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Making the case for systems change

VOICES change the system

Dean Spruce, Communications and Media Coordinstor, VOICES

In my role for VOICES the term and the concept of ‘systems change’ is never far from the front of my mind.

Having previously worked in a number of support based roles within the sector (rough sleeper outreach, homeless hostel and tenancy support officer within a housing team) the list of things I perceived could be changed for the better was quite a long one when I arrived in my current post. Making the transition from front line operations to an office based role was quite a culture shock however, and did require adjustments on my part, in both my thinking and in my approach. Discussions relating to ‘the system’ and ‘how we can change it’ were increasingly seeming more abstract to me, often being approached from a much wider angle than conversations I’ve previously had on the front line, and leaned more towards the political than the practical I’d previously been used to.

What is ‘the system?’ Where does it begin and end? Is there one, or are there many? Which parts need to change? Which parts can we change? Who do we need to influence to affect these changes? How do we talk about ‘systems change’? What language do we use?

 

These are all complex questions to answer, not likely to be resolved in the space of a conversation, or several even. In contrast when managing a caseload of 30+ people, a situation within which ‘having time’ is the abstract concept, the elements of your processes and procedures that would benefit from being tweaked, completely changed, or eradicated entirely, become apparent very quickly.

I recently received two short case studies written by a Service Co-ordinator here at VOICES that made the huge neon ‘systems change’ sign in my head light up, and created a shift in my internal monologue on the subject.

The first reports of an individual who was living in a homeless hostel being voluntarily admitted to a mental health unit for a short period, during which their bed space at the hostel was closed. The justification for this being their ‘support needs were too high’. When the ward deemed this individual ready for discharge the problem was then, where to? Through multiagency meetings and action, led by the VOICES Service Co-ordinator, this person was eventually offered appropriate supported accommodation. The problem then became, ‘who will assist with the move?’, as this individual has a physical disability. This seemingly did not fall within the remit of any of the agencies involved and the ward could only provide support once the move was complete.

In this case, due to persistent and consistent advocacy, a solution was arrived at and the move went ahead, however I have to wonder if the outcome would have been different if that level of advocacy was unavailable. This case very clearly brings into question the ‘systems’ of both the homeless hostel and the hospital. There is a very real chance that others following the same pathway may find themselves sleeping rough, in addition to suffering mental ill health.

The second case I want to talk about involves an individual who suffers mental ill health, alongside substance use, something I’ve come to know as ‘dual diagnosis’. This person recently moved into supported accommodation for the first time in their lives. Unfortunately, as is often the case with supported housing, other residents there were using substances, so this person’s substance use also  increased as a result. A move was then made to supported accommodation with a specialist focus on mental health, which would be brilliant, if they didn’t have a ‘zero tolerance’ approach to substance use. With a ‘three strikes and you’re out’ policy I can’t help but wonder if this will result in homelessness once again. I have to question the appropriateness of such an absolute policy, especially considering that in the vast majority of cases I’ve worked with over the years, metal ill health and substance use seem to go hand in hand, so much so it warrants its own term. Often self-medication is the only coping mechanism available that provides any relief, where severe mental ill health is concerned.

The reason I mention these cases is upon reading my thinking shifted, from a confusing space full of ideals, abstraction, and hypothetical conversations, to a much more familiar place where the ‘systems’ that need reviewing and changing are no mystery, in fact they’re staring right at us. People with direct lived experience of these systems, and the staff tasked with front line delivery of them can, and do, provide valuable and accurate insight into what is and isn’t working, and what we can do to make improvements.

Coming back to my role as Communication & Media Co-ordinator, and in the context of communicating our mission to the wider community, I wonder why people seem to have a hard time talking about ‘systems change?’ I would suggest it’s not as complicated an issue as we sometimes make it, or at least it doesn’t have to be. If we really want to change the multitude of complex systems that surround us, firstly we must acknowledge it’s going to be a difficult, slow process, to be ’chipped’ away at over time. We have to listen very carefully to what people are saying and experiencing, and act on it.

When talking about ‘systems change’, whether that’s in a report, on a website or indeed on social media, my advice is to be specific, and be realistic. Define which system we are talking about, which elements of it we think need to change, and why. If we can be specific about what those changes look like, even better. Remembering that the idea isn’t to promote the term, it’s to promote the action of creating positive change itself, and who doesn’t want that? No change is too small, and lots of small changes lead to substantial change.

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