Support or Social Control?

Communities Secretary Eric Pickles’ announcement that he’s going to focus on ‘troubled families’ had a slightly familiar ring to it. It smacks of an attempt to co-opt health and social care agencies into getting those who are a nuisance to behave themselves.

In Child and Adolescent Mental Health Services (CAMHS) we’ve been here before. Pickles’ ‘troubled families unit’ reminds me of the recent fad for anger management classes.

You all know the scene. The violent husband is confronted on the TV chat show. The audience boos. The host gives him a long spiel about how he needs to change. The wife nods patiently. Then the host offers him the chance to save his marriage by signing up for anger management with the show’s in-house psychologist. The husband gratefully agrees, the audience cheers and the credits roll.

What happens next? Quite possibly he goes along to six sessions of anger management, dutifully completes them…and then goes back to merrily knocking seven bells out of his wife.

In CAMHS we keep getting requests for anger management from parents, GPs, teachers and social workers, because a child “has an anger problem”. Anger management came into vogue a few years ago, and I can see why it’s attractive – especially to policymakers. Disruption in the classroom? Youth offending? Antisocial behaviour? Not to worry, it can all be therapied away in 6 sessions. I’ve no doubt that if I spent a while on Google Scholar I could come up with a few research papers to say that anger management is an effective, evidence-based intervention for children.

But here’s the problem. Of all the kids I’ve seen who’ve been sent for anger management, I’ve been struck by how many of them have actually benefited from it.

None of them.

A lot of anger management classes are, quite frankly, a bit dire. They talk about the causes of anger, the fight-or-flight response, about breathing techniques and distraction. All too often, what they don’t ask is, “Why is this child angry?”

Children usually don’t become automatically angry. More likely, something has made them angry. Abuse, trauma, neglect, being in an environment where anger is a default way of expressing emotion. Labelling the child as having “an anger problem” ignores the wider context.

Worse, it can reinforce child-blaming. Sending the child for anger management can give out the message from services, “Yes, we agree. The child is the problem. He’s the bad one, it’s his fault and he needs to go away and sort out the problem.” I’ve seen kids attend an anger management class, and then be handed back to their parents, who start bellowing and swearing at him before they’ve even left the reception. Those parents are the first to us that we’re rubbish, because we still haven’t sorted out their kids “anger problem”. Often they tell us this while going into a long, loud tirade about what a terrible kid he is, while jabbing an accusing finger in his direction.

Anger management not only ignores the wider context, it also focuses on one particular emotion at the expense of others. An angry child is usually a distressed child. Anger just happens to be the problem that others (parents, teachers etc) want dealt with, because they want the child to behave. Others may say that the kid has an anger problem. The kid might just feel he has a problem. Or indeed, a world of problems.

No doubt the ‘troubled families’ that Pickles wants to target will also have a world of problems. He’s even kind enough to list them.

A family with multiple problems has been defined by the cabinet office as “no parent in the family is in work; the family lives in poor quality or overcrowded housing; no parent has any qualifications; the mother has mental health problems; at least one parent has a long-standing limiting illness, disability or infirmity; the family has low income (below 60% of the median); or the family cannot afford a number of food and clothing items”.

So, does Pickles envisage these families getting a comprehensive package of support, or some politically-attractive non-solution like anger management? Here’s a clue.

Pickles revealed a single problem, or troubled, family can cost the state up to £300,000 a year and predicted this figure can be cut by £70,000 annually simply by reducing the number of agencies involved.

Some of these families can be involved with the local authority, schools bodies, drug and alcohol services, the police and an array of social service departments. Pickles claimed less than 1% of the population can cost the economy over £8m a year.

Well, I’ve certainly come across cases of “agency overload” where too many professionals have become involved with a family, but are we supposed to say that if a child goes to CAMHS they can’t also go to, say, a young carer service? If not, what on earth is multi-agency working for?

So, to summarise, the message from Pickles is, “We’re cutting back the support you guys offer. Oh, and at the same time, we also expect you to sort out the stuff that gets voters irate.”

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3 thoughts on “Support or Social Control?

  1. I must say I am fascinated by the Cabinet office definition of a problem family. it does not actually say anything about behaviour, which surely is in most peoples’ definition. why does the mother in a problem family have mental health problems but not the father? why is being out of work ( in a recession) a core element of being a problem family? When Dad gets made redundant because the factory is moving production to China how does that suddenly make him a bad parent? What about “the family cannot afford a number of food and clothing items” what the hell does that mean? That benefits for a family where the parents are out of work does not support a decent diet, so whose fault is that? These defining characteristics seem to follow a left wing agenda of putting all social problems down to lack of money, but I thought Conservatives were about personal responsibility? or is he saying that poor housing, diet, mental health and job prospects are all totally within peoples’ control?

    I would have thought all those PPE Firsts could have thought up something a bit better than this or all those school fees were money down the drain.

    Pickes is right of course in that one family can chalk up a huge bill – he hasnt even mentioned Legal aid for the divorce proceedings, involving multiple accusations of child abuse, domestic abuse etc, social reports, CAFCASS, etc etc conducted in the style one might have expected of 19th century aristocrats. If you are not paying for it, why not conduct your playground mud slinging via solicitors, it is like being in your very own Jeremy Kyle show. Coming from a bit of a working class background myself I am not too sentimental about this sort of thing.

    He might be right in that a bit of case coordination wouldnt go amiss between all the agencies involved, though I am sure people try. How he intends to simply stop agencies getting involved however, for example if a child meets the criteria for a service, I am not sure. I would quite like to see Paxman ask him for a bit of detail.

  2. Most of my issues are about the labelling and the mixed messages of withdrawing services (incidentally CAMHS has been cut back dramatically in my local area) while trying to blame the families involves.
    I agree with that I’m not opposed to more support – of course not but I don’t like the way the language has been couched in blame and the ‘otherness’ of ‘people like that’.

  3. Absolutely spot on about anger management ‘sessions’ usually being dire. Most of the time they are generically delivered never seeking to get to the root of a young person’s anger. While the content in a lot of programmes (triggers, fight-flight’ etc) has the potential do help a young person to understand what is going on and why they respond to certain situations the way they do, unless real time and care is taken to scrape below the surface and get to the heart of the matter, they are of little use. As with helping anyone deal with any personal issue, if you don’t really care and put a great deal of effort in then you won’t get to the root of the issue and be able to help them. This applies all the way through from the individual worker to the government.

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