Responsibilisation at the Margins of Welfare Services

Kirsi Juhila, Suvi Raitakari, Christopher Hall

• Publisher: Routledge
• Year: 2016
• Print ISBN: 9781138928381
• eBook ISBN: 9781317401117
• Edition: 1
• Topic: Medicine
• Subtopic: Social Work

The impetus for this book is the shift in welfare policy in Western Europe from state responsibilities to individual and community responsibilities. The book examines the ways in which policies associated with advanced liberalism and New Public Management can be identified as influencing professional practices to promote personalisation, participation, empowerment, recovery and resilience. In examining the concept of 'responsibilisation' from the point of view of both the 'responsibilised client and welfare worker', the book breaks from the traditional literature to demonstrate how responsibilities are negotiated during multi-professional care planning meetings, home visits, staff meetings, focus groups and interviews with different stakeholders.

The settings examined in the book can be described as on the 'margins of welfare' - mental health, substance abuse, homelessness services and probation work, where the rights and responsibilities of clients and workers are uncertain and constantly under review. Each chapter approaches the management of responsibilities from a particular angle by combining responsibilisation theory and discourse analysis to examine everyday encounters. Taken together, the chapters paint a comprehensive picture of the responsibilisation practices at the margins of welfare services and provide an extensive discussion of the implications for policy and practice.

Drawing upon both the governmentality literature and everyday encounters, the book provides a broad approach to a key topic. It will therefore be a valuable resource for social policy, public administration, social work and human service researchers and students, and social and health care professionals.

1
Introduction

Kirsi Juhila, Suvi Raitakari and Christopher Hall

Managing responsibilities between parties

Dave and Carol, a client and a worker in a supported housing service, sit in Carol’s office with the purpose of discussing whether Dave’s care plan has been actualised up to this point. Carol initiates the topic:

CAROL: You don’t seem to have progressed in this housing support service as was originally agreed in your care plan. You haven’t attended our group activities for a while, and you haven’t always been at home when we’ve come to visit you. Also, you still seem to use drugs every now and then. Do you remember how three months ago we agreed, when we were completing your care plan, that you would join in with group activities and commit to an addiction rehabilitation process?

DAVE: I have tried my best. But I didn’t know exactly what the plan meant back then. I just don’t feel comfortable with joining group activities and talking about my life for home visit workers. I haven’t been well, and sometimes I find the expectations too much. But it is really great that I’ve now got my own place to live, after so much homelessness.

CAROL: Good to hear that, but unfortunately we can’t make any exceptions for you, Dave, since we have a contract with the council that means we have to make a certain amount of home visits each month, and to offer group activities for our clients. The contract also says you have to commit to abstinence during a rehabilitation process. I know these rules sound really inflexible, but that’s how it is. Perhaps we should start working out a service and housing option that suits your wishes better, although I know it’s really difficult, with the service options that are available in this city at the moment.

DAVE: Does this mean I might end up homeless again?

CAROL: We try to avoid it in every way. The next step could be to ask your social worker to arrange a care planning meeting, where we can assess your current situation and decide on your future service options with other professionals.

DAVE: Okay.

Although not an actual dialogue between a worker and client in a supported housing service setting, this exchange displays many of the key features of the management of responsibilities in services at the margins of welfare. It is typical of the dilemmas that have emerged from our multiple empirical investigations and which will be examined in this book. To begin with, Dave is expected to fulfil his responsibilities as a client: for example, to participate actively in his recovery process in ways that have been agreed in a care plan. The worker’s responsibilities, on the other hand, include helping, supporting and advising the client in his recovery process, and also checking up and reminding him if he neglects or does not fulfil the agreed responsibilities. However, responsibilities are not managed only between the client and the worker, but also between the worker as a representative of a service provider and the purchaser of services (the local council). The supported housing service has a contract with the municipality that regulates the contents of service packages (e.g. home visits, group activities, commitment to abstinence during a rehabilitation process). The service provider therefore has responsibilities in two directions, which might sometimes come into conflict. In our example, Carol explains the requirements based on the contract, and on that basis justifies why Dave’s lack of commitment to the plan may mean that he cannot continue in this service. Although the conflict seems unresolved, Carol does not “abandon” Dave by just guiding him out of the service to find other housing and support options. Instead, she suggests that a care planning meeting should be organised by the social worker who is responsible for the client’s overall situation and the package of services. The participants at the meeting can include the client’s family members and other professionals concerned, such as the client’s psychiatrist from the health services and his social therapist from a substance abuse outpatient clinic. The core function of a meeting like this is to negotiate each stakeholder’s responsibilities (or non-responsibilities) in finding new solutions, choices, resources and support arrangements in the client’s current difficult situation.

The core concept of this book – responsibilisation – is present in several ways in Dave and Carol’s conversation. Responsibilisation in its simplest sense means treating some individuals or groups of people (e.g. clients and workers) as having certain responsibilities and making efforts to get them to act according to these responsibilities. Responsibilisation of the client by the worker is the most obvious in the example: Carol makes it clear that the client should fulfil the obligations as stipulated in the care plan. Accordingly, as he has not acted as expected so far, he needs to start meeting the obligations he has agreed to. However, responsibilisation does not solely mean efforts to regulate others, but also oneself. In the example, Carol accomplishes self-responsibilisation in the sense that she justifies the demands on Dave in terms of her contract-based responsibilities towards the municipality. She explains to Dave that, according to the contract, clients should accept home visits and join group activities, and they should commit to abstinence from drugs and alcohol during the rehabilitation process. Whilst explaining this, she simultaneously displays herself as responsible for acting according to these expectations. Conversely, this self-responsibilisation is constructed as a consequence of responsibilisation targeted at the supported housing service by the purchaser. Dave, for his part, displays both self-responsibilisation and resistance towards expectations. He first gives an account of himself that suggests he has tried his best, and in that sense portrays himself as a responsible and “trying” person. After that, however, Dave excuses his apparent failures by placing blame on the lack of clarity in the care planning process and on too-high expectations in regard to his state of health. He also justifies his absence from certain service occasions by making apparent his discomfort with home visiting and group activities. In other words, he constructs the responsibilities set upon him as unsuitable and unreasonable in the current situation. Eventually, the example also implies responsibilisation targeted at absent parties: Carol suggests that the next step could be that Dave’s social worker will organise a care planning meeting. There, the responsibilities of all the stakeholders for finding solutions and ways to proceed in the difficult situation can be negotiated and possibly reorganised.

Managing responsibilities between different parties is highly consequential for clients who are vulnerable and stigmatised, and suffer from complex problems. Who defines the responsibilities for supporting, helping and controlling the client, and on what grounds? What kinds of services are they assessed as being entitled to? What are their own positions and possibilities in negotiating responsibilities at various multi-party meetings? Furthermore, grass-roots level workers who are near to clients (such as the supported housing service worker in our example) are often regarded as being central to the negotiation of such last-resort service obligations: they can be delegated large responsibilities in regard to ensuring clients’ lives and progress, but they are not necessarily given enough resources, possibilities and discretion to influence the contents of their work. This book concentrates on the management of responsibilities at the margins of welfare services, especially from the point of view of clients’ and grass-roots level workers’ responsibilisation and self-responsibilisation. In examining this, we treat workers and clients as active participants, who are able to negotiate their own and others’ responsibilities and also to challenge and resist the practices of responsibilisation.

Responsibilisation at the margins of welfare services

The title locates the context of the book at the margins of welfare services. By this we refer to such services that are categorised as last-resort supporting, helping and controlling places in Western welfare states. In other words, they are not understood as universal in the sense that all citizens are expected to use them during the course of their life. These kinds of universal services include, for example, general health services, children’s day care services or old people’s services. Since services at the margins of welfare are culturally understood as being part of unusual or even deviant life courses, clienthood is often stigmatised. Furthermore, clients at the margins of welfare often have scarce resources and limited choices, and are therefore dependent on existing services and workers’ support. The marginal services can also be characterised as being targeted at socially excluded citizens with complex and multiple needs related, for example, to severe mental health and substance abuse problems, homelessness and criminality. Clients can have clienthoods in several services at the same time, and often move or are forced to move between them – a phenomenon known as “revolving door syndrome”.

As the book’s title suggests, by examining the margins of welfare services our focus is on responsibilisation. Above, we have defined it in an everyday sense, but in the social science literature it is a highly theorised concept. Its origin lies in Nikolas Rose and Peter Miller’s writings on advanced liberalism and governmentality (e.g. Rose and Miller 1992; Rose 1999, 2000; Miller and Rose 2008), and the concept has been developed by a number of writers (e.g. Kemshall 2002; Clarke 2005; Bennett 2008; Ilcan 2009; O’Malley 2009; Brown and Baker 2012; Hansson et al. 2015; Peters 2016). According to this literature, clients are subjected to new kinds of responsibilisation as a result of welfare policy shifts in recent decades. Instead of the state taking the main responsibility for promoting citizens’ well-being and providing services, increasingly this has become the primary responsibility of individuals, families and communities. It is not only clients but also welfare service providers and workers whose responsibilities have been under scrutiny. Their roles have changed considerably under the influence of managerialism, which is closely related to an advanced liberal way of governing. Welfare service providers and workers have become deeply responsibilised for the conduct, cost-effectiveness and outcomes of their work through a process called “new accountability” (e.g. Martin and Kettner 1997; Banks 2004; Saario 2014).

Building a bridge: responsibilisation in grass-roots level welfare practices

Whilst much has been written about the all-pervasive move to advanced liberal policies, the direct impact on workers and clients in terms of the actual, grass-roots level provision of welfare services is less clear. How do policies, procedures and organisational arrangements constrain and enable interaction between clients and welfare workers in the era of responsibilisation? Workers as grass-roots level practitioners mediate between state policies and clients’ realities. They encounter clients face-to-face as a definitive part of their work and participate in institutional assessments and decision making about service provision and monitoring. They have been called “street level bureaucrats” (Lipsky 1980). Such workers have considerable power over the clients’ lives, whilst at the same time they are themselves controlled by managers and institutional procedures. They are required to take on responsibility for professional practices that enable and produce independent and responsible citizenship. Clients, for their part, have responsibility to strengthen their independence and life management. This mutual “dependence” of welfare workers and clients makes it important to study the everyday negotiations and management of responsibilities from the point of view of both workers’ and clients’ responsibilisation and self-responsibilisation.

This book aims to build a bridge between more macro-level and theoretical literature concerning responsibilisation and grass-roots level practices at the margins of welfare services. This means studying the management of responsibilities by analysing in detail client–worker conversations, multi-party case-planning meetings, workers’ team meetings and interviews with various stakeholders. In analysing these data, ethnomethodologically informed analytic concepts are applied that help to indicate subtle responsibilisation practices in welfare work. Mediating analytic concepts are needed, since the concept of responsibilisation as such is unlikely to appear in everyday language use by those whom it may concern. The data used in the book are mainly pertaining to Finnish and English supported housing and floating support services, targeted at people with complex mental health and substance abuse needs who are at risk of becoming homeless. As the clients of these services often use various other social and health services, the representatives of these other services, as well as municipal service purchasers, are also strongly present in the data.

There are several practical reasons why the data come mainly from England and Finland. Nevertheless, these two countries also form a reasonable pair in the sense that England has often been named as a forerunner in welfare state transformations, including a shift to an advanced liberal way of governing, whereas Finland can be described more as a follower although it has a strong history as a Nordic welfare state based on universalism. Despite this data concentration, we believe that this book’s findings on responsibilisation in grass-roots level practices are largely recognisable at the margins of welfare services in other Western countries as well. This is because strong policy-level ideas on the changing roles of the state and citizens in welfare provision and promotion are applied and challenged currently across the Western world.

The organisation of the book

The book is organised so that the chapters form a coherent whole. Chapters 2–4 create theoretical, conceptual and methodological premises and reflective grounds for the subsequent empirically grounded chapters. Chapter 2 provides a short overview of governmentality literature from the point of view of the concept of responsibilisation. The review summarises the following interconnected themes by demonstrating the transformation of welfare states towards an advanced liberal way of governing:

• autonomy and choice
• enterprising selves
• governing at a distance.

It examines the managing of responsibilities as described in the literature from both citizens’/clients’ and service providers’/welfare workers’ perspectives, and how both parties are created as subjects of responsibility (the central viewpoint throughout the present book). Chapter 3 widens the discussion towards currently influential discourses on the new directions of Western welfare states by reviewing sociopolitical and professional literature concerning both welfare workers’ and clients’ expected roles in welfare services. It is demonstrated how responsibilities and responsibilisation are among the core topics not only in the governmentality literature, but also in the influential welfare discourses. Discourses are organised around such keywords as empowerment, participation, consumerism, personalisation, recovery and resilience. These welfare discourses both support and challenge the ideas presented in the governmentality literature. Chapter 4 constructs a methodological framework for the rest of the book, introducing first the premises of ethnomethodologically oriented research on grass-roots level practices. It then moves on to discuss how macro-level policies and policy transformations, and related welfare discourses, can be examined as human and interactional accomplishment in everyday welfare practices. After that, such analytic concepts are presented that are pertinent for analysing the management of responsibilities and responsibilisation. The analytic concepts introduced are responsibility, accountability, categorisation, boundary work, sequentiality, advice-giving, narrative and resistance. The chapter ends by briefly describing the welfare service settings and research material that are used in the subsequent chapters in studying welfare practices.

These chapters are followed by six analyses (Chapters 5–10) that approach responsibility management from a particular angle, by combining certain key ideas of responsibilisation and related welfare discourses, analytic concepts and research data. Together, these chapters create a comprehensive and multi-voiced picture of the responsibilisation practices at the margins of welfare services. These empirical chapters are briefly described below.

The first three of these chapters (5–7) concentrate on the management of clients’ responsibilities. Chapter 5 demonstrates how on the one hand the interviewed clients at the margins of welfare services (try to) live up to the idea of the responsible self, and on the other hand resist this cultural expectation as impossible or unreasonable. It deepens self-responsibilisation discussions by first introducin...

Table of contents

• Cover
• Title
• Copyright
• Contents
• List of contributors
• Acknowledgements
• 1 Introduction
• PART I Conceptual and methodological premises
• PART II Managing client responsibilities
• PART III Managing worker and service provider responsibilities
• Index