Reimagining Social Services for a Participatory Society
[Contribution to the Reimagining Society Project hosted by ZCommunications]
On the surface it may seem a remarkable coincidence that the origins and future of social services are both intimately intertwined with Anarchism. However, it is less a surprise when one considers that each is based on mutual aid and compassion. This makes the process of reenvisioning today's social services and its relation to those receiving assistance -- across the fields of mental health, addictions, treatment, counseling, homelessness, and joblessness -- in a future participatory society (what could be called an anarchist society) a natural progression.
This common bond goes far beyond simple association of a few overlapping values. For example, Jane Addams (1860-1935) -- widely considered one of the early influences on the social work profession, also co-founder of the legendary settlement house movement in the
The Hull-House visit:
"attracted little attention at the time but two years later, when the assassination of President McKinley occurred, the visit of this kindly scholar...was made the basis of an attack upon Hull-House by a daily newspaper.... Hull-House had doubtless laid itself open to this attack through an incident connected with the imprisonment of the editor [of] an anarchistic paper, who was arrested in
Jane Addams continued her own social work while also providing political support for those experiencing repression for their anarchist beliefs. In a 1915 demonstration by the
If social work and anarchism have common affinity then what are the implications of each for both and for a classless, self-managing, participatory society?
Participatory Society & Social Services
Between most of 2001-2007 I was employed as a social service worker in the Down Town East Side (DTES) of
My work was often in an "emergency crisis" setting, meaning in shelters, transition homes, on the street, and included liaison with police, hospitals, and psych wards. The work I was most familiar with included working with homelessness, mental health, and addictions. A single person often experienced any combination of two, and in many cases all three of these problems at once. This meant that if someone came to me and they had lost their job, yet had a home and stable mental health, I would help if I could, but because they didn't fully match our mandate, my help would be limited and I would often have to refer them to other service providers that operated on a mandate more in tune with their needs (the mandate is tied to funding and the funding tied to service statistics). Or, if someone was seeking help because they had no money, yet their schizophrenia inhibited them from holding a stable job, and therefore they were in need of shelter and food, I would try to get them plugged in with appropriate housing, mental health, and welfare services. It was also likely that anyone experiencing homelessness and life on the street or was involved in drug or sex trafficking had also experienced violence and trauma which often translated to distrust of many others and dysfunctional relationships. The purpose of much of my job was to build professional working relationships with those most in need, help with what resources I could offer, provide guidance for their own decision-making, make my own interventions when useful, while looking for opportunities inside and outside the social service system to improve their lives. I was what is sometimes called a "professional helper."
An anarchist or socialist society -- a classless, self-managed participatory society -- is not only possible, it is necessary to end suffering of all kinds. But will there still be social problems and suffering in a participatory society? Yes... On the one hand, in this type of society, social work will be needed to ameliorate social problems that a classless society cannot fully address. For example, a mental health imbalance that develops organically, say schizophrenia, or even inorganically, say a bike accident or chronic methamphetamines use, which causes mild or severe brain damage, resulting in visual, auditory or other sensory hallucinations, and that inhibits a person from taking care of themselves in basic ways like shopping for food, managing personal hygiene, working, attending appointments, etc. Social acts of violence and trauma resulting from a crime of passion or even residual racism, sexism, or homophobia, may still occur in a future society. In all the above scenarios, and there will be more too, counseling, medical treatment, therapy, and life-skills support will be needed and social workers will exist to provide these services.
On the other hand, such a society -- a participatory society -- will deliver social and material benefits that will improve things immeasurably. The economy will be defined by workplace balanced job complexes for an equal distribution of both empowering and disempowering work; remuneration of labor for duration, intensity and onerousness; workers' and consumers' self-managed councils; and decentralized participatory planning. The polity will likely have a nested council system for self-governing law-making and adjudication. Community relations will embody equitable and diverse norms. And there will be new kinship arrangements providing non-patriarchal socialization and care-giving of all generations. These ideas are spelled out in much more detail in my book Real Utopia: Participatory Society for the 21st Century (AK Press, 2008, website).
These transformations of society's institutions will lift a heavy burden off the backs of social services as we know them today. Such a society is not utopian in the sense that it does not demand anything from people that they are incapable of. Again, there will likely be all kinds of social problems in the future society, not only in transition, but affecting many generations long afterward too, and it cannot be guaranteed that people will ever quite eradicate all crime and violence in such a society. However, three great benefits of this societal change that impact on social services should be obvious:
(1) Massive re-distribution of resources away from class rule and towards classlessness which translates into not only more resources directed towards social services (an amount perhaps incomprehensible today), but also the coming into existence of many social workers due to a fully employed society and accompanying positive changes such as improved social and material relations lessoning environmental factors that may influence drug use, violence, and mental health.
(2) Greater self-managed control over social service resources by social workers themselves as well as by those receiving services as consumers where each have decision-making input in proportion to the degree they are affected instead of resources being determined by funding based on profitability or accrued power.
(3) In this new social and material context there will be greater solidarity, mutual aid and compassion for others due to the institutional features the new society offers which will help ensure healthy social roles, behaviors, and outcomes consistent with a more emancipatory world.
The above offers basic thoughts on the mutual interaction between social work and a participatory society. Now let's consider some broad implications for the social service sector and profession, systemically, as well as regarding the hands-on experience of everyday life as a worker and consumer for how these may change in a participatory society.
The "Client" / Worker Relationship: The Need for Revolution
As in many jobs, it is common in the social services to use language and labels that define the worker-consumer relationship -- in this case between the social worker and those receiving their care. Across fields, for example in the Mental Health and Psychiatric professions, the label "Mental Health Consumer" is often used. In the field of social work the term "client" is used. This can be seen for instance in such terms as "Client Centered Models of Care." The "client" can be seeking help either voluntarily or because they are forced or mandated to. Someone seeking voluntary help may walk into a shelter or clinic and refer themselves. Someone forced to seek help, as in conditions a parole officer may impose, such as attending a weekly drug and alcohol counseling session upon release from jail, faces consequences (going back to jail) if they do not attend.
The worker assessing the referral decides if the person in need qualifies for the help that that service provider can offer and this is determined by funding which defines the service mandate. In either case, the services received are either subsidized by the state or privately funded, or sometimes a combination of both. Due to the push for privatization of social services both in the U.S., Canada, and elsewhere, it is often true that while high quality expedient private services are made available for a few at higher prices, overly stressed, underfunded, and generally problematic public services are offered to the many. The market institution, its mentality and outcomes, dominate.
The perception of social service consumers as "clients" is prevalent, but to focus on the language only, without seeing the institutional influence, is to miss the point, for not only does it affect the quality and availability of services across class, race, and gender positions, but it also deeply affects the type of treatment that many receive. For example there are various types of "Client Centered Care" that could be interpreted to mean:
(A) The case manager (social service professional assigned to help) identifies the treatment or life goals (i.e. work, education, drug & alcohol treatment, abstinence, etc.) on behalf of the person seeking help.
(B) The case manager works with the person seeking help to define the goals together.
(C) The case manager guides the person gently and skillfully, helping assess various options and possibilities, hoping to enable that person to define goals themselves and to make decisions in light of various consequences.
The most obvious and best approach is to let that person engage in as much healthy self-managed decision-making as they are capable of and try to assist where it is needed. But admittedly this is not always clear and depends largely on each persons own circumstance and, if they are suffering from addiction and/or mental illness (dual-diagnosis), their physical and mental capability to care for themselves is often compromised and judgment clouded. Additionally, a person's needs change over time and under new circumstances. When I was a social service worker, the problem that I found with all three "client centered" orientations above comes when each tried to motivate behavioral change in the person, either by coaxing, prodding, or guiding it internally (from within that person) or externally (forcing it upon them) without seeing, as anarchists do, many of the institutional influences on these problems and getting equally aroused and passionate about institutional injustice and the need for fundamental change in economy, kinship, politics, and community.
Personally, seeing the institutional class, race, and gender problems endemic to society is one of the reasons I sought fulltime radical political work (even though I do miss aspects of being a social worker and think I was good at it, and see it as a necessary and honorable service to society). Politically it made sense for me to transition to fulltime political work once I saw how far my expectations for change in people to improve their lives had to be ratcheted downward and measured in increments in order for me to act as social worker. For example, getting someone to change drug dealers so they wouldn't get ripped off or beaten was a success. Getting someone to use a safe crack kit or needle exchange to minimize the risk of HIV transmission was a success. Going for a 5 minute ice cream to engage someone usually suffering from drug induced psychosis was a success. Getting someone to a mental health team after years of self-medication with street drugs was a success. Getting someone on a bus out of the city was a success. And on and on...
But these "successes," which I believe were real and took skill and patience to achieve, would end in someone coming back into the city, losing their housing, going back to jail, being beaten up, murdered, entering the psych ward, or overdosing. Then, if the person was still on our caseload, the cycle would start all over again, trying to point out to them their strengths (strength based care giving) while drawing lessons for behavioral change and plotting strategic interventions (professional tools used: Transtheoretical Model of Change, Motivational Interviewing, Decisional Balance Grid, etc.). And through this process we would try to build even stronger working relationships with people and along the way make some semblance of progress, and sometimes there was progress -- huge progress -- for a single individual. But most of the time progress is small steps, and other times a loss of life would occur before significant positive life-saving change could, and so you learn to savor the small stuff. I believe there is benefit to be had in incremental change rather than no change. But not enough people believe that what is also and ultimately needed is monumental change -- revolutionary change -- redefining society's institutions.
In addition to abolishing private ownership of productive assets, markets and corporate divisions of labor that define capitalism and class rule, workers and consumers of social services will also have to transform their workplace service and treatment mandates, methods of diagnosis and decision-making about individual rights, laws criminalizing drug and sex work, and the overall system of funding that misallocates social service resources and narrowly determines segregationist service mandates between drug, alcohol, and mental health consumers. The overall purpose of these changes is to provide new social services compatible with an anarchist or participatory society that is classless and self-managing and where people have new and empowering social and material relations and where we strive to reduce human suffering to its absolute minimum.
One way to fundamentally re-work the social services is to allocate resources in such a way that service mandates and worker skills and training can accommodate drug and alcohol as well as mental health issues. This doesn't mean that every worker needs to have a Ph.D in cognitive science & substance abuse (comorbidity), counseling or behavioral psychology, in addition to being able to diagnose or administer medication and deescalate aggressive behavior in individuals, etc. It means having mental health teams that are able to work with people who not only are diagnosed with schizophrenia but who also use crack or some other drug or alcohol. It means having detox and recovery centers which not only cater to someone who is abusing substances, but who also has bi-polar disorder or some other mental health diagnosis or suspected mental illness. The alternative is to have segregated systems that deny service to those in need, as when a Mental Health team won't provide regular treatment to a schizophrenic patient who drinks.
Luckily, I don't think these suggestions are too controversial, as there are many places that either provide diverse service professionals under one roof or the different service providers are in close proximity and working together through a coordinated caseload (For example, the ACT Model: Assertive Community Treatment).
The revolutionary insight, however, is that in a participatory society, social service producers and consumers will themselves allocate resources through self-managed worker and consumer councils and democratic planning. Where someone is unable to participate in society due to health problems inhibiting their participation they will be compensated accordingly because of need.
Institutionalization & Community Care
Another problem that will need a participatory solution is the process of institutionalization. In today's society people of all kinds, young and old, spend time in foster homes, jails, and hospitals and after significant time, when released, have a very difficult experience relating to society and society has a hard time relating to them. A participatory society will have new socialized care giving which will help people make the transition back into the community, but this alone is not enough. Prisons, jails, psych wards and hospitals will all have to be transformed to establish new humanitarian social and material relations making sure that people, even those that commit terrible crimes, do not become less human while there, and are able to exercise their decision-making capacities and have control over their lives without harming anyone else. What this looks like exactly is hard to foresee, except that there can be diverse solutions within and across society and nobody should be made to suffer.
However, a big problem for today's social services is the "NIMBY" complex -- Not In My Back Yard. Often, people who have been institutionalized and need short-term transition housing, or who need an assisted living arrangement (say to receive medications or meals) move into some kind of permanent or temporary transition quarters. Often, these quarters provide shelter for many in similar circumstances and there are sometimes people in the surrounding community who attach a stigma to such institutions and those people they serve. These people are worried -- sometimes with some rational basis and sometimes because of class or ethnic bias -- about these institutions being in their community or next to a park or school. The result is that often social services, especially in cities, exist either in highly concentrated areas, where in just a few blocks you can find social housing, detox centers, mental health services, walk in clinics, and also crime, sex and drug trafficking, etc., or they exist very far outside of town on the outskirts or in low-income suburbs. The result is that there are very few lifestyle options for social service consumers to choose from and this unbalanced service density does not promote success. Someone may have to walk a few blocks from their social housing to an Alcoholics Anonymous (AA) meeting and on the way pass people drinking rubbing alcohol on the street or if they choose the out-of-town option, be placed in a drug or alcohol rehab center with no place to go after being released except back to the city; and while away they have not been able to develop the skills needed to live in the environment they are returning to. Similarly, youth who become adults have to transition, often abruptly, into adult territory where they are seen as vulnerable and preyed upon. The same is often true for women in safe houses who are fleeing violent relationships.
For these reasons, in a classless and self-managing society, social service workers and consumers may choose a more balanced distribution of resources across regions and in a more geographically equitable way to ensure many positive attributes, not least so that vulnerable users accessing the system have safer and more diverse and successful options to choose from.
Revolutionizing Mental Health
The concept of "mental health" seems amorphous yet many have tried to put meaning and organization to it so as to identify and define mental health problems and solutions. The widely used and near mandatory diagnostic system in the U.S., Canada, and many other countries, is the Diagnostic and Statistical Manual of Mental Disorders (DSM) which is published and controlled by the American Psychiatric Association (APA). Flipping through its pages you can find at least one -- and likely more than one -- diagnosis for yourself. Indeed, one of the many problems with the DSM is that, despite its usefulness, it has sometimes been used as a tool of social control and has been designed largely out of control of those most affected -- people who have been diagnosed. In other words, in a new society this standardized diagnostic tool (and others like it) will have to be completely redefined -- likely every single entry will have to be pored over by both mental health professionals as well as mental health consumers and those who have had diagnosis to assess what is of value and what is garbage.
The DSM, now in its fourth edition and currently undergoing its fifth revision, was first published in 1952. Prior to that, in the mid 19th Century, the U.S. attempted to collect statistical information to develop a classification system for mental disorders. The first official attempt was in 1840 and used a single category: "idiocy/insanity." Further attempts and revisions were made by the APA before being heavily influenced by World War II when U.S. psychiatrists and physicians were used for the selection and assessment processing of soldiers and their medical treatment. Early versions of the DSM included homosexuality as a disorder but it was eventually removed under pressure from gay activists, despite attempts to bring it back in under another name. Today there remain many troublesome features of the text. For example, Michael G. Conner, Psy.D, Clinical & Medical Psychologist offers this useful critique:
"There is considerable overlap among diagnostic categories in the DSM and it is possible to reach a more desirable or less desirable diagnosis depending on the evaluator. Even when there is agreement, many professionals are becoming concerned that the diagnoses and conclusions that follow from the DSM are not very useful. In other words, the diagnosis reached is not much more than a label that is based on an arbitrary set of symptoms. Most of the time a DSM diagnosis does not indicate the best course of action or even what treatment is necessary."
"Unfortunately there does not appear to be any clearly useful relationship between the DSM diagnosis, treatment, and the outcome of treatment. For all the apparent precision and reliability, the DSM diagnostic system minimizes one important fact. The DSM was not constructed scientifically but is based on a consensus building process that is highly political, partially democratic and even resistant to scientific evidence. The mere fact that any diagnostic system is reliable does not mean the process is valid, useful and not harmful.
In my experience as a social service worker the DSM was a highly valuable asset to prepare myself for talking with psych ward staff and doctors and mental health teams so I could be on their playing field in an effort to increase my bargaining power on behalf of the person who was unable to do so for themselves -- they needed me to go to bat for them and I did. Other than that, it was slightly interesting to read and was mostly useless in the rest of my work. However, rather than propose it be abolished I think mental health consumers and professionals should attempt a fundamental assessment and revision of it and every diagnosis in its pages if it is to be compatible with an anarchist participatory society.
The world of social services today is incredibly different from anything Jane Addams could have envisioned in her day. Indeed, capitalism and oppression have warped society and people in ways early 20th Century anarchists probably would not have imagined as well. Yet many of the same institutions that define society now as then -- capitalism, dominant order-giving and order taking relations, patriarchy, and racism - still all need to be transcended. Social services and social work will remain a valuable and honorable service to society and to those in need in the future - although fundamentally redefined. Much more could be said on the topic of what this could look like. However, this is only a start and will have to be filled in by many others who can bring all sorts of expertise to bear.