The mental health group of the British Association of Social Workers is right to warn of the dangers of separating social work from NHS managed integrated mental health services.
Service users and families rarely benefit from multiple assessments and transitions between services. We must focus on making integrated services and systems work better. We need to build the voice of social work within integrated services rather than dismantling hard-won interdisciplinary and interagency arrangements.
But the debate about integration needs to go further. It is not just about a social work presence in NHS teams, but instead should mean creating and sustaining a wide range of statutory, non-statutory and community networks and partnerships to meet local needs and aspirations.
We need to be more ambitious about what social work and social care can achieve in mental health. Our aim should be to use the concept of integration to fundamentally modernise the institutions of the NHS, to work with allies across the mental health sector in this endeavour, and to lead on the development of new partnerships with service users, families and communities.
The impact of social work in the NHS
Social work is all about relationship-based practice, promoting empowerment and justice, countering stigma, enabling people to access their entitlements, often taking difficult decisions about the rights of different parties.
Research has shown repeatedly that the things of most value to service users often overlap with social work’s priorities, skills and knowledge base. While social work and social care have brought these perspectives and interventions into integrated services, they have not yet had the wholesale impact many mental health activists would like to see.
At policy level the inexorable progress and dominance of diagnostically-driven ‘care clustering’ and Payment by Results is testimony to this. In frontline practice, the difficulty of integrating truly personalised self-directed support into mental health care coordination structures offers evidence that mental health has not yet truly transformed into what is most needed; an overarching social approach and a culture.
Time to assert our role
The reasons for this are complex and varied. Social work practitioners and managers are usually just a small part of NHS trusts, and the institutional power of the medical and other health professions cannot be underestimated.
Commissioning processes and partnership agreements between local authorities and NHS trusts have often lacked the rigour required to uphold high quality social care performance and social work practice.
Local authorities have had variable commitment to ensuring and supporting very senior social care leadership within host NHS organisations. And over more than a decade, social care leaders in local government have largely shied away from seeking to lead and influence strategy in the mental health sector, both nationally and locally.
Now is the time for professional mental health social work leaders and managerial leaders within local authorities to work together to get more leverage on the mental health sector.
The College of Social Work seeks to work closely with directors of social services, the Social Care Strategic Network for Mental Health, the NHS Confederation and other key allies to not only promote integration but to ensure future integration means social and recovery approaches have a greater impact on the shape of the future mental health.
Ruth Allen is chair of the College of Social Work’s mental health faculty