Group care

This could be either in a small or large institution where care is provided on a 24-hour basis, or on a much more intermittent “hands off” basis. To distinguish group care as a method of social work from other methods such as group work or community development, there will always be some degree of emphasis on “shared (daily) living arrangements in a specified centre of activity” (ibid:8). My placement in the Community Mental Health Team, Cookstown, did not automatically present me with an opportunity to complete my group care requirement, as it is a fieldwork team.

However, I was given the chance to undertake work in the local Beacon Centre, which provides a day care setting for people with mental health problems. I worked in the centre for one week, during which time I had the opportunity to experience the similarities and differences in group care and fieldwork. There are some similarities in the work done in a group care setting and that done in fieldwork teams. These include individual assessment of need and counselling. Social workers in both settings will continually be assessing, planning, implementing and reviewing (Parker and Bradley 2005).

They will always hold statutory responsibilities, even if the group care setting is voluntary, as outlined in the NISCC Code of Practice, e. g. reporting any risk to self or others to the necessary bodies. Also they will always be guided by legislation. For example, in my fieldwork setting the main pieces of legislation we are guided by are The Mental Health Order 1986 and The Human Rights Act 1998. Even though the group care setting I was in is voluntary, both these pieces of legislation still guided my practice.

The Mental Health Order 1986 allows you to work with people with mental health problems to promote mental health and emotional well-being, it is about managing risk and safeguarding rights. This is the case no matter which setting you are working in, as the overall aim is to promote the mental health of the service users you are working with, while managing any risks they might pose to themselves or others.

Although there are obvious similarities between group care and fieldwork, group care can be seen as a distinctive method of social work which use aspects that are not usually found in fieldwork such as the ongoing and creative use of incidents and exchanges arising in everyday life, and the maximising of these informal opportunities to offer constructive help” (Ward 2007:14). I experienced this in my group care setting everyday. For example, each morning the members decided what they would like for lunch that day. It was then decided who would cook the dinner, depending on who would gain the most constructive help from this. On the other hand, in my fieldwork placement, service users are seen by appointment at differing intervals, depending on their level of need.

Although these interviews can sometimes be lengthy and serve an important purpose, they are quite formal and the social worker will have an agenda to follow. However, it is important to note that this agenda can be postponed depending on what the worker is presented with on the day, e. g. if the service user is in crisis, it will be their agenda that will be followed. The worker is only seeing the service user for a minimal time and won’t always be able to determine how the person interacts socially. In social work, we try to find out how a service user interacts with various surrounding systems: family, agency, school, and so on” (Schulman 1999:302), but in fieldwork this can be difficult.

Only seeing “snippets” of someone’s life makes it difficult to fully understand how service users are on a regular basis, dealing with situations that arise daily. From my experience of group care, I found that it is much easier to see how service users interact with the systems to which they belong, as much more time is spent with them, both individually and in a group (Smith, 2005). In group care, time is usually organised into an effective routine, which the service users are central too.

Although there will be formal elements to this routine, e. g. user led meetings took place every three weeks at an agreed time in the Beacon Centre, the workers are also with the service users during the informal times. This allows them to observe how individuals interact within a group, and how they deal with any conflict or difference of opinion that may present itself. Ward (2007) suggests this prolonged exposure can be stressful for workers at times as they are continually assessing service users and managing risk, but it can also present opportunities for work that can be capitalised on.

In a fieldwork setting, a team consists of different disciplines that often carry separate caseloads. The workers tend to utilise the multi-disciplinary setting by seeking occasional peer support. For example, in my practice learning opportunity in the Community Mental Health Team, I share an office with an occupational therapist, a social worker and a community psychiatric nurse. Each professional has their own caseload with individual clients they work with. There is a formal opportunity once per week, in the team meeting, for workers to discuss any cases they would like advice on.

Other than this, informal advice can be sought from colleagues were and when it is needed. On the other hand, in group care, it is more of an active and sustained co-working that is carried out. This sort of team can be referred to as “interdependent” (Saleebey 2005), in that the workers rely on each other during the everyday running of the centre. I experienced this directly in the Beacon Centre. As there is only five members of staff, there is a good working relationship between them and they depend on each other to provide support continually.

This is beneficial for the service users also, as they form good relationships with all of the staff and therefore can relate to more than one person, even if they are allocated a keyworker. In my opinion, one of the main benefits of group care is the social interaction it affords its users, and the sense of belonging it gives to many individuals. Although writing more than twenty years ago Carter (1981:278) states that people who use day care said “coming to the unit helped them by giving users social contacts, friendship, or company with others…

In short, most users got most from the personal and interactive aspects of the day unit”. Just allowing users to be in a place where there are other people around gives them the opportunity to talk to those in a similar situation to themselves. They get the chance to realise they are not the only ones with problems and in some cases may see that their problems are not as bad as they thought. People suffering from mental health problems may have a tendency to socially withdraw themselves and their social interaction becomes very low (Adams et al 2005).

A day care setting, like the Beacon Centre, can change this, by providing a safe and enjoyable environment for users to come together and make friends and social contacts. During my time at the Beacon Centre, it was obvious from the beginning that the centre was very much user-led. This is different from my experience in the fieldwork team I work with. The appointments for users are normally set by the worker and a letter sent out with a time and a date. However, the service user is offered the option to contact the worker to negotiate a more convenient time, though it can sometimes be hard to find a date and time that suits both individuals.

Also, a lot of work done with the service user can be agency led. For example, when a service user comes for an initial assessment, there is a form that has to be filled out and so the worker will be trying to gather specific information that will allow them to fill in the agency form. Although this information is necessary when deciding what services would be best for the service user, it can be intimidating for service users to have someone write personal information about them while they talk. They may wonder where the information will be stored and who will have access to it.

It would be vital at this stage that the worker would explain confidentiality and its limits to the service user. They may not be ready to answer some of the questions on the form, especially as this is the first time they will have met the worker, yet this is not always taken into account. This is not necessarily the workers fault, as the worker will have a statutory responsibility to make this assessment and the preceding risk assessment whereas the workers in the Beacon Centre would not hold this duty. If they were concerned about someone they would contact the Community Mental Health Team.

So although the assessment tool can be seen as daunting, I understand that it is there for a reason and if the worker takes time to put the service user at ease by explaining the purpose of the assessment, it does not have to be a traumatic experience for them. In the Beacon Centre, what happens during the working day is very much decided by the members who are there that day. Although the staff organise specific classes, members are not required to take part in them, it is completely up to them what they want to do.

For example, during my time spent there, two of the members wanted to go to a snooker hall to play pool. I facilitated this and went with them. I feel this gave me the opportunity to get to know the members better, as they were able to talk informally without fear that I was assessing them or judging them. This is something that fieldwork social workers would not have time to do because of the extent of cases and the time constraints placed on them. There are user led meetings every three weeks, where users are given the opportunity to express any concerns they have or to suggest new ideas for activities.

Ward (2007:44) suggests that “most of all… people in group care want to be heard – to be able to express their views”. As the workers facilitate these user led meetings, it provides the members with an opportunity to convey their views and allows them to be heard. Having these meetings and implementing the members’ views, means that they look forward to coming to the centre every day as they are getting the opportunity to do things they want to do and not what they are told to do.

Biestek (1961:25) states that individualization is the recognition and understanding of each client’s unique qualities and the differential use of principles and methods in assisting towards a better judgement”. During the team meetings that are conducted in the Community Mental Health Team, the language used can be oppressive and leads to users losing their individuality. For example, when people have a diagnosis of personality disorder they are referred to as a “PD”. Although this may be seen as a time saving measure, it is highly oppressive and it means the client is talked about by their diagnosis, rather than their name.

This is an example of how the medical model can sometimes be seen as more important than the social model. The language used is oppressive and does not promote the value of individuality. No matter what diagnosis a person has, they are a human being first. Biestek further comments that people should be treated “not just as a human being but this human being with personal differences” (1961:25). They may have the same diagnosis, but they are different people as so cannot be grouped together as the “PD’s”. In the Beacon Centre, not only is individualisation encouraged, it is actively promoted and practiced.

No one is categorised into groups depending on their diagnosis. Time is given to members individually to discuss issues personal to them. Schulman (1999) states it is important to be able to pick up indirect cues and respond to them directly. This was evident in the Beacon Centre. Because staff have the time to get to know each member individually, they are able to sense when something is wrong with a member by changes in their behaviour and body language. The staff can then address the situation with the member and provide them with an opportunity to talk.

This is very effective practice as everyone feels valued, they feel like they belong and they feel like they can be themselves. Treating someone as an individual is an important social work value, and from my experience it is a value that is held with high regard in group care settings. I do believe the social workers I work with in my fieldwork placement treat their service users as individuals, but because of demanding case loads and time constraints they do not have the same amount of time to get to know their service users as much as the staff in the Beacon Centre.

This is the contested nature of social work that exists in society today and one of the reasons group care exists. Alston and Bowles (2003) would argue that the social model of care is just as important as the medical model, yet it is constantly undermined and under budgeted. In the community team, the medical model seems to take precedence over the social model. For example, in team meetings, if there is a service user who’s mental health is deteriorating; the first thing that is looked at is the medication they are on.

The psychiatrist decides if the medication can be changed or increased in order to help the service users mental health. If someone misses an appointment for a depot injection there is a strict procedure that has to be followed. The service user has to be contacted and asked to come in as soon as possible. If the CPN cannot get them on the phone, they normally call at their house; contact their next of kin, or any other agency that may be involved with them. On the other hand, if someone was to miss one of the walking groups run by the occupational therapists, there isn’t as much formal follow up.

The onus is on the patient to participate, even though the benefits of attending groups include social inclusion, social interaction, increased confidence and boosted self-esteem. On the other hand, I do understand that it is very worrying if someone with a serious mental illness misses their medication and that there should be a formal procedure followed, I simply believe that there should be more formal follow up’s for the members who miss social activities as well. In the Beacon Centre, the majority of the work is centred on the social model.

This is because there is no trained medical staff in the Beacon Centre, therefore they have no medical responsibilities, except to contact the Community Mental Health Team if they are worried about an individual. So, although medication is recognised as being important, the benefits of social interaction is also highly valued. Walking groups, arts and crafts, creative writing, computers and other similar classes are all offered and service users are encouraged to attend. It promotes learning and helps increase confidence and self-esteem.

It is equipping users with new skills and can have a positive impact on their mental health as it is increasing their motivation and encouraging peer support. Brandon and Brandon (2001) talk about the effects of stigma on service users. They argue that service users will respond negatively to treatment if they feel stigmatised or prejudiced. Mental health, to an extent, is still a taboo subject in society. People can feel embarrassed to admit they have depression or anxiety as they may feel people will treat them differently or see them as ill.

Even if they are receiving treatment for their illness, service users have the right to privacy and if they do not want people to know they are involved with mental health services, it is their choice. Therefore, service users may feel stigmatised if they are coming for an appointment with their social worker and have to walk into a building with a sign saying “Community Mental Health Team” on the wall, however this is not an issue in my PLO as the office is in a generic building with a GP’s surgery downstairs.

In other settings, this should be considered when arranging appointments with service users, and the worker should go to their home if it is suitable and if this is what the service user wants. Going to a service users home, means they are in their comfort zone and should not feel as intimidated or under pressure. They may feel able to talk more and open up, as they are familiar with their surroundings. However, this is not always taken into consideration, as there are risks involved with visiting a service users home when you don’t know much information about them.

You will not know how unwell a service user is, or who else will be in the home. Symptoms of serious mental illness can include aggression and hostility and this needs to be taken into account. Therefore the service users may feel apprehensive about coming in for appointments. In the Beacon Centre, everyone who is attending is doing so on a voluntary basis. Although the stigma of mental health still exists in society, the centre is almost an escape from this. All the members suffer from some form of mental illness, therefore everyone has something in common.

They most likely have all felt what it is like to be stigmatised and so the staff go out of their way to make sure it is not an issue in the centre. The atmosphere in the centre was a positive one and because everyone is treated as an individual the issue of stigma is less prominent, although stigma is recognised in the Community Mental Health Team though cannot always be avoided. Overall, my experience of group care as a social work setting was an entirely positive one. Workers have much more time to spend with service users and take part in opportunity led work when unexpected issues arise.

This is offering constructive help when something unplanned happens. Group care is “complex and demanding work, requiring understanding, skills and professional teamwork of a high order” (Ward 2007:191). The work can be intense, as the service users are there on a daily basis and so there is much more contact with them. Fieldwork is also intense because of demanding caseloads and the managing of risk to service users. The Beacon Centre pass any concerns onto the Community Mental Health Team, and it is up to them to manage the risk, either in the community or by arranging an admission to hospital, sometimes under The Mental Health (N.

I) Order 1986. So although I fully understand the importance of fieldwork, and how vital their role is, I felt my input made a positive impact on service users in a group care setting because of the time and attention I was able to spend with them. This will help influence my practice in my fieldwork placement. I will try to allocate sufficient time to each individual service user, to give them the opportunity to talk about what they feel are causing them most problems. I will promote the value of individuality, both when working with service users directly, and when participating in multi-disciplinary team meetings.