Recently in Mental Health Category

Mark Drinkwater is a community worker and Community Care's practice adviser.

By Stuart Ayris

In 2009 I was given the opportunity to manage a community mental health team, having spent the previous 12 years of my career as a psychiatric nurse working on the wards.  

Although I have been a nurse for 14 years, I have never defined myself by my profession. The first thing that struck me about my social work colleagues was how important being a social worker was to them; their passion for what they do, the oft expressed belief that all decisions should be considered within an ethical and moral framework. Phrases such as "in the spirit of the Act," and "the best interest of the client" echoed around the walls of my newly inhabited office. These people were proud of their profession.  

The first time I was told, "you should have been a social worker," I was a little bemused. All I had done was remark that medication isn't always the answer. Did that imply nurses only consider pharmacological interventions and that social care has a monopoly over right and wrong? When a student nurse asked me what it was like being a social worker, I began to look deeper at what was going on. Me, being mistaken for a social worker? The cheek.

Working with my social work colleagues has been very much a learning experience. Not only have I had to learn the language but, in my role as team manager, I have had to negotiate the labyrinth that is the council HR and payroll policies. More importantly though I have also been obliged to let go of the years of pre-conceptions that had crept into my consciousness as I toiled away in the acute admission ward.

About a year into my new post, I began to see that what underpins our professions is nothing more complicated than values. The austere economic conditions have forced us, due to increased referrals and reduced budgets, to bridge those historical gaps between the professions. I am not talking about generic working but of one shared value - that of compassion.

If I were a client, I would not care if I were shown a name badge stating "social worker" or a name badge stating "community psychiatric nurse". What I would want to be shown is compassion. And compassion is not the proviso of any one profession. It is beholden upon all of us, social workers, nurses, psychologists, doctors and allied health professionals so show compassion for each other and for those whom we try so hard to help.

So I guess being mistaken for a social worker isn't such a bad thing after all. Not any more. Now that is one hell of a compliment.

Stuart Ayis is a community mental health team manager

by Phil Collins, head of social work at Cedar House, a low-secure hospital near Canterbury for people with learning disabilities and mental health problems

One of the welcome changes in 2007 to the Mental Health Act was that all detained patients have a right to an independent mental health advocate. They act as an extra layer in standing up for a patient's interests and, in the worst cases, bringing to light any malpractice.

However, in March a report by the Mental Health Alliance found detained patients were not getting independent advocacy due to under-funding and inadequate commissioning.

At Cedar House we have advocates visiting twice a week. But, particularly when such advocates are not available, there is a real onus on social workers operating in such services to act as scrutinisers of care.

This is even more pressing when considering that such an in-house social worker will usually be the only non-medical professional on the multi-disciplinary team responsible for a patient's care and treatment. The psychiatrist (responsible clinician), nurse, psychologist and occupational therapist all have a medical training and background. Social workers come to the table with a different skill set. With their emphasis on social models of care and treatment they are - in effect - the only non-clinician in the clinical team.

Every member of every multi disciplinary team in the UK will say they take a patient-centred approach and uphold the highest standards of care. Usually they do. But it is the social worker in that team who is slanted to see a patient's care from a less clinical perspective. I won't tell a psychologist what psychological intervention to use, nor will I tell a psychiatrist which anti-psychotic to prescribe. But I will, for example, make sure a patient's family is kept in the loop on any significant changes to treatment.

One patient I used to work with who was diagnosed with autism was prone to aggression towards another patient. Rightly, the clinicians' proposed intervention was therapy-based -  about improving the interpersonal relationship between the two. My emphasis, however, was on doing our best to keep the two patients apart in the immediate future. It was in the best interests of the victimised patient, I argued.

In a high-standard secure unit, there should be many layers of scrutiny of patient care, as there are at Cedar House. But social workers are the ultimate scrutinisers of a social model of care.

I am not a shy and retiring person, and if something is not as it should then I mention it. I'm not always right and it can sometimes lead to a fierce exchange of views. But I see this as nothing but positive, and so does my team.

If it means being like a sergeant major, and banging our fist on the table to put across our point, then so be it. As the learning disability sector is still in a state of shock after the Winterbourne View scandal, this is what needed to be a social care scrutiniser in a secure clinical setting.

by Nigel Leaney, manager of a mental health residential service

The government may have been forced to rethink its Health and Social Care Bill by endorsing the main proposals of the Future Forum report but they have quickly regrouped and re-emerged as the government which is all listening, all caring. It's a sickening spectacle, especially when nothing much has changed. But sorry there are no sick bowls available; they've disappeared amongst the stink of efficiency savings.

The reforms to the legislation will now require the NHS regulator, Monitor, to soft focus its role in introducing more competition to the NHS while hyping its duties to promote choice, collaboration and integrated provision between health and social care.

Choice or quality

The rhetoric sounds laudable yet increased choice does not necessarily mean a better service. My cable TV offers more choice of channels than I know what to do with. But why bother when most of them are crap? Quality was better when we had a choice of just three or four channels.

Health and social care would be better served if we concentrated less on choice and more on quality. Yet the legislation and proposed reforms don't seem to grasp this.

Extending local commissioning consortia to include other health and social care professionals as well as GPs is clearly an improvement on the original proposals but hardly worthy of hanging out the bunting and issuing three cheers for enlightened reform.

Privatisation obsession

At the heart of the legislation, with or without reforms, lies the government's ideological obsession with privatisation. And the plans to fully embrace the private sector to meet our health and social care needs will continue as before, with the reforms just slowing the pace a little.

The most telling outcome of the government drive is that vulnerable adults will remain exposed to the risk of abuse of the type recently exposed at Winterbourne View. The Financial Times revealed that sub-standard care is far more likely to occur in homes ran for-profit than in charitable institutions.

Left floundering

Spouting the benefits of consumer choice is a smokescreen to ensure as many private care companies as possible get to dip their bread in an £80 billion gravy train. Good for them, good for all the Tories with personal shares in private healthcare companies and future seats on their boards.

The less profitable, more difficult services, not so attractive to the private sector, such as mental health and the elderly, will be left floundering in a financially bereft NHS after £20 billion is stolen in so-called efficiency savings.

No cherry picking, announce the reforms. And how exactly will the government stop this? Of course! In the same way stern, no nonsense way they reined in the bankers - excuse my cockney rhyming slang.

(Pic: Kreative Eye - Dean McCoy)

by Peter Corser, a social worker in a mental health team

This comprehensive spending review is going to lead to a double whammy of driving more people into the arms of services that are less well equipped to deal with them. It seems more an ideological move to shrink the welfare state than a move to tackle the deficit. We already have genuinely unwell clients being pushed towards relapse with the stress of being forced to work when they are not well enough to do so.

by Dr Steve Rogowski, a social worker (children and families) with a local authority in NW England.

The happiness and well-being of people is an increasing priority for western governments. In effect, New Labour had its own happiness tsar in Richard Layard, professor of economics at the LSE. He is involved in the publication of a new report on this ever more important topic: 'The State of Happiness'.

Review of  A Straight Talking Introduction to Psychological Treatments for Mental Health Problems by David Pilgrim

Rating: 5 stars

Review by Tina Coldham, national development consultant at the Health and Social Care Advisory Service

by Nigel Leaney, manager of a mental health residential service

It isn't often that soap operas get it right when it comes to portraying someone with mental health needs. Yet the character from Eastenders, Stacey Slater, played superbly by Lacey Turner, gave a credible and poignant account of a person with bi-polar affective disorder slowly going under. Of course it's a soap, so all the conventions of high drama and conflict were a necessary part of the ingredients, though the writers steered clear of becoming gratuitous or pandering to the merely sensational.

writes Nigel Leaney

Rituals are important to humans but it is vital to banish those with negative connotations and develop new, positive ones

Ritual is important. It marks beginnings and closures that punctuate our lives. We all need a sense of our time passing and a space where we can be reflective and honour transitional events. Birthdays, anniversaries, important moments in our lives stream by in a seemingly endless procession, tracking down the years. Marking occasions as a ritual gives greater shape and structure to them and an added sense of meaning.