1 Disclosure issues and entering the professions Jill Manthorpe, Nicky Stanley, Jess Harris & Julie Ridley.

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Disclosure issues and entering the professions

Jill Manthorpe, Nicky Stanley, Jess Harris & Julie Ridley

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DRC Formal Investigation into Fitness Standards in Nursing, Teaching and Social Work 2006-07

• To investigate how health and fitness standards operate for disabled people in the professions of nursing, teaching and social work

• Elements of investigation:– Analysis of law, and regulatory frameworks– Research into employers’ & educators’ decision-

making– Written evidence and case studies– Research into disability disclosure (Stanley et al

2007)

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Disclosing Disability

• Qualitative research into views and experiences

• 60 students and practitioners

• Focus on ‘unseen disabilities’

• Sample covered England, Wales & Scotland

• Limited time-scale

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Study sample

Type of interviewee

Profession

Social Worker

Nurse Teacher TOTAL

Practitioner 10 17 11 38

Student 10 4 8 22

TOTAL 20 21 19 60

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Sample by Disability CategoryCategory Number %

Long term health problems 17 28

Multiple impairments 10 17

Physical mobility impairment 10 17

Sensory impairment 9 15

Mental health problems 7 12

Dyslexia 6 10

ALL 60 100

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Fitness Standards

Generally low levels of awareness of fitness standards and requirements about disclosure:

….in the handbook this year for the BA Social Work there’s a very clear passage on fitness levels and it’s about mental health and physical health and if you’re not deemed not to be fit enough then you’re off the course but it doesn’t state what constitutes not fit enough. Social Work Student

I’ve heard it apply to, for instance, dyslexic students, as in they may not be fit to practice because they might write the drug name down incorrectly. Student Nurse

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Perceptions of Regulatory Bodies• Perceived as remote and threatening, “closed

organisation”, uncertainty about consequences

It was a bit unnerving this disclosing to this great big GSCC when you have never met anyone, and don’t know anything about other than all the paraphernalia that you get. You know no one really knows what happens if you disclose something … because it doesn’t say on that form, it says that they might want to talk to your GP or whoever, and they might want to talk to you, but why, what do you want to know? … Just to put your own mind at rest.

Social Work Student

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Awareness of DDA Yea, yea [I’m aware of my rights under the DDA], and it’s a

good job I am, that’s all I can say, ‘cos I think I’d get walked all over if I didn’t. I know what I’m entitled to, I know what I’m not entitled to as well. I think that’s why I got…all of what I did, it was because I knew my rights.Student Teacher

It gives me confidence that I can disclose, I can tell them that I know that I’ve got legal backing should I need it and I’ve got some legal rights that they can’t discriminate. They can’t turn round and say, ‘you’re not fit to practice’.Social Work Student

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Terminology – Labels & Language

• Varied readiness to accept labels

• Labels facilitated adjustments

• Term ‘disabled’ = physical disability

• Divided on term ‘impairment’

• Most acceptable term was ‘long term health condition’

• Mental health difficulties seen as most stigmatised

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On LabelsI don’t mind disclosing about my back, I guess for

me it doesn’t carry the embarrassment factor, I mean anyone can get physically ill but mental illness is a different thing, there’s a stigma related to it and it’s not something that you talk about.Social Work Student

The word (disabled) itself suggests that you’re incapable, the whole stigma that goes with it says you can’t function, you can’t do something, it’s negative in itself. Social Work Student

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Experiences of Disclosure

• Only three participants had not disclosed

• Some had only partially disclosed

• Or had understated disability

• Positive, negative, mixed stories

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Disclosure - a multi-staged processIt’s a bit like coming out of the closet, it’s

something you’re constantly doing, you don’t just disclose it once… because you’re going on a placement, when you are on placement you might go and spend a couple of weeks with another institution, so each new place you go to, actually means is that you’re disclosing all over again … it’s not just you fill in a form and you’ve disclosed it, that just tells the University … and for me it means every client I meet I’m making that disclosure to, it’s on-going, it’s continuous.Social Work Student

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Disclosure – a high-risk strategyIf you don’t declare and things go wrong then you’re

dropped in the shit, and if you do declare it and things go wrong, then you get dropped in the ****.

Nurse Practitioner

The fact that they’re saying…you’ve got to give this health questionnaire and you may be refused a place on the fact of your health or your disability, but not giving any guide to what they’re looking for, may prevent people with any sort of disability applying. Social Work Student

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Reasons for Disclosing

• Moral/political choice• Pragmatic reasons – “I haven’t got a

choice”• explicit forms – e.g. ‘Are you dyslexic?’• Confidence

– In organisation– Acquired through experience

• Believe disclosure will lead to assistance and/or adjustments

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Consequences of Disclosure

I did disclose to my personal tutor and I was informed … [that] everybody now had to know about it, the university had to officially know about it and my placement to where I was going had to know about it, and I was really unhappy with that … I’ve just been diagnosed … it was very personal to me, I’d just found out and I just wasn’t ready to disclose.

Social Work Student

It took three months before I got the equipment that I needed… and I probably moaned and groaned my way through that at that time and so then when I got the chair that was wonderful, it made all the difference.

Social Work Practitioner

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Consequences of Non Disclosure

• Practical – ‘takes longer to do physical things’

• Emotional – ‘I feel like people don’t know the real me’

• Missing out on support – ‘may be benefits but I don’t feel that I would necessarily get that understanding.’

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Experience in Placements

• Placement agencies less flexible than HEIs

• Differences reported by students with dyslexia

• Voluntary sector agencies more accepting

• Some positive experiences in statutory sector

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Preparation for Placements

They knew before I went, it was all there and nothing was done and then three weeks before the end of my placement the link worker decided to make comment about my spelling in reports which caused me a lot of distress.

Social Work Student

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Career progression

• Confidence in disclosure increased with seniority • Managers’ attitudes crucial:

The boss that appointed me for this job is very, was very good about my depression, so that’s why I took the job in the end but he’s moved into a different department, so I’m back with a new person and I found that very difficult.

Social Work Practitioner

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Promoting Disclosure

• Value of ‘disabled friendly’ environments

• Disclosure processes should be clear & transparent

• Need to communicate with identified individual

• Disability awareness training

• Disseminate positive stories

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Maintaining Standards: Promoting Equality (EHRC 2007)• Requirement to disclose health conditions

– discriminatory and has negative impact on disabled people

• Diagnosis of mental illness is not a predictor of unsafe/poor practice

• Health standards do not protect public.

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Recommendations

• Government and regulatory bodies to abolish health requirements for the professions

• Regulation should be concerned with assessing conduct and competence

• Competency for a profession should not be judged at the outset of professional training

• Failure to disclose should not be linked to ‘bad character’ / evoke disciplinary response.

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The Response

• Initial enthusiasm from unions and some regulatory bodies

• 2008 – GSCC recommends to government abolition of requirement to declare health condition on registration for social work

• Health and Social Care Bill will enable the regulatory change to be made without a need for primary legislation

• Await interest of CEHR

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report

Full and summary Maintaining Standards reports available at:

www.maintainingstandards.org