Should social workers’ training include basic medicine to help them identify clients’ needs and find appropriate help? Journalist and mental health service user Richard Shrubb says that it should
Social workers are not trained in medicine. For people who have health and social care needs, such as those with mental health conditions, this is a hole that needs to be filled.
Someone in regular receipt of support from social services told me: “If you are talking about recognising ill health you need to be three parts dead before they spot it.”
Once, my wife Penny attended a care programme approach review, in which she and her GP tried without success to explain to her social worker why adding medication for her Raynaud’s Syndrome to her medication for her attention deficit hyperactivity disorder could kill her.
After the meeting, her social worker said that Penny should not use medical terminology as social workers were not medically aware. But that left Penny wondering how much plainer she had to be than using the expression “bleeding to death” to make the social worker understand.
While the medical model may be dominant in mental health care, the bulk of the support that people with mental illness receive is within the “social” part of the term “psychosocial”. This means social care professionals can have far more impact on patients’ lives than their health colleagues.
Almost all the client sees or does in treatment is at least partly influenced by the social care they receive.
The national occupational standards for social work do not mention medical knowledge though they say practitioners should have knowledge of services relevant to individuals and their families.
They also say social workers should “work effectively with others to improve services” for service users and carers. A certain level of understanding about each others’ roles will improve communication between health and social care professionals and smooth the care process for individuals.
For example, most antipsychotic drugs make the patient fat. Knowing the client has been put on such medication and understanding what it means may encourage a social worker to help them access a personal trainer through their personal budget.
A Midlands-based social worker I spoke to said: “In training we have placements, during which we pick up some medicine, such as how to spot someone in crisis. We aren’t formally trained or examined on this”.
Mental health first aid courses are now being provided and involve teaching people to intervene in a crisis in the same way as traditional first aid is about getting someone’s heart restarted after a cardiac arrest.
This Midlands social worker says neither type of first aid course is part of social work training though some of her colleagues have gone on courses and used the knowledge they gained in their practice.
Not being able to intervene if someone is in dire need of medical treatment seems counterproductive, given a core part of social work is being able to support the vulnerable in crisis.
However, the social worker I spoke to says relationships between her and her medical colleagues are good, meaning she can access support when necessary. “We have good inter-team working, and can go up the corridor from our office to the medical team when we think something’s wrong and an intervention is necessary.”
She refers to a case where a colleague was visiting someone in a medical crisis. “They were assessing the client’s care package and saw the client needed a GP. They got on the phone, the GP attended and the client recovered from their medical problem.” In the absence of medical training, knowing where to go for help is crucial.
However, in my experience and those of others I know, social workers need more training in spotting when they need to send for the medics.
We have a lot to learn from users and carers about specific training and professional curricula, writes Jill Manthorpe.
Medication does get addressed in social work training, in my experience, but often at the post-qualifying stage. But it is important not to turn social workers into “mini-medics”. Perhaps their value is that they have more training on disability and social models of support?
Sometimes, within mental health teams these perspectives are confined to social workers. All professionals have different expertise and good inter-professional working can be more than the sum of its parts.
Jill Manthorpe, director of the Social Care Workforce Research Unit, King’s College London
This article is published in the 15 July issue of Community Care magazine under the heading A yawning gap in knowledge