The Disease of Loneliness
Mother Teresa was once asked, “You’ve been in India dealing with illnesses like cholera and AIDS. What’s the worst illness you’ve ever seen?” and she replied, “The worst illness I have ever seen is the loneliness and isolation in the West.”1 In another quotation she referred to loneliness as “…the leprosy of the West”2. These are very interesting, and to my mind stark, observations.
As a person who has suffered throughout my life from periods of feeling very alone, Mother Teresa’s comments have a deep resonance. In my view it is not, in the main, the physical manifestations of loneliness that are most significant; it is the psychological and emotional issues that are most important. Despite having been surrounded all my life by people who love me, I have periodically battled with my feelings of being alone, which in my case may, in part, be linked to feelings of a failure as a child.
In my time working within the area of child protection, the emotional and psychological issues were the most difficult to help people resolve, in large part due to the fact that these issues are individual and linked to people’s own perceptions. In looking back, I think what is also clear is that I spent too much time on assessment. This may seem a surprising admission on two counts, one being that I strongly believe that assessment is the cornerstone of social work and the second being that my role was often to undertake assessments for court.
Assessment : the Risk of the Superficial
The reason I make this rather strange admission is due to the fact that assessments so often are about looking in from the outside and trying to make sense of what is going on in a particular family. Perhaps I was not skilled as an assessor and I failed to gain a sense of people’s lived experience. Whatever my shortcomings I have begun to feel that social work may be becoming sanitised and separate from the very people we are trying to help.
The task has become sanitised because it has been cloaked in endless procedures and it is these procedures that are becoming the raison d’etre of practice rather than a deeper understanding of the lived experience of service users. Part of the reason for this, I believe, is that as practitioners we have become separated from the very communities we are trying to help. Social work cannot be a purely bureaucratised procedurally driven process in which we tick boxes. We are dealing with people not objects. Social work should not be just about assessment and monitoring it has to be about engagement.
At this juncture it is worth reminding ourselves what is the Government’s aim as laid out in Every Child Matters, which “…is for every child, whatever their background or their circumstances, to have the support they need to:
- be healthy,
- stay safe,
- enjoy and achieve,
- make a positive contribution,
- achieve economic well-being”3.
Communities as the Context for Children’s Lives
If we are to understand people’s lived experience, we need to understand the communities they live in, which includes – I would suggest – also being involved in the design of new communities. I recently heard a report on the radio that was talking about the opening of a new housing estate on the outskirts of London. Not a particularly earth shattering event in itself and yet it was not the event itself that made me think. It was the comment of a designer who predicted that in 25 years this new estate would be another slum area that would need to be redeveloped.
What I felt was so interesting about his comments was not his observations on the unimaginative architecture, but that in his analysis he talked about the lack of benches and that there were no places for people to sit and talk. He then went on to talk about the importance of “a sense of place and identity” in our communities. If we are to attempt to reduce people’s sense of isolation and loneliness we need to have a greater understanding of communities within which children live.
Starting from the point of understanding the community in which people live also allows us to also gain an understanding of which agencies are working in the area. As Boddy J, Potts, P and Statham, J. (2006) show in a report looking at assessment of children with ‘significant and complex needs’ there needs to be culture shift in which “The child and family were seen as playing a central and active role in this assessment process. They participated in the assessment, rather than being the passive ‘subjects’ of expert evaluation”4.
In their analysis of six local authorities they cite a piece of research which looked at the impact of the Common Assessment Framework (CAF), which “…found that most CAF work to date has been undertaken by practitioners from education and health sectors, rather than social services; and that links with the statutory children’s social care ‘in need’ assessments have not been extensive”. 5
Further on in the report they identify difficulties in working across professional boundaries, in particular, in working with schools. What is needed, they argue, is “The importance of place: location and co-location” in which professionals see families in places of their choice and in which professionals spend time with one another. Professionals “…also spoke of the benefits of seeing the child and family as a whole, in contrast to their experience before integrated assessment, when they ‘didn’t really know what [services] families had and why6’.
As the authors state, “Workers must be prepared to be challenged, to think and communicate in new ways..”7 This is not some kind of dig at social workers because in the local authorities surveyed (bar one) there was a constant theme shared by all professionals of the difficulties of involving ‘educational professionals’.
We will never be able to end people’s sense of isolation but we may be able to understand people’s lived experience if we return to seeing communities as the focus of our practice. The Common Assessment Framework should be the centre of all our interventions, and should be part of a process of engagement rather than some form of static event. The idea of the lead professional should also allow us to move away from the limited notion of the ‘key worker’ and move into a different arena in which the professional who has the greatest understanding of the child within their community takes the lead.
The Fundamental Question
For this to happen perhaps the starting point for all our practice should be to ask the child the fundamental question, “What is it like to be you?”. As Body et al. (2006) state there needs to be a willingness on the part of child care professionals to be “self reflective and enthusiastic about collaborative working” to ensure our interventions are holistic, appropriate and focused reflecting “local needs and contexts”.
3Every Child Matters : Change for Children http://www.everychildmatters.gov.uk/aims/
4Boddy J., Potts, P. and Statham, J. (2006) Models of good practice in joined-up assessment: working for children with ‘significant and complex needs’ p. 14 .Thomas Coram Research Unit Institute of Education, University of London http://www.dfes.gov.uk/research/data/uploadfiles/RW79.pdf
5Boddy J., Potts, P. and Statham, J. (2006) p. 4 Brandon, M., Howe, A., Dagley, V., Salter, C., Warren, C. and Black, J. (2006) Evaluating the Common Assessment Framework and Lead Professional Guidance and Implementation in 2005-6, DfES Research Report 740. Nottingham: DfES
6Boddy J., Potts, P. and Statham, J. (2006) p. 22
7Boddy J., Potts, P. and Statham, J. (2006) p. 34