A fictional community day service, and six months in the life of a fictional woman referred to throughout as R. Everything below is agreed by everyone involved. No account disputes any of it.
R, the service, the assessment and all five accounts are invented for teaching. No real person, service, record or document is reproduced, and nothing here is a clinical description of anybody.
The account you are analysing stays pinned at the top of the result while you answer. Read it again before each question - the answers are in the wording, not in the ledger.
Progress
| Account | Kind of person | Legitimate next action | Who may say what is happening | Responsibility |
|---|
Each extract is one sentence somebody wrote about R. For each, say what it does to her: what position it puts her in.
"Non-compliant", "service user exercising choice", "self-advocate", "person taking ownership of her recovery" and "customer" are not five words for R. They are five positions, and a position comes with a specification of what someone in it can reasonably do. Somebody positioned as non-compliant who writes to a manager is escalating. Somebody positioned as a self-advocate who writes to a manager is doing the thing self-advocates do. The letter is the same letter.
Notice how the same act - starting a peer group in the library - appears in the five versions. It is disengagement, it is unmonitored risk, it is community organising, it is recovery-oriented self-management, it is a customer taking her business elsewhere. Each of those makes a different response by the service obviously appropriate, and only one of them makes asking R what she wanted obviously appropriate.
Accounts do not only describe; they nominate whose description counts. A case note authorises the clinician, a risk register authorises the safeguarding lead, an advocacy bulletin authorises R and people like her, a recovery narrative authorises R in a carefully bounded way - she may narrate her journey, but the service still decides what a journey is. Asking who is entitled to say what is happening is often more revealing than asking what is said.
Between the case note and the recovery account, responsibility for the six months travels from R's illness to R's choices. In neither version does it arrive anywhere near the decision, in ledger entry 2, to halve the programme's hours. That decision is in the ledger and is not disputed by anybody, yet only the advocacy bulletin states it outright; the commissioning report acknowledges a reduced-hours model but keeps neither its cause nor its consequences; the case note and the recovery account, like the risk register, have no place for it at all. The most consequential thing a discourse does is often not what it says about a person but what it has no place to say about anything else.
None of this is about wording in the sense of politeness. The positions are held in place by forms, templates, review meetings, funding conditions and the professional training of the people who write them. That is why changing the vocabulary alone rarely changes very much, and why the recovery account - which changed the vocabulary comprehensively - can leave the distribution of authority almost exactly where it was.