The Government tasked the Local Authorities, through The Social Work Scotland Act to supply statutory societal services and in subdivision 12, a responsibility to “ advance societal public assistance ” . Although this act has been amended several times it “ is now the primary Act sing the general societal work maps of the local governments. ” ( socialworkscotland.org 2005 ) . The construct of community attention in Scotland continues to germinate to back up and care people who wish to remain in their ain places and communities. Supported by farther statute law and policies, the NHS and Community Care Act ( 1990 ) proposed a new method of supplying this attention. As both my arrangements have been with Local Authorities ( LA ‘s ) and have involved lovingness and back uping people within a community scene, cognition of these two pieces of statute law have been indispensable to my pattern. My 2nd arrangement was with an Adult Mental Health Team and was based in a secondary scene within a psychiatric infirmary. The chief pieces of statute law regulating their work were included in The Adult Support and Protection ( Scotland ) Act 2007 ( ASP ) , The Adults with Incapacity ( Scotland ) Act 2000 ( AWI ) and the Mental ( Care and Treatment ) ( Scotland ) Act 2003 ( MHCT ) .
I was placed in a Local Authority Adult Mental Health Team which covered a semi-rural country. The primary remit of the squad is to supply services set out in the Mental Health ( Care and Treatment ) ( Scotland ) Act 2003, where the Local Authorities have a responsibility to supply these services to mentally broken individuals.
I have found my 2nd arrangement to be rather different from my first, even though there were many similarities. The construction of the squad and the manner the squad was managed greatly influenced my learning experience. In my first arrangement the squad was really structured and hierarchal with the squad leader being really much of control of everything within the squad. All appraisals had to be marked by her, in ruddy pen, corrections done, so resubmitted for farther corrections before being typed up and entered within the instance file. This ensured I developed strong and robust appraisal accomplishments as I had to warrant all facets of my appraisal, particularly if a demand for services had been identified. All staff, including experienced societal workers, were capable to this procedure and it could be clip devouring as it added yearss to the completion of all appraisals. My 2nd arrangement squad was structured really otherwise, liberty and colleague support were encouraged with input from the squad leader merely as a last resort. I was expected to pattern as a autonomous practician, placing preparation demands and happening the agencies to carry through them but ever with support from the remainder of the squad if required. I felt as though all the squad took bends taking on the function of being my work topographic point supervisor and they provided me with an encouraging and supportive environment.
My experience of supervising was besides different from my first arrangement, where I had frequently viewed it as an unneeded break to my instance work. This clip, I set clip aside for planning and readying prior to supervising. My deficiency of readying in my old arrangement was frequently apparent in the feedback from my Practice Teacher but I now realise it my ain attitude to supervising that impacted negatively on my supervisory experience. This readying included giving an up to day of the month reappraisal on all my instances and the theories, statute law and policies that I was utilizing to measure up my pattern. I had to formalize my concluding on why I had utilised some instead than others, to show an consciousness of different theories, intercessions, and issues. Archambeault ( 2009 ) suggests that ‘supervision may be a scheme to ease and steer you in bettering you pattern. ‘ I found the KIT theoretical account of the Three Stage Theory Framework ( Collingwood, 2005 ) really helpful to concentrate my thought on incorporating theory with pattern and used it with every instance that I was allocated. Mind maps were another method I used, ab initio in supervising so subsequently in pattern, as I found they were utile tools to broaden my mentality and found it helped to arouse a more thoughtful on the job pattern.
A repeating subject in supervising was my experience of multi-agency working. The SSSC codifications of pattern 6.7 provinces that you must recognize and esteem “ the functions and expertness of workers from other bureaus and work in partnership with them ” ( SSSC, 2003 ) . There were many occasions where I was the lone non NHS member of staff within a squad and felt that there was a distinguishable deficiency of consciousness of a societal workers function. I was normally asked to supply support for lodging and benefit applications or requested to measure a service user for a support bundle. Initially I thought it was because I was a pupil societal worker and they thought I was unable to make much more. After working with some squads for a piece I ascertained that they truly did non cognize what my function was and idea of me as a support worker instead than a societal worker. Some of them were surprised that we even used theoretical accounts of intercession such as Cognitive Behavioural Therapy or Psychosocial theoretical accounts. I was a spot aghast by this attitude but looked upon it as a challenge to educate by showing a positive, professional demeanor. I co-worked with a CMHN over two instances and after finishing both appraisals, met with her to explicate why I was traveling to utilize CBT with one service user and Psychosocial/talking therapy with the other. I met with the service users on a hebdomadal footing for several hours over several months and she met with them for an hr one time a month. Near the terminal of my arrangement, the CMHN and I had our concluding meeting where she acknowledged that both service users had greatly benefited from the intercessions I had used and laughed when she said she had a better apprehension of what societal workers really did now. I did hold to state her that as a pupil, I had much more clip to pass with service users than most societal workers would hold but I was glad to hold enlightened at least one member of the NHS on the function of a societal worker.
Ethical motives, anti-disc
I had been allocated a instance in which C, a 45 twelvemonth old adult male, who required support to entree a homeless lodging application. I was ab initio defeated to have another lodging application petition from a Community Mental Health Nurse ( CMHN ) and discussed in supervising wither a societal worker ‘s function was truly understood by members of the National Health Service ( NHS ) as the bulk of my referrals so far had been for lodging or a benefits reappraisal.
Preparation before our initial meeting consisted of reading C ‘s instance notes exhaustively but besides aware of Watson and West ‘s ( 2006 ) premiss non to trust on the truth of antecedently gather information as it can mislead current pattern.
As C had been having support from assorted NHS sections for several old ages, there were significant sum of instance notes contained within his file. The instance notes showed that C was already being supported by a CMHN, a homeless lodging officer, a public assistance rights worker and go toing a Cognitive Behavioural Therapist and a Psychiatrist which made me oppugn what function a societal worker could play but my workplace supervisor told me that he may necessitate an appraisal for community supports, even if it had non been requested. C had a diagnosing of terrible depression and had attempted suicide several times within the last several old ages. He had been populating in his sleeping room at his parent ‘s house for five old ages and had seldom left it. I telephoned each of the squad that was back uping C to present myself and inquire if there was any more information that they could provide. C responded to the missive of debut I had sent him really quickly and we arranged to run into ulterior that twenty-four hours.
I was still non comfy with my sensed function as a mental wellness expert and reread the information I had gathered about depression prior to go forthing the office. C was really welcoming and we spoke for several hours about his life, both past and present, and the issues and quandary he was confronting merely now. His penetration into his ain unwellness gave me a glance into how dreadfully enfeebling an illness depression can be, in a manner that no book of all time could. He spoke about his want to decease at length, the awful mental torment and hurting he was sing and his unhappiness that he could ne’er hold his old life back. I felt over-whelmed and wholly untrained to offer any support other than to softly listen and to give non-committal responses when required.
Immediately after the meeting I sat in my auto in the dark street and merely sat seeking to work out what to make. I had worked with the Samaritans many old ages ago where the chief ethos was to back up person in their picks by listening but non act uponing their determinations. I knew this was non plenty as the SSSC ( 2003 ) codification of behavior requires that a societal worker must ‘Promote the independency of service users while protecting them every bit far as possible from danger or injury. ‘ I called the CMHN on my Mobile and recounted to her what C had been speaking about. She had been back uping C for two old ages and knew him good and told me that he spoke like this most of the clip and although he had made advancement by traveling out of his parent ‘s house, it was a traumatic clip for him and she would see him the following forenoon. C had told me he had merely moved out so that his parents would non be the 1s to happen his organic structure. I was to hold several more meetings with C over the following two hebdomads where my ain values and moralss were to be challenged. C told me that he did derive some impermanent alleviation and felt a small better after speaking to person who had the clip to listen. Talking therapies are being promoted in the Scots Government ‘s Mental Health Plan ( 2006 ) in a command to cut down the high degrees of prescription drugs being used to battle depression and one of its cardinal aims is the bar of self-destruction and self-harm.
He explained to me that he had tried every available method he could to acquire alleviation from his mental anguish but did non desire to populate with his depression any longer. After depicting the manner his life was, he asked me if I would experience any otherwise and I could non candidly answer him. This one inquiry made me look once more at the SSSC codifications which besides said in 1.3 that we should be back uping the service user ‘s right to pattern liberty over their ain lives. As student Social Workers, we had been taught about individual centred pattern where the service user is the expert in his/her ain life. In some societies, such as in Japan, self-destruction was non merely an recognized right but could be viewed as honorable. Calls for the legalisation of assisted self-destruction have been deriving impulse within western societies but even these statements tend to favor physical unwellnesss but price reduction mental unwellnesss. Is it oppressive and prejudiced to coerce social norms and values on person with differing positions? The more I spoke to C, the more I agreed, in private, that he should hold the right to make up one’s mind. I was confused and needed support to clear up my thought.
This support came through supervising with my pattern instructor ( PT ) when I discussed my quandary with her. I was a spot hesitating and uncomfortable to discourse my ideas at first as I thought I might be censored for non automatically holding with the NHS squad that the lone option was to halt C from seeking to kill himself. We discussed this over several Sessionss and this allowed me to critically analyse my pattern and research the grounds I had felt so bad about it. Initially I was concerned about our right to exercise control over C ‘s ain right to autonomy but after discoursing transference and counter transference during supervising I began to gain that past negative experiences could besides be act uponing my thought. C reminded me of a good friend I used to cognize, in visual aspect, idiosyncrasies and address but who was besides a really grounded and reasonable individual. This may hold caused me to subconsciously underact the consequence that C ‘s mental unwellness had on his idea processes. An experience during my short clip with the Samaritans, over 25 old ages ago, where a company had completed self-destruction during a telephone conversation, had caused me to go forth as I was unable to get by with traveling back on the telephone lines. This could besides assist explicate my feelings of weakness, turning away and anxiousness when confronted with the topic of self-destruction once more. We discussed how to travel on from these feelings and appropriate preparation in suicide bar was identified. I progressed through the Scottish Mental Health First Aid Course, SafeTALK, ASIST and STORM preparation and now experience much more confident in my ability to measure and back up person with self-destructive causing. During the developing the facilitator told us that normally people did non desire to decease, they merely wanted the hurting to halt. This was precisely what C had told me but I had non heard or understood what he really meant. He had said he had wanted the hurting to halt and that what the squad environing him were back uping him to make. These preparation classs are portion of the Health, Efficiency, Access and Treatment ( HEAT ) marks set by the Scots Government as portion of the Choose Life scheme ( Scots Exec, 2002 ) and used to mensurate the public presentation of NHS Scotland in the decrease of self-destruction in Scotland.
This instance was polar in several ways for me: it highlighted how the usage of good supervising can make a safe and structured environment, which facilitates contemplation and critical thought and therefore a better apprehension of one ‘s ain pattern ; the importance of actively seeking out farther preparation and cognition to continually better one ‘s apprehension and to constantly inquiry one ‘s ain premises, moralss and values to guarantee best pattern. I feel that the Competence theoretical account accurately reflects the larning procedure I went through during this instance. My initial attack was ‘ unconscious incompetency ‘ in which I was unaware of how small I knew about issues of self-destruction and mental wellness but as I spent more clip with C my incompetency was no longer unknown to me. To seek and rectify this I brought it up in supervising, read up on relevant statute law such as the Mental Health Act and accessed appropriate preparation in suicide bar. As I reflect upon the accomplishments and cognition I have attained through both the university and on arrangement, I feel as though I may be nearing the phase of witting competency, at least every bit far as suicide bar and back uping person with mental wellness issues. I think accomplishing unconscious competency will merely be achieved through experience and pattern. As each service user you work with is uniquely single, I may be required to travel through this procedure many times before constructing my ain personal grounds base adequate to let me to make the unconscious competency degree.
A is a 54 twelvemonth old adult female who was born with spina bifida which has adversely affected her mobility and has caused several hernias asking the usage of a pore. She has a diagnosing of depression and was capable to mandatory steps under the protections of the Mental Health Care and Treatment Act ( 2003 ) following a self-destruction effort which required her to be on life support machines for three hebdomads. Her hubby, B, will be her chief carer when she returns place. During the last 12 months two old discharges had rapidly broken down, necessitating farther infirmary admittances to a psychiatric infirmary. Lowering the readmissions to psychiatric infirmaries within a twelvemonth of discharge is one of the cardinal NHS HEAT public presentation marks for each NHS board throughout Scotland. ( Scots Gov. 2010 )
Reading through A ‘s instance notes prior to our first meeting highlighted several issues for me. The quality of some of the recordings was really sporadic and quite perfunctory in cases but detailed in others, taking me to take notice of who had written them. The best notes had been late written by an Orthopaedic Therapist pupil who had detailed everything in a really consecutive forward and legible mode. As the following worker to utilize the instance notes, I was instantly struck by the pertinent item he had incorporated within them, conveying place how of import the quality of note pickings is for future workers. The following issue centred around the last two unsuccessful discharges, where the Community Care ( Direct Payments ) Act 1996, which amended The Social Work ( Scotland ) Act 1968, allowed for the proviso of direct payments to supply more liberty and personalisation in the proviso of services. This in bend was amended by the Community Care ( Scotland ) Act 2002 which placed a responsibility on local governments to offer direct payments. A ‘s senior sister had provided her attention as her paid, chief carer but the proceedingss taken at meetings showed that she had repeatedly made negative, derogative comments both to A and about A to others present at the meeting. It had been noted that her sister had removed A ‘s places on occasions without which she was unable to call up. This had been recorded as a possible fire jeopardy but I viewed it as a serious violation of her human rights, efficaciously keeping her in her chair and covered by the Human Rights Act 1998 and Adults with Incapacity Act ( Scotland ) 2000.
Our first visit took topographic point in an unfastened ward which small chance for privateness or confidentiality. This was in direct contrast to the SSSC codifications of pattern 1.3 which requires the worker to esteem and keep ‘the self-respect and privateness of the service users. ‘ ( SSSC, 2005 ) . The nurse appeared to be surprised when I asked if there was a private room that we could utilize and state me there was none available so I asked her if I could book one for our following meeting. Trevithick ( 2005 ) suggests that “ confidentiality is indispensable to make a clime of trust and to protect the service user ‘s rights. ” Entering and go forthing the ward required me to utilize my designation badge which reminded me of the power I held as a professional to come and travel as I wished, unlike A who had to inquire permission to acquire the external doors opened.
Over several subsequent meetings A mentioned the shame she felt with being classed as mentally sick and she did non desire to run into any of her old friends when she left infirmary as she felt they would hold a negative reaction to her stay in a psychiatric infirmary. ‘Being female and being disabled is a dual subjugation which can intensify feelings of impotence, rejection and invisibleness. ‘ Begum, 1992 as cited in Davies, 1997 ) The negative response to the mental “ unwellness ” label that A had identified has been acknowledged by recent alterations in authorities policies which aims to undertake the stigma experienced by people in A ‘s place. Delivering for Health ( 2005 ) and Delivering for Mental Health ( 2006 ) drives frontward an enterprise designed to raise public consciousness and better services. They recognise that mental wellness can be adversely affected by psychosocial factors such as hapless lodging, stigmatism, deficiency of occupation chances and relevant services. See Me Scotland is an anti-stigma run designed to raise public consciousness and challenge negative cultural attitudes to mental wellness with Doing Well by Peoples with Depression promoting self aid schemes to battle the rise of temper affectional upsets. The authorities show that 25 % of the population have “ mild to chair mental wellness jobs ” ( 2006 ) , demoing that anyone at any clip can be affected.
I recognised that the medical theoretical account being used in the infirmary relies to a great extent on medicine to command depression and A spends most of the twenty-four hours lying on her bed making nil but thought. I asked her what she thought approximately and she told me she merely reran everything anyone had said to her that twenty-four hours, over and over once more. Looking round the ward I noticed really small of involvement or stimulation. The Social Model of mental wellness expressions at several factors that can hold an consequence on our mental wellness, Hothersall et Al ( 2008 ) high spots several of them “ societal causing, labelling, critical theory, societal constructivism and societal pragmatism. ” Many of them are straight connected to favoritism and societal exclusion.
Over several subsequent meetings I was to happen A had developed an about childly dependance on other grownups, to the point she struggled to do the simplest of determinations and was unable to dress or pull off her ain personal attention. My old experience as a support worker enabled me to measure her motions and I thought she was physically able to more than she was trying at that clip. During the assessment procedure I was to detect that I had wholly underestimated many facets of A ‘s abilities. I was surprised to larn that A had worked for many old ages as a full clip stock accountant with a big company, a occupation that carried a batch of duties. Upon contemplation, I had to dispute my ain thought. Why was I surprised? Why had it had non occurred to me that Angstrom might hold successfully managed a calling? Was it because she was physically handicapped or because she was now a patient in a psychiatric ward?
A ‘s advancement was discussed in a multidisciplinary reappraisal meeting which was held in the ward on a hebdomadal footing. Attending were a head-shrinker, ward physician, two members of the ward staff, a CMHN, a societal worker and A. A ‘s household could go to but take non to and ulterior treatments with B, A ‘s hubby, showed that he felt uncomfortable and nervous sitting around a tabular array with so many professionals and felt he could hold small input or impact upon the proceedings. I instantly noticed in the first meeting that A ‘s instance was discussed and determinations made about her advancement and intervention before A was asked to fall in the meeting. She was to wait outside the door until being invited in about half manner through the meeting. I besides felt that the seating agreements reflected a power instability, with the head-shrinker sitting at the top of the tabular array, flanked by the physician and senior nurse and A sitting about apart at the underside of the tabular array. McLeod ( 1998 ) argued that this can suppress an unfastened and effectual working environment and for the subsequent meetings I ever met with A prior to traveling in to do certain I was cognizant of her ain sentiments and could recommend on her behalf during the first half of the meeting, which I did on several occasions. I besides moved my chair to sit beside her and walked with her into the room to adumbrate support and reassurance to her as she had besides told me that she felt powerless to belie what the medical staff were stating. We used Cognitive Behavioural Therapy to construct A ‘s assurance and ego regard, placing when and where she felt most vulnerable, so speaking through this procedure on a hebdomadal basis. ‘ The most of import characteristic of cognitive-behavioural therapies is that they teach get bying accomplishments, therefore authorising the client, forestalling backsliding and avoiding dependance on the healer ‘ ( Lishman, 1991 ) Using an ABC theoretical account where A is the stimulation, B the reading and rating and C being emotional response allowed A to hold a better penetration into why she felt as she did at times and gave her accomplishments and cognition to seek to pull off her mentality and reactions in a more positive mode. We besides discussed how institutionalisation can adversely impact a individual ‘s ability to cover with the outside universe and as A was come oning towards another discharge, I was determined that she should be as to the full informed as possible. We both recognised that she was exposing many of the recognised symptoms after her twelvemonth long stay in infirmary. She was afraid to go forth the ward without a professional with her, felt unable to take her apparels or frock herself, was unable to finish her personal attention or do treatments which she felt she could hold taken before her admittance. Once once more, holding that cognition empowered A to travel frontward and derive more assurance as she did so.
The twenty-four hours prior to A ‘s discharge, B collapsed in the street and infirmary trials showed he had to undergo a bosom operation two hebdomads subsequently. A instantly withdrew from the discharge procedure and refused to contemplate traveling place saying that there would be B would be unable to care for her. Her discharge was delayed for one hebdomad but the medical squad insisted she must travel place, after increasing her medicine, as they felt she was mentally able to make so.
Bing a carer can hold a damaging consequence upon the carers wellness.