We’re at the Crossroads

Mark Blinkhorn has been an approved social worker since
1995. Prior to that he spent some time working in children’s
services. He is currently employed by Redcar and Cleveland social
services department as a senior practitioner within Redcar’s
integrated community mental health team (Newlands).

The shifting of resources within mental health from the hospital to
the community has had a major impact on the workforce, as have
government policy and legislation. These in turn are likely to have
been coloured by responses to inquiries into adverse incidents over
the years. Little work has been done with mental health social
workers in integrated community mental health teams to explore
whether the changes have been positive for the profession and for
users.

The Northern Centre for Mental Health (now re-formed as one of
eight regional development centres for the National Institute for
Mental Health in England) commissioned a project which resulted in
a report being published last year.(1)

It was argued that social work continued to play a key role in
promoting a whole person and whole system approach to users from a
more social perspective. Such an approach was felt to be necessary
to the implementation of the government’s National Service
Framework and other supporting initiatives.

But the report found certain problems for such an approach –
particularly the lack of integration between various social care
roles. Social workers and mental health nurses especially need to
promote the cross-fertilisation of their differing skills and ideas
through inter-disciplinary working – a better option at present
than seeking to create some form of hybrid worker.

Other barriers to effective practice included the amount of
duplication of work done by social workers when seconded to the
larger more dominant health organisation. Also, equal access with
health colleagues to leadership and higher academic training was
felt to be necessary.

Most social workers strongly endorsed the desire for line
management and supervision systems to reflect joint and separate
professional accountability, ongoing support and conflict
resolution issues.

That there has not been enough emphasis on the social care
perspective in mental health has been acknowledged by the National
Institute for Mental Health Excellence, the Social Services
Inspectorate, now the Commission for Social Care Inspectorate, and
others.

Many social workers felt that they were at a clear disadvantage
compared with health staff when it came to tackling the complex
causes and variables which impact upon mental well-being due to the
paucity of the social work knowledge base. This indicated the need
to promote more evidence-based practice and research.

The lack of identifiable specialist skills and expertise
(consistently called for by the social work professional and
accrediting bodies) was felt to be in need of urgent rectification.
One way of countering this deficit and at the same time creating
services more in line with the user perspective was to involve
users more in research, planning and current practice.

The need for a greater emphasis on a more social perspective within
mental health has led many social workers to reflect upon their
relationship with the wider community. Many social workers felt it
important to play a more prominent part in developing preventive
measures to tackle the causes of mental ill health, as well as
addressing the causes of social exclusion.

Some felt that such an opportunity was likely to arise soon given
the greater community leadership role to be undertaken by the local
authority in promoting the social, environmental and economic
well-being of all its citizens. Such a role could utilise the
generic social work training and experience across statutory and
non-statutory organisations to build bridges at all levels within
the community.

The proposal to extend the role of the approved social worker to
other disciplines was seen to be a threat and an opportunity. A
threat because of the watering down of the social perspective and a
loss of the independent, non-medical role currently unique to the
social worker.

Opportunities, however, were envisaged in allowing social work to
regain roles more in line with ideal practice and values.
Additional intensive work with individuals, family and groups might
also be possible within the primary care setting. Work of this
nature with a more therapeutic, educational and preventive focus
was also envisaged as a possibility within the new emerging
functional teams.

Many adult mental health social workers thought the profession was
now at a crossroads. The social model and promotion of the social
perspective in mental health are mandated in government
initiatives.

Although social work would seem to be in a good position to play a
significant role here, some crucial implications do not seem to
have been fully considered and tackled. A lack of proper emphasis
and understanding of the social perspective and the social care
workforce are reportedly a continuing issue within greater
integration processes.

There is also a feeling that social work needs to take a good look
at itself in terms of its relationship with research-related
matters and the community as well as evolving specialist roles and
skills.

Whether social work will be sufficiently able to mobilise itself to
avoid the demise of the profession in mental health, by default
rather than by design, is a question requiring urgent attention
particularly if the outcome is to the detriment of users.

Responsibility for change clearly rests at all levels.
Nevertheless, advances made at an organisational level (local,
regional and national), appear to need greater attention and better
communication to ensure the most positive outcome for all.

PROJECT METHODS
In-depth semi-structured one-to-one interviews with 28
representative approved social workers from the North East,
Yorkshire and Humberside region.  Focus of the interviews was on
both the statutory nature of the approved role under mental health
legislation, as well as the wider role of the qualified mental
health field social worker within inter-disciplinary working.

Additional data from two small group sessions following the
one-to-one interview phase as well as input from a workshop day for
approved social workers within the North East.

ABSTRACT
This article reports on how field social workers within
adult mental health services (from the North East, Yorkshire and
Humberside region) have been adjusting to the complex changes
brought about by government policy. It is suggested that it is
important to incorporate a socially driven perspective as an equal
partner in looking at all aspects of the continuing integration
with health, to provide a more modern service.

REFERENCES
(1) M Blinkhorn, Discussion paper: Leading roles in mental
health – social worker, Northern Centre for Mental Health, Durham,
2004. Copies can be downloaded free of charge – www.ncmh.org.uk

FURTHER READING

• P Gilbert, The Value of Everything: social work and its
  importance in the field of mental health, Russell House Publishing,
  2003
• C Williams, From Social Care to Social Inclusion: changing
  perspectives on mental health amongst social services managers in
  the North East, Yorkshire and Humberside, Northern Centre for
  Mental Health – Durham, 2003
• ADSS/NIMHE, Briefing for the Directors of Social Services on
  the Integration of Mental Health Services: positive approaches to
  the integration of health and social care in mental health
  services, 2003 (www.nimhe.org.uk) Telephone 0113 2545000 for free
  copy

CONTACT THE AUTHOR
E-mail mark.blinkhorn@tney.northy.nhs.uk
Tel: 01642 490881