The appeal is being heard on three points, as follows:
1) Creativity
2) Contacts
3) Decisions
1) Creativity.
The job evaluation officer's statement, which we are challenging, refers to the amount of creativity required to do the job, but offsets this against the constraints within which I act - namely that ultimate responsibility for all things lies with the manager (Andrew). It recognises that I am required to interview clients, but states that all activities are in agreement with the manager. We reply to this that I am required to be innovative and imaginative in responding to issues and problem solving, and that my contact and agreement with the manager comes nearly always after the event. There is no textbook of concrete procedures that I am required to follow, my responses to every situation are dictated by my experience, theoretical knowledge and intuitive understanding of the situation (”informed intuition"). At every point of contact with clients of the centre, whether in a keywork session with one of my designated clients, in a group situation with a number of clients, or in a less formal situation in the drop-in cafe area with people who may or may not be known to me, I am required to be creative and sensitive in my responses to what the clients may bring to me.
I have no way of knowing in advance what difficulties I may be required to deal with, and I have to rely on my intuitive response to the here-and-now situation. It is only after the event, in fortnightly supervision with the deputy manager or in handover sessions when a manager may or may not be present, that I am able to present my work and decisions to another person. I am frequently required to respond to distressed, anxious, depressed, angry or acutely mentally ill persons who may at times present themselves as delusional or suicidal. At such times it is my sole responsibility to respond in what I judge to be the most appropriate way, drawing on my past experience of similar situations and perhaps on some previous knowledge of the client. It is expected that I will respond in an appropriate and reasoned way without any recourse to discuss the matter in advance.
At no time do I hand over responsibility for any situation to my manager.
In addition, I am required to interview and assess potential clients for our day care programme. In such situations it is solely my decision on the basis of my experience in the interview whether a client may be accepted onto the day care programme, and may be allocated a particular programme of groups and activities. Again, there is no input from the manager until after the event, and even then he has no direct contact with the client, but responds to my presentation of the interview.
I am required to plan group activities (sometimes in conjunction with a co-worker) and the decision to go ahead with a particular activity is made by the staff team as a whole in consultation with the manager. Once the decision to go ahead with an activity is made, it is then my responsibility to plan and facilitate these activities. Responsibility for the internal structures and the final activity plan of these activities lies with me alone, and there is no further managerial input until a presentation of the group or activity to the staff team, which may be after the group has been running for several weeks, or even after it has finished. Groups generally run for an indefinite period, or in batches of ten weeks.
2) Contacts.
I make contact on a daily basis with a wide variety of other people, ranging from consultant psychiatrists and senior social workers to mentally ill clients and distressed members of the public. In many of the latter cases, I have to deal with violent and threatening behaviour, I regularly suffer verbal abuse, and I have been physically assaulted on a number of occasions. These have resulted in incident report forms being sent to senior management. The nature of the drop-in cafe is such that we are openly available to anyone, and although we have a "No Alcohol" rule we regularly have to deal with members of the public who have become violent and abusive through drink. I have been verbally assaulted and threatened on a number of occasions, and these are of such regularity that only the most extreme are formally reported. It should be noted that my responses to such occurrences are necessarily influenced by the knowledge that there may be any number of distressed or fragile people witnessing the incident, and my first duty is to protect them from any undue anxiety.
My keywork responsibilities are to an average of five clients, whom I see at varying intervals depending on their situation and requirements. I am presently seeing two on a regular basis, and am required to hear and experience a great deal of their distress without trying to avoid or deny their feelings. One of them is currently trying to deal with extreme physical and sexual abuse experienced as a child, and many of the details which she is trusting me with are being revealed for the first time. The other is an extremely socially isolated man who has no family or friends, and who was referred to the day centre some time ago but was unable to maintain contact with us. He was being seen until last year by a community psychiatric nurse. When she went on a year's maternity leave there was considerable anxiety expressed about whether this man would maintain the will to live without regular contact, and it was my task to attempt to re-engage with him in a therapeutic relationship and try to ease the loss of this CPN. This involved firstly trying to encourage him to come to Bedford Hill, then attempting to forge a trusting relationship, and then attempting to maintain this in spite of an at times overwhelming apathy on his part. I am happy to say that after nearly eight months of regular weekly meetings with him, at which he set the agendas, he seems to be functioning considerably better.
As a part of my job, I am regularly entrusted with the most intimate details of people's personal lives which demand handling with the utmost discretion and sensitivity. At times I find myself very affected by what people are saying, or have experienced, and it expected that I will keep my own feelings out of the situation. I have to deal with these elsewhere.
3) Decisions (and Consequences sub-factor):
We are claiming that I make decisions which have considerable effects on the life of the individual client without previously consulting the manager. Decisions which directly affect the running of the centre as a whole are ideally made by the staff team in consultation with the manager, but the reality is that there are often periods of time when there is no manager present for several days. In these cases I have to make decisions which have a significant effect on the client or the centre and the responsibility for these decisions is mine. Decisions which affect the client and which have considerable implications for them attending the centre are made by the client and myself without necessarily consulting the manager. These decisions would include which activities a client attends, changes to an existing program, and frequency and nature of keywork sessions. It is my responsibility to organise regular review meetings on the client to which the manager is invited to attend. I have a client who has been regularly attending groups and keywork sessions at the centre for six months now and who has never met the manager other than informally in the drop-in. Her first formal contact with him will be in her review which I am planning for August. It is my responsibility to formulate a client's weekly program and to monitor it's progress.
My work is with people who have experienced mental health problems and may have spent some considerable time in psychiatric hospital, but who are presently attempting to live in the community. They often live in constant fear of breakdown and re-admission and may find even the most mundane day-to-day tasks fraught with anxiety and fear. They may from time to time experience partial or total relapse, with the world suddenly becoming a frightening and unfamiliar place with invisible beings speaking in terrifying voices inside their heads, perhaps telling them that they are evil and must kill themselves. Among the decisions I am required to make are assessments of how serious, or how immediate, the potential of a suicide is. whether to attempt to get someone formally assessed for admission to hospital, what sort of effect a stated suicide threat may be calculated to have on me, whether it is an attempt to be manipulative, all need to be decided by me alone in the course of a discussion with client. I have no opportunity to go away and discuss the situation with the manager or other colleagues until after these decisions have been made. Fortunately I have not yet had a client commit suicide, but I have had one key client who became convinced that he was responsible for much of the civil unrest in the world, and that it would cease if he put his foot under the wheels of a car. Thankfully he received only minor injuries as a result of this, although as a result of a similar incident some years ago he has only three toes on one foot.
Since it is a reality that there are often times when management or other colleagues are not available, I am also required from time to time to make decisions about a client or a service in the absence of the appropriate person. Sometimes a client may come in in acute distress and I will be required to deal with the situation even though I may have had little or no previous contact with that client.