Social workers are increasingly located within multi-disciplinary settings that have no established understanding of the social work role. This article explores what it is like to be a social worker in one such service, an adolescent psychiatric unit. It sets out one particular model of social work practice, and highlights the rewards and pressures that come with the job.
There are 99 child and adolescent in-patient units in the UK. Some have social workers. So why should the experiences of such a small number be relevant to the profession as a whole?
We are reminded continually of the need for joined-up thinking and good multi-disciplinary practice. But the main challenge facing any social worker walking into a specialist environment, such as a hospital, is established practices going back years. Nurses and doctors have to be there, nobody else does. So social workers have to prove their value, fight for their voice and be explicit about what they do in a way you never have to as one social worker in a team of many.
There is also a moral and professional duty to be the best practitioner that can be achieved for children and young people in these units. This entails being able to offer a coherent account to yourself and your colleagues about what you do and how they can support you. Finally, in-patient social workers, like the profession as a whole, have a responsibility to share these accounts with each other, learn from them and establish good practice in all units where there is a social work presence.
The role of the in-patient social worker is shaped by the unit. There are different admission criteria, such as acute (crisis or short term) psychiatric illness, eating disorder, challenging behaviour, different age ranges. Some units require the child to return home at weekends, or to come off psychiatric medication. Catchment areas may cover a local, regional or national area.
I work in a purpose-built unit in east London that serves three London boroughs. The Coborn Centre was opened in March 2006, replacing an interim unit opened in 2001. It admits young people, aged 12 to 17 with severe mental health problems including psychosis, bipolar affective disorder or post-traumatic stress disorder. Many will have complex conditions that may include learning difficulties, eating disorders and behavioural problems. Some have experienced abuse or have difficult family and social circumstances. It has 12 acute beds, three intensive care beds and a dedicated day service with six places.
The Coborn has an extensive multi-disciplinary team with doctors, nurses, psychologists, occupational therapists, a family therapist, an art therapist, teachers and social workers. It has also employed social therapists and a fitness instructor and has its own in-house catering.
I have been the social worker since the unit opened and I receive supervision from the child and adolescent mental health service.
Most health professionals are familiar with adult hospital social work. It can be a challenge to explain that dealing with benefits, finding accommodation or writing mental health tribunal reports are not necessarily what social work is about. To use my skills and time effectively I have developed eligibility criteria to determine which young people and carers I need to work with, those presenting with:
●Significant issues of child protection.
●Possible need for accommodation by the local authority.
●Significant social need.
I support these young people with referrals and liaison with community health and social services, voluntary community services, addressing practical concerns and relationship issues in the family and preparing for discharge.
There are many young people and families who, while not meeting these conditions, do have significant social needs. My role here is to advise and support those colleagues in the unit who are involved. This includes ensuring easy access to child protection procedures, advising on child-in-need referrals to social services, useful numbers and developing specific issue guidance.
Alongside casework and consultation, the in- patient unit offers me opportunities to contribute to the life of the service such as: running a music group and facilitating the community meeting supporting colleagues in their sessions with some young people contributing to in-house teaching developing the service, including assessment practice and user involvement and linking with systems outside the unit, such as a carers’ forum and an inter-cultural practice group.
I practise an enormously privileged version of social work with significant scope to define my role. I have a lot of autonomy and, by working across a trust area, I can compare and contrast what is available in different boroughs. I help young people and families find valuable help, put my therapeutic training and skills to good use, learn a great deal from my colleagues, and study and training are actively supported.
At the same time the role can be professionally isolating. It is difficult persuading other staff to understand my role and inter-disciplinary practice – team relationships and politics can be very complicated. Working with distressed young people, their families and professionals can be exhausting. Much of the social work practice in the area struggles to get to grips with the needs of adolescents with mental health problems and mediating between the service and social services can often be uncomfortable.
Regardless of a social worker’s aspirations for the service and a person’s views on psychiatry, it is important to learn to “go with the flow” of the unit. It is essential to respect the pressures on the nurses caring for distressed and disturbed teenagers and on the managers and psychiatrists, whose careers are on the line if things go wrong. In this environment the social worker must, to adapt a phrase of Minuchin and Fishman, “earn the right to gently influence the system”. (1)
Only by being seen to know what they are doing, doing it well and making a positive difference to patients and their families and carers will social workers come to be understood and valued. The next step is to connect with other in-patient social workers and gather our stories and expertise. I am encouraged by the establishment of an annual conference of in-patient units and by developments in Department of Health policy that sets out ways psychiatry and mental health practice across all disciplines require a change in culture if the needs and rights of patients, families and carers are to be properly addressed. CC
Alastair Pearson is the social worker at the Coborn Centre for Adolescent Mental Health, East London. Before this he worked in many child and social care settings. He is passionate about the support of the families of those with mental health difficulties and the application of systemic ideas.
Training and learning
The author has provided questions about this article to guide discussion in teams. These can be viewed at www.communitycare.co.uk/prtl and individuals’ learning from the discussion can be registered on a free, password-protected training log held on the site. This is a service from Community Care for all GSCC-registered professionals.
(1) S Minuchin, H Fishman, Family Therapy Techniques, Harvard University Press, 1981
● B Speed, “All Aboard in the NHS: Collaborating with Colleagues who use Different Approaches”, Journal of Family Therapy, 2004, 26 (3), pp260-279
● R Chesson, D Chisholm eds, Child Psychiatric Units At the Cross Roads, Jessica Kingsley, 1996
● New Ways of Working for Psychiatrists
● New Ways of Working, CAMHS link worker, Timothy.Morris@elht.nhs.uk
● Ten Essential Shared Capabilities
This article appeared in the 19 April issue under the headline “Young pioneers”