Ministers and mental health strategies talk about the need for increasingly integrated care in mental health. Yet feedback from social workers on the frontline suggests a growing trend in the opposite direction.
In the face of a combination of cuts, reduced capacity and rising demand, health and social care services should be working together on integrated mental health care, not retrenching to our own professional areas in a shortsighted bid to defend our individual budgets.
The retreat from integration
Yet this retreat from integration is already happening in parts of the country.
Some councils have already pulled their social workers out of integrated mental health teams, with other local authorities considering following suit. In other areas mental health trusts are pulling out of integrated working.
In some cases, social workers say there was little or no consultation on the decisions, even in areas that have been fully integrated for over two decades.
Meanwhile radical reform and restructuring programmes in NHS mean that many areas have lost staff and management who were dedicated to integration and committed to the dogged determination required to make it work.
Payment by results and ‘silo’ working
More barriers to integration are on the horizon too. Social workers fear that initiatives like payment by results in mental health, with its emphasis on medical treatment and intervention, have been developed in isolation from social care partners. That can only lead to more working in ‘silos’.
At BASW we are undertaking a joint piece of work with The College of Social Work’s Approved mental health professionals (AMHP) network on the extent of disaggregation in mental health. You can help by completing our survey and sharing your experiences of integration and disintegration.
The project will inform a planned joint declaration on integrated working from the inter-professional collaborative BASW is part of alongside organisations including The Royal College of Psychiatrists and the Royal College of Nursing. We have already sent a paper on integration to Norman Lamb, the social minister and will continue to make him aware of social workers’ experiences of disaggregation.
Integration benefits service users
Why are we taking on this piece of work? Well, most importantly, shifts away from mental health integration threaten to damage the care provided to service users and their families.
Service users and their carers tell us, particularly in mental health, that they do not differentiate between their health and social care needs. They need services to work together, not retreat into silos.
Fragmentation of services leads to multiple entry points. It means people are subject to multiple assessments and forced to tell personal stories time and time again to different professionals.
It risks disengagement from service users at a time when they are most distressed. These are the very reasons integrated care was introduced years ago, yet in some areas that seems to have been forgotten.
Disintegration’s threat to professionals
Feedback to BASW’s mental health forum suggests disintegration can negatively impact professionals too.
Social workers withdrawn from integrated teams give varying accounts. Some complain that their role has been reduced to just doing community care assessments with no long-term work. Others talk about having been made a service broker, not a social worker.
Social workers bring an extensive knowledge of mental health law through our previous role as approved social workers (and currently as AMHPs). Several social workers have had specialist training in forensic work, family interventions and cognitive behavioural approaches.
Losing these skills from mental health teams risks a loss of specialist knowledge.
Doing integration well
We know that integration hasn’t been done well in every area. And when it is done badly it can affect social workers’ ability to carry out their roles. It can result in them feeling isolated and undervalued.
But integration can be, and is being, done well. Areas such as Torbay and Cornwall remain committed to integration and have overcome issues which others perceive as barriers.
Approaches that involve factors such as joint commissioning, strong leadership and a culture of respecting all members of multi-disciplinary teams need to be shared more widely. It is reassuring that Monitor, the body charged with regulating health and social care, has affirmed the benefits of integrated care.
BASW supports integration if is done well. We are clear that integration should not be about assimilation that attempts to turn professionals into one homogenous body.
Role identity, and the different skills and approaches brought to mental health from different professions, is crucial. It benefits staff and, most importantly, service users. We must not forget that.
Faye Wilson is a social worker and chair of BASW’s mental health forum