Blog: Taking Responsibility

The ways we care about each other and the ways we are supported when struggling to make our voice heard are indicative of the health of our society as a whole. When our society is at its best kindness, listening and a good life are hardwired into its DNA, but we choose to remove some people from this best society and a life well lived.

Ben King died at Cawston Park, a specialist, secure ‘hospital’. His was the third death since 2018 and the service was in special measures. His inquest details a list of failings in Ben’s short life (he was 32). Not his or his family’s failings, but those in the system that should have supported Ben, listened to him and kept him safe. A quick look at their balance sheet challenges any myth about provider underfunding.

Ben’s death is just the latest in a very long list of scandals about the mistreatment of people who are identified as ‘challenging’ and who are sent away to large, isolated, secure institutions. Each of these placements was and continues to be someone or a group of people within ‘the system’ making a choice. Maintaining these placements in the face of, often overwhelming, evidence of harm is also a choice.

Sometimes placements are presented as coming from a lack of choice because of the lack of person-centred community services. Part of that is true – frequently this type of support is not available – but we also need to understand a bigger truth: where person centred, community-based support is not available, it’s because of a choice not to invest the time, creativity and resources into making them happen.

Some steps will help start the process of taking responsibility:

Learn about people’s rights and assume that everyone has capacity to make their own decisions about their life. You will probably find that understanding and upholding people’s rights will make many placements impossible to justify.

People (commissioners, clinicians, senior managers) need to take personal accountability for the decisions they make. This includes knowing the motivations and history of providers (not just the individual service but the whole provider, parent company, etc.).

Understanding the impact that making a ‘placement’ (rather than developing support) has on the whole individual. This includes the impact on family relationships, connection to school, workplace, community groups, etc. It’s usually devastating.

Identifying every compromise that has been made between the person’s (and their family’s) aspirations and the reality of what is being offered. There is a good chance that this triangulation will make any placement very hard to justify.

And then:

If we look at the history of many failed placements they have been identified in a time of crisis and based on availability alone. This is shopping not commissioning. Commissioners need to stop shopping and understand why bespoke support isn’t available locally. Usually this is because the local system relies on broken procurement processes and is doing nothing to welcome and encourage innovation.

Individuals, families, communities, bespoke providers and commissioners walking together is where we have the chance to break cycles of sending people away and begin to get it right. Walking together is not best started in a time of crisis when it is hard to see the whole unique person, when it’s hard to see a good, ordinary life.

People are experts in their own lives. Families are usually experts too. Listening to and respecting people’s experiences, values, contributions and aspirations feels a million miles away from removing some people from the best society and a life well lived.

Jane Friswell and Bill Love