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Research: role of social work in mental health services

About one in six people in England experiences some form of mental health problem at any given time, with some groups more likely to be affected than others. Social workers have historically had a major role to play in co-ordinating and delivering services for people with mental health problems.

At a time of much change to professional roles and organisational structures, where concerns have been expressed about the diminution of the distinctive part that social workers have played in the broader provision of health and social services for people with mental health problems, it is worth noting the role and contribution of social work in community mental health provision in statutory community mental health teams, integrated or multidisciplinary teams, assertive outreach and crisis intervention teams in the UK.


Professional perspectives and values

People who use services value the non-stigmatising help and access to services provided by social workers and the core values of social work practice directly support the principles underpinning self-directed support and the independent living movement.

Similarly, analysis of the “essential capabilities” required to practice in mental health also emphasises the importance of a professional value base which promotes dignity, human worth and social justice, and includes a commitment to the principles and social perspectives of the recovery model. Indeed, research exploring community care practices found that social workers frequently identified empowerment as a fundamental principle in their practice.

There is also widespread agreement among people who use services, practitioners and researchers that service developments such as mental health promotion, crisis resolution, and the implementation of support based on the principles of recovery, must be explicitly underpinned by social perspectives. These perspectives can help promote access for people susceptible to discriminatory institutional practices, including people from minority ethnic communities.

Holistic approaches

People who use services value social workers who are able to provide practical help, counselling and advocacy on their behalf and have responded positively to practice that combines practical assistance with emotional support.

Diary-based research examining differences in approach to care management in different settings, found that care managers in mental health settings were more likely to provide direct help alongside their care management role (that is, combining the practice of assessment, care planning and review, with a significant allocation of time for counselling and emotional support), than care managers in an older person’s team, who tended towards spending more time involved in care brokerage (that is, procuring care packages and practical support).

A study that examined attitudes and role perceptions in mental health teams in a London borough concluded that of all professional groups, social workers were most likely to identify the importance of support to children combining individual emotional and practical support, as well as appreciation of their social circumstances.

The significant role of social work in promoting the involvement of people using services and developing systemic approaches to practice with families and groups has also been identified. Joint-working initiatives between social services and Camhs, which encompassed an extended therapeutic role for social work practitioners that included family therapy, have identified positive outcomes including quicker response times, more effective prioritisation, improved multidisciplinary work and a more positive experience for children and families.

Reducing isolation

Several studies have identified the challenges that people with mental health problems face in sustaining and preserving social contacts and social networks. People with mental health problems who live in more isolated rural areas and small communities with little service provision are likely to find it more difficult to develop and preserve supportive social contacts and networks.

Research into the development of social networks in rural areas has shown the crucial role that some services, such as drop-in and day centres, play in promoting and sustaining relationships between people who use services. The Highland User Group, for example, has provided opportunities for people who use services to work together to influence the development of those services and challenge discrimination.

Social work and social care staff have a key role to play in working with and supporting groups of people who use services to secure better practice and resist marginalisation and discrimination.

For older people, the most effective interventions aimed at alleviating isolation and loneliness appear to be those which have an educational focus or where clearly focused support interventions are built into existing services, and where older people have been consulted about their own particular needs.

Promoting self-directed support

A random sample of 262 people with severe and lasting mental health problems found that two-thirds thought that their care programmes helped them to be more independent, but reported that they were rarely asked if they wanted family members or informal carers involved in their care. Frameworks which helped people participate in their own social care included common assessment protocols and the identification of a named, single key worker or care co-ordinator.

Social work practitioners skilled in family work were identified as being particularly suited to this role. Research also found that people who use services responded more positively where there had been joint training of social workers and community psychiatric nurses towards a common goal of person-centred practice and a care management model based on strengths.

Research has confirmed that direct payments for people with mental health problems are under-used. A national evaluation of direct payments identified several barriers to their use which included service reorganisation, work role uncertainties and difficulties in managing workloads. It also found that care co-ordinators (including social work practitioners), rather than offering direct payments as a matter of course, tended to decide themselves who was suitable for these payments.

The study reported that care co-ordinators overcame initial ambivalence about using direct payments as they found they were able to use a range of skills including advocacy, partnership working and facilitating empowerment, to increase access to direct payments.

Further information

● Mental health and social work and Mental Capacity Act training materials

● Commissioning and Providing Mental Health Advocacy for African and Caribbean men

● A Common Purpose: Recovery in future mental health services

Each of the above at Scie’s website

Useful links

Care Services Improvement Partnership (CSIP) – supports positive changes in services and in the wellbeing of vulnerable people with health and social care needs.

Depression Alliance – provides information and support services to those affected by depression through publications, supporter services and network of self-help groups. A user-focused organisation with offices in England and a sister charity in Scotland.

Joseph Rowntree Foundation (JRF) – charity supporting research on social issues.

Mental Health Foundation – leading charity that provides information, carries out research, campaigns and works to improve services for anyone affected by mental health problems.

MIND – the leading mental health charity in England and Wales providing a variety of services including publications and a confidential information line for users, carers and practitioners.

National Centre for Independent Living – a support, advice and consultancy organisation that aims to enable disabled people to be equal citizens with choice, control, rights and full economic, social and cultural lives. The website provides information on independent living, direct payments and individual budgets.

National Institute for Mental Health – is responsible for supporting the implementation of positive change in mental health and mental health services.

Refugee Council - the largest organisation in the UK working with asylum seekers and refugees.

Sainsbury Centre for Mental Health – works to improve the quality of life for people with mental health problems, through research, policy work and analysis to improve practice and infl uence policy in mental health as well as public services.

SANE – a charity concerned with improving the lives of everyone affected by mental illness.

Shaping Our Lives – is a broad network of people who use services promoting user perspectives, involvement in service planning and development, and the sharing of information between different user groups.

Social Perspectives Network (SPN) – SPN is a coalition of people who use services, survivors, carers, policy makers, academics, students, and practitioners looking at mental health from a social perspective. SPN also seeks to promote the importance of social care and social work. Free membership and e-newsletter

Research abstracts: approved social workers

Author HUXLEY Peter et al

Title Staff shortages in the mental health workforce the case of the disappearing approved social worker.

Reference Health and Social Care in the Community, 13(6), November 2005, pp.504-513.

Abstract Approved social worker numbers in England and Wales were compared on the basis of two national surveys conducted in 1992 and 2002. These data were supplemented by reports published by the Employers’ Organisation in the intervening years. Although raw numbers suggested a modest absolute increase over this time, rates of ASWs per 100,000 population declined by over 50%. Possible explanations for this dramatic fall are explored. The authors conclude that specific and targeted action needs to be taken by the government and public sector employers to determine the numbers of mental health social workers needed in modernised community mental health services.

Author MAKETLOW Roger et al

Title The experience and practice of approved social workers in Northern Ireland.

Reference British Journal of Social Work, 32(4), June 2002, pp.443-461.

Abstract Reports on the first extensive survey of approved social worker activity under the Mental Health (Northern Ireland) Order 1986. The practice and experience of ASWs was surveyed by postal questionnaire and user and carer experience of compulsory hospital admission was investigated by a series of focus groups. The study revealed that two-thirds of ASWs had experience of acting as an applicant in compulsory hospital admission during the past two years. Nearly half of these ASWs had reported experience of between one and five admissions and one-tenth had completed over twenty admissions in the two-year period. In only a small minority of cases did joint face-to-face assessment with the general practitioner (doctor) take place nearly half of ASWs reported difficulties in obtaining transport and only one-fifth of ASWs had experience of acting as a second approved social worker. Half of ASWs reported experience of guardianship, either as applicant or in making the recommendation. Both service users and carers reported a lack of understanding about the role of the ASW and complained about the lack of alternative resources that ASWs could use to prevent hospital admissions.

Author CAMPBELL Jim et al

Title The management and supervision of Approved Social Workers aspects of law, policy and practice.

Reference Journal of Social Welfare and Family Law, 23(2), May 2001, pp.155-172.

Abstract This article reports on the first extensive survey of Approved Social Worker (ASW) activity in Northern Ireland. It begins with a review of literature that identifies the complexity of legal and professional functions expected of ASWs, in the context of mental health legislation in the UK. Findings include high levels of perceived competence reported by practitioners, but diversity in the management of the service, and some problems in multi-disciplinary working. The emergency, out-of-hours duty teams in which many ASWs were employed appeared to vary in organisation and operation. Service users and carers were generally dissatisfied with the responses to crisis services and appealed for adequately funded community supports. At a time when the review of the Mental Health Act 1983 is taking place, the authors suggest that ASWs can still perform an important statutory role, on condition that there is a more consistent approach to training, re-approval and funding of community-based services.

Author MERCHANT Chris

Title Matching skills to need.

Reference Mental Health Today, April 2007, pp23-25

Abstract The amendments to the Mental Health Act 1983 are designed to bring the mental health legislation in England and Wales up to date. This article looks at the implications for the mental health workforce and mental health service users of the introduction of two new roles in England and Wales those of the responsible clinician (replacing the responsible medical officer) and approved mental health professional.

Author BASSET Thurstine CAMPBELL Peter ANDERSON Jill

Title Service user/survivor involvement in mental health training and education overcoming the barriers.

Reference Social Work Education, 25(4), June 2006, pp393-402

Abstract This article discusses 10 barriers to the involvement of service users/survivors in learning and teaching about mental health in higher education, suggesting ways of overcoming each. The paper is addressed to mental health trainers and educators, some of whom will be mental health service users/survivors. The involvement of carers/relatives in learning and teaching is not covered in this article, thought it is acknowledged that they have an important role to play and some of what we have written will have relevance to their involvement.

Practitioners’ messages

● Social workers have a distinctive role in multi-agency settings.

● Social work needs to develop practices which help people with mental health problems identify and realise their own needs.

● Social work has a significant role to play in co-ordinating efforts to support those who have had negative experiences of mental health services.

● Social workers need to maintain a broad social view of mental health problems especially in regard to concerns about discriminatory practices, civil rights and social justice.

● Policymakers need to focus on the role that social work plays in integrated mental health services and support further professional development.

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