Experiences of a service user advisor to a post-qualifying social work course: a personal account

ABSTRACT

In this co-produced paper, we write about a collaboration that developed over more than a decade between a service user advisor and a social work educator within a higher education context. Starting with how we came to work together, the paper outlines early apprehensions about service user involvement, both as we experienced them and as expressed by colleagues, students, and managers. The paper discusses such themes as confidentiality, professional boundaries, and power imbalance. As authors w identify principles that have underpinned our relationship as well as obstacles faced and understandings reached. We emphasise possibilities discovered from this project which may have application for other courses and settings for the service user advisor role. As we write, we are confronting a new challenge as one of us continues in the work and one of us retires from it.

KEYWORDS:

• co-production
• service-user involvement
• experts by experience
• social work education
• mental health policy and practice

Introduction

An aspect of the personalisation project, often termed co-production (Filipe et al., 2017), refers to a working relationship between someone who may more usually be in a role designated ‘service-user’ or ‘client’ and someone more usually in a role termed professional or clinician. Here, from a project involving close contact over time, we present details particularly from a ‘service user’ perspective of a collaborative experience in a social work education context.

In this paper Helen considers aspects of the relationship she formed with the co-author, Clare. This involves looking back at the early days of work we embarked on together including initial apprehensions shared and encountered in others.

Helen explores the emergence of the specific role she has occupied and developed. She identifies the contribution this made and continues to make to the relevant social work course over more than a decade of weekly academic activity.

We came to entitle the role Helen occupies as Service User Advisor and this title has, in turn, served as a prompt for further articulation and specification of the role.

In the UK, service user involvement is not a new concept or practise. In the early 2000s the then regulator, the General Social Care Council, made service user involvement a requirement for their approval of social work courses at qualifying and post qualifying levels (General Social Care Council [GSCC], 2007). This was based on the stated premise that, for both education and practice: ‘If service users and carers are involved in planning and reviewing social care services, the services are more likely to meet their needs’. In UK social work, then, there is an established place for such work (Beresford & Carr, 2012). Within mental health social work, service user involvement has arguably played an even more central part in policy and practice development. Service User-led organisations have influenced the nature and direction of the work since the 1970ʹs (Weinstein, 2010). Mental health practitioners have celebrated a generally close connection with service user groups and, where channels of communication have been open and two-way, the voice of the patient or former patient has been a significant resource (Cummins, 2019). Service users who have contributed to the field, often viewing themselves as survivors, have shared facets of their own personal experience and identified the implications of these in ways that have informed education and service delivery. (See for example, Crepaz-Keay et al., 1997.) This work continues in many forms and fora (Tjoa, 2021; Shaping our Lives).

Helen steps into the role

I have been involved with the organisation for about thirteen years in the work I will discuss here. I had worked as a teacher and a civil servant until I had a major episode of depression and anxiety, after which I retired on ill health grounds. I went to a mental health day centre where I saw an advert asking for service users to become involved with the social work programme at a local university. A new lecturer was a student at the organisation, and for her workplace discussion seminar, she decided to co-teach the mental health module with some service users. After the first year she asked me if I would like to write a paper with her about our emotional experiences. It was eventually published, and we were asked to present it at a conference held by the organisation (Gregor & Smith, 2009).

It was at this conference that I first met Clare. It was strange meeting her as I already felt I knew her. She was the new lecturer’s tutor and had also run the workplace discussion seminar, and I’d heard quite a lot about her. I believe the feeling was mutual, as Clare had heard about me in the workplace discussion seminars.

As a result of the conference, I was asked if I’d like to become involved with the teaching programmes at the organisation.

Some apprehensions encountered

On hearing that a service user was to join the learning group, one student, a mental health social worker, privately told Clare that they immediately remembered many service users they had worked with (presumably their bad points!) and thought Helen would be an amalgamation of them all. They eventually realised Helen was just Helen. Another student said they thought that Helen must have so many problems that the group would spend the entire year trying to solve them.

Some lecturers also had their doubts. One wanted to know who Helen’s line manager would be. Concerns were expressed about confidentiality – Helen pointed out all they had to do was to tell her what it was that needed to be handled in confidence. That was an interesting reflection on the lecturers concerned. Did they think that a service user couldn’t be trusted? Another lecturer that Helen joined for seminars said they thought Helen had been put there to spy on them. Fears were expressed about how much ‘extra’ time Helen would take up away from the lecturers’ already heavy workload. We’d had our share of doubts too. Clare had consulted with a trusted colleague before Helen’s arrival. The suggestion she found most helpful was: Don’t focus on what you imagine could go wrong, concentrate on what you want the outcome to be.

Early on Helen wondered if Clare was seeing herself as her social worker. She felt that Clare occasionally seemed to slip into what she termed ‘social workiness’ mode. For example, if Helen was quiet in a seminar, Clare would ask directly for her contribution. Helen did eventually tell Clare that she didn’t like it and she stopped. Later, as we got used to working together, Helen said her it was all right to do that now as she no longer felt so sensitive about our ‘other’ roles.

Helen remembers worrying that, as a number of the lecturers were also psychotherapists, they would be analysing everything she said or did. She soon realised that, outside their professional roles, they were ordinary people with their own individual quirks.

A sense of belonging

Helen recalls one incident that made her feel she was fully accepted as part of the staff team. One of the course lead’s pet peeves was people wandering off topic in staff meetings. She had seen them snap at other people when they did that, but not at her. Then, one day they snapped at her and Helen felt she truly belonged!

Helen’s role

My first involvement in role was in a workplace discussion seminar. After a little while I was asked if I would like to get involved in some other seminars, and I was adamant that I would not – I did not want to do any reading. However, my exposure to psychodynamic theories in the workplace discussion seminars sparked my interest as I found that some of them resonated with my own experiences. I had always known that if I phoned my community psychiatric nurse and just talked to him, I would feel better even though he didn’t do anything or even say that much. I was intrigued to discover that what happened was a known phenomenon of containment (Bion, 1970). Again, I had previously developed a strong attachment to a social worker who I had seen for several years. It was so intense that I could only describe it as falling in love, although I knew I wasn’t. And then I found out about transference (Heiman, 1950).

As well as learning about psychodynamic theories, I have also benefitted from being able to use my experiences to help the next generation of social workers. I always tell them that my care by the NHS has been very good, but of course it hasn’t been perfect, and I can use examples of both good and bad practice to make my points. It has also been a way of keeping my mind active and increasing my self-confidence.

I have now been involved in seminars which do require a considerable amount of reading, such as research, institutional observation, and project management. My role in the seminars is to provide a service user perspective on the topics being discussed. I am also involved in commenting on each student’s assignments, again from a service user perspective. This is outside the usual marking and verifying by lecturers and does not affect the student’s marks. For example, if the student is talking about containment, I might offer my experiences of it or if the student is reflecting on their feelings doing an observation, I could talk about how I have felt being observed by a student social worker. One student told me how, after checking their mark to make sure they had passed, they then read my comments to validate themselves as a social worker. I showed a new member of the course team a couple of my sets of comments to explain what I do, and they commented that they were ‘beautiful’, and they wished they’d had that sort of feedback when they were a student.

Some tensions in the title

Given that my title within the team came to be ‘Service User Advisor’ sometimes, inevitability, the service user part of me takes over. I can remember a couple of times when this happened.

A few years ago, when the question of my payment came up (I am paid as a visiting lecturer, on a renewable yearly contract) there was some disagreement about whose budget my work would come out of. I felt so unwanted and devalued before it was satisfactorily resolved that I could hardly bear to be in the building. When I was not actually involved in a seminar or meeting, I felt I had to get away. I discovered several places in the vicinity that I could go to, including a museum, a church, a park and a few cafes. Anywhere but in the organisation.

A more recent example was when I was experiencing an episode of low mood. For some reason I started to cry in the staff meeting. I was due to co-teach a seminar with Clare in a couple of hours, but in the meantime, she had another seminar. We had discussed the possibility of this happening and had agreed that her primary responsibility was to the students. So, she left me in her office while she went to the seminar. I made a couple of phone calls and slept and when she returned, I was feeling better and able to go to the seminar.

Boundaries

The question of boundaries has arisen on a few occasions, both between me and students and myself and lecturers.

A few years ago, a student who lived near me but worked in another town changed their job to be an out-of-hours social worker for my area. At first, I thought that as I was unlikely to ever use that service, it didn’t matter. But I continued to feel a bit uncomfortable and after a few weeks I broached the subject with them. They said they’d felt uncomfortable too but after discussing the situation, we realised it was unlikely they’d end up on my doorstep and if they did, we’d be able to be in role of social worker and service user. Another potentially awkward situation was when a lecturer from my previous university enrolled on the course. Again, we were able to acknowledge the situation and the awkwardness was alleviated. A few years ago, I tried group therapy. It was not a good referral as the other members of the group were ending three years together and were preparing to leave and I was the only one starting. I continued for a couple of months and did use the informal meetings with students to express my frustrations. Whilst this may have been off-task, one student became overly involved with my situation and tried to talk to me too much about it. I found it quite difficult to re-establish an appropriate working relationship.

Clare and I had very different views about one student, and it caused problems between us. When I communicated my views about their work in a staff meeting Clare felt I had overstepped my role. We did discuss it with the course lead who acknowledged that I felt that Clare had ‘put me in my place’. This made it difficult for us to work together for a while as we had to rebuild the trust between us.

Some effects of online teaching and learning

As a result of the pandemic, we went online. Until then I occupied a very definite ‘third position’ (Britton, 1989). Although I am a member of the staff team, I was able to build informal relationships with many of the students. One student and I bonded over the difficulty of finding shoes. She had very small feet and I have very large ones. We had some painful conversations in which she told me about stopping wearing her hijab because of racism she encountered and how, after the bombing of a bus in London, her work colleagues would look sideways at her. Another one told me about some serious health problems. When lecturers would ask me how I knew something, I’d just say the student told me in the cafe or the garden or in reception. I miss that opportunity for informal connections now we are online.

The ongoing impact of the work

So, has anything changed over the last thirteen years? My post has been moved from the social work course budget to that of the team that specialises in service user involvement. This provides a secure base for funding, which is a relief. However, my lecturing post is still a rolling contract which means that each autumn I have to sort out my payment details, agree hours etc.

I am now an accepted part of the course team and I believe, not a source of worry or speculation for either staff or students. I think both staff and students benefit from my involvement. Some of the staff have been away from direct work with service users and I am a living reminder of what social work is all about. I have also been able to say things both to students and teaching staff that the other lecturers might not feel able to say.

I have benefited hugely from my involvement. I have learnt a lot, I have enjoyed it immensely, and I have been able to put my experiences of mental health to good use (although I hate the term ‘expert by experience’).

I would like to encourage any service user or course leader to seriously consider implementing the role of Service User Advisor. Yes, there will be some difficult conversations and situations along the way but that is true for all teams. And I do believe the benefits to all concerned will be considerable.

Conclusion

At the point of working on this paper one of us, Clare, has mostly left the organisation. The other of us, Helen, has continued in the work with new close colleagues in a changing staff group and new cohorts of post qualifying students. Over the long years of our co-working, our relationship has changed in various ways. Yet whilst a collegial friendship has certainly flourished, it is the work focus that has continued to be at the creative centre of our connection. We have enjoyed and benefitted from thinking together, for example, about the content of the seminars including the dynamics between students and us as staff, searching for meaning and naming our discoveries as they emerge. There have been times of tension between us and difficult feelings to manage as in any working relationship and, as far as possible, we have regarded these as part of the work, crucially, requiring our joint attention.

As far as we are aware, the course Helen advises is the only one in the institution to have a service user role embedded in the team. Other courses employ service users on an ad hoc basis (Helen is involved in one on such a basis) but the commitment from and impact on the students and staff is very different. During a large awards event, Helen gave a talk on her present role which was, we believe, well received by senior management. The hope has been that, as a result of this, other courses might be inspired and encouraged to involve service users in various ways. We are currently unaware of any such initiatives, but maybe after the pandemic is over … .

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Notes on contributors

Helen Smith

Clare Parkinson has been a qualified social worker for 45 years, most recently in a mix of social work education and clinical practice.

Clare Parkinson

Helen Smith has used mental health services on and off during much of her adult life. Since retirement she has been involved as a service user in social work and nursing programs at several HEIs.