , dependency on prescription drugs (for depressive and sleeping disorders) often leads to anxiety.

Men and Mental Health

Men tend to be more vulnerable to mental health problems and suicide than ever before due for a number of reasons including:

Men in general are less likely to talk about their problems or feelings or to admit that they have depression.

Men are less likely to seek help for mental and emotional health problems.

Unemployment has a greater impact on men in general.

Some mental disorders are more serious in men for example suicide is the leading cause of death among young men. The rate for young men aged 10-24 years is higher among those from deprived communities compared with those from affluent communities. Men also experience earlier onset of schizophrenia with poorer clinical outcomes (Piccinelli, 1997)

Risk groups for mental illness in men include (DHSSPS,2004):

Older men: they are less willing to use health services because of the perception that these services are for older women.

Divorced men – because they have less support available from family , and services designed to meet the needs of this group is particularly.

Male victims of domestic abuse -especially boys in rural areas.

Gay and bisexual men – few services are available to help men deal with problems such as homophobic bullying and harassment.

Male survivors of sexual abuse – lack of co-ordinated support for adult survivors of abuse

Fathers – despite examples of good practice, men have comparatively less access to support services than women, to enable them to cope with the stresses of parenthood.

Bereaved men – lack of appropriate services specifically targeted at men who have experienced bereavement.

Men in rural areas – particularly isolated in terms of service access.

Young offenders – inadequate psychological services in juvenile justice centres despite the high proportion of young people entering the juvenile system with a range of mental health problems.

Ethnic group:

A review by Commission for Healthcare Audit and Inspection,( Count me in, 2009) noted that “Rates of admission were lower than the national average among the White British, Indian and Chinese groups, and were average for the Pakistani and Bangladeshi groups. They were higher than average among other minority ethnic groups – particularly in the Black Caribbean, Black African, Other Black, White/Black Caribbean Mixed and White/Black African Mixed groups – with rates over three times higher than average, and nine times higher in the Other Black group.”

Employment Status and Mental Health

Having a job helps to maintain better mental health than not having one, but this is not always true as many factors involve

For example, jobs which are unsatisfactory or insecure can be as harmful to health as unemployment (Wilkinson et al , 2003). Anxiety about job security, lack of job control, perceived effort-reward imbalance, negative relationships in the workplace, including bullying and harassment can have negative mental health consequences.

According to OSC Health Inequalities Review (2006) people with a common mental disorder are five times more likely to be unemployed, and if they have work they are more likely to be excluded, people with an identified mental health problem are twice as likely to be on income support and four to five times more likely to be getting invalidity benefits. A person with a diagnosis of a psychotic illness leaves him with only a one in four chance of being in employment.

Geographic variation:

Studies result on geographic variation of mental illness are inconsistent , for example Hollie has concluded that “In mental health problems there is substantial variation at the household level but with no evidence of postcode unit variation and no association with residential environmental quality or geographical accessibility. It is believed that in common mental disorder the psychosocial environment is more important than the physical environment” (Hollie et al, 2007)

On the other hand, a recent Swedish study of 4.4 million adults found that the incidence rates of psychosis and depression rose with increasing levels of urbanisation (Sundquist K.et al.,2004).

Another study by Royal Commission on Environmental Pollution shows that people from densely populated areas had a 68-77% and 12-20% higher risk of developing any psychotic illness and depression respectively when compared to a control group in rural areas. Within urban areas the rates for psychoses map closely those for deprivation and the size of a city also matters; in London schizophrenia rates are about twice those in Bristol or Nottingham (Royal Commission on Environmental Pollution, 2007a, 2007b).

Disability and Mental Health:

Definition: According to Disability Discrimination Act (1995) (DDA)

‘A person has a disability if he has a physical or mental impairment which has substantial and long-term adverse affect on his ability to carry out normal day to day activities’

In the light of this definition we can focus on mental health inequality of three groups of people:

aˆ? People suffer socio-economic disadvantage caused by stigma and discrimination associated with their mental health problems.

aˆ? People with both mental health problems and physical disabilities.

aˆ? People with physical disabilities, whose experience discrimination and stigma because of their physical impairment and become mentally ill because of this experience.

Disabled people are more likely to experience stress and emotional instability than those who are not disabled.

a report by the Equality Commission for Northern Ireland (2003) has found that whilst 34% of those who were not disabled had experienced quite a lot or a great deal of stress in the last 12 months prior to the survey, the percentage rose to 52% for disabled people. Experiences of depression within the last 12 months were higher among women who were disabled (44%) than men (34%).

Conclusion:

Inequality in mental health is as important as any other form of health inequality, however the interaction between social and personal level in mental illness makes it more difficult to address different kinds of mental health Inequalities associated with it.

Question 2 : word count (2000)

Tackling inequalities in mental health
Introduction:

Mental illness, among other disorders, is widely considered as a significant determinant of both health and social outcomes and many studies have spotted mental health disorders as both consequence and cause of inequalities and social exclusion.

Mental health diseases have two distinct characteristics as a public health problem: first very high rates of prevalence; secondly : onset is usually at a much younger age than for other health problem , Mental health diseases effects all areas of people’s lives : personal relationships, employment, income and educational performance. (Friedli and Parsonage , 2007; McDaid , 2007)

Who is at risk for mental health problems?

Defining risk groups enables policies makers to determine how to manage available resources to achieve better health equality. Furthermore, these groups are the main targets for health equality promotional programs.

A review of recent evidences on mental health inequalities can help to define the large groups at risk:

aˆ? People living in institutional settings: such as care homes or those in secure care or subject to detention.

aˆ? People living in unhealthy settings and who may not be reached by traditional health care such as veterans or the homeless.

aˆ? People with physical and/or mental illness, people misusing drugs, people with alcohol problems, people who are victims of violence and abuse.

aˆ?children whose parents have problems with alcohol or with drugs, children whose parents have a mental illness and looked after and accommodated children,

aˆ? People from groups who experience discrimination.

Key policies:

These policies can be long term policies focusing on deep change over long period or short term seeking fast results such as health promotion.

Long term aims:

Inequalities in mental health are not only about equality of access, but also about quality of access.

In the year 2009 Mental Health Foundation has published a report on resilience and inequalities in mental health (Mental Health, Resilience and Inequalities ,2009)

This report mentioned four priorities for action:

1-Social, cultural and economic conditions that support family life:

This can be done by reduce child poverty , parenting skills training and high quality preschool education , increasing access to safe places for children to play, especially outdoors, inter-agency partnerships to reduce violence and sexual abuse.

2- Education that helps children both economically and emotionally by:

schools health promoting programs, involving teachers, pupils, parents and supporting parents to improve the home learning environment (HLE)

support social, sports and creative achievements, as well as academic performance

3- Reduce unemployment and poverty levels and promote and protect mental health by:

Supporting efforts to improve pay, work conditions and job security.

Facilitate early referral to workplace based support for employees with psychiatric symptoms or personal crises to prevent employment breakdown.

4- Tackle economic and social problems, which cause the psychological distress. Such as housing/transport problems, isolation, debt, beside that art and leisure centres can help to reduce stress too.

However, these strategies take long time to be effective, that means the need for more rapid actions or short term aims.

Short term aims: Mental health promotion:

To build an effective strategy to promotion for health equality the following points should be achieved:

aˆ? Comprehensive: Mental Health promotion is not only the responsibility of health services alone; other sectors of society should join that effort.

aˆ? Based on evidence

aˆ? Based on the needs of the local communities, and with the agreement of these communities.

aˆ? Subject to evaluation: The strategy should be subject to critical evaluation and can be changed when necessary.

A good example of such strategy is the Mental health national evidence based standards which have been issued by The National Service Framework for Mental Health (DOH 1999). The purpose of these standards is to deal with mental health discrimination and social exclusion associated with mental health problems. And that can be achieved by promotion:

promote mental health for the whole society, working with individuals and communities

Stop discrimination against individuals and groups with mental health problems, and take steps towards better promotion for their social inclusion.

Tackling inequalities for special risk groups:
The Suicide prevention strategy:

One of the best example is the strategy based on work by (DOH 2002) and The NSPSE (National Suicide Prevention Strategy for England), the report was the result of literature review of suicide prevention programs around the world and has reached the following goals:

1. To reduce the risk in key high-risk group.

2. To promote mental well-being in the wider population.

3. To reduce the availability and lethality of suicide methods.

4. To improve the reporting of suicide behavior in the media.

5. To promote research on suicide and suicide prevention.

6. To improve monitoring of progress towards the target for reducing suicide.

Women and Mental Health: Preventing:

The results of UK-based survey (Williams, 2002) shows that mental health services for women:

Do not meet women’s mental health needs.

Can replicate inequalities.

Can be unsafe for women.

Can be insensitive to the effects of gender and other social inequalities, such as race, class and age

However, in their response to a survey conducted in England and Wales, women said that they wanted services that:

aˆ? Keep them feel safe.

aˆ? Promote empowerment, choice and self-determination.

aˆ? Place importance on the underlying causes and context of their distress in addition to their symptoms.

aˆ? Addressee important issues relating to their roles as mothers, the need for safe accommodation and access to education, training and work opportunities.

aˆ? Value their strengths, abilities and potential for recovery.

(DH, 2002a)

These points are important to build a need-based action plan for better equality in health services.

Men and Mental Health: Preventing:

The Equal Minds conference workshop which had special focus on men and mental health listed five service design features targeted at men’s mental health and well-being (equal minds, 2005):

aˆ? Accessibility and flexibility of services regarding time, location. For example, Select places familiar for men, ‘Men Only’ sessions run by male staff, make use of some activities, such as sport and physical activity programmes.

aˆ? Holistic approach, works on the person as a whole, not just on mental health.

aˆ? Early intervention to prevent anxieties and concerns build up, especially in stress and anger management.

aˆ? Trust and confidence are important to solve problems of identity and role that can underlay men’s anxieties and self-perceptions or lack of self-esteem.

Ethnicity and Mental Health: Preventing:

The main problem in this field was the barriers to access services. Barriers include:

aˆ? Language.

aˆ? Stereotyping.

aˆ? Lack of awareness or understandings of mental illness.

The report Inside Outside (Sashidharan, 2003) which addresses mental health services for people from black and minority ethnic communities in England and Wales. Suggest that patients from all minority ethnic groups are more likely than white majority patients:

aˆ? To follow aversive pathways into specialist mental health care.

aˆ? To be admitted compulsorily (there are differences also between ethnic groups at all ages).

aˆ? To be misdiagnosed.

aˆ? To be prescribed drugs and Electroconvulsive therapy (ECT), more than talking therapies.

aˆ? To have higher readmission rates and stay for longer periods in hospital.

aˆ? To be admitted to secure care/forensic environments.

aˆ? Their social care and psychological needs are less likely to be addressee within the care planning process.

aˆ? To have worse outcomes.

A strategic approach in Ethnicity and Mental Health:

In England and Wales a framework have been developed for action for ‘delivering race equality’ in mental health (DH, 2003b)

The framework focuses on three ‘building blocks’ which are essential to improved outcomes and experiences of people from black and minority ethnic communities:

aˆ? Information of better quality and more intelligently used.

aˆ? Services which are more appropriate and responsive.

aˆ? Increased community engagement

In other words any approach should take in consider both quality of health services and the socio-economic disadvantages experienced by people from ethnic communities.

Some suggested steps for this approach may include:

Providing interpretation and translation services beside mental health service to insure highest possible quality.

Adopting equalities practice in mental health services, that mean better understanding for cultural identity, the impact of racism, and culture differences in expression of mental distress.

Developing assessment and diagnostic tools that can better assess patients from different backgrounds and ethnicities.

Ensuring that services understand and respect spiritual requirements for different cultures.

Ensuring access equality to culturally appropriate services including, counseling, psychotherapy and advocacy.

Addressing common problem for people from black and minority communities, such as housing, employment, welfare benefits, and child-care.

Disability and Mental Health:

people with disabilities may experience high levels of socio-economic disadvantage due to discrimination and stigma , this group need a special interest regarding mental health services , they are liable for what Rogers and Pilgrim (2003) described :’inequalities created by service provision’.

Mental health services for disable people should be customized to their needs, some recommendations for such services may include:

Promotion for mental health, well-being and living with disability.

Early intervention: for people who show symptoms for possible mental illness.

Personalised care based on individuals’ needs and wishes

Stigma: work for better social inclusion and tackling stigma and discrimination associated with some disabilities.

Elderly and mental health:

In order to achieve better equality for this group, policy makers should insure better access to mental health services on the first place.

In the year 2005 the Department of Health published a report titled “Securing Better Mental Health for Older Adults to launch a new programme to bring together mental health and older people’s policy in order to improve services for older people with mental health problems.

The National Directors for older people and mental health promoted the dual principles of:

aˆ? Delivering non-discriminatory mental health and care services available on the basis of need, not age and

aˆ? Holistic, person-centred older people’s health and care services which address mental as well as physical health needs

Here, it is essential to emphasis the importance of specialist mental health service for older adults.

Sexual Orientation and Mental Health:

In this group health promotion plays a great role to address the mental problems associated with sexual orientation.

PACE organization has drawn up a set of practice guidelines for working with lesbian, gay and bisexual people in mental health services (PACE guideline.2006).

The guidelines suggest promoting services and resources specifically for LGB people, including services such counselling and advocacy provided by LGB organisations.

In response to these guidelines and studies about LGB such as (McNair et al, 2001). Mental health services for LGB people should:

Reflect upon the homophobia and heterosexism that LGBT people may experience within mental health services.

Enhance awareness of LGBT people problems, and the forms of discrimination and social exclusion they may face.

Consider the nature of a ‘culturally competent’ for LGBT people

Preventing in Mental Health Problems:

people with mental health problem are in need for “resilience factors” that enable them to recover from mental distress and to fight the effects of discrimination and stigma, we can name some of these factors such as confiding relationships, social networks, self-determination, financial security, however, support health services are essential for individual recovery and to achieve socially inclusive ‘accepting communities’ (Dunn, 1999).

Examples for these services can be found in “report on Mental Health and Social Exclusion” which has been published by Social Exclusion Unit. The report included a 27-point Action Plan aimed at tackling stigma and discrimination, focusing on the role of health and social care in addressing problems of social exclusion, unemployment, and supporting families and community participation through ensuring access to goods and services such as housing, financial advice and transport (SEU,2004).

Beyond this report, it is important that policy makers be aware of connection between inequalities and mental health as a result and a cause, this will encourage more holistic approach that aim prevention on the long run.

Conclusion:

It is essential to put the different recommendations on mental health inequalities into everyday practice , for example a recent study by Glasgow Centre for Population Health found that policies are not driving practice for reducing inequalities in mental health within primary care, and the primary care organization studied is not conducive to addressing inequalities in mental health. (Craig, 2009).

For that reason, it is the responsibility of government, health services and health professionals to put these strategies and plans into action to insure a better and healthier society.