Output 2

3. Emergent themes and practice guidelines

3.1. The teaching and learning environment and trust building

It has become evident though our activities that participation with service users was embedded in many areas of social work practice and education, in a variety of forms. Such processes of engagement, however, often created complex ethical and professional dilemmas. These ‘complicating’ issues were articulated by students, service users and academics. For example, it may be that students and service users are not always listened to by educators or are sometimes excluded from the design and delivery of teaching, as their (implicit) knowledge is often judged to be inferior to knowledge derived from standardized academic procedures. There also appear to be parallels with how policy and practice are delivered to service users in particular political cultures. When service users are involved in the classroom, or in the delivery of services, it was agreed that common ground rules should be established to enable difficult conversations over divergent viewpoints and priorities to be carried out in safe spaces that correspond to the principles described below:

Managing the self

Acknowledge our own pain and the pain of others, when dealing with problematic situations
Attend to the emotional and cognitive content of discussions
Own our own ideas and do not project them onto others
Issues discussed are in strictest confidence before generalised conclusions can be drawn from them

Pedagogic approach

Exploring common and contrasting dimensions of roles and identities
Allowing service users, sometimes for the first time, to talk about their experiences, for example by expressing their experience of mental health issues, addiction, poverty, but also their experience in relation to dealing with professional organisations and policies designed to support them through with these issues.
Encouraging services users to talk about future, as well as past and present services

Catharsis

Opportunities for engaging more authentically with ‘the other side’ without stating pre-conditions
Students can use the small and safe group space to listen to and engage with the often painful experiences of service users
Services users’ sense of recognition and esteem both in terms of their past experiences and the role they were now given as educators.

Theme 1) Case Study Example: Complex ethical and professional dilemmas and building trust (see Donnelly et al.2021)

The Dublin case study relating to a Psychiatry of Later Life Team and the participation of people living with dementia and their carers in assisted decision-making and advance care planning, offers some useful learnings on complex ethical and professional dilemmas. The aspiration to ascertain the will and preference of the person living with dementia is often complicated when, for example, the person is perceived to make an ‘unwise decision’ or when their expressed will and preference differs from that of their family carer (particularly in situations when they are also dependent on their family member’s support to ‘action’ the decision).

There can also be tensions between expressed will and preference and what may be perceived to be in their best interests by the multidisciplinary team and/or family carers. Working in partnership, taking time, openness and transparency in conversations and creating an emotionally secure environment for the person living with dementia and their family members, all help when navigating this complex ethical terrain.