‘Enabling’ is one of those terms that is bandied around a lot in social work.
We are supposed to be a profession that promotes self-determination and focuses on enabling individuals to fulfil their potential or take control of their lives, things which are sometimes easier said than done within the systems that we work in.
As a mental health social worker I am continually trying to balance enablement and empowerment with protection, the ultimate sanction of course being detention under the Mental Health Act when an individual’s risk to themselves or others becomes too severe to manage within a community setting.
With this level of power imbalance it can sometimes be difficult to see where enablement comes into play, and it can sometimes feel like we are stuck between a rock and a hard place with risk being the focus across services and professionals. So what do we do? How can we enable someone when we hold the power over their liberty?
I remember when I first did my ASW training. At that time I was very uncomfortable with the idea that you could be both protective and enabling, and many of my supervision sessions were focused on trying to come to terms with what I essentially saw as a conflict in the role.
The first individual I assessed who was also on my caseload actually helped to resolve this. I had heard many colleagues, particularly nurses, talking about the therapeutic relationship and how that relationship was not compatible with being able to apply Mental Health Act powers. I had bought into that idea and, as a result, I was reluctant to do the assessment – but I was on duty and that’s how it worked in my area at the time, it needed doing and so I was doing it, regardless of my anxieties and reluctance.
Dan* was a thirty-something man who lived alone and had a diagnosis of schizophrenia. His mental health had been deteriorating following a weekend bender of drink and drugs, and he was becoming more and more psychotic. I recognised the risks and knew that I needed to do something but felt that using the Act would damage the relationship we had built up.
I actually couldn’t have been more wrong! Now, I am not saying that this will be the case with every individual (or indeed every AMHP), but following assessment and admission (under section 2) I continued to work alongside Dan, and although he was initially angry with me he also became aware that he was really not very well and needed someone to do something.
That admission only lasted a few weeks. His mental health was stabilised with medication, we were able to clean up his flat and re-establish contact with his family, and the spell in hospital gave him the time and space (and indeed safety) to really consider his life and what he wanted to do. The process of intervening changed our working relationship, but not in a bad way – the power imbalance is always there, and while we talk about partnership and collaboration, sometimes it can feel that this is not possible. In fact, if managed sensitively, boundaries and safety can be just as enabling in terms of an individual making positive changes.
For me, ‘enabling’ is not just about an individual doing what they want to do, it is also about recognising power relationships and planning for crisis to enable the individual to have a say about what they want to happen when they are unable to make their own choices or are at significant risk. It is a complex concept which can mean different things to different people at different times.
What does enabling mean to you? How can you both enable and hold authority at the same time? What impact do power relationships have on your practice and the ability to enable individual choices and aspirations?
DaisyB