The way mental health treatment and social care was historically organised, it felt to me that greater individualisation of care for our clients had been put in the “too difficult” box.
There would be a mental health diagnosis and treatment with someone’s social care needs bolted on the side. This approach flowed into how budgets were managed and was compounded by our structure.
When I started at Bromley there was a senior manager for social care and one for mental health. It was if never the twain should meet.
A very radical step
Change had to start at the top. A single senior manager was appointed across mental health and social care. All the professionals involved in mental health services – mental health managers, commissioning managers, the head of social care and housing managers – were also brought together to form a panel that agrees services or, on occasions, challenges whether they are required.
The panel also ensures procedures are followed to enable the service to be delivered.
Looking back these moves look like common sense but at the time the reorganisation seemed a very radical step.
What started at the top cascaded into our work on the frontline. I no longer spend my days as a manager looking at the social care needs of my client but as an assessor working with a multi-disciplinary team to look at every aspect of a client’s treatment and needs.
I look at a package driven by their lives rather than their lives revolving around their care and treatment.
Less risk averse and more imaginative
This holistic approach has freed up our thinking as social workers. We now work with the client to look beyond the mental health diagnosis and treatment, beyond their social care needs. We can step out of that “too difficult” box in how we use someone’s personal budget.
We are less risk-averse and more imaginative about what we put before the panel. Plus, because we as professionals are looking across the complete picture, all the ground-work has been done with the client before anything is presented to panel. It leads to quicker decisions and a much clearer picture about spending.
For example, take someone who is in and out of residential care because their mental health is being damaged by an abusive relationship.
We would work with them to look at supported living options, at how their personal budget could be best used in terms of on-site support to break out of the destructive relationship; or issues around culture and language might be addressed using the budget for a personal assistant who speaks the client’s language.
We all know that mental health has been an area of overspend. The transformation made the panel the gatekeepers of the budget across the board so when we present they know exactly how much and where it is being spent, what someone’s future needs are likely to be and the impact on the overall budget.
Of course, addressing budgetary issues is important not least because the money is being reinvested in much needed community services such as individual flexible support and strengthening the borough’s appointee and deputyship service to work with people to safeguard their monies.
Clients are rebuilding their lives
But for me the success of our approach is in supporting our clients to rebuild their lives, to help them get the foundations right through the right support for them; seeing clients with complex and difficult mental health issues spending dramatically less time in residential care and supporting them to be as independent as possible.
There are many clients who had been in long-term residential care for over 15 years who, with a lot of hard work by them and those involved in their care, are now living successfully in their own home and enjoying life.
By working across the disciplines and because of the make-up of the panel itself, I feel strongly that our working environment is one of sharing experience, learning from each other and a sense of support as we draw on a vast range of professionalism and expertise.
Olu Afuape has been a social work senior practitioner in Bromley since 2004