Mental health services risk becoming fragmented and put under increased pressure by councils withdrawing social workers from integrated teams, NHS leaders have warned.
Councils across the country are reviewing partnership agreements with mental health trusts and, in some cases, have scrapped them. Under these, social workers are seconded to trusts to work within integrated mental health services.
“In the main, it’s being driven by the significant financial difficulties that local authorities are finding themselves in,” said Steve Shrubb, director of the NHS Confederation’s Mental Health Network.
Though he said it was “some way short of being a trend”, he feared more cases would follow. He added that, although councils were taking the decisions “reluctantly”, they were having adverse effects.
“Most community mental health teams have one or two social workers,” Shrubb said. “They have got caseloads. The workload doesn’t go. It’s bad news for the patients. It’s bad news for the staff.”
He added that it could cause care to fragment: “You’ve got the less-than-effective process of the community mental health team having to refer on their patients to a social worker. It runs the risk of a more fragmented approach.”
Shrubb said he was talking to the Association of Directors of Adult Social Services to determine how widespread the practice was and what was driving it.
Councils were also concerned that mental health trusts had different agendas in areas including personalisation and adult safeguarding, said Ruth Allen, director of social work at South West London and St George’s NHS Trust.
However, she said integration helped ensure that families didn’t “jump through hoops” and enabled social workers to help make the NHS more personalised.
“One thing that will also be lost is for social care and social work to change the institutional thinking of the NHS,” she added.
One of the five boroughs Allen’s trust works with, Sutton in south London, brought its mental health social workers back in-house last year, in agreement with the trust.
Shaun O’Leary, Sutton’s executive head of adults and safeguarding, said it reflected the council’s belief that social workers were “micro-commissioners” of care, like GPs.
“This allows the council to have a common approach to social work practice across all client groups with the primary focus being on personalisation by promoting choice and control, promoting independence and robust risk enablement,” he said.
Claire Barcham, chair of the national approved mental health professionals leads network, said some social workers had felt their professional identity diluted by secondment to mental health trusts, and that the response from practitioners brought back under council management had been mixed.
“It’s fair to say that some social workers have been quite relieved; some have not been so happy because we have learned a lot from being in integrated services,” she said.
Birmingham Council withdrew its social workers from Birmingham and Solihull Mental Health NHS Foundation Trust’s management in 2007, though staff are still co-located with their NHS colleagues. Northamptonshire Council announced plans to do the same earlier this year, so that it could deploy its social work staff “flexibly” and make savings in mental health, while retaining an “integrated care pathway”.
Isle of Wight Council is also consulting on bringing its mental health social workers back in-house but it emphasised it would continue to provide a combined service with Isle of Wight NHS.
Lucy Butler, secretary of Adass’s mental health, drugs and alcohol network, said she expected most councils to retain partnership agreements, because the “pain of integration” was worth it.
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