‘Health and social services too often mirror the fragmentation we see in people’s lives’

Integration between health and social services is back on the national agenda. As someone with experience of working in both systems – and who has never felt ‘at home’ in either – I’ve seen some of the challenges of working together from both sides.

One issue is agencies’ perceptions of one another. For example, when I worked as a child protection social worker back in 2001 I remember feeling like CAMHS (child and adolescent mental health services) was one-step removed from what we did. It felt like a distant ivory tower. One that I part despised and part envied.

In more recent times I have been based partly in CAMHS after training as a psychotherapist. I have sat in multi-disciplinary team meetings and seen for myself the raised eyebrows and tuts of colleagues despairing at another story of a child not meeting the ever higher threshold for social services.

Bridging this gap in understanding of one another’s roles is really important. Almost all serious case reviews reach a conclusion that staff across agencies failed to communicate with one another and pass on essential information about children and families. So what is getting in the way of successful joint working?

A major problem is that for all the talk of ‘integration’, in reality many professional systems are far from joined-up. Instead they often mirror the fragmentation and dysfunction that tends to be at play in many of the lives of the children and families we all encounter.

The culture that emerges from fragmented services can be damaging. Misinformation, collusion, mistrust, guilt and blame of different agencies can quickly infuse professionals and dominate meetings. Once staff, from whatever background or profession, become more alert to these fairly universal tendencies we may well be one step closer to new forms of integrated working becoming more of a reality.

we can also promote and contribute healthily to true integrated ways of working on more of a personal level.

I try to always reflect on why my feelings towards a colleague can be so strong? We all feel frustration towards one another at times. In meetings we can unwittingly come to represent the agency we are a part of and attract strong negative feelings accordingly.

CAMHS workers can often be expected to work miracles through the provision of some kind of magic therapy or other. Social workers usually cop it for either not doing anything or appearing to underplay the risk factors in a child’s life or not being reliable enough.

As my career progresses I feel more strongly that the more we can all focus on the needs of the children and families we see and less on differences amongst us as professionals the more effective we are likely to be in our interventions. The reality is it is very tough being a social worker, a CAMHS worker and a teacher, police officer etc. in these troubled and troubling times we all work and live in.

We can all learn from each other along the road towards integration. Ultimately children and families need us to build trusting multi-agency and multi-disciplinary alliances that value one another’s unique, but equally valuable, skills and approaches.

Stuart Hannah is an independent social worker and child and adolescent psychotherapist in Leeds