Professional support…or is it
I would love to think that we live in a world where we are essentially altruistic and look to the needs of others as much as we look to meeting our own needs. In reality I think that this is rarely the case and that in some ways whatever situation anybody puts themselves into is somehow in order to meet their needs.
And this also applies very much to people who support others with their mental health issues.
I am a huge believer in the need to support each other in order to get over specific or certain issues in our lives, in order to get past difficult periods etc.
What concerns me hugely is when people require support of some form or other on a day-to-day basis, just simply to be able to function.
The people offering that kind of support will offer the logic that it is essential to help that person live a normal and fulfilling life.
I would challenge this and say that very often you are sustaining something that is very not normal, and by doing so you are actually preventing people from finding a way of building a sustaining life for themselves.
One of the rules that I developed many years ago and have lived by professionally is that I do not do anything for anybody. That sounds very simplistic and very harsh, but what it means in reality is that I will not do something for somebody if I have any perception that they can do it for themselves.
And in the majority of cases, there is very little that normal functional people are unable to do within the normal range of experience. In other words, most people can reasonably do most things.
What it does mean is that I do not ever get into the “doing this for somebody” to support them role. And there are a couple of reasons for this. The first is that I truly believe that the majority of people can take care of the majority of things in their lives independently.
And this is particularly relevant when we are talking about things that most people would consider to be normal attributes of living independently.
An example of this would be by paying your bills, shopping and making food for yourself, being able to maintain some kind of work. To have friendships and relationships without these being enabled for you.
And the result of this approach. In the majority of cases, the client will make an effort to do whatever it is by themselves…and usually succeed. Great, progress, if only to shift the mindset that you(they) cannot do things.
Of course, many take a slightly different yet equally effective approach. They simply seek out someone else who will help them the way they want. And they will always find someone. (but I would argue that their ability to seek out and secure other sources of help is in itself an indicator of capability)
This is where I have concerns when I meet people who are now part of that vast army of what we call support workers for mental health.
The one characteristic that comes across in virtually all of these is that they are always well-intentioned and believe that they have the best interest of their clients in mind.
Underlying this is often some form of need to be caring for people, supporting other people, being liked by other people.
In other words we are talking about people who are extremely invested in the role that they undertake.
And that role is not one that shifts and changes because their need to be supportive and caring will often match with individuals who need to be requiring support and care from others.
So it’s fantastic. It’s a mutually beneficial relationship, and in many ways it completely is and can work well, and be sustained for years. However what it’s very often isn’t, is productive.
It does not promote independence, it does not encourage change or challenge existing situations or conditions and in fact, very often, providing support workers for people becomes a continuous need that then needs to be fulfilled in some form or other indefinitely. And does this help people? Well in one sense yes it does, but i believe that it helps in a very counterproductive way.
Oh and there is always the fact that the client will often be hugely appreciative of the support offered by their support worker. And this in itself provides the perfect, but unchanging feedback loop.
Oh and I am speaking from a position of experience here. I have worked with lots of clients who have managed to get themselves support workers over the years.
What then inevitably happens is that the client and the support worker effectively form a coalition that will demand ongoing support from professional services.
In part this is to validate their own perception of the client as being needy, and the support worker being essential to help alleviate that need.
In reality professionals are often attempting to promote independence and reduce the person’s dependence on others, and they often find that they are effectively being undermined by a support worker whose clear goal is to maintain that (existing) level of functioning and therefore dependency.
I would however say that the majority do this in a completely unconscious way. They are utterly convinced that they are doing the right thing for their clients and very often their attitude towards us is one of righteous indignation.
The fact that we take a different position in terms of what we perceive their client needs and about what would genuinely help them simply feeds that righteous indignation, and in some cases reinforces their position of being “us against the world” when they ally themselves with the apparent needs of their clients.
The client of course in many cases is at the centre of this battle, and yet somehow not participating in it.
What is clearly happening in many cases is that the support worker, even more than the client, is battling to have their position and role validated. The net result of this though is that mental health services will be dismissed as being seen as unsupportive, uncaring and lacking awareness of what people actually need.
In mental health services we also have support workers, but in our case they are working towards an objective and doing so with a bit of a plan in mind. They will also always be supervised by a qualified mental health professional, and so their actions and intentions will be questioned and clarified.
However what then often happens is that the clients will fail to work with them to make the kind of progress we hope is possible, we then withdraw as they are clearly not working towards anything constructive, and this is when the third sector support workers will then step in. And in many ways this is the point at which the real work then stops.
One thing to consider is what does the client actually have to do to maintain the support at its current level.
They simply have to stay the same, they don’t have to get worse, they don’t have to get better, they just have to continue to appear to have that need.
That in itself is indicative of how skewed these situations actually are because most people, as they go through life, go through periods and processes of action and change. This is entirely normal, and so when you see this process literally being stopped in its tracks and its tracks, and people functioning in a state of homeostasis, there has to be something about this that is very very wrong.
So if you have a support worker, or if you are a support worker, are you working to progress and improve, or do you perceive the need as immutable, and unlikely to change.
There are only two situations where people have little or no ability to adapt and change and that is (some forms of)schizophrenia, and people with severe learning difficulties.
Everyone else has some ability to function entirely independently, and to adapt to meet their own needs.
Do you think that this sounds harsh?
In our society, we assume that all adults, unless debilitated in some way, will be able to function autonomously and essentially independently. And this is what we should actually strive for.
It’s normal for adults to strike out on their own, usually sometime in late teens, early 20’s and from that point onwards, function pretty much independently, with little or no ongoing support. It’s what the majority of us would consider normal, and healthy. And it is.
What is not normal is when adults require high levels of support from others to maintain any kind of life.
In the majority of cases, that is not mental illness, It is dependency.
And we are starting to accept it as normal, because we believe it is an attribute of mental illness. It isn’t. It just is, and always will be dependency.
And unfortunately, we now have a range of services whose very function is to promote independence, and yet the reality of their support is that in most cases, they are supporting and enabling dependence. This is not, and never will be healthy.
Support can be very good when it is time limited, has clear objectives, or goals to work towards, and will withdraw, regardless of whether those goals have been achieved.
If it does not meet that definition…then it is not good.
A couple of things I notice over time
People who have a group of people who support them, over time, the individuals in the group often change. The roles they take on rarely if ever do.
Conclusion…over time people get worn out, pissed off, or can withdraw for any number of reasons. But there are always others prepared to step in and take their place.