Keeping social work at the heart of integrated mental health care

 Strong relationships between social workers and NHS staff must be maintained as teams restructure

Splits in mental health teams highlight the value social work has brought to the NHS, say Ruth Allen and Claire Barcham

The mantra of “integration” has long been dominant in national health and social care policy. In mental health, this approach often took for granted that the delivery of statutory mental health services would be largely the preserve of the NHS and that local authority resources would be increasingly managed by trusts.

But we now have a new and more uncertain policy agenda with financial pressures on both sides, and adult social care focusing particularly on self-directed support and more effective safeguarding.

There are also questions about whether all large NHS provider trusts will survive to be the local health provider of choice – let alone the manager of local social care – because of the planned “pluralisation” of provision implied by the Health and Social Bill.

The current turbulence has significant implications for mental health social workers. Despite calls for greater integrated working, there is also a trend towards separation; for example, a minority of local authorities have recently returned mental health social workers to direct council management and some others are considering the same.

The “separatist” tendency is a wake-up call to address some of the underlying problems in partnership agreements that have often not been fully resolved. There has not always been sufficient emphasis on:

● Consistent social care performance management and governance.

● High-functioning operational social care management structures.

● High-quality social work and social care development and leadership.

This challenge needs to be grasped and requires strong strategic leadership at all levels from both the NHS and local authorities. Both organisations must work together to ensure that trust boards give social care the priority it deserves.

In a variety of surveys, social workers have reported that they have sometimes felt “abandoned” by their local authorities and left to survive in an NHS culture that does not consistently preserve or grow their practice. This must be more systematically addressed within arrangements for integrated management if social work is to flourish.

In integrated mental health services, professional leadership of social work needs to be put on a par with the professional leadership that is taken for granted in medicine, nursing, clinical psychology and occupational therapy.

An infrastructure is necessary to ensure social workers are well represented, have a formal voice at the top table and support the development of the whole workforce.

The implications of the Social Work Reform Board, the creation of a unified College of Social Work and the findings of the Munro review we hope will herald a new confidence and higher professional profile for social work.

Employers and managers – in all agencies and sectors – need to promote this so as to liberate the talents and energy of social work staff to work alongside citizens in creative and effective ways.

Social workers make a huge difference to integrated mental health services, challenging dominant models of practice and power bases. Without social work embedded in NHS provider trusts, it is doubtful that the recovery and social inclusion agendas – promoting ordinary life opportunities such as employment, good housing, a social life – would have developed so strongly as the guiding ethos of many mental health services now.

It is also doubtful that community teams could have developed to manage risks without the need for institutional care, enabling lengths of stay on wards to decrease so significantly and bed provision levels to drop dramatically.

Nor would we would have seen the steady increase in referrals of vulnerable adults and children to safeguarding services as practitioners and others pick up more effectively on signs of abuse or exploitation, within services and in the community.

As colleagues in other branches of social work contemplate more inter-agency working, we should be asking what can be learnt from the experiences of integration in mental health.

Above all, we should make sure we are not throwing away the benefits of good multi-professional understanding when responding to the risks that have emerged.

Whatever the structures of provision, the system as a whole must be properly linked together. We must develop strong, local social work professional leadership as well as sound governance arrangements within and between organisations.

This can be done in any structural arrangement that supports integrated delivery on the frontline. What matters is commitment to ensuring social care values and practices are promoted and that social workers are empowered to become ever better at working in partnership with citizens.

Dr Ruth Allen is director of social work, South West London and St George’s Mental Health NHS Trust, and Claire Barcham is professional practice development adviser, the College of Social Work

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This article is published in the 27 October 2011 edition of Community Care under the headline “Integration under threat”