By Civil Service World

03 Nov 2010

This week’s interviewee works for a charity providing social care for people leaving psychiatric hospitals

“I’m a senior residential care worker, with five years’ experience working with people with long-term mental health problems. Currently I work nights for a specialist charity in a team of 10, with support from a pool of temps. We provide accommodation for 15 people – men and women, aged about 30 to 60. Some need complete care, with meals provided and enforced bed times. Others require less attention, but need someone on hand 24/7 to make sure they’re not entering an unsafe state of mind. Most are schizophrenic or severely bi-polar.

The local county council purchases our services. When people forcibly admitted to psychiatric hospital re-enter the community, they’re assessed for their aftercare needs; if they’re deemed to need constant social care, the care coordinator – usually a senior nurse or doctor at the hospital – sends them straight to us.

We see a lot of the same faces. The long-term aim is rehabilitation, but these are the long-term service users, who may need 24-hour care for the rest of their lives. We would love them to need less looking after, but for many that’s not an option.

These mental illnesses are often linked to poverty, and some of those affected have limited intellect and ability. There are a lot of people who the school system failed; the social care system failed. They fell into behaviour patterns called schizophrenic, and became social outcasts. These people end up in the safety net of the mental health system. We are the last people who will look after them; for many of them, it’s either us or the criminal justice system.

In recent years, some parts of this field have been improving. The new Mental Health Act brought in by the last government updated the 1983 legislation to streamline things at the hospital end, getting people into the system and out the other end. However, things are changing: there’s currently an emphasis on finding people employment, which is brilliant for some – but for others, it’s definitely not what they need.

Right now, the most pressing issue is the government’s plans to tackle benefit fraud. My clients typically receive Employment and Support Allowance, plus Disability Living Allowance (DLA). The latter is a tax-free top-up for disabled people to spend on extra goods or services that they need because they are disabled.  For example, it can fund taxis for people who can’t safely travel alone.

DLA is very good at lifting people out of poverty, and consequently helping improve their mental health. One study showed that at the lowest level, with just an extra £20 a week, this group of people are a third less likely to go back into psychiatric hospital in the next year than a control group; it really is crucial. However, the implication of the coalition’s stance on DLA is that if you’re outgoing and trying lots of new things, you aren’t disabled and don’t really need it.

We are encouraged to help clients exercise and take them to local sports centres; I have been trying to get teams playing in local leagues. But that work has been affected, because clients don’t want to be exposed in the local paper as ‘a disabled person running about in a 5-a-side team’. The uninitiated associate disability with wheelchairs and crutches. There’s already a social pressure for care users not to disclose their disability, because of the stigma surrounding serious mental health problems; now there’s also the fear that if they try to live a normal life, their benefits will be cut.

Benefit fraud costs about £1bn per year, with errors in the system accounting for about £2.5bn; meanwhile, tax fraud amounts to about £15bn a year. When the UK welfare budget for 2009 was £97bn, it’s hard to see how squeezing DLA will make a big difference – but the crackdown could damage our clients’ ability to improve their lives.

The bigger cuts announced in the spending review won’t hit us for a while: most of our funding comes from county councils, and their big cuts don’t come into force until April. So we’re in limbo at the moment; but if our council funding does drop, I think it’s highly unlikely anything will replace it. We’d simply have to reduce the level of care or the number of people we deal with. And if we do that, the effects will be felt in the community, because some of these people will be more visible and doing visible things. I’ve heard the government’s ideas about the ‘Big Society’ and I have no problem with volunteers – but this is a skilled job, and well-meaning people in church groups will only be able to help to a limited extent.

My fear is that people who need high levels of care will be left behind, given food and shelter, but little that will help them to lead fulfilled lives. I would say there’s no way to save money in the short term here: cuts in this area will create additional costs in others, such as criminal justice and healthcare. Our services have a monetary and social value that reaches far beyond social care objectives.

There’s nothing wrong with innovation and involving local communities, but it will take years for more voluntary sector groups to provide working services. It’s difficult to think long term with a budget deficit of this size, but there’s no choice. It’s either that or give up.”

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