“This is radical help: where the capabilities of all are fostered, and we take care of everyone.” (pg 210)

Radical Help on Goodreads

If you care about applying systems thinking to social services of any kind, Radical Help is the book for you. At Systems Thinking Marin, I have been identifying examples of both “systems doing” and “systems being.” This book documents systems doing in the realms of psychological, career, health, senior support, and a number of other welfare or social support services.

Cottam is based in the UK, yet her assessment of the problems (and solutions) within the modern welfare or social services sector very much apply here in the USA. As she explains, the Beveridge Report was exported to the U.S. around the time it was published in the UK, and fundamentally shaped the invention of the U.S. social welfare system. Another source cites the connection:

The Beveridge plan famously called for social insurance “from cradle to grave”—a phrase Roosevelt insisted that he himself had coined. “Why does Beveridge get his name on this?” he joked to Frances Perkins. “[I]t’s not the Beveridge plan, it is the Roosevelt plan.” Roosevelt was not entirely joking: he began to turn back to the idea of comprehensive health insurance. (Ref, pg 30)

The Problem

Reading Cottam’s book as a United Statesian gives you a clear picture of the overlaps between the UK and the U.S. systems. If you’ve ever applied for medical coverage, food benefits, or other services through your local government, you will likely recognize this description:

Working out of twenty departments–each with their own agenda–the professionals trip over themselves. Every professional is held responsible for the outcomes of their particular agency, whether it is school results or a reduction in alcohol consumption, and they view the family from this single perspective. Some of the agencies are very good–and there is statistical evidence that their approach ‘works’ when applied to each problem in isolation. But in real life problems are not experienced in isolation, nor can they always be solved at the pace required by a mandated programme. For the service manager, however, there is a real need to prove outcomes in order to apply for the next round of funding, or to bid for the next contract… (pg 58)

If you happen to work in the service sector, so too are the outcomes familiar:

The combined effect of overlapping efforts driven by the timetables and goals of each agency is confusing and time-consuming for the families. And there is a deeper problem. In the effort to manage problems, the families and professionals alike have lost sight of the bigger picture. (pg 58-59)

Luckily, Cottam and her group offer a set of crucial insights to ameliorate this situation.

The Power of Relationships

So how do we know this book is a systems approach to making the world a better place? The subtitle helps: How We Can Remake the Relationships Between Us and Revolutionize the Welfare State. Referenced over and over throughout the book, Cottam’s emphasis is first and foremost on building relationships. And when you’re trying to make the world a better place, building relationships is the prime directive. (This is discussed in the Systems Thinking Mini-Course.)

Cottam cautions against a too-easy label of a program as “relational,” saying, “…a programme takes on the new language, but it is only speaking in new ways to veil the fact it is still fixing in old ways” (pg 245). But she also explains the constraints faced by the currently existing institutions and systems that keep the old ways in place, and the pressure on administrators to meet the old set of expectations. She characterizes administrators who dare to embrace the new (considering the forces working against the new) as “heroic” (pg 63).

An Example

Here is one small example of an experiment conducted by Cottam and her team that demonstrates the subtilty, and really, the elegance of the relationship-centric approach.

Some years ago I worked in a school where bullying was a problem. The lunch queue was a particularly frenetic aspect of the school day…One day we set the dining-hall tables with cloths, put flowers in jam jars and carefully placed knives and forks in ordered settings. The pupils rushed through the doors, tumultuous as usual, and then stopped in their tracks. Is this really for us, the pupils asked in frank amazement. Yes, we said, come and eat. And something extraordinary happened: there was a busy hubbub of conversations, pupils connected to each other and they stayed seated…The pupils responded wholeheartedly to the different expectations our beautiful tables had set up. (pg 245)

Most of the work portrayed is complex, and often required many iterations and ongoing adjustments. Successes were sometimes hailed by local officials, or sometimes shutdown, and sometimes–confoundingly–both. But all examples illustrate in touching detail the power of the relational:

I would call this new form of organization relational, because it is characterized by relations between peers rather than through the control of traditional management hierarchies. (pg 103)

Cottam articulates, “Our expectation that if we gave families space and support, they would address their own challenges, was borne out” (pg 79). She explains further, “The challenge is not one of how to contain, but rather how we can open up” (pg 92).

The importance of relationships is not simply between the provider and the client. It’s about finding ways to support individuals, families and communities to cultivate relationships of all kinds.

Over decades of work I have observed that people who make change with others are able to make bigger changes and to sustain them. Of course, put so bluntly, the role of relationships in sustaining change seems absurdly obvious, and yet relationships are never designed into any of our solutions. Our health services are designed around the lone individual. (pg 160)

Building Relationships is Cost Effective

Citing example after example, Cottam’s programs save money. This is in part because the programs make effective use of technological tools that weren’t available back in the Beveridge report days (and today’s institutions have not changed much since the mid-20th century). These new programs are not, however, top-heavy in terms of research and development:

The process is affordable. The tools I use are cheap: many can be downloaded and photocopied. Like the pebbles in my pocket, they don’t look very much, but used with intent they can create space for both personal change and system change. (pg 239-240)

As noted by the Health Resources & Services Administration of the U.S. government (an agency with $12.1 billion in funding for fiscal year 2021, by the way), “The good news is that friendships reduce the risk of mortality or developing certain diseases and can speed recovery in those who fall ill” (Ref). This is an important point given that for seniors in particular (though not only), this same website cites what some call a “loneliness epidemic.” According to their studies, 43% of seniors report feeling lonely on a regular basis. Further, “Loneliness and social isolation can be as damaging to health as smoking 15 cigarettes a day…”

I strongly disagree with a purely fiscal point of view, but nevertheless, even if reducing government spending is all you care about, programs such as those outlined in Radical Help save money.

We Need This in Marin

Though I am not a social services professional, I support community organizers who are. Through them I have learned that right here in Marin County our public social services programs share many of the struggles with the UK system portrayed in this book. From clients lost in the system–or who have had enough of it and given up on seeking help–to disenchanted service providers who can’t stand it anymore and seek other lines of work, we have a lot of work to do to update our safety net to 21st century standards.

For an example of a Marin-based initiative that did embody many of the aspects of what Cottam describes, read this blog entry: Operation Give A Damn – A Former Wrap-Around Organization in Marin City.

Government Involvement is Key, At All Levels

Local program administrators are beholden to state and federal constraints in terms of how money is spent. Virtually all of the funding is reactive as opposed to preventative. At present, we are dragging around outmoded (and expensive) methods of providing for the general welfare that are outdated. At the end of the day, people tend to hold government responsible for attending to society’s well-being. Cottam underscores this, saying,

Everyone has something to bring to radical help. But the state–whose purpose is the development of its people–has a particular and unique role. Only the state, our leaders and political actors can create the pivot we need, developing the framework, supporting the vision and nurturing the principles that will guide the behavior, funding the activities of others. (pg 264)

It is important we realize that we are “the state.” We vote, run for office, work for government, work for all number of NGOs that lobby governments, and attend (or fail to attend) public forums. This is all in addition to paying taxes. Perhaps we should take the ethic of building relationships from Radical Help and apply it to the public building much better relationships with this body–our government.

Radical Help, Radical Change

But again, we’re not talking about small, incremental changes. While some of these types of programs would happily run parallel to existing services, they are not something that can be readily added on top of existing structures. Cottam’s approach turns the hierarchy on its head, which is why current leaders who embrace radical help are necessarily heroic. The quote below summarizes the differences in the hierarchical/mechanistic versus relational/systems approach.

Our current welfare systems have a logic that runs like this: assess me, refer me, manage me. These systems count inputs (buildings and professional time) and outputs (reduced risk behaviors). They restrict access and try to manage costs.

The experiments proposed a different logic:

Foster a core set of capabilities so that each and every one of us can thrive. Ensure, where necessary, that we are supported in the face of adversity. Include as many people as possible. Measure change and the quality of our lives: our sense of freedom, purpose, of having something to give and our connections to one another. (pg 198)

If you are a fan of Donella Meadows, or have been following the Systems Thinking Marin blog series, the question of purpose should come to mind here. The “current welfare systems” have a fundamentally different purpose from the Radical Help approach.

Unfortunately, current systems seem to exist to serve the system itself: dotting “i’s” and crossing “t’s” in accordance with the policies and procedures that make up the system. This way the people in charge can claim success, having fulfilled their job description and adhered to the strategic plan. (Government rarely sets goals, by the way. At least not publicly.)

Radically Helping as the Purpose

Radically helping involves some reasonable amount of policies and procedures. However, the moment adhering to policies and procedures becomes the purpose you aren’t helping anyone but bureaucrats. The humans have been left far behind.

The purpose is, as Cottam says, helping “each and every one of us” to thrive. That is, in itself, a radical statement. This includes, as quoted above, “in the face of adversity.” We’re not measuring dollars and numbers of people through the door as an end in itself. We are taking on the much more challenging task of measuring change, “…the quality of our lives: our sense of freedom, purpose, of having something to give and our connections to one another.”

This is not easy work, but if the stories documented in Radical Help are accurate, it does work. Let’s turn to Donella Meadows, who makes an important statement related to the point above:

Pretending that something doesn’t exist if it’s hard to quantify leads to faulty models. You’ve already seen the system trap that comes from setting goals around what is easily measured, rather than around what is important. So don’t fall into that trap. Human beings have been endowed not only with the ability to count, but also with the ability to assess quality.
Thinking In Systems: A Primer, pg 176

Take the “ability to assess quality.” Cottam speaks of “freedom, purpose, and of having something to give,” as well as “our connections to one another,” and asserts that these are fundamentally impactful on our quality of life.

If so, shouldn’t our public psychological and social support services measure these factors? Not in a dry, Vogon manner, but as human beings genuinely caring for other human beings? If you see the potential in this direction, I urge you to purchase and read Radical Help. And then, if you happen to live in Marin and want to help make a difference locally, my colleagues in the social services world need your help. Contact us.


Check out this article for further details about and images from Radical Help: Reimagining Health and Care – An Apocalyptic Moment?

Radical Help Book Image in 3D

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