Debate on role of new approved mental health professionals

We asked:- Will the new approved mental health
professionals be sufficiently independent to fight for the rights
of the patient?

These are some of the comments we received.

“The role of the ASW is soon to disappear in new
legislation, we should not fool ourselves into believing that the
role of the AMHP is broadly similar to ASW. It is legislation and a
role that the other mental health disciplines are welcome to.

The nearest equivalent to the ASW role in the new legislation is
as a tribunal member. We should use our skills, knowledge and
professional values to critically examine the need for compulsory
treatment orders as members of these tribunals. For the rest of us
we can go back to being mental health social workers freed from the
time consuming burden of ASW work. We can effectively advocate
alongside the users of services for a wide range of support and
care that is based on the person and not on narrow diagnostic
categories. We would also be in better position to independently
question the need for and the ethics of compulsory treatment in
hospitals or in the community.”

Paul Earnshaw

“Once you open the ‘ASW’ role up to professionals bought up
in the medical hierarchy, it is inevitable that many future ‘CPN
ASW’ raised in this culture would defer to the psychiatrist and
just sign the form.  Psychologists (who may be more likely to stand
their ground) are indicating (as a body) they would be not be
interested in this role.

During a Mental Health Act assessment when I explained that I
was  independent of the two doctors attending, a service user said
to me, “you all piss in the same pot”.  What hope then for the
Approved Mental Health Professional already stuck in the medical
hierarchy?

Perhaps, though, I’ll be surprised and common sense (and human
rights) will prevail – and the role will be kept where it belongs –
away from health professionals.”

Thomas Payne

“I have been an ASW for 25 years and it is clear that with
regard to basic human rights and balanced judgement only social
workers or some other trained group independent of the medical
profession should have this role.

This is so obvious and has been stated by professionals and
service users alike. The government and its advisers clearly do not
listen, do not understand this basic concept or have a vested
interest in continuing down the current path. Social workers are
trained to have a more holistic systems type outlook.”

John Herod

“I honestly believe that the role of the AMHP is ill
conceived and will do nothing to maintain an independent
perspective. If anything it will do little more than rail road the
social model of care out of the field of mental health. But lets be
honest that’s what the “New Labour  Machine” has been striving for
in all its supposedly new initiatives.”
 
Paul Calder ASW (for now at least)

“If the government’s proposals do go ahead, despite the
overwhelming volume of opposition to their proposals for abolishing
the ASW role, I cannot for the life of me see how other
professionals who come from different professional backgrounds, can
fully appreciate and implement through their practice, the unique
and explicit value base which is inherent in good social work
practice.

I am referring here to the fact that anti-discriminatory and
anti-oppressive and inclusive practice is an inherent component of
all professional social work practice. This is not to disregard the
excellent work done by the vast majority of mental health workers,
both qualified and unqualified. However, I find it difficult to
believe, that without the social work training, the role currently
undertaken by the ASW’s is not possible.

Of course, anyone can undertake the necessary knowledge
acquisition, but without the training and experience in social
work, I struggle to see how that knowledge will be applied in the
assessment and application process. It boils down not to what
professional people do, but what underpins those actions at a time
when people are at their most vulnerable. In addition, the
‘independent’ nature of the ASW’s role is
absolutely vital and paramount in these situations.

I was also interested in the statement made by Debbie Green
(College of Occupational Therapists) that:- “At the moment,
OT’s are not ASW’s and service users do not consider
them as a threat.”

This statement made me wonder whether Debbie really understands
the role of the ASW. There is an implication in her statement that
she does not seem to appreciate that a primary role of the ASW is
to ensure that people’s rights are not violated, the very
opposite of what is being implied in that statement. If this is a
reflection of the Occupational Therapy perception of the
ASW’s role, then it would appear that there will be a steep
learning curve for those occupational therapist who may decide to
become AMHP’s.”

David Kell

“I have recently arrived in the UK from Australia where l
worked as a Youth Psychiatric Rehabilitation Support Worker in the
non-clinical sector. My role was to develop a best practice model
for working with young people with severe mental illness aiming to
reduce future hospitalisations.

As there is a long history within the mental health sector to
maintain support for young people in mental health services, unless
sectioned, because of the stigma associated with mental health. The
consumer driven community based approach was extremely effective in
retaining young people in the voluntary participatory service,
Consumers felt empowered and in control of their treatment and as a
result would regularly attend and maintain their clinical
appointments and over time would attend them independently.
Clinical consultation for the young people was seen as a means to
an end in their road to recovery and not so daunting when supported
by someone who was not perceived as an authority in their health
and well being, though had the clout to advocate for them when
necessary.  

You can almost propose that in a sense taking the ASW’s
out of mental health would be re-institutionalising mental health
service taking the ‘psychosocial’ out of a
biopsychosocial approach which has and is increasingly proving to
be so effective. It seems to disregard recent studies into
effective service delivery for people with psychiatric disorder,
for example; an American (Yale University) study on schizophrenia
when interviewing people with the disorder concluded that the one
consistent factor in treatment that contributed to recovery was not
medication or hospitalisation it was having one individual in their
life whether a support worker, friend, partner or doctor, that
would pay them the time to listen, support, encourage and believe
them.

This if anything just enforces the need for non-clinical
influences in mental health and enforces the work of Oliver James
that looks at the role environmental influences play. From my
experience in Australia is has often been an uphill battle in
working with the clinical sector as they often fail to acknowledge
the environmental factors in mental illness wanting to pay far more
attention to the symptomology, prescribing, diagnosing and
assessing. I do not argue that this is not important but pose that
it is more a portion of the road to recovery and not an
emphasis.

From my perspective medications provide a holding ground fro the
illness while the life management work can be implemented with
support by the service consumer. With my strong views of this
approach the strong clinical views proved good grounds for positive
conflict and balance into the effective treatment of mental
illness. The clinical emphasis will always be in place when service
is delivered from someone from that school of training thus the
need for ASW’s for that holistic approach to complete a
biopsychosocial framework for service delivery

Just from my perceptions from the articles l have read since
being in the country is that it seems that the psychosocial aspect
to recovery is being undervalued (as seen article in Community Care
July 04 ‘week in the life’) which may be a result of
the culture within the services which in this article it seemed
that the service consumers are not listened to, that while the
theory emphasises self determination the approach in this case
seemed more patronising which thus results in ineffective service
delivery.

When looking at the comparison between the UK and Australia /
New Zealand community mental health services the service theory and
framework is similar but the key difference (based on the said
article) was people, training, culture and attitude. Like with all
services they will continue to be ineffective if they do not adopt
and promote these key ingredients.

Ash Creighton

“So, three quarters of those surveyed about the replacement
of ASW’s disagree with the government’s (or should I say Alan
Milburn’s) proposal. At first sight, it may just seem as if this is
New Labour being contrary again, like over the peace protests, or
clause four, or any occasion when the population disagrees with it.
They say “No!” so Tony says “Full steam ahead!” 

But it is only too obvious why Labour wants rid of not only
ASW’s — but all “social workers” of any shade. There are two
reasons. One is that it wants to kick the last vestiges of local
government into touch, and cut thousands of posts in local
government, just as they’ve just cut thousands of civil service
posts. The proposal is consistent with “e-government” etc. but the
real agenda is to centralise power through more and more distant
forms of accountable political structures (i.e RDE’s et al.)

The other reason is the cultural need to disassociate Labour
with its former political allies in the radical movements of
yesteryear, including the social work movement. Anyone to the left
of George Bush is now the “enemy within”( just as I remember the
way “New” Labour purged long respected members who fought to keep
clause four ten years ago). Of course, we ought not to be too
precious about the ASW tag; some CPN’s are already coming forward,
and some police officers and military people too. All we ask is —
do the same training, and broadly speaking be ready to challenge
potentially officious, and often misguided medical assessments,
which have a potential to damage people’s lives.

What is galling, is that there aren’t many examples of “good
news” stories about our profession, but it seems this is one story
about how social work got it right for over 20 years, on the whole.
Now, despite this, all is to be swept away. The real losers — and
they don’t yet know it, are the public — who, when they are to be
assessed in future, may very well find their liberty, and their
rights compromised.”

Martin Wall (ASW)

“As an ASW I am very concerned about the diluting of the
role.

The ‘paternalistic’ medical approach needs to be balanced with
the ‘rights based’ approach of social work to ensure that people do
not get detained when there are more appropriate alternatives. 
Social workers are more skilled at taking positive risks and better
at balancing rights and risks.  They are also taught to challenge
the status quo, which other professions are not.

I do not believe that a nurse or an Occupational Therapist would
challenge two doctors in an assessment as challenge to doctors is
rare in their work to date.  Their culture just does not work in
this way.  In any event, both professions want to ‘preserve their
therapeutic relationships’ with their patients (note that it is
mostly only social workers who think service user) i.e. you ‘do to’
patients rather than ‘work with’ service users

At a meeting I attended recently, social workers who work with
older people are particularly concerned that a higher number of
older people will be brought into hospital; currently it is the ASW
who declines to make the application which allows a lot of older
people to stay in their own homes.  I guess I could be one of those
people, which is very scary!” 

Teresa Henson
Approved Social Worker