My practice

    I have heard it said that the only difference between social workers in mental health services and their community psychiatric nurse colleagues is that social workers don’t give injections.

    I find it a real challenge that my identity as a social worker is likened solely to a nurse, but with the skill deficit of not being able to stick a needle in!

    But I want to explore my role positively, considering the responsibilities we have to our service users, our social work values and our professional identity, working in a health-dominated environment.

    Good mental health services consist of three core models: the psychiatry model, psychological (talking) therapies, and the social care model, which is what I believe and practise. Mental health services work best when the three core models are integrated within a single care programme.

    The case of Hannah Southam* illustrates this point. Hannah had been suffering from what her GP believed to be a post-natal depression for several months after the birth of her second child. She was referred to us when she talked about feelings of suicide and that week a psychiatrist and I met Hannah at her home (with her agreement). We concluded that Hannah was depressed, but the psychiatrist felt that Hannah had been depressed before and throughout her pregnancy, and prescribed an antidepressant.

    Over the following weeks Hannah and I established a good relationship and I could introduce some ideas around mother and baby groups and so on. This eased the pressure on her mental health. Hannah disclosed to me (and for the first time) a traumatic history of family sexual abuse. This helped me to understand possible origins of her feelings of low self-esteem and self-confidence. With Hannah’s permission I referred her to a psychotherapist, which she found useful.

    But most depressive disorders are symptoms of social or psychological difficulties or trauma. Antidepressant medication can only “treat” the depression; it cannot resolve the underlying difficulties.

    Social work can make a positive contribution to mental health work. The values that we hold, including working with honesty and working to maintain dignity, self-respect, recovery, determination and independence are as important here as in any area of social work practice.

    But it is difficult. Working in a health-dominated workplace is different from being in a social services one. The challenge of promoting and upholding our value base and the social care perspective is often difficult and time-consuming. But the benefits for services users, carers and families are worth the determination, perseverance and persistence.

    * Not her real name

    Mark Sloman is a social worker, community mental health team, Somerset.

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