A new publication just out, which I think provides a good summary of issues in palliative care social work at present. In particular, it argues for going beyond clinical social work into health promotion so that communities, families, workplaces and schools can all get better at responding to death, dying and bereaqvement in their midst. This is from a special edition of Internatioanl Social Work in Health issues.

Payne, M. (2009) Developments in end-of-life and palliative care social work: international issues. International Social Work. 52(4): 513-24.

Jounral website: http://isw.sagepub.com/content/vol52/issue4/

And while I’m at it (that is, talking about whether people have problems or we give them the problems), just to mention a bit of nursing research that I came across today. I looked at it because I wrote an article years ago saying we should actively find ways of promoting people’s good feelings about things that they are being stigmatised for and getting the people around them to see that they need to be less stigmatised. A load of psychologically-oriented Swedish nursing academics studied people who were stigmatised by their mental illness. The findings were that they felt less stigmatised if they had a higher sense of coherence, and (rather less) if they felt higher self-esteem and empowerment in their lives.

But this asks the wrong question and tells the stigmatised that they have to improve their capacity to cope with their rejection (and doubtless employ nurses and psychologists to help them). Instead, ask the sociological question: why are these people being stigmatised? It’s the others who are stigmatising them, so we ought to target the stimatisiers, not the stigmatised. And the answer is that, in spite of the high proportion of people who have mental illness, most people are still ignorant about it and behave badly towards these vulnerable people.

Instead of enhancing mentally ill people’s sense of coherence, self-esteem and empowerment, let’s spend money to educate the crass individuals who behave so badly towards their fellow human beings and make it just as socially unacceptable to be pigs in our social relationships as it is to smoke in company.

The article: Lundberg, B et al (2009) Are stigma experiences among persons with mental illness, related to perceptions of self-esteem, empowerment and sense of coherence? Journal of Psychiatric and Mental Health Nursing 16(6): 516 – 522

http://www3.interscience.wiley.com/journal/122421488/abstract

A social work colleague (not at St Christopher’s) was asked yesterday by a doctor to see an in-patient who seemed to be depressed: he was crying all the time. She found out that the day before he’d had a day out to attend the funeral of his wife of 48 years; not depression, just reasonable sadness. Still, better get a psychiatrist to see him just in case.

This connects for me with the Guardian obituary for Bob Sang, the campaigner for patient and public involvement in health and social care. I quotes a view that I apply to bereavement care (particularly in the little contretemps that has led to a 4-page ‘debate’ in the latest Bereavement Care Journal) and social work in general. They’re right to say this is an important issue. Sang is quoted as saying:

A deep, taken-for-granted assumption in our culture is that if you have a ‘problem’ or ‘need’, you get a label: ‘patient’, ‘user’, ‘client’, ‘sick’, ’disabled’, ‘handicapped’. One consequence of such labelling is the separation of citizens into categories and groups defined by the service models that have been constructed to ‘meet this need/problem’.

Exactly what I think about bereavement needs assessment. Psychology, counselling, psychiatry and, following along behind, social work, look at the problems they come across, see that people have difficulties, and set up services based on the assumption that people need help with the problem. Therefore, in the case of the debate in Bereavement Care, they establish bereavement risk assessment or, the latest thing, bereavement needs assessment. The document I was reviewing says some relative (one of probably many) should be assessed for their bereavement needs for every patient who goes through a hospice, including collecting up information from the nurses who were caring for the patient about how whether they showed various mainly negative behaviour traits. Bereavement is a perfectly natural corollary of love, commitment and connection: we should not see it as one of Bob Sang’s problems or needs.

All the research says that most people do not need more bereavement support than good information and if you offer it at a point when they need it, most of the rest will accept it. So why assess everybody for it? Note that this everybody is you and me; we were not the patients who agreed to receive palliative care, and we have not given ‘informed consent’ as the jargon has it, to having our bereavement need checked out by the collection of information and covert observation about us. Just provide good information, a good service and make sure people can have access to it when they need it.

Bob Sang’s answer, and mine in this case, would be that we do this because we in the people-working professions, have defined something perfectly natural as a problem because we have sometimes come across people who have problems with it. There’s a bigger risk that we’re propagating unnecessary involvement in services than the risk people run by feeling sad when someone important dies.

Bereavement Care journal, having developed from small beginnings and still run by Cruse, has this year been taken over by Routledge and is becoming a much more substantial affair; it always was authoritative and well worth reading.

Its website: http://www.crusebereavementcare.org.uk/ber_care.htm

The Guardian obituary of Bob Sang: http://www.guardian.co.uk/society/2009/jul/02/bob-sang-obituary

An interesting exchange of papers in the International Journal of Social Welfare, in which Stephen Webb, recently a scourge of all sorts of trendy posturing in social work, takes an intellectual axe to people who say diversity is a right, and who promote the politics of difference. And a reply, cautiously pointing out that we need to balance the need for accepting and acknowledging difference within social work practice, while looking at the universality of the human condition as well.

You’ll gather from the titles below that the debate is in fairly high-flown terms, but many practitioners will appreciate an occasional debate about the extent to which diversity has always to be accepted and valued (rather than just recognised), and universality of understanding is also to be valued, rather than knee-jerk ‘let it all hang out’ political posturing.

Webb, S. A. (2008) Against difference and diversity in social work: the case of human rights. International Journal of Social Welfare 18(5): 307-16.

Sohlberg, P. (2009) Is there nothing beyond postmodernism and ‘the theoretical Other’?… International Journal of Social Welfare 18(5): 317-22.

A really interesting special edition of Australian Social Work on ageing arrives, including some papers from the UK. This reminds us of some forgotten or ignored groups of older people, such as homeless older people and aged prisoners. there is also a focus on abuse, with an interesting paper on the financial assets of older people. Some of the most difficult family disputes that we experience with patients in St Christopher’s is dispute about family assets. One of the fears of old age is the way in which it may deplete the family’s assets.

Australian Social Work 62(2)