Sunday, 09 June 2013

Care in the community - it has to be reliable

A couple of weeks ago, with reference to the case of Ariel Castro, I was wondering if

‘Maybe we need to put more effort into pre-emptive services for all kinds of mental ill-health; and to normalise or de-stigmatise the idea of consulting them.’

It's critical that people who fear they could harm others should know that help is available. Care in the community has to mean genuine formal and informal support, and not just one or the other. And as this poignant story in Saturday’s Guardian illustrates, it has to be genuinely available. Sean Clifton, who has a history of schizophrenia and obsessive compulsive disorder, apparently obeyed commands in his head ‘to seek out the "prettiest girl in the mall" and go and stab her.’ We are told that earlier that day,

‘He went to the emergency ward of the local psychiatric hospital and asked for help. "But they didn't take me seriously. I asked if I could just sit down and have a cup of coffee and talk a little and get it off my chest. But they were all too busy to listen."’

Years later his victim said:

‘If I have any anger, it is that the system failed him that day.’

As I’ve said, I think future societies will look back on our primitive disinterest in mental health with distaste. The full story of Sean Clifton as told illustrates a wonderful support system (carefully hidden from public view) once the diagnosis and admission was in place. But we need reliable services available locally at all times, in the first place, to accommodate the fact that mental ill-health is widely experienced, varies enormously and is potentially very dangerous. Sometimes, post-welfare capitalism feels torridly anti-compassionate.

 

9 Jun 2013 20:14:50 | Social exclusion

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What is the place of emotion in the making of policy? In the years I spent shuttling between local initiatives in low income neighbourhoods and oddly clean cupboard rooms in Westminster, I never really cracked the way the experience of disadvantage was absorbed or dismissed as ‘personal’ and disconnected from policy. You see this constantly in the skirmishes of local democracy of course – a local meeting where an officer or elected member gets a thorough bashing by a resident who’s living a kind of hell that current policies don’t address. Fierce steam gets released but policy is unaffected. Such occasions can be off-putting for the well-meaning policy maker. I think most are aware of the gravitational effect here, caused often by internal pressures of work, of the risk of gradually becoming detached from local experience. Politicians shield themselves from occasional bombardment, and disparage the ‘personal’ as ‘emotional’ while routinely exploiting examples through the media when it suits them to do so. Sometimes politicians try to use public events to draw the sting of citizens’ anger, and occasionally find they’ve over-estimated their own political skills. When they view confrontation with residents as political sport and not as a chance to understand and address needs, that illustrates the tension I’m talking about. At the same time, people who have profound experience of the failure of social systems to protect them, may not have the perspective that helps anyone relate it to policy in a meaningful way. But sometimes you hear a really considered, articulate exposition of experience that takes the personal and places it in a generalised policy context. That’s rare, and risks diluting the very emotion of lived experience that gives pertinent urgency to the cause. And often intermediaries, like housing workers say, who can speak the equivocal language of policy while combining understanding of several individual examples of disadvantage, can make contributions that are valued and welcomed by both sides. So what is the place of emotion in the making of policy? Rosie Anderson has done some work on this ‘essential but difficult territory’ and TSRC have just published a fascinating paper based on policy making around poverty in Scotland (Summary; 4-page briefing; working paper). Emotional knowledge, she says, is frequently described by her informants as ‘ambiguous, unreliable and potentially overwhelming knowledge – in contrast with “rational” knowledge, which is the prerequisite for “professionalism” in policy-making and a necessity for making policy decisions.’ This sounds a lot like what Ivan Illich described as a ‘cognitive disorder’, resting on the illusion that ‘the knowledge of the individual citizen is of less value than the “knowledge” of science. The former is the opinion of individuals. It is merely subjective and is excluded from policies. The latter is “objective” – defined by science and promulgated by expert spokesmen. This objective knowledge is viewed as a commodity which can be refined… and fed into a process, now called “decision-making.” This new mythology of governance by the manipulation of knowledge-stock inevitably erodes reliance on government by people.” (Tools for conviviality, 1973). Anderson makes the point...
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