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Health and Social Care
Textbooks, monographs and policy-focused books on our Health and Social Care list push forward the boundaries of teaching, theory, policy and practice. The list covers areas including global health, health inequalities and research into policy and practice.
Key series include Transforming Care which provides a crucial platform for scholars researching early childhood care, care for adults with disabilities and long-term care for frail older people, and the Sociology of Health Professions, offering high-quality, original work in the sociology of health professions with an innovative focus on their likely future direction. Our leading journal in the area is the International Journal of Care and Caring.
The context of online safety, and its policy evolution, has been dominated by protecting children and young people in online spaces. The statutory focus, such as the UK government’s Online Safety Bill, continues with an approach that looks towards prohibition, rather than empowerment, while ignoring an evidence base that calls for inclusive approaches. Reflecting upon the impact of this policy direction related to adults, the risks associated with being online, for example grooming and exploitation (both sexual and financial), are poorly understood in multi-agency perspectives and are in conflict with the needs of individuals who might be at risk of harm online. With little formal training in adult safeguarding practice, and a dearth of research around adult online safety, professional practice falls back, instead, on personal experience, and biases arise from personal use of technology, which presents challenges to effective and consistent support of adults at risk.
We introduce the broad topic of online safeguarding and highlight the challenges of applying such approach to individual cases affecting adults who are potentially vulnerable as a result of brain injuries or other capacity issues. We argue that the narrative needs to be moved from prohibition underpinned by children’s online safeguarding to truly apply best interests in each case, considering individual needs, as well as a need to develop the knowledge of the workforce from anecdotal to professional
Examining subsequent Court of Protection rulings in detail demonstrates both positive and negative impacts of the Re A and Re B cases, highlighting issues in judgments that perhaps set the bar too high for those with capacity issues, how ‘experts’ bring bias to their evidence, and, perhaps most importantly, how the ‘internet and social media’, the now established term for capacity to engage with any online technology, is far too broad when considering capacity. In particular we highlight a recent judgment where Williams J raised this point and moves thinking forward such that those with caring responsibilities need to argue protection from harmful practices without withdrawing positive experiences online. We argue that most adults without capacity issues would struggle to pass the ‘tests’ defined in the Cobb J ruling and while Court of Protection judgments have moved the legal understanding of capacity to engage with the internet and social media forward, there are still questions to be asked around consistency of application.
The fundamental legal framework affecting adults who might be at risk as a result of online behaviours lies within the Mental Capacity Act 2005, the Care Act 2014 and statutory guidance which set out responsibilities for professionals working together. With a focus on the second principle of the five set out in the MCA that ‘a person is not to be treated as unable to make a decision unless all practicable steps to help him do so have been taken without success’, we question the notion of person-centred emancipatory practice in maximising and assessing mental capacity and the role of ethical decision making in professional practice in relation to online spaces for vulnerable adults. Using the Cobb J ruling in Re A and Re B and relevant Court of Protection rulings in the UK and the wider UK legal system, we also explore the right to online participation by vulnerable adults drawing upon the UNCRPD and the ECHR, making it clear that participation is a right for all.
This chapter focuses specifically on the debate on mental health and pro-harm content online. It outlines the increasing concern related to the widespread impact of online harms, mental well-being and reported mental health impacts of viewing harmful content online. The exploration of the complex relationship between mental capacity and mental health in the chapter reveals that vulnerability is a far from static concept. Using examples from pro-eating disorders, pro-self-harm and pro-suicide online communities and forums, this chapter examines the phenomenon of ‘pro-sites’, their significance in managing mental health and the importance of understanding their influence in safeguarding vulnerable adults. It is well recognised that vulnerable adults use these sites as they often lack a sense of acceptance and belonging in the ‘real world’, and this chapter argues that while calls to ban these sites and restrict access to such content have been ineffectual, supporting adults to understand how and why they use them alongside pro-recovery content in a non-judgemental way can enable a more realistic understanding of their mental health.
This much-needed volume fills an overlooked gap in adult safeguarding – the digital arena – in providing a comprehensive overview of policy and practice in supporting vulnerable adults online.
Providing an essential analysis illustrated by recent court rulings and case studies, the authors advocate for the effective support of adults with learning disabilities and/or mental capacity issues in their digital lives without compromising their privacy and participation rights.
The text balances a theoretical exploration of the tensions between participation and protection, legislation, human rights, professional biases and social wrongs. It encourages a critical approach in adopting both a practical and realistic understanding for policy makers, professionals and students in social work, law and adult social care.
This chapter proposes that the approach adopted in policy and practice around online safeguarding does not reflect best interests and instead centres on prohibition and prevention. We explore whether professionals and practitioners are in position to provide effective support to those in their care in relation to engaging with virtual environments and in assessing an individual’s capacity to make decisions about their online lives. As everyday interactions online comprise a milieu of activities from financial to social to exploring and interacting, effective support requires both an in-depth understanding of the individual and knowledge of the nature and arguably the risk associated with a variety of activities. Drawing upon empirical data and professional reflections on knowledge, understanding and training in relation to online safeguarding, we highlight taken-for-granted assumptions made about online risk and question the often overlooked rights of those at risk of harm in an online content.
In concluding, we bring together theoretical, legal and practice-based perspectives to consider how stakeholders with safeguarding responsibilities best respond to online risk based upon our experience of ‘what works’ and how vulnerable adults can have their best interests supported. Building on previous arguments, we consider the role of technology, such as filtering and monitoring in safeguarding, what works, when it can be empowering, and how it can be excessive. Providing a counter-narrative, we argue that there is not a ‘one size fits all’ approach to the safeguarding of vulnerable adults when it comes to online behaviours, and cognisance of their capacity issues, online risk, and risk mitigation are required. We conclude by reflecting once more on the foundations laid by the Cobb ruling and how we are at the genesis of both thinking and practice around adult online safeguarding.
This penultimate chapter brings together the theoretical, legal and practice-based perspectives to consider how stakeholders with safeguarding responsibilities can best respond to online risk. It is based on a ‘what works’ approach and how adults can have their best interests supported. It builds on the arguments about how technology, such as the use of monitoring and filtering in safeguarding practice, can be empowering but can also be excessive. This chapter considers both digital divides and social inequalities and draws on Actor Network Theory to emphasise one of the book’s central themes – that there is no ‘one size fits all’ approach to safeguarding adults online and an individualised approach is essential. It argues that a holistic approach across policy, organisations, education and training, technology and professional practice is critical to effective safeguarding based on evidence-led, informed, person-centred assessments free from value bias and in the best interests of the individual at risk.