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Jo Campling Memorial Prize EssayChristopher Daniel Moran BA Hons. (First Class)Published online: 06 Apr 2010.

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Jo Campling Memorial Prize Essay

Christopher Daniel Moran

Introduction

The following account provides reflective analysis of an ongoing rationalization

operation that entails the eventual closure of my placement agency. This

politically motivated undertaking demonstrates some of the inequities that exist

within the complex and ‘ . . . evolving relationship between the state and the

individual’, which forms the principal domain of social work practice (Howe 1996,

p. 77). The closure of this service carries consequences not only for the agency’s

personnel and service users but also for the service users’ immediate social

systems and the wider community. My involvement in this matter, which is

analogous to Schon’s ‘swampy lowlands’ of problematic social work activity,

required me to introspect and deliberate rigorously as I strived to address practice

implications, social injustice, difficult value judgements, conflicts of professional

and organizational interests and dilemmas concerning personal ethics and official

directives (Schon 1983, p. 42). Written from a perspective that is both humanistic

and pragmatic, this account avoids reference to religious belief systems and

prescriptive models of reflection in favour of a flexible format, compatible with

this rapidly unfolding, highly emotive situation. The names and other identifying

features of all service users, staff, establishments, services and agencies have

been changed.I had completed 64 days on placement with South-Evecastle’s Community

Alcohol Team (SECAT) when the agency’s manager notified me that the govern-

ment’s commissioner of substance misuse services, the Drug and Alcohol Action

Team (referred to herein as ‘the commissioner’) would be decommissioning SECAT

in three months time. This action, according to the commissioner, was an

appropriate response to a failure by SECAT to meet government-set service

targets, officially termed key performance indicators (KPIs). A special health

authority called the National Treatment Agency (NTA) stipulates these targets,

ISSN 1749-6535 print/1749-6543 online/10/010081-10– 2010 Taylor & FrancisDOI: 10.1080/17496531003608212

At the time of writing Christopher Moran was in the final year of a BA Honours degree in Social WorkStudies, at the University of Salford, UK. He graduated from the University in July 2009, and is nowundertaking an MSc in Addictive Behaviour at the University of Liverpool. Correspondence to:Christopher Daniel Moran BA Hons. (First Class), 15 Boardman St, Eccles, Salford, M30 0FP; E-mail:christopherdanielmoran@googlemail.com

ETHICS AND SOCIAL WELFARE VOLUME 4 NUMBER 1 (APRIL 2010)

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which substance misuse agencies must meet to secure government funding(National Treatment Agency 2008).

The specific targets that SECAT failed to meet are as follows: waiting times

between referral to the agency and initial assessment should be no longer than

two weeks, service users should be retained in treatment for a minimum period

of 12 weeks and unplanned disengagement from treatment by service usersshould not exceed 52 per cent of the agency’s total annual caseload. SECAT failed

to meet these targets, due largely to a workforce shortfall, which caused

assessment backlogs, service disruption and unmanageable caseloads. These

problems prompted SECAT personnel to appeal to the commissioner to fund more

staff, but no money was released and the situation remained unresolved.SECAT’s closure will take place at the end of May 2009, despite excellent service

user feedback provided in a recently held survey that gauged service delivery

within the agency. This independent survey, which consistently rated SECAT

highest for service user satisfaction, aimed to capture the opinions of individuals

currently engaged in substance misuse services within the Borough of South-

Evecastle. The commissioner stated that no plans existed to replace SECAT

following its closure, leaving the South-Evecastle community without a dedicated

alcohol service. This constitutes an injustice for SECAT’s 412 existing service users,alongside other individuals who may need SECAT’s specialist support to address

alcohol-related harm, such as the 205 South-Evecastle residents who ‘admitted

that they drank at harmful or hazardous levels’ in the government’s ‘Big Drink’

survey (Griffin 2009, p. 10). Those affected by alcohol-related harm already

experience discrimination at a national level, since alcohol services are tradition-

ally underfunded compared with illicit drug services (Soodeen 2008 cited in

Alcoholics Anonymous Reviews 2008; Burrowes 2007; Alcohol Concern 2003).The commissioner instructed SECAT personnel not to inform anyone of the

agency’s closure, including service users and volunteers, until instructed to do

so. My colleagues and I believed that via this instruction, the commissioner aimed

to disempower service users by keeping them uninformed for as long as possible.

This would probably thwart the service users’ capacity to organize a timely

strategy to halt SECAT’s closure, for example, by lobbying the local media.

According to Swift and Levin, people’s ‘Level of awareness is a key issue inempowerment . . .’ because ‘ . . . knowledge mobilises action for change’ (1987,

p. 81 cited in Dalrymple & Burke 2006, p. 111). However, because SECAT’s service

users were not privy to the information that affected them, they were unaware

of the commissioner’s intentions and did not, therefore, mobilize themselves to

save their agency from closure. Placing a professional duty on me to confront the

unfairness of this situation, the British Association of Social Workers emphasizes

the need to ‘Challenge the abuse of power for suppression and for excluding

people from decisions which affect them’ (BASW 2002, p. 4).The commissioner’s ‘business as usual’ policy presented me with a practice

dilemma because I had to continue organizing care plans, therapy sessions and

referrals to inpatient alcohol detoxification, knowing that these interventions

would overrun SECAT’s closure date. Clinical concerns notwithstanding, this

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situation breached my principles of honesty and respect, whilst infringing theservice users’ right to ‘ . . . make informed choices about the services they

receive’ (GSCC 2002, p. 15), given that they were to remain oblivious of SECAT’s

closure. Consequently, wishing to act in my service users’ best interests, I felt

compelled to inform them of SECAT’s impending closure, enabling us to work in

partnership to plan alternative support. Banks states that ‘The rights of users to

information . . . fits with the principle of treating users as rational, self-

determining agents and can serve to protect them against . . . excessiveparentalism or illegitimate power . . .’ (2001, p. 61). For SECAT’s service users,

however, excessive parentalism and illegitimate power were stifling their right to

access the information that affected them.

To manage my dilemma, I accessed advice and support during group super-

vision from SECAT’s senior practitioners, since they had experienced thedecommissioning of social care services previously. Furthermore, like me, these

practitioners were under instruction not to inform their service users of SECAT’s

closure, so they appreciated my predicament. Koons notes that an ‘ . . . important

source of ethical knowledge is the testimony of persons who have already

achieved a high level of developmental maturity and experience’ (2000, p. 266).

Drawing on the ethical knowledge and practice experiences of SECAT’s senior

practitioners, I considered the moral validity of not informing my service users ofSECAT’s closure. Aware that this would probably entail withholding information

and constructing ruses, I realized that by taking this deceptive approach I would

undoubtedly experience the negative consequences of dishonesty, such as guilt

and loss of trust. Consequently, I also considered the moral validity of disobeying

the commissioner’s instructions and informing my service users of SECAT’s

closure. However, if I opted to take this alternative approach, how could I inform

service users without causing them anxiety because, for example, the agency’sclosure affected their care plans? This was often the case, since SECAT’s

interventions normally continue for many months, if not years, given the chronic

and relapsing nature of alcohol dependence (Murphy & Cowan 2008, p. 34).

Faced with a matrix of difficult choices that evoked stress and concern in me,

I noticed that my ability to focus on practice matters had diminished. Aware thatthis could affect my therapeutic efficacy, I felt urged to resolve the dilemma

expeditiously, whilst remembering that deciding not to act would still be a choice

with moral consequences. After carefully considering the advice and opinions of

my colleagues, I consulted the General Social Care Council (GSCC) and British

Association of Social Workers (BASW) codes of practice for guidance. I also

consulted ethical decision-making tools such as Crisham’s M.O.R.A.L. paradigm

(1985). This recommended that I ‘Collect data about the ethical problem’,decide ‘ . . . who should be involved in the decision-making process’ and affirm my

‘ . . . position and act’ via an ‘ . . . implementation strategy’ (Marquis & Huston

2008, p. 82). To contrast these prescriptive approaches, I referred to the

postmodernist perspective, which asserts that ‘ . . . there are no fundamental

truths’ (Howe 1996, p. 86 cited in Parton 1996), so ‘No rule of general morality

can show you’ precisely ‘ . . . what you ought to do’ (Sartre 1946, p. 13). Having

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considered these divergent standpoints I decided that, ultimately, my ownknowledge and values should guide my course of action, for which I should

remain accountable (Banks 2001, p. 139). Whilst various options to resolve my

dilemma were available to me, I still felt burdened by the many onerous and

inescapable consequences of this situation that threatened the welfare of

vulnerable individuals. Sartre captures this difficult ontological paradox of

having to confront life’s inescapable choices in his aphorism: ‘ . . . man is

condemned to be free’ (1946, p. 10).During an inter-agency child protection meeting, I felt unable to conceal the

truth about SECAT’s closure when the meeting’s chairperson asked me a direct

closed question about SECAT’s capacity to provide open-ended support for an

alcohol-dependent parent. Given the gravity of this meeting, which affected not

only the interests of the parent but also the welfare of her child, I felt duty-boundto disclose the truth about SECAT’s future. However, making this information

public entailed disobeying the commissioner’s instruction not to inform anyone of

SECAT’s closure. Nevertheless, faced with having to make an immediate decision

under pressure that implicated a child’s welfare, I decided to tell the truth to the

meeting’s attendees about SECAT’s future. This decision, made without the

benefit of a detailed assessment, was the upshot of a hasty trade-off between my

duty to conceal the truth about SECAT’s future and my personal, professional and

societal values. Hence, my personal values of equity and honesty; my professionalvalues of accountability, beneficence and ‘respect for persons’ (Plant 1970, p. 11)

and society’s values of helping the disadvantaged and protecting children,

outweighed the commissioner’s instruction to hide SECAT’s closure. Immediately

after this meeting, I reported my decision to be honest about SECAT’s future to the

agency’s manager who expressed her solidarity with me, stating that, given the

circumstances, she would have done likewise.Of the values mentioned above, respect for persons was the most salient in my

mind when I decided to disclose the truth about SECAT’s closure. This value,

which is essential for ethically sound social work practice, stems from a basic

tenet of Kant’s moral philosophy called the ‘categorical imperative’ (Thompson

2005, p. 117). This states that we ‘ . . . should . . . always treat humanity whether

in your own person or in the person of any other, never simply as a means but

always at the same time as an end’ (Kant 1785 cited in Paton 1948, p. 91).Therefore, with respect for persons in mind, I aimed to treat all those present at

the meeting, as I believe all people should be treated: with dignity, honesty and

freedom from manipulation as a mere means. However, if during this meeting,

I had somehow concealed the truth as requested, justifying my decision by

stating that I was ‘only following orders’, I would have allowed ‘bad faith’ to

displace my integrity, given that to ‘ . . . engage in bad faith: I must know the

truth to conceal it from myself’ and others (Wider 1997, p. 50).By divulging SECAT’s closure to those present at the child protection meeting,

I felt satisfied that I had aided the dissemination of this important information to

some of SECAT’s partner agencies. This facilitated open discourse between SECAT

and these agencies, which helped to prepare for, and mitigate, the wider impact

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of SECAT’s closure. For instance, the social workers present at the meetinginformed me that they would advise their colleagues to contact SECAT to help

them locate alternative agencies for alcohol-related referrals. This helped to

prevent a glut of referrals into SECAT, which would have otherwise remained

unprocessed due to the agency’s closure, thus creating ‘false hope’ for SECAT’s

partner agencies and their service users.Whilst providing support during therapy sessions, my ability to remain

congruent with my service users about SECAT’s closure became untenable. Rogers

describes congruence as an attribute of effective therapeutic relationships that

‘ . . . is genuine and without front or facade’ (2004, p. 61). Since maintaining the

commissioner’s facade had started to affect my practice, I informed my supervisor

that I felt it necessary to advise my service users of SECAT’s closure. I also

explained how the commissioner’s instruction to conceal SECAT’s closure wasadversely affecting the relationship that I shared with my service users. This was

significant, because ‘The personal relationship’ is ‘ . . . a central feature of social-

work practice . . .’ (Howe 1996, p. 93) and widely recognized as a vital component

for effective therapy (Gossop 2006; Orlinsky et al. 2004; Martin et al. 2000;

Najavits & Weiss 1994).During supervision, I discussed various practice implications caused by the

commissioner’s instruction, highlighting to my supervisor how SECAT’s surrepti-

tious closure was inconsistent with both my own values and social work’s

professional codes. I felt this was necessary because ‘Social workers have a duty

to . . . Account for the ethics of their practice . . .’ (BASW 2002, p. 5) and

‘Appropriately challenge, and work to improve . . .’ policy, which is ‘ . . . not in

the best interests of service users’ (BASW 2002, p. 11). Moreover, since the agency

had no future beyond May 2009, though this could not yet be disclosed to serviceusers, SECAT’s practice could be perceived as, at best, morally dubious, and at

worst, dangerous and deceitful. Therefore, compelled by a sense of duty towards

my service users, and a desire to ‘Uphold public trust and confidence in’ (GSCC

2002, p. 19) the agency, I helped my colleagues to prepare a report to request

clearance from the commissioner to announce SECAT’s closure officially. This

request was successful, and following the announcement I was able to work

transparently with service users, enabling us to construct viable care and relapse-

prevention plans that were compatible with the realities of the practice situation.Acquiring the commissioner’s consent to talk openly about SECAT’s closure

enabled me to work congruently with service users, which helped to restore my

confidence in my therapeutic role. However, my renewed confidence faltered

when in-patient detoxification, which is a standard clinical intervention used to

break alcohol dependency (Galanter & Begleiter 1998, p. 367), was discontinuedfor SECAT’s service users because of a funding problem. Despite this problem

occurring annually during the month of March, the commissioner has rejected

repeated requests for an increase in SECAT’s yearly in-patient detoxification

budget. Social workers frequently find themselves performing roles as ‘gate-

keepers’ of rationed resources (Heng 2007; Postle 2002; Futter & Penhale 1996);

however, because SECAT’s annual detoxification budget had been completely

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spent, the option to triage service users according to their severity of need was

not available to me. Consequently, as the key worker of two service users

affected by this problem, I had to inform them that their much-needed referral

for in-patient detoxification had been rejected on financial grounds. Delivering

this news, which the service users received with indignation and despair, not only

left me feeling unprofessional, ineffective and disempowered but also damaged

the service users’ trust in SECAT. Discussing service users’ trust in agencies, Smith

notes that ‘ . . . an absence of trust at the point of access may impact upon

confidence and suggest that further contact should be avoided’ (2001, p. 296). As

Smith’s quote implies, the two SECAT service users excluded from their

detoxification treatment did not contact the agency again.Given the removal of the detoxification service, I considered SECAT to be failing

in its duty of care as an alcohol treatment agency, since the only intervention now

available to service users was graduated withdrawal from alcohol using psycho-

social support. This approach exposes individuals to unnecessary risks and

discomfort (Gill 2007, p. 193) and is less effective than in-patient detoxification

(Hayashida et al. 1989). My colleagues and I considered SECAT’s inadequate

detoxification budget as a tacit demonstration of state exclusion, since the

government, via the commissioner, has repeatedly underfunded this means of

addressing alcohol dependency. Moreover, the government is appreciably respon-

sible for alcohol dependency, since it not only permits but also supports the

widespread promotion and availability of alcohol, via its 24-hour licensing laws.

Davis echoes this charge, stating that ‘ . . . the Government’s answer to too much

drink, too much of the time, is more drink, all the time’ (2005, p. 1). If ‘The

efficient state is . . . one that protects its citizens against the risks and excesses of

the free market’ (Freire 1998, p. 11) then the government has demonstrated acute

inefficiency by failing to protect its citizens from the commercial excesses of

companies such as Scottish & Newcastle, which produces a beverage containing

15 units of alcohol for approximately £3.33 (Teather 2009, p. 11). In 2002, Craig

stated that individuals who are alcohol dependent ‘ . . . have been known to

suffer . . . social exclusion on a substantial level but . . .’ this has ‘ . . . yet to be

addressed effectively by government’ (2002, p. 677). Sadly, however, this problem

remains unaddressed in 2009.Influenced by critical social work, which opposes the ‘ . . . relations of power

that pervade social worker encounters with clients’ (Heron 2005, p. 341), and

motivated by the injustice of SECAT’s closure, I took an active role in helping to

mobilize SECAT’s service users to save their agency. This entailed coordinating

meetings, relaying relevant information, liaising with local media organizations

and helping service users to construct cogent arguments in their letters appealing

to the commissioner to reconsider SECAT’s closure. By involving myself in this

action, I aimed to, if not prevent, at least delay SECAT’s closure for long enough

to provide time to arrange alternative support for SECAT’s service users. When

disempowered individuals cooperate, they can augment their power and

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influence, thus increasing their capacity to overcome structural oppression and

achieve their objectives (Fooks 1995; Wharf & Mackenzie 1998). Nevertheless,

confirming the notion that ‘ . . . there are no easy remedies in social work,

especially when we are confronted daily with oppression’ (Coulshed & Orme

1998, p. 3), my supervisor informed me that our attempts to save SECATwould be

futile, because the agency’s closure had been ratified at the highest level of local

government. I considered this fait accompli to be a travesty of social justice,

which reinforced my impression that whilst ‘ . . . stigma and oppression . . . travels

with certain oppressed groups’ (Trevithick 2000, p. 7), it is the hegemony of

institutions presenting ‘ . . . particular interests as the interests of society as a

whole’ that perpetuate the subordination of these groups (Gramsci 2006 cited in

Storey 2006, p. 63). Hence, the government had imposed its politically driven

fiscal interests upon the South-Evecastle community, via the commissioner, to

the direct detriment of SECAT’s service users.

Since my supervisor had informed me of SECAT’s inexorable closure, I

became aware that I was gradually being preoccupied by feelings of anxiety

and resentment about this ‘done deal’. Whilst Ferrard and Hunnybun regard

self-awareness as ‘ . . . the first necessity on the part of those who seek to help

others’ (1972, p. 34), my self-awareness had become burdensome, extending

beyond my practice, with negative feelings permeating my home life and affecting

my relationships with family and friends. However, by engaging in regular

supervision sessions, which provided dependable access to my supervisor’s insight,

support and experience, I was able to temper my negative feelings by exploring,

contextualizing and rationalizing them. This helped to ensure that my future

practice-related decisions remained safe and effective. Apart from providing a

forum where I could access support and guidance, supervision also involved

reflective discussion and appraisal of my previous practice-related decisions, such

as my choice to divulge SECAT’s closure to those present at the child protection

meeting. Examining such decisions during supervision helped to ensure that

I remained accountable for my practice, and often yielded alternative approaches

that I could use to address similar situations in future.According to Collins, ‘ . . . research indicates . . . that if social work staff are to

function effectively with problem drinkers, then appropriate support and super-

vision are vital considerations’ (1990, p. 32). Despite the considerable challenges

of supporting alcohol-dependent individuals (Barlow 2008, p. 493), which I had

never experienced previously, combined with the organizational and emotional

disruption caused by SECAT’s closure, I was still able to manage both my caseload

and therapeutic role proficiently. I partly attributed my newfound resilience and

skills to SECAT’s supervision process, which incorporated a ‘restorative function’

that helped me to relinquish the negativity of practice, thus avoiding ‘burnout’

(Inskipp & Proctor 1995 cited in Carroll & Holloway 1998, p. 90).

Since my supernumerary position within SECAT largely removed me from the

employment issues relating to the agency’s closure, my involvement in this

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matter centred, almost entirely, upon minimizing the harm that SECAT’s closure

would cause the agency’s service users. By maintaining my focus on the service

users’ plight, particularly during supervision sessions and whilst conversing

informally with my colleagues, I aimed to highlight the moral, psychosocial

and practical importance of informing SECAT’s service users that their agency

would close at the end of May 2009. According to O’Brien and Bannigan, social

workers ‘ . . . have an obligation . . . to create a therapeutic context in which the

people they are working with can . . . make informed choices’ (2008, p. 306).

Promoting the rights of SECAT’s service users to make informed choices about

their future support helped to impel the creation of the report that successfully

obtained the commissioner’s authorization to notify the service users of SECAT’s

closure. According to my supervisor, attaining this authorization helped to foster

a broader ethos of transparency within SECAT that encouraged greater openness

towards service users in relation to other matters. For example, when the in-

patient detoxification service ended, SECAT’s manager immediately informed all

the agency’s service users that this intervention would be unavailable.

Notwithstanding the disappointment of losing this service, the manager’s prompt

announcement allowed me to practise with the confidence that service users

were aware of this unfortunate service change, enabling us to work accordingly.

Conclusion

Whilst this account explores an episode that contains many negative conse-

quences for a vulnerable group of people and their community, my involvement

in this process has helped me to recognize and comprehend some of the drivers,

mechanisms and effects of service rationalization. This phenomenon of modern

social care provision indicates a managerial strategy that is dependent on

targets, monitoring systems and auditing regimes to ascertain the economic

viability of services, often at the expense of considering the qualitative, and

frequently immeasurable, value of services to individuals (Clarke & Newman

1997, p. 29). Hence, for me, this episode has underscored the importance of

questioning the morality and rationale of official plans and directives, instead of

blindly accepting their formulation and introduction. This is not to reject

wholesale the concept of change, which can be necessary and/or beneficial.

Throughout this lamentable period, which involved questionable tactics such

as the commissioner’s ‘business as usual’ policy, my efforts and concerns have

focused on highlighting the needs and maintaining the welfare of SECAT’s service

users. Following their agency’s closure, SECAT’s service users must continue to

manage their alcohol problem without specialist support. Many of SECAT’s

service users have become reliant on the support they receive from their agency,

so its closure is likely to impede their recovery, causing harm to these individuals

and their social systems. Moreover, of utmost concern, at the time of writing

this, no coherent plans to replace SECAT exist.

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