The media exposure of the culture at Rampton and other high profile hospital settings in the seventies and early eighties led to the large-scale re-organisation of services catering to those people whose behaviour was characterised as ‘challenging’. While this was undoubtedly well-intentioned, legislation such as the “Working for Patients” legislation in 1989 led to actions such as the ill-considered “Care in the Community” programme in the early nineties. In the eyes of many this is now viewed as having been an effective abandonment of people with complex needs, who found themselves in bedsit accommodation and the like, with little or no support or supervision. This in turn led to high-profile tragedies such as the killing of Jonathan Zito by Christoper Clunis on the London Underground in 1992. 

The Zito case – and several other lower-profile instances of neglect – has led to a sharp-growth in number of community-based services for people with mental health difficulties as well as learning disabilities over the past two decades. The intention of all of these services is to promote independence and to support people to live lives as normally as possible. These services may therefore

  • Support people who are living independently and who may just need occasional visits and help from domiciliary-style services
  • Be provided within group-home/supported-living services, which are staffed around the clock with support workers who assist with daily activities and provide a link to other services
  • Support people with more complex needs, frequently within locked “low-secure” facilities, which are usually based in community settings

The Winterbourne View home in Bristol fell within this last category of service – and the recent Panorama exposure of abusive practice at the unit, followed by well-publicised trials of the staff involved, has led to the residential area being placed under more scrutiny than at any time in the past thirty years. The public have made presumptions based on the high-profile nature of care scandals, and many of you reading this may well have been subjected to questions from friends and family, asking if “this is what you do for a living.” For the vast majority of us, who continually give our best under circumstances which can be highly stressful, such assumptions can be hurtful and soul-destroying.  The scandals have, however, served to highlight warning signs that can occur among individual staff and staff teams:

Staff Burnout: This is defined as feelings of hopelessness and despair among staff in the face of high levels of challenging behaviour. It is also seen as being highly contagious, and is correlated with high levels of staff absence and turnover. This then becomes a vicious circle as it is universally acknowledged that the best care is delivered by staff who have develop a familiarity with the people they are supporting. Managers should be aware of the signs of burnout and ensure that constructive feedback and deserved praise is delivered to directly to carers, through the media of supervision, appraisal and staff meetings, as well as via informal interactions.  For more information on this crucial skillset see our supervision course.

Lack of Underpinning Knowledge: It has been well-publicised that the government intends to make certain levels of training compulsory within the care sector, including making sure that carers and support staff learn more about the clinical conditions prevalent within their workplace.  While formal training is valuable, it is also important that managers impart their own knowledge to their staff teams, and also utilise the experience of their senior staff positively by encouraging them to pass on their experience and the knowledge they have gained as direct carers. Staff also need to equipped with the skills to recognise behaviours as possible evidence of a relapse into a severe mental health condition, or as possible signs of physical ill-health, in order to promote early intervention.  SecuriCare offer a range of courses covering the underpinning knowledge required to support people with Learning Disabilities, Mental Health Difficulties, Schizophrenia, Substance Misuse as well as Dually Diagnosed Individuals.

Negative Assumptions and Attributions: When carers work with people who challenge services, and they experience poor levels of training and managerial support, research indicates that they will develop their own negative interpretations of client behaviours. Symptoms would include staff expressing a belief that the person is “doing it deliberately” or is “just playing up,” without making any attempt to understand or deal with problems proactively. This is correlated with emotional neglect of clients – and can even lead to abuse through staff behaving in a retaliatory fashion. Managers need to listen for signs of this type of culture developing, and encourage staff to develop alternative, positive views of behaviour – such as seeking to uncover what the person may be attempting to communicate. SecuriCare advocate the strong need to identify and empathise with service users in order to be able to deliver optimal and compassionate care. The initiative is called “Empathy through Understanding”.

Use of Appropriate Reactive Strategies: The Winterbourne View documentary vividly illustrated that –as a result of burnout, lack of training and negative attributions - staff had completely given up on proactively working with the users of their services, and were reliant on restraint as the only option for managing challenging behaviour. In some cases, this had even led to staff actively provoking situations in order to “show who was boss.”  SecuriCare advocate a range of preventative strategies ranging from person-centred care and active support, through to the effective use of communication and de-escalation skills. We offer a suite of courses about Working with Challenging Behaviour in a number of different clinical specialisms including ‘Learning Disabilities’, ‘Mental Health Difficulties’ and ‘Schizophrenia’.

“Them and Us”: It is very easy for direct carers to feel distanced from clinical decision-makers and from senior managers, resulting in inter-disciplinary conflict – and in some cases even a siege mentality developing. There have been documented cases of carers refusing to carry out prescribed care because they felt that they had not been consulted and did not agree with the care plans. Research indicates the importance of flattening hierarchies, making sure that clinicians and managers have a visible profile at unit level, and can be approached by staff with any concerns or contributions. Demonstrating respect for the expertise that staff develop in knowing their clients as people is a vital part of maintaining positive communication, consistency and staff morale. Our team fully understand the challenges of creating a positive culture and have experienced consultants able to offer their expertise.

There is, of course, no magic wand that can be applied to all situations, and managers need to be sensitive to the unique needs of their own workplaces.  Most research since Winterbourne, however, highlights the need for supporting and maintaining staff teams, and meeting their supervisory and training needs, as being essential in preventing negative and abusive cultures from developing. SecuriCare pride themselves in having an extremely experienced clinical team on hand to provide training and consultancy support. To discover how we can help you, just get in touch: T: 01904 492 442 or E: . Or visit our website: