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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