CPEA Nose Guest Blog from Steve Scott: Leadership and Mental Health

The Shaw Trust reported in 2010 that only 2 in 10 employers have a reactive or proactive mental health policy to support staff with mental ill health. What role does leadership have in addressing this challenging issue?

Employee mental well-being should be an integral part of the boardroom agenda, on a par with physical health. Leaders should insist that regular monitoring of progress or issues is reported to the board. The Chartered Institute of Personnel and Development (CIPD) has found that 70% of employee mental health problems are either directly caused by work or by a combination of work and home. In light of this, there simply is no excuse for this not be a mainstream issue for leaders to address. By proactively managing mental well-being in the workplace, leaders are not only dealing with their legal and ethical responsibilities, they are also looking after their bottom line as well. Absenteeism and presenteeism are responsible for losing British organisations billions of pounds, so how can this subject be ignored.

All employers should include safeguarding mental well-being into their standard operations, particularly when employees and/or organisations are embarking on change processes, which can be and are very challenging times for everyone. Training from the leadership down in proactively managing mental well-being, including offering additional support to staff or simply leading by example, is essential. Safety net support such as coaching and occupational health needs to be incorporated into health and well-being policies.

Leaders should be ensuring that management have a huge positive impact on mental health. Good line managers are essential in spotting early signs of distress and initiating early intervention, whereas poor line managers may make the situation worse or even be the cause of mental health problems through their approach, management style of behaviour.

Leaders should be insisting that comprehensive and, more importantly, mandatory mental health training for line managers is introduced and embedded into the culture and development plans for their employees. This training and change in culture will ensure that the organisation develops employee resilience and emotional well-being.

Steve Scott is co-founder of CSP Coaching LLP steve@cspcoaching.com

Guest Blog From Rosemary Milmine: Life As A Registered Care Manager

As an actual Registered Manager, doing the 60hrs plus a week, (at the moment working the night shift because a member of staff went off suddenly and there was no one able to cover at short notice), I can only applaud any move towards better recognition that the job we do is often complicated and quite frankly often unrealistic. I am being put under pressure by the local authority to reduce the fees we currently charge for residents – (basically telling me how I must cut down on basic good care) and whilst I am digging my heels in for the moment I am not sure for how much longer I can hang on and I am not the only care home facing this. The upshot will inevitably be staff reduction and managers’ workloads will become even more unmanageable.  

Focusing on Registered Managers is a good idea, I have a lot more confidence than I had when I started in this role and I know that I provide a good service, (a CQC inspection last week confirmed this!), but it has taken me quite a few years to get to this position. It would be good if Registered Managers were supported to get to the same point quicker than I have! I still haven’t worked out how to get down to a 40hr week!

My worry would be whether Registered Managers could be released from their roles to attend forums and training – when I undertook my Registered Managers Award seven years ago most of us were doing it in our own time and since then thinks have got busier. However I think we need to somehow start taking control we can’t have all and sundry waltzing into our homes telling us how to run them…

Guest Blog from John Burton at The Association of Care Managers: In Defiance of Compliance

A care home that is run simply to be “compliant” is unlikely to be a good place in which to live or work. Compliance is alien to the ethos, principles and good practice of the social care profession and residential social work 

Compliance, the principal tool of measurement used by the Care Quality Commission, has no place or validity in the life and work of a care home. It is a negative and submissive concept. Nothing ever grew and developed, no initiative, no advance was ever made by compliance. Compliance is static and change is dynamic. The notion of compliance could only be of use to check important but secondary technical services to the home, and such checks should be made by suitably qualified and experienced technicians. For example, the lift must be properly maintained, medication managed well and accounted for, and food stored and prepared safely, but such compliance is not the primary purpose of a care home. 
Those of us who were trained and qualified as residential workers or residential social workers – trained to practise, manage and lead – received a thorough grounding in such areas as human growth and development, loss and change, social psychology, group processes, community and institutionalisation, leadership, ethics, ageing and society, social work methods, social policy, counselling, dependency and power relationships, family and individual therapy, etc. etc. We were encouraged to enquire, to challenge, explore, and debate ideas. We thought, read, and argued. We were not taught “compliance”. Courses differed and, of course some were better than others, but I very much doubt if any residential social work course ever mentioned “compliance”.
No, I’m wrong. In the early 70s, when I did my qualifying training, the word compliance described a worrying aspect of, for example, a child whose infancy and early years had compelled them to keep their heads down and to find a way of surviving the hostile and persecutory world around them. These days, we might take compliance in an eighty-year-old resident of a care home to indicate that they may be being abused, bullied or medicated, and they had attempted to avoid further pain and humiliation by withdrawing into themselves and being “quiet”, compliant and unnoticed. “No trouble.”
“The creativity that we are studying belongs to the approach of the individual to external reality . . . Contrasted with this is a relationship with external reality which is one of compliance, the world and its details being recognised but only as something to be fitted in with or demanding adaptation. . . in a tantalising way many individuals have experienced just enough of creative living to recognise that for most of the their time they are living uncreatively, as if caught up in the creativity of someone else, or of a machine.” D.W.Winnicott, Playing and Reality.
Care homes are caught up in what the machine of CQC has created – compliance. We will break free of the constraints of compliance only if we start acting like professionals and leaders of our care communities. We must stop acting like quiet, frightened, compliant children, anxious to please by fitting in with the rules and restrictions imposed on us. We must grow up, join forces in taking responsibility for our own profession, and lead the development of care homes as highly valued local centres of care and support.
Over ten years, the national regulators have turned social care upside-down. Instead of the needs of users instigating the form and operation of care services, and those services, led by the registered managers, being designed and managed at a local level to meet those needs, the regulators have imposed their misinformed and blinkered design for care. This top-down approach has in turn spawned a new layer of quality-assurance, management and consultancy which is now seen as essential to prove to the regulators that providers are compliant. And this self-perpetuating arrangement flourishes alongside the cosy pretence of personalisation. Compliance-centred is the very opposite of “person-centred” care.
It seems extraordinary that while those at the head of this appallingly wasteful and dysfunctional system have had the advantages of sophisticated management training and mentoring, they seem incapable of understanding their part in it.
According to Paul Hoggett (University of the West of England), social work/social care professionals need the capacity . . .
  • to tolerate and contain uncertainty, ambiguity and complexity without resorting to simplistic splitting into good/bad, black/white, us/them, etc.
  • for self-authorisation, that is, the capacity to find the courage to act in situations where there is no obvious right thing to do
  • for reflexivity, that is, to take oneself as an object of inquiry and curiosity and hence to be able to suspend belief about oneself; all this as a way of sustaining a critical approach to oneself, one’s values and beliefs, one’s strengths and weaknesses, the nature of one’s power and authority, and so on
  • to contain emotions such as anger, resentment, hope and cynicism without suppressing them and hence to be both passionate and thoughtful. 
What do we think Tom Kitwood would have made of this compliance culture? Would it not fit perfectly with his description of a “malignant social psychology”? Is it not understood at any high level in Government, Department of Health or CQC that the malignant effect of compliance does not merely “filter” softly down to the way residents in care homes are treated, it is – albeit unwittingly – aimed directly at them and blights their lives.  
When senior members of CQC are cornered, and when they cannot bully their way out of the corner, they resort to the excuse that they have no choice and are merely following the orders given them by government but are short of resources, and “give us time – we’re a young organisation”. Such excuses are a betrayal of professional ethics.  
As social care professionals and leaders, registered managers must take their cue from their own professional standards. We must support each other, learn from each other, and always put our clients first.  
John Burton, ACM

In tribute to Ian Mallinson

It is now five years since Ian Mallinson passed away. I am very pleased that Janti asked me to say these few words at this Masterclass and annual Birmingham seminar where we in the SCA remember his contributions to social care. Now what to say about a unique man that some of you will have known better than me, some of you will have just heard his name and wondered, whilst others may not know of him at all.

 In these circumstances I did what many of you may do. I Googled him and in doing so I realised that this was something that Ian would have appreciated. In so doing I lighted upon the theme of what I want to say about Ian today. Although it is only five years since Ian’s death, with his illness, it is all of ten years plus since his last major publication on social care practice. For those of you that don’t know that was the 2000 Personal Care Planning in long term social care of older people – empowering service users – written with Susan McClean. As an aside, and I am getting diverted from my chosen theme here, this publication is still available from SCA and was and is ahead of what a lot of social care organisations are practicing even now.

In the preface it says “personal care planning is about workers jointly identifying needs with service users and then finding ways of meeting them. The personal support plan, defined by a named worker in conjunction with the service user, helps to provide a framework that gives a sense of clarity and focus to the activities of all involved”. I hope that says enough to give you a flavour of his work.

Now in the 10 years since that Mallinson/McClean publication Google has exploded alongside other technological advances and social media. In 2000 the information revolution and knowledge economy was just being ignited in the UK and it is only now just beginning to explode and change our world, including social care, forever. What would Ian have made of this? What would he have made of there being 5 professional Dr. Ian Mallinsons on LinkedIn, pages and pages of Ian Mallinsons on Facebook and many people with Twitter accounts who own up to being Ian Mallinson. Well I tell you what he would have loved it. You see Ian was an early adopter. Ian had a steam driven computer in the loft room where he lived and worked at Policy House in Bourneville – this was the place that most of the thinking and creation of Ian’s work for the SCA took place – before we even knew what a home computer was. He had CDs while the rest of us were still buying Vinyl and what an eclectic collection – jazz, choral, classical and rock/folk. There is no doubt in my mind that Ian would have a top of the range iPod, iPad and phone if he were around now. He would have switched to Mac no doubt about it and probably would have tackled the technical side of home computing as well.

I think Ian would be a driving force in social media and social care today. He would be promoting best practice through Twitter, running forums on LinkedIn and challenging leaders, managers and academics with a popular blog. The blogosphere was made for Ian’s knack for joining theory and practice and working alongside people on the ground to get the messages out far and wide. I think Ian would have invented a keyworker App by now that we would be debating the ethics of using and discussing how this can benefit service users and the risks be minimised. For those of you that don’t know keyworking was Ian’s middle name and as Janti said to me yesterday – you can’t get more person-centered than keyworking.

Yes Ian would have liked being googled, he would have liked that Social Care Online (SCIE) has 24 of his publications listed and that you can buy his books on Amazon. He might have even taken issue with the fact that apparently his most read book – Keyworking in Social Care – is now ranked 1,416,711 in books sold. He would have expected us all to do something about that. Ian believed in credit where credit is due, gave it and expected it in equal measure, and hated plagiarism and academic snobbery.

Those of you lucky enough to have been tutored by Ian at Bourneville College know that he would not have been fearful of social media. He would have been building it into learning and best practice, he would be using it to benefit his students and getting them to address how technology could improve quality of life for service users. He would be fighting to get a voice for people, for himself, in
the busy world of social relationships on the Internet – he would addressing the issues of communication up front. As a distinguished man he would have found a way to distinguish himself and those around him.

I have concentrated on one particular strain of thought that hopefully does justice to Ian’s memory. If you do Google Ian you can read all about his achievements in social care and other fields. In particular I would commend Joan Becks memorial piece to this event in 2007 published in SCAs magazine and available online or Natalie Valios’s item in Community Care 2000 when Ian was Association President.

However for me the inspiration in Ian was not about looking back, however valuable that maybe, but in forever looking forward and side ways as that was the type of man he was. I was lucky to have been his colleague, collaborator and conspirator for some 15 years and just thinking about what he would be doing today excites and inspires me still. He would probably be preparing an electronic wallchart of the forthcoming changes in legislation in social care – now there’s an idea worthy of Ian.

(I gave this address at the annual Ian Mallinson masterclass in September 2011)