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

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