Supervising Mental Health Clinicians in The Context of Complex Organisational Dynamics

This article discusses the complex dynamics and challenges of providing supervision to mental health clinicians working within an organisational context when the supervisor is not part of the organisation and has no formal managerial or accountability responsibility. It considers two models of supervision and their application to three supervisory relationships in an organisational context. It concludes that for supervision to be effective there needs to be a consideration of the social defences in operation within the organisation and how they are met by the anxieties and defences of the supervisor and supervisee. This requires a mixed approach by the supervisor of the technical with the inter-subjective as a reliance on one model of supervision risks limiting the effectiveness of the intervention. The role of the supervisor can enable the supervisee to establish a clinical framework and the necessary environment essentials for their practice

Palliative care in UK prisons: practical and emotional challenges for staff and fellow prisoners

Despite falling crime rates in England and Wales over the past 20 years, the number of prisoners has doubled. People over the age of 50 constitute the fastest growing section of the prison population, and increasing numbers of older prisoners are dying in custody. This article discusses some of the issues raised by these changing demographics and draws on preliminary findings from a study underway in North West England. It describes the context behind the rise in the numbers of older prisoners; explores the particular needs of this growing population; and discusses some of the practical and emotional challenges for prison officers, health care staff, and fellow prisoners who are involved in caring for dying prisoners in a custodial environment

Time is not enough : promoting strategic engagement with writing for publication

Research, scholarship and publication are central to the work of higher education. However, even academics with the necessary research and writing skills can struggle to publish as often as they would like. Research suggests that a writing retreat is one solution; there is a process going on there that addresses the problem, but how it does so has not been fully explained. We used a novel approach, containment theory, to explain why the functions of a structured retreat work. We argue that a retreat does more than simply provide time to write; it is a model for academics to meet the demands of research assessment. Finally, we conceptualise this as strategic engagement - a model for producing regular writing for publication while continuing to meet other professional demands

Making a target work: messages from a pilot of the six-month time limit on care proceedings in England

Since 2014, it has been a legal requirement in England and Wales for child care proceedings to be concluded, apart from ‘exceptional cases’, within 26 weeks. When this was first proposed there were concerns that it might lead to poorer decision-making, or to delay being squeezed to either side of the court proceedings, before or afterwards. This paper reports on the messages from a pilot programme to hit the 26-week target that took place in London in 2012-13. The study compared the progress of the cases from the pilot year with those the year before, 180 cases in total, involving 256 children. The local authorities involved were able to achieve considerable improvements in timeliness, not just in the proceedings, but for the pre- and post-court processes too; and the quality and fairness of decisions did not seem to be impaired, in terms of the plans for the children and subsequent outcomes over a period of two years. ‘Targets’ do not generally find a warm welcome in the social work literature, but this paper shows that when collaboratively implemented, with a measure of flexibility and adequate resources, they can be an effective way of helping to achieve positive change

‘Stumbling through’? Relationship-based social work practice in austere times

In recent times relationship-based practice has become a familiar term in social work practice and education. Despite its widespread adoption, how relationship-based practice is understood varies widely. Drawing on contemporary conceptualisations of the child and family and individuals as psychosocial subjects experiencing social suffering, this paper explores how current social work practice can be understood in the context of neoliberalism and austerity. Setting these ideas in an historical context helps to inform our understanding as to why social work seems to be the focus of sustained political discontent and scrutiny, making it difficult to retain a balanced relationship-based professional stance. Contemporary responses to the current challenges of everyday practice are outlined and the contribution of psychodynamic and systemic ideas to promoting relationship-based practice is explored. The paper concludes by considering how the concept of social systems as defences against anxiety can inform our understanding of the resistance amongst practitioners to relationship-based practice and emphasises the importance of reflective spaces and places for developing and maintaining integrated, mature relational approaches to practice which impact on practice at both the individual casework and social structural level

Introducing compassion into the education of health care professionals; can Schwartz Rounds help?

Whilst health care professionals embark on their careers with high ideals these can be eroded by the pressures and stress of the system. This paper explores the problems, which may lead both students and professionals, working in health care, to feel isolated and stressed. It considers the value of Schwartz Rounds as an initiative that can be used to enhance student well-being and ultimately enable students to treat each other, colleagues and patients with more compassion

Conflict, compromise and collusion: dilemmas for psychosocially-oriented practitioners in the mental health system

The nature and causes of mental health problems are contested. The dominant approach in services views them as ‘illnesses like any other’. The structure, legislative base and practices of mainstream mental health services are largely predicated on this idea, known variously as the medical, illness, disease or diagnostic model. By contrast, psychosocial theories highlight the role of the events and circumstances of peoples’ lives. The tension between these two approaches can lead to challenges and dilemmas for psychosocially oriented practitioners. Clinical psychologists participated in interviews and a focus group about these challenges and how they managed them. A grounded theory was constructed which suggested that their responses took three forms: openly ‘dissenting’ (conflict), strategically ‘stepping into’ the medical model (compromise), or inadvertently ‘slipping’ into it (colluding). Strategies for managing the challenges included focusing on clients; foregrounding clients’ contexts and understandings; holding the tension between ‘expert’ and ‘not-knowing’ approaches; using ordinary language; forging robust working relationships; being mindful of difference and of constraints on colleagues; recognising one’s power and ability to influence; self-care and work/life balance; taking encouragement from small changes; consolidating a personal philosophy; mutual support and solidarity; drawing on scholarship and finally engaging in activism outside work