When I used to tell people that I was doing a PhD, they would often ask me, “What is it about?” My PhD was about adult support and protection, in the sense made standard by the Adult Support and Protection (Scotland) Act 2007. For people familiar with this legislation and its history, this answer made some immediate sense. For most other people, including academics in many other disciplines, “adult support and protection” rang few bells at all.
If they were asking just out of politeness, we would sometimes leave it at that. But more often, I would try to explain what ASP was. And I wanted to do this in a way that was accurate. In the field of ASP there have been so many struggles over terminology. Phrases that used to be relied upon to sum the field up have been rejected now in Scotland, for reasons that some important stakeholders feel strongly about (6). So reinstating these phrases didn’t feel right, even for the sake of a simple explanation. For instance, people with some knowledge of social care would sometimes ask, “do you mean it’s about vulnerable adults?” And I would fumble through an answer that probably made things more rather than less opaque – trying to explain that the answer is “yes and no” – that ASP is not about a defined group of people who we’re prepared to think of as generically “vulnerable”, but that the idea of “vulnerable adults” is related to ideas that have now developed into ideas about ASP.
Even dated terminology was no help for people with no social care or related background, or people familiar with very different state systems for organising welfare and related services. I once got into a discussion about my research with a Czech professor of philosophy on an overnight train from Amsterdam to Prague. Or I tried to. I still cringe when I think about how little I probably managed to convey – even about the basic subject of my PhD – how very few coherent words I seemed to have to set this out. And I was once asked by an older acquaintance if “adult support and protection” is the study of “battered wives”. Again, I fumbled through a confusing, “yes and no” answer, trying to articulate that it isn’t so gender- or marital-status specific, and there’s this element of “vulnerability” (for want of a better word) tied up in ASP somehow: that it’s a type of “vulnerability” that might come from something like an impairment or frailty, though it doesn’t always have to – it’s more about the circumstances people find themselves in – but it definitely isn’t just about gender. Trying to put this in a way that made some sense raised some puzzling questions for me (5), quite aside from those it no doubt raised for the unfortunate person who had asked the question, and I’ll come back to this later.
So I would try another way. I would try by beginning, “It’s kind of like child protection, except…” and then spend a long time trying to articulate how ASP isn’t like child protection. Or I began, “it’s kind of about abuse, except…” and then spent twice as long explaining how it’s much broader than the kinds of things you might stereotypically think about when you hear the word “abuse”. The term “harm”, now preferred in Scottish policy, was no help at all. You can be harmed if you catch a serious disease or if you’re knocked down by a car, but ASP isn’t really about that.
I would give up comparing it to anything, and just try to start from the beginning. I would explain that it’s about a very broad range of responses to help keep people safe and well where there may be some limits on their abilities to do this for themselves. But then I found it difficult to articulate the distinction between ASP and a much broader swathe of adult services. I also found it was easier to give the impression that ASP is entirely about social care, or entirely about criminality, than to convey that it’s a blend of some parts of these and other things. “So it’s like bath rails for older people things like that?” I might be asked. Well, yes, kind of – but no, not really. “So it’s to do with crime against older people?” “So it’s to do with looking after people who can’t make their own decisions?” Well, yes – but also no.
I don’t mention all this out of any disrespect for people whose expertise lies elsewhere. There are plenty of people whose professional and academic work I don’t understand very much about. I also appreciate that immediate accessibility to those without a grounding in the subject is not necessarily the hallmark of “good” or “authentic” social science. Nevertheless, this almost complete absence of a language to articulate the basic topic of my PhD to almost anyone who wasn’t an adult health or social care professional, or an ASP specialist in a related field such as the police, played on my mind. I thought it might be telling me something quite important. Bear in mind that non-ASP specialists are still pretty likely to have heard of instances that ASP professionals might classify as “harm”, or indeed to have experienced them, first or second hand. We could generally find shared ground over examples. These were typically extreme ones though: Winterbourne View; Steven Hoskin; the Borders case. The more inclusive “box” that ASP draws around the gamut of things that fall within its remit in contemporary Scotland was still not a familiar “box” to many people. They might be more inclined to conceptualise things that are clearly criminal in quite a separate “box” from things that aren’t. They might “box” interactions in families quite separately from staff practice in care homes; or older people’s concerns quite separately from the concerns of younger adults with learning difficulties; or services to adults who lack mental capacity quite separately from services to adults who don’t. They might “box” anything to do with the quality of care provided to those who require it together, blurring the boundary between things that we might call “ASP” and things that we might call “care regulation and inspection” or “care management” or just “care”. In short, they might struggle to see how the kinds of issues that currently “count” as ASP have been conceptualised as similar enough to each other, and different enough from other things, to constitute a distinctive category of phenomena that someone might be doing a PhD about.
Four years later, and I have still found no better way to explain what ASP is than to explain its history. This works better for training sessions or conference presentations, though, than for chance conversations with people who may wish they’d never asked – because I need to start as far back as I can. I need to talk about the long-stay institutions, and the concerns that arose around and within these, and then the different but related concerns that arose with the move to “care in the community”. I need to talk about changing approaches towards “risk” in health and social services, and towards “rights”, and towards “accountability”. I need to talk about the “discovery” of elder abuse and of the abuse (primarily the sexual abuse) of adults with learning difficulties. I need to talk about huge shifts in social work and its relationship with other services, and in particular the introduction of the care management role and the purchaser/provider split. I need to talk about “protection of vulnerable adults” policies and how they developed, and why they were superseded, and all the debates around the legislation we now have.
I also think that people’s own “boxes” for conceptualising things when they’re not steeped in ASP can only really be understood in the context of their histories, and of the building-blocks of sense-making of which they’re made up. For instance, people might be starting from a different set of assumptions about independence and its relationship to dependence, or about what “care” is and why people might need it, or about the distinction between a private issue and a state concern.
And it seems to me that there is just no neutral ground. Or at least, there’s no suitably nuanced shared language by which we can cut to the chase, and say what we “really mean” without all this background needing to be got through or else getting in the way. And if we need to engage with a myriad of trajectories of meaning-making in order to find some common ground, at least when we step out of our professional silos, then this changes the conversation about ASP in my view. It helps us to look more critically at what we’re doing, and what it’s really all about.