Advocates not against mental health reform

I heard that a government minister (probably some months ago now) made a barbed comment at a meeting of advocates that suggested the government thought the advocacy movement was somehow responsible for scuppering the Mental Health Bill.

This seems amazing and unlikely to me. This is mainly because I don't think we have this sort of power. Also because advocates were finally due to get some recognition and support from the bill.

Of course some of us did join in the many voices that said the proposals for locking more people up were unrealistic and unproductive (or whatever was said).

The idea that the advocacy movement was in any way responsible for the bill's failure must be pure paranoia on the governments part however. Now I'm sure this little blog won't have any influence, but if there's any ministers or special advisors or senior civil servants reading this (and if not, why not?) then DON'T BLAME US please...

Controversy on the blog

Someone has left a distressed comment on the post about self-healing systems. I've replied, appropriately I hope, but I feel like adding a couple of extra comments here.

1. Re-reading the bit that caused the distress I can see why, and in some ways I regret that I didn't write that bit more carefully. At the same time I've set myself some rules for this blog, and one of the main ones is that I write quickly and I don't go over and edit stuff. This runs the risk of me making mistakes occasionally and even upsetting people, but I think the advantages outweigh this (and it was only a tiny part of a long post that caused the upset - do read the whole thing if you follow the link). (Also many of the concerns of the commenter could have been allayed if they'd read some of the other posts, it does look like they only read the one post and didn't see any of my many comments on professionalism, my post on advocacy and therapy, or other reflections on practice and ethics.)

2. This blog is not about my professional practice, it's about testing the boundaries, it's about challenging myself first of all to reflect further on issues I encounter, and then challenging my readers - but mainly in positive ways by offering other unusual sorts of ideas that may fit in with advocacy practice or may be something to avoid.

3. As such, and this is my main point, I want to be challenged. This anonymous commenter has given me a chance to repair an error and think again about an old post. I like comments, questions, emails, suggestions, etc. I've said this several times before, but I've got plenty of readers and not many responses. A blog is potentially very one-sided, but it doesn't need to be, and you can help... (but please leave some sort of name so I can reply properly and follow your comments on other posts)

Thanks
:-)

Relationships

I agreed in an article for Planet Advocacy (March 2005, pp.10-11) that advocacy was all about 'relationships, drama and expression'.

It's not really possible to pick out one of these terms and stress it above the others, but I do want to say a few words about relationships at this point. I'm talking about 'professional' relationships between advocate and partner, and I'm also thinking about other types of professional relationship (e.g. doctor-patient, etc.). I also wonder what we can learn from our experiences of all kinds of relationships (including with friends or children say), although sexual relationships are far more complicated and I'm not thinking about them here.

Firstly we do form some kind of relationship as soon as we meet someone. Sometimes we immediately find ourselves in some kind of conflict, occasionally we seem to have a meeting of minds, but mostly there is an initial period of getting to know each other. Whatever, if we are engaging or communicating with someone, there is a relationship.

Very often today as soon as we start to think about relationships in a professional context alarm bells start to ring: there have been so many scandals and abuses of trust that professional relationships are clearly prescribed and objectified - in particular they must be objective and dispassionate.

I think this is the wrong place to start: I've already argued that we need to protect vulnerable people from objectivity, and surely a working relationship should be about identifying some shared goals first of all, and, as advocates know well, this is often irreconcilable with having a dispassionate and objective relationship (where a 'person' inevitably becomes known as a 'client'...)

On the contrary, advocacy has a history of being partial, of being on the side of the partner: the primary goal is to form a relationship of mutual understanding and trust. This is very important as it's the only way to get to be able to really communicate with someone. It's very hard to break through the barriers of distrust and suspicion that many service users harbour, and we need all the benefits of independence and sympathy, loyalty and tenacity, inclusion and respect to be able to support people properly. Yes, boundaries need to be clear, but they come after (or at least during) the informal negotiations about trust.

All I'm going to do in this post is to open up and question the role and type of relationships. They certainly form a key part of advocacy practice, yet I think their role and the way we work with them is far more complicated than most people have acknowledged in writing about advocacy.

Food for thought hopefully...?

Don't write everything...

More christmas drinks...

I met a social worker from another town. Seems like she challenges expected practice. Had a nice chat with her...

One thing that stuck out. She was asked to do a social circumstances report for a MHRT with about 3 days notice. On her first visit to the patient she decided he was too sedated to engage properly, she told staff she would come back the next day and she hoped his medication would allow her to talk to him properly. This didn't happen - his meds were still too high, and she couldn't get the information she needed from him.

The report she wrote was therefore very brief. It mainly said that she had been unable to get sufficient information to be more comprehensive. She then came under some pressure to explain why she hadn't gone into full detail (although she had explained this in the report).

It struck me that very often people are expected to deliver comprehensive reports, but also very often it is difficult to be so comprehensive. Social workers and psychiatrists and others use their professional experience and judgement to fill in the gaps, which is of course what they're trained and paid to do. The problem is twofold: that this gap-filling process is fraught with difficulty (it's hard enough to assess how people are, let alone guess what fits in the gaps); and the second problem is that whatever is written could well be referred to for years after.

These two small problems combine into one big problem: the guesses people make with the best of intentions then become the 'truth' that can dog the patient for years to come.

What a good idea then to produce a minimalist report that leaves gaps where there are gaps - at least there are fewer chances of making mistakes that could affect people for years...

Another way of saying what I'm trying to say: when we work with people with mental health problems, in fact whoever we're working with, there are bound to be gaps in our understanding and assessment of them... what we need to do is acknowledge these gaps and let them be reflected in our reports, instead of trying to be comprehensive and ending up misrepresenting people.

A resolution for 2007? Shorter reports, more gaps?

Self-healing systems

[End of post edited 16/12]
When we think of cybernetics we usually think of bits of machines being incorporated into people, but this is an error caused by film and other media. It's actually a useful idea for patients in psychiatric hospitals and many other people too...

Cybernetics is really about self-managing systems. It comes from the Greek Κυβερνήτης (kubernites - meaning steersman, governor, pilot, or rudder; the same root as government).

A very simple example of a cybernetic system is a bathtub. You turn the taps on and go to make a cup of tea or iron some clothes. There's plenty of space to hold the water most of the time, but the space is limited. If you are distracted by whatever else you're doing, there is a safety mechanism: the overflow. When the water level gets too high, it starts to escape down the overflow. This is self-managing in a way - you don't need to intervene in order for the overflow to start to work - it works when a predefined critical point has been reached.

In a way this example is oversimple: it almost fails to be cybernetic because it is only a very primitive loop (and the taps fill the bath up quicker than the overflow can empty the excess water, so it does overflow eventually anyway. There are more impressive examples from many fields, but I think this one reflects nicely on the fragility of the cybernetic system that is the human body.

Which brings me to my experiences in psychiatric hospitals, and out in the community for that matter. Quite a few years ago now I read some of Carl Jung's writings. While I liked these quite a lot, I always felt that he was just missing some of the context of what he was thinking about and I never bothered remembering sources or doing anything too 'academic' with what I was reading.

Despite this I now find myself regularly recalling an idea I certainly read in Jung's work, though I can't find a direct source tonight. I talk about this to people and it seems to help (but I don't go into the detail I'm mentioning in this post).

What Jung said was that as we live our lives we develop 'habits' (this may be my term, but I know he was a fan of Bergson too) to deal with situations we come across regularly. So we go to work and we have quite a small range of different things we need to deal with, and at root there is only one thing we need to do - 'our job'. There is a similar situation at home and in the other places we go to regularly.

I don't have space to go into it in detail here if you haven't come across the idea before, but many people have observed and commented on the role of habit in our lives. In many ways we let the habits get on with themselves so we can concentrate on the more interesting things in our lives.

The problem comes because the world around us is constantly changing, and over time the habits we developed to be able to cope with the world usually begin to fall out of sync with the changes around us. The fact that we don't pay much attention to our habits makes this even more of a problem: we do things automatically because in the past they've helped us to live, but now as our automatic, habitual actions begin to cause us problems we remain blind to the cause as we're not paying attention to those parts of our life.

So we find ourselves increasingly having problems that are distressing because we can't understand them - they even seem irrational and unjust. The natural self-healing process that then comes into play often characterised as depression, although it can appear in slightly different ways or be given other labels. The point is that even if our conscious mind can't see what's happening to us, our subconscious can feel it and does react. The subconscious reaction is not particularly directed or understandable (my earlier post on the space not enclosed by words is relevant here in a way) but it takes the familiar form of a 'turning-in-on-oneself'.

The outward affects of this 'turning-in-on-oneself' are a tiredness, a difficulty in engaging with people or things, a slowing down. Eventually the conscious thought processes that define us as individuals can become so broken down that strange and unruly elements of our subconscious are regularly coming through into our consciousness. Sometimes these incursions of the unconscious are distressing and unpleasant, but some of them are much more positive. The key that Jung discovered is to engage with them. This is one element of his work that became a foundation for the various practices of psychotherapy that we find today. We can engage in them through journal-keeping (or other forms of writing), through drawing or painting, or through a range of other expressive practices.

Eventually, after the body has been shut down sufficiently to break the bad habits that have been constraining it, the idea is that we will be able to begin to go in new directions, begin to learn new approaches to dealing the world, techniques that will hopefully become habits that are more appropriate to today's world.

OK, so I said I don't go into that sort of detail. I suppose the main thing is the idea of habits, those habits getting out of sync, and then our bodies shutting down so that we can have a new start. This is a positive way of thinking about mental distress that seems to be sadly lacking in some institutions (as far as I can tell from what the patients say to me).

[added bit:] The question is, how can this be used, especially from the more non-interventionist stance of an advocate. Clearly it would be wrong to go and start talking to all our new clients about this idea: the main thing is to get people to speak out, and it's important that we concentrate on listening at first. I think it's more about putting things into context, especially after we've known people for a while. Advocacy isn't all about listening, it's more proactive than that, we set goals and develop action plans, and in between we need to care about the relationship we have with our partners. This relationship needs to be empowering, and it seems to me that helping people to find a context where their 'illness' can become more of a 'healing process' can help to give a little more hope to their situations. [end edit]

A more extreme example: when a very ill patient talked about his medication killing him, and wanting to die anyway but not by being poisoned by doctors, I talked about these ideas very productively with him. I explained the idea that mental illness was a self-healing process, that it could be seen as a 'little death' - a death of the old to make way for a renewal, and that these feelings of dying were a natural part of the process. I even went so far as to suggest that in a way the meds needed to make him feel like they were making him die, as they were trying to help him along and speed up this process of (partial) death and rebirth (though I think this is probably taking the analogy a bit far). N.B. Please see the distressed comment and my reply below.

I hope that some people who read this may get some insight, that this may ring a bell or touch a cord of recognition inside you. If that does happen then you'll find your own way of using the idea in your practice.

This is not advocacy in its pure form. I struggled with doing this sort of thing at times, and I do it sparingly. I do think it's relevant to engage with people in a wider and deeper context as an advocate than would happen if we simply did our jobs. Of course citizen advocates and others have known and practiced this for ages, and perhaps it's because my recent role has been as a professional/case work advocate in a very formal setting. I did also touch on these issues in my earlier post about advocacy and therapy.

I'm going to publish this without even proofreading as it's getting late. I hope it's come out ok.

The right to advocacy

I just read in someone's engagement protocol that ‘access to advocacy is a right to which service users are entitled.’

My immediate thought was that this must be wrong: where does it say in legislation that people have this right? And why are people now saying that IMCAs give some people the right to an advocate for the first time in England and Wales?

But then I realised that it was true in an important way, and that we should say it loudly and clearly.

People do have a right to the support of an advocate much of the time:

• If someone arrives at a meeting with an advocate, they have a right to ask for the advocate to attend the meeting, and there is no law which prevents an advocate from attending most meetings (though they can be denied entry on a similar sort of ad hoc basis)
• If someone wants to speak to an advocate they can, as long as they fit into the advocacy scheme's criteria
• If someone asks an advocate to obtain information from an agency, and they fill in the appropriate form of authority, the advocate then has the same right as the person to access information about them

People may not have a statutory right to our support, but they do have these informal rights, and we can thus correctly say that people do have a right to advocacy support.

Drawing the line on advice

I haven't mentioned advice much on this blog (just in 4 or 5 posts). It's a bit of a tricky subject for advocates. I'd even go so far as to say that there's a bit of conflict there, although it's usually quite a friendly sort of conflict...

Certainly it's very common to see the statement, often in the middle of definitions of advocacy, that advocates don't give advice. I've always been at the forefront of arguing this point, partly because of the way I got into advocacy through more informal community work, and partly because of the way one local advice centre insisted that they did advocacy too, so there was no need for a separate advocacy scheme... Words fail me, almost.

Moving swiftly on, it is important that we differentiate our practice from advice work for at least two main reasons:

1. Advice work has become heavily regulated over the years. Now you need loads of training, loads of procedures, and loads of monitoring. Advocacy is, and needs to remain, simpler than this.
2. There's plenty of people out there wanting to hand out advice - proper regulated advice, professional opinion, or informal 'caring' advice. The problem is that the people who need advocacy can never get away from all the advice and begin to talk about what they really want. Advocacy needs to continue to support these voices.

On the other hand, despite the clear problems with falling into advice work, many people still find the separation from advice both difficult to understand, and difficult to do in practice. I've also recently had to admit coming across lots of situations where the line is a bit more blurred than I thought it was. Take these two examples:

• Working with someone who has been in the care system for many years: they've expressed a problem, explored a range of options, could be on the brink of making a decision, but they still insist on taking your advice...
• Or someone who just gets angry whenever they meet a professional: you can talk to them sensibly in private, but however much you plan together what to say, when it comes down to it they just lose control and ruin all their plans...

There are many more examples, but these are interesting because in the first example the advocate is being asked for advice against their will, and in the second example the advocate could easily get frustrated and want to impose more control than they would normally think reasonable.

There's at least a third general example too: when you are asked to do an independent check on a decision using a best-interests approach (especially in non-instructed advocacy, and what about if you want to bring a third option into the field?). I think this is the most problematic example, and it needs another post.

My conclusion when thinking about these issues and giving advice has to be pragmatic in the end: we should be able to work with people wherever possible, and we shouldn't let abstract principles get in the way unnecessarily. The first reason advocacy doesn't give advice is because it needs to remain simpler than the current state of advice work. For the same reason, we need to be able to identify for ourselves those boundary points where simplicity demands that we relent and start giving advice for a while.

Who's the victim?

I keep on hearing calls for courts to be more focused on the victims of crime, and I agree completely - they shouldn't cause these victims even more suffering.

But who's the victim? I've come across a couple of cases recently that have put this question into perspective.

Firstly two people with severe learning disabilities and a high level of support have been having problems in their shared tenancy for quite a few months. Some plans to address the problem by moving one of them were dropped a while ago. Now one of them has attacked the other and all sorts of emergency procedures are being invoked. I'm not so interested in the details of the case, only that one of the two is currently in the classical position of the victim (of an assault), while the other therefore becomes a perpetrator.

Secondly a person I know with a high level of support needs, but not quite enough of the right kinds of problems to enable him to access certain key services immediately. As time goes on he is increasingly presenting with additional problems, and there are 'rumours' that these include a return to some of the violence that he has been involved in in the past. Violence again implies a perpetrator and a victim.

It's clear that the perpetrators of violence in both these cases are also victims. Like all the stories I'm trying to tell I don't think there's anything particularly unusual or newsworthy about these situations - similar things happen to hundreds or even thousands of people in the UK each week. I don't want to start accusing statutory services of neglect, because again I think this is in a way a violent approach to solving the problem, which often results in violent defensiveness and doesn't get anywhere.

What I would like to think about is that if we are to take a more person-centred approach to working with people in general, then we also need to take a person-centred approach to people who are violent towards others and to all the people who are victims of this violence. At the same time I think there are some natural developments towards taking a more holistic approach to our understanding and responses to violence.

Some examples of this would be:

• protecting people who suffer from, say domestic violence or sexual crimes from the added violence that can come in the investigative and judicial processes that current legal systems still tend to impose (there are already many initiatives that address these issues, and they are linked to this agenda in diverse ways);
• recognising that people who behave in violent ways are usually victims of violence and abuse themselves, that they may suffer from the multiple effects of poverty, or that they may well have low level mental health problems for example that would be amenable to community based approaches to support and rehabilitation (all sorts of people are doing this);
• questioning the value of punitive approaches including imprisoning people or stigmatising them with criminal convictions and making it harder for them to find work or access other services;
• supporting more informal preventative and community-based approaches to avoid reaching crisis situations, including recognising some of the violence still inherent in our education system and incorporating a more ethical and community based approach to teaching and education from an early age (see the Steiner schools for one approach to this);
• recognising that violence means restricting action, that sometimes violence is necessary, but we should be able to see it for what it is, discuss it properly and act on our conclusions, including a recognition that bureaucratic processes are inherently violent and that while they are necessary in some ways we need to recognise this violence and develop more effective ways of dealing with it;
• the list goes on...
  

Benefits for psychiatric patients

There have been a few changes to the benefits of some of the patients where I work. This affects patients in Forensic units, and maybe others.

• people on a section 45A or 47 are no longer entitled to benefits until their prison sentence expires
• they will still get 'hospital pocket money' of £16.40 a week
• other people who previously had their benefits cut after 52 weeks will have the full benefit reinstated

Full details are in the DoH circular Changes to benefit entitlements for patients transferred from prison to mental health units, 6 April 2006.

Bullying and harassment of doctors

From the Work related blogs and news blog:

instead of taking the view that bullying and harassment is the work of errant individuals, it is the context of the NHS that provides the main basis of analysis. This includes:

1) The training of doctors includes an ‘initiation rite’, justifying the bullying and harassment that is often a feature of the undergraduate medical culture.

2) Bullies are attracted to the caring and health professions by opportunities to exercise power over vulnerable patients and employees. It is viewed that this problem is not just confined to junior doctors, but senior doctors and consultants may be bullied by other consultants or senior managers.

3) The established culture of the medical profession is one that potentially perpetuates an environment of bullying and harassment, especially during training.

4) A culture of secrecy exists in the NHS which prevents people from speaking out and reporting bullying and harassment behaviour.

No wonder the standards af care can be so unpredictable, when the carers are spending half the time looking out for the bullies...

Recipe for paranoia

I recently saw in the Education Guardian a description of how to make a staff member clinically depressed. It was too frighteningly true to reproduce here - I was left hoping that it wouldn't give anyone ideas...

It does strike me though, that there is a similar recipe for paranoia. There's no chance of an individual carrying out this plan fortunately. Actually it's more of an accidental recipe, and it depends on mental health systems rather than individual relationships. This is also a caricature (if you've read Delivering the world from its exhausting boredom) that is knowingly dramatic but seeks to bring together a set of images of reality in a familiar and useful form.

The first ingredient in this version of the recipe, although there could be many variations, is an admission to a psychiatric hospital. Imagine. You must be thinking you're in pretty deep shit when you wake up. You'll quite possibly be wondering why you got there and what's going to happen to you. The seeds are set for paranoia already: the uncertainty, the questions, the doubts.

Then you meet your consultant. She explains where you are and who she is. She tries to make you feel at ease: she just wants to find out how you are and what's going on, and she's there to help you. There's no rush, we've got 28 days to assess you. Despite all the words though, you feel there's something menacing about her: she seems a bit distant and machine-like, as if she's following some sort of instructions or procedure.

Around you there's all sorts of strange things going on, and you've also got to live with a whole load of other crazy people. Some of these will be nurses ;-) and they've each got their techniques and approaches for caring for you, some of which will probably be helpful. But there are so many things going on it's not easy to assess what's helpful at this stage, or how you should be conducting yourself. There will also be plenty of advice from your fellow patients, also somehow contradictory, and some of them could well be really paranoid...

Another thing that you could well be feeling at the moment is anger. There's a lot of anger in society today, and expressing your anger inappropriately can be one of the triggers to getting you into this sort of hospital. Even if you're not usually an angry person, it's quite possible that your developing sense of injustice is beginning to make you feel quite irate. And anger is a natural defensive reaction to feeling cornered and powerless.

Anyway, a week goes by. If you're on medication you're probably feeling pretty sick at this stage as your body adapts. You're hoping that your body will adapt and you'll feel better soon, but the evidence from your fellow patients is not too hopeful. Your consultant returns. There may only be one more meeting before your assessment period is over, although obviously nurses and social workers and other more junior doctors will also be involved in the process. She's still quite nice and reassuring and she's not going to jump too quickly to any diagnosis, but there is this one thing...

Now this one thing may be quite clear and relevant to everyone, especially if its a body under the stairs, but you're a more complex case, more borderline. The hospital, and especially the consultants, have a duty to carry out risk assessments as well as psychiatric assessments. This is the other key ingredient in this recipe. We all have some skeletons in our closet, we could have just split with our partner, our dog could have died, or we bought a golf club to mess about on the park. You've had a hard time recently, and you don't think that this one thing that they've picked up on is very relevant to the situation, but they seem to think it's much more important.

This is where we come back to the Guardian article. It's the small things after all that really trouble and disturb us. When we have family arguments we often find that the real issue is a really small misunderstanding, but these small misunderstandings can multiply remarkably. And the really upsetting thing is that it's so small it should be easy to resolve, but you still can't make each other understand...

If you're cruel you'll confound and disturb someone by causing small difficulties and changes, and then rebuke them remorselessly for their failures and inadequacies, thus causing mental distress. If you're caring for someone's mental health problem you probably don't want to do this at all, but it seems that the risk assessment compels you to enquire about that one thing, and your patient's anguished reaction of denial and avoidance rings alarm bells that force you to continue the questioning.

Finally, the diagnosis. They didn't want to tell you earlier because they thought it would upset you. You're showing symptoms of paranoia - and you'd better not argue because that'll only make it worse...

Everyone can help in this situation, and I look forward to a time when we won't need advocates, but in the meantime you'd better write down your local advocacy scheme's number somewhere handy.

Advocacy and therapy

I'm usually keen to distinguish advocacy from other disciplines, especially advice, mentoring, mediation, and the model of support work that underlies so many professional roles.

Some other roles, notably interpreting and befriending, are still different but have a more interesting and closer interplay with advocacy work.

Recently however I've realised that advocacy falls wholly within the realm of therapy, and we should see it as part of an 'art of healing'.

Some quick notes to begin to explain and explore this:

• There are lots of modern therapies (whose practitioners can guard the boundaries jealously) but the art of healing has been practised for millennia;
• Healing isn't just based on specific medical symptoms - it's wider than 'curing' for example. In it's more holistic sense it's more about re-adapting people to their environment (and sometimes trying to adapt the environment for people);
• The idea of 'just therapy' developed by the Family Centre in New Zealand makes these observations, but also describes therapy as helping people to place new and more positive meaning structures on their experiences, to replace problem-centred meanings that can make life seem so difficult;
• There is an analogue here with the description I wrote about Helping someone not to get angry, and with many other advocacy interventions: people feel they can't communicate with services, or people are not listening to them, but working with an advocate helps them to develop communication skills and strategies that can overcome these difficulties, so they can get services and live more easily.

I think there's a lot of interesting potential in exploring the links between therapy and advocacy further. I know some other people have got some ideas in this direction too. Watch this space.

Helping someone not to get angry

In a way there is a potential subtle conflict here: if someone is angered by something, shouldn't we, as advocates, help them to express this anger? In this case however the individual had clearly expressed the view that they saw their anger wasn't helping and they wanted me to help them avoid it.

In a way, this situation appeared entirely ordinary to me, and I just saw it as a normal sort of advocacy activity. But then when I was describing some of the work I'd done, to another much more experienced advocate than me, whose work I really respect, they said that they'd never thought of doing that, and it sounded like a really good thing to do. So maybe its a useful thing to write about...?

Hopefully I'll soon be posting a Recipe for paranoia which also touches upon this problem, and maybe this is something like an approach or maybe even a solution to the situation. The context this time was mental health, but I also think it has relevance to any other sorts of client: we all get angry when (allegedly, we feel) spurious events get into official reports or discussions about us. So what do we do?

It seems that often people get more angry about the apparently small issues. The problem is that quite often it seems that small issues for an individual advocacy partner can easily grow into big issues for various professionals. It is the gulf in perceptions that generate the anger or distress however, not the nature of the action (say self-harm or drug use, or sex or travelling on a bus). These issues or incidents then become the focus of reports, especially in this risk-averse society. Social workers or doctors or others then start asking all sorts of questions which aggravate the already antagonistic perceptions and provoke anger or other aggressive or defensive responses.

I used a much more local and specific description of this phenomenon with my partner, but we spent quite a lot of time talking about the things that made them angry or upset or anguished, and we developed ways of dealing with these issues in less destructive ways, and concentrating on making more positive statements, recognising what sort of arguments provoked conflict and which sort of arguments encouraged sympathy and understanding in people.

Here's an advantage of the advocate's role. My partner and I and the professionals all saw these issues as something that needed to be dealt with. The professionals needed to clarify, objectify and assess various bits of conflicting information, so they continued to need to ask objective questions. The fact that my partner would react badly to these questions caused particular difficulties for the assessment part of the process and led back to more questions.

My partner didn't want to talk about these things, because they didn't see them as particularly relevant, or even valid or based in truth. But I could provide a valuable space for them to talk about the issues they didn't want to talk about without getting angry, to talk about how they became angry, to identify the issues and where the problems were developing from. This comes from a basic approach of advocacy: giving people a safe space to vocalise things that they may not have been able to vocalise before, and being able to speak about something is an important boost to being able to think about it, put it in a new perspective, and relax about it.

To me this is one of the important methods of advocacy: to help people express themselves in a way that is more understandable to others and less confrontational. There are risks with this sort of approach: you risk at a not too distant extreme the problem of neglecting people's real wishes in favour of ready compromises. However I believe it is possible to maintain your commitment to specific goals, but develop less confrontational and more effective strategies and tactics to achieve these goals.

I don't know what more to say at this point. I feel as if I haven't really managed in this short space, confined by the written word, to explain clearly what I set out to explain. I seem to have got a bit repetitive, and at this point I wish I just had a few bullet points and a discussion group to explore these ideas. Anyway, as always I'd value comments.

Cheers.

Welcome to the mental health hotline...

Mental Health Hotline (MP3)

File under humour.

Thank you to the Mental Nurse for this, and for adding me to their blogroll...

;-)

Protecting vulnerable people from objectivity

Sorry. I've already abused millions of people and I've only written a title. If this label is sometimes applied to you, I hope what follows might be of use, and please believe I usually try not to use the term except for ironic or dramatic effect. If you ever talk about or work with 'vulnerable' people, then you should understand this (that is, I hope you already understand this).

What is objectivity, and why must some people be protected from it? Let's start with some more dramatic language, and then think about some examples. Objectivity not only fixes some people with labels, it is also an excuse, a lie, and full of contradictions.

Objectivity fixing people with labels
This is an obvious one: 'you are autistic'; 'you have learning disabilities'; 'you are black'; 'you are a woman'; 'you are a child'; 'you are disabled'; 'you are a paranoid schizophrenic'; 'you have adhd'; you are sick, you are inadequate, you will never be able to escape from this because this is who you are and 'I am an expert'.

Once you have been categorised, objectified, by experts or by common opinion, it's very difficult to escape. As I reported with Ronelle and Shara, if Shara had been taken into care because of an admin error and because Ronelle had changed address so she didn't know about the Court proceedings, the objective fact would be that Shara had been in care. This objective information would have stayed with her for the rest of her life, and at the very least for the next 17 years and 7 months, until she reached adulthood. 'Shara has been in care (because her mother didn't pay a fine) and is thus vulnerable'.

Objectivity is an excuse
'We can't prove that in a court, therefore we can't do anything about it'; 'we can't take action without objective evidence, so you must keep a diary of the racist abuse against you over the next three months'; 'we're sorry, but you were the only witness, so it's your word against their's (and you have a learning disability or whatever) so we can't possibly take any action/believe you.' I could go on. It's worth pointing out that these are all things that I have actually heard professionals say repeatedly over the last couple of years. I expect most people reading this will quickly recognise these excuses.

Objectivity is a lie
'We saw your flatmate apologise for hitting you, but we can't objectively establish that he did hit you because you both have learning disabilities and we don't believe you are capable of objective and consistent communication, therefore we don't believe you, i.e. we have decided that you are lying'; 'we can find no objective evidence to support what you say, we do not accept that your subjective evidence (what you feel or believe) has any weight, therefore we demand that you withdraw your subjective evidence (i.e. apologise for 'lying')'.

Objectivity is full of contradictions
What is the most objective thing you can imagine? 2+2=4? Maybe this is true, but mathematics is in many ways a completely abstact system. It has been constructed to be objective. You're right: maths is the most objective thing you can think of; arithmetic, adding, is the most simple form of this objectivity. 2+2=4. But it is also true that 2+2=11 (in base 3). And it is also true that even the most basic and 'objective' system, like arithmetic, is not objective! (or see the more comprehensive Wikipedia article).

Objectivity is everywhere, and we all need protection from it
'You claim your manager did this to you, but you are unshaved, very agitated, your story isn't very consistent, you keep on bringing up other incidents, and we can't keep track of what you're saying. On the other hand your ex-manager is very calm and well presented, he has explained all the difficulties he has had with you and the ways he has tried to help, but you didn't cooperate...'

Objectivity really started taking hold of life in the enlightenment, when science was taking over from religion as the dominant guiding force of society. It is the basis of today's education: learn these objective truths, and we will objectify you by your capacity to remember them. Many of us are stuck in the world of objectivity, and as we grow older and 'wiser' we learn to fit in even more to the unwritten rules of society and not rock the boat too much. If we don't fit into these rules we are in danger of becoming outcasts, outlaws, or lunatics. (N.B. That's very far from saying religion was a better system, for religion was also an attempt at reifying [sic] certain beliefs and excluding lunatics and heathens.) Foucault writes a good history of all this.

What are the alternatives?
Many feminist activists have shown us ways forward: let me have the freedom to be who I want to be; let me act and show what I can do; do not objectify me as a woman or a housewife; don't insist that I use your language; don't make the mistake of believing that you can understand me. Rosa Parks believed in her right to sit near the front of a bus, despite her 'racial classification'. Ghandi's non-violent campaigns also showed us ways forward. Both of these have unfortunately been transformed from the simplicity of principled action into systems of objective human rights (which I and many others can never support), but there are many good contemporary examples.

Advocacy is another good way forward. We don't believe in (objectively) representing people's 'views' (or even worse, their 'best interests'). We listen to their thoughts and feelings and wishes and help to express them. In many instances this is helpful. It's more than helpful: it's the most positive way forward I know. The more people are forced to listen and take account of thoughts and feelings and wishes and other such subjective and occasionally irrational kinds of communication, the less likely they are to come down hard and refuse and deny and lie and avoid and label and abuse.

Because this is what's happening at the moment, and we need to open our eyes and ears and hearts to it and protect people.

And then we need to come to a time when we can forget about the negativities of protection and vulnerability, and open our eyes and ears and hearts to life.

Can you have my body? What about my mind?

I'm currently working with two people who want to take out writs of habeas corpus (literally, 'you may have the body'). This is the right people have to ask the Court to test whether they are lawfully imprisoned. There is quite a nice historical article in the BBC News Magazine from a year ago: A brief history of habeas corpus.

In both cases the solicitors involved don't seem to be taking these requests seriously. According to a quick internet search the law of habeas corpus is rarely used in the UK today, partly because it is being superceded (or perhaps obscured?) by other legislation (e.g. the Police and Criminal Evidence Act 1984 which sets out the law for police custody, and the Anti-terrorism, Crime and Security Act 2001 which prevents suspected terrorists from using the law, as per above article).

Several solicitors firms do mention habeas corpus work on their websites, but I wonder if the approach is gradually falling from people's minds. This is not helped by comments like this from Lord Bingham in 1999 when he was Lord Chief Justice:

"The concurrent application for habeas corpus was wholly unnecessary and served only to increase costs unnecessarily. It should not have been made."

In the same year Lord Justice Brown, in the Annual Lecture of the Administrative Law Bar Association said:

"I have come to regard habeas corpus in its present form as a defective process, unnecessarily and unsuccessfully competing with judicial review. No one, I think, would defend the law of habeas corpus as it operates today." Link

What interests me in these cases is the desparation of the people involved, and their certainty that the system has detained them unjustly but will never let them go. Both say with some persuasiveness that they should not be detained in hospital, that they are not receiving treatment (or it's not working). The hospital may have their bodies, and there may be nothing much that can be done - but they certainly don't have their minds...

So despite this bit of knowledge that I've gained today, should I support their applications for habeas corpus as an independent advocate, as this is what they want to do?