By Dr Martin Webber
Lecturer in Social Work, Institute of Psychiatry, King’s College London
Social workers consider evidence-based practice to be a ‘good thing’, but can rarely identify research evidence which underpins their practice. This is the finding of many surveys on evidence-based practice in social work and of our work with experienced social workers undertaking advanced post-qualifying training at the Institute of Psychiatry.
The lack of a robust evidence base is a particularly acute problem for mental health social workers. Working alongside psychiatrists and psychologists whose medical and psychological interventions are supported by a well-developed evidence base, social workers often struggle to find evidence for the effectiveness of their practice.
This undermines their position within multi-disciplinary teams and makes them a soft target for cuts.
Mental health services are increasingly shaped by National Institute for Health and Clinical Excellence (NICE) clinical guidelines. NICE guidelines recommend interventions with randomised controlled trial evidence of their effectiveness.
This rational way to make policy makes sense, but has led to evidence-biased practice with more easily-measurable medical and psychological interventions taking provenance over ‘messy’ and complex social interventions.
NICE guidelines mean that community mental health team managers now appoint new staff on their ability to deliver cognitive behavioural therapy rather than their professional background.
Further, the bureau-medicalisation of mental health care, a concept which prioritises care co-ordination and risk management within a medicalised framework over social interventions or relationship-based practice, leaves social workers out in the cold (unless they are performing their statutory functions, that is).
If social work is serious about developing an evidence base to support its practice, it needs to produce it in a form which will be recognised by health colleagues and policy makers.
Unfortunately, this means using randomised controlled trials.
Although expensive, unpopular and complex, they can be done and they should be led by social work researchers. If not, psychiatrists and psychologists will do it for us and claim it as theirs, as is happening with the recovery agenda.
At the Institute of Psychiatry we are developing practice guidelines for practitioners to support people recovering from psychosis to connect or reconnect with other people. Funded by the National Institute for Health Research School for Social Care Research, the Connecting People Study is using ethnographic methods to develop this social intervention which mental health social workers will lead.
Grounded in existing good practice, we are aiming to incorporate as much practice wisdom as possible to make the guidelines both relevant and accessible. Next year we aim to pilot these guidelines and pave the way for a randomised controlled trial.
Systematising practice in this way may be an uncomfortable culture shift for social work, but it may be necessary in order to demonstrate the effectiveness of our practice.
Blog: Martin’s Webber’s blog