The one where he had to use the emergency services to remove an elderly lady from her home so she could receive care in hospital, only to later discover from a neighbour that she’d been frogmarched from her home by the Gestapo during the Second World War.
“I felt awful,” he says. “Another set of men in uniform must have been terrifying for her.”
He also remembers the young man with bipolar disorder who, during a manic episode, ruined the family business, causing devastation for his relatives. The case sticks with Mitchell because the man had children a similar age to his. His decision to make an admission under the Mental Health Act meant only one of the two fathers would put his kids to bed that night.
“Going home and thinking about the impact of those decisions you’ve had to make, the trauma someone has been going through…and the fact that you get to go home, to sleep in your own bed, everything’s kind of alright. Those were the cases that shaped me,” he says.
Mitchell, now principal social worker and service manager for adult social work at Calderdale Council, held these cases during his time as an approved social worker (approved mental health professional) – a role he says changed him and the way he thought about social work.
“As a hospital social worker I knew that people in hospital and care homes had a roof over their head, they were relatively, superficially safe, so I was able not to worry too much and enjoy the early parts of my career,” he says. “But the AMHP training changed all that a bit.
“I found having that statutory responsibility to admit people to hospital under the Mental Health Act really difficult. It started a series of questions in my head about what I thought my role was as a social worker; who are social workers here for and who are we accountable to.”
‘Challenging care management’
These are questions Mitchell has reflected on throughout his career. He trained as a social worker in the late 1990s, after a stint as a care assistant in a nursing home (where he met his wife, now a nurse) taught him he was never going to work in any other industry. Mitchell didn’t rate his social work course highly and says his learning started on day one at the council.
Mitchell’s first post was in one of Calderdale’s hospital social work teams. There he worked under a manager who encouraged him to challenge the idea social work was “care management, assessing the life out of people, writing massive assessments and nobody reading them” – something he didn’t believe social workers should be doing.
“Not only did she say I was right; she also said she was really pleased I was having that conversation with her because it kept her fresh in social work as well,” he says.
“I didn’t realise at the time how lucky I was to have such a passionate social work team manager – she was probably the biggest influence on my professional career.”
‘The decision maker’
Another major influence on Mitchell’s development as a social worker is Ian Burgess. The pair met on day one at university and have been friends for 20 years. For the past decade, they’ve been colleagues too – Burgess is Calderdale’s Mental Capacity Act lead and works closely with Mitchell day-to-day.
Mitchell says the two have “always shared ideas” on social work and rights based practice. Burgess agrees and still remembers how they used to argue with lecturers about human rights and personalisation. “We would ask: ‘why should the organisation that fixes your streetlights and collects your rubbish be the decision maker about someone’s rights and wishes?’”
Importantly, the pair share common values on the purpose of social work. Mitchell says he hasn’t always had that in his career, and recalls a conversation with one of his former managers during supervision.
“I said to him: ‘you do agree with me don’t you, that the people we serve, they are the same as you and me?’ He bluffed his way around it. He absolutely could not move himself from that lofty position of being the decision maker to being the same as someone who uses services.
“I’ve seen that throughout my career and that is why I love working with Ian in particular because he absolutely gets it to a fault that the person in the home, regardless of their circumstances or how they present, they are the decision maker, they are the important ones.”
‘A balancing act’
There are signs of these values in every corner of Calderdale’s social care offices. A Lord Justice Munby quote – “the local authority is a servant not a master” – is sticky-taped to a desk. There’s the wall of ‘unwise decisions’, where social workers have shared ill-advised choices they’ve made as a reminder of the Mental Capacity Act principle that the capacitated decisions of people receiving social care must be respected, even if they seem unwise.
These visual clues hint at the dilemmas social workers in this service face every day.
On behalf of the state, they have the power to make life-changing decisions – whether it’s to assess someone as lacking capacity to make decisions about their lives, or in recommending a care plan that restricts someone’s liberty. But this power must not be misused. Every action must be in a person’s best interests and the least restrictive intervention possible.
It’s a tricky balancing act. To support staff, Mitchell’s introduced Mental Capacity Act clinics that offer a space to discuss anxieties around cases, and a risk enablement panel where professionals and people using services can discuss positive risk-taking opportunities.
Both projects recognise the tight judgement calls social worker make – but it’s a case that arrives late this afternoon that really highlights just how hard it can be.
“Have you got a minute?” Burgess asks Mitchell. A call’s come in from a social worker and an urgent case conference takes place around a potential deprivation of liberty.
The dilemma of the ethical decision making is weighing heavily on Burgess and he is looking to Mitchell for advice and support as his PSW.
“Ian’s going to have a real dilemma with that one,” Mitchell says, away from the office floor.
“If that set of circumstances actually results this afternoon in having to use the state machinery to put somebody in hospital, somebody who just gone home because they want to be at home. That’s the kind of case in adult care you go home thinking about.
“Those are the ones that have a profound impact on us.”
The case jogs Mitchell’s memory back to his days an approved social worker and those big questions about social work. He remembers working as a shop steward for Unison at the time, representing social workers’ rights. That’s still important to him, but it’s not his motivation.
“I’m at the stage now where I’m really passionate about social work and working alongside some really inspirational social workers across our Calderdale teams, but I’m not in social work for social workers.
“My motivating factor is actually, how can we do our role better for the people we serve?”
‘Social work legacy’
The people Calderdale’s social workers serve will play a key role in Mitchell’s latest project. With the council’s backing, he’s setting up a mutually-led social work practice in an old shopfront in Halifax’s marketplace.
The service, which will be piloted for a year, will be overseen by an advisory group of service users and a management board. It will be staffed by 12 social workers and a team of volunteer peer mentors with experience of using services. The aim is to get social workers more accessible to their communities and working more preventatively.
It’s a building site at the moment and a flicker of disappointment crosses Mitchell’s face as he’s told about the latest discovery – a big patch of dry rot in one of the upstairs rooms. But this is soon replaced with his usual (and infectious) enthusiasm, as he talks about the project and what he hopes it might bring to the future of social work delivery in Calderdale.
“If we can get a group of people who use services managing it and begin to manage some kind of social work approaches, the potential that gives us in terms of good outcomes, in terms of that preventative agenda, is huge. It’s absolutely worth a pilot.”
Yet Mitchell adds that he’s not trying to convince social workers to be accountable to people, or that signing up to the mutual instead of a local authority is the right thing to do.
“What I try to do in this building is surround ourselves with social workers who honestly believe it anyway. We’ve changed the way we think about social work, we are genuinely person-centred in our approach, that wall of unwise decisions – it typifies what we’re about.
“So even if the mutual never happened, for whatever reasons, I think the fact that we’ve been able to move our social work thinking on a bit, that’s a legacy really. I think that’s alright.”
Source: Community Care