‘I’ve gone from a skilled mental health social worker to a petty rationer of services’

When news emerged last year that a number of councils had pulled, or planned to pull, their social workers out of multidisciplinary mental health teams, the social work profession was divided on the potential benefits or shortfalls of the moves.

Now findings from a snapshot survey of 76 mental health social workers, including 17 who have been pulled out of multidisciplinary mental health teams, offer an interesting insight into how these changes are impacting the social work frontline for better, and for worse.

The survey, conducted by the British Association of Social Workers, covered social workers in 23 areas. Most – although not all – respondents voiced concerns over the impact disintegration of mental health teams was having on their work.

Problems reported by social workers pulled out of integrated teams

Practical issues raised by social workers about the break-up of multidisciplinary teams included:

• Problems with new social workers building positive relationships with medical staff
  
• Social workers are “no longer viewed” as part of recovery-oriented mental health services in some areas
  
• Joint assessments are more difficult to arrange
  
• Social workers pulled out of teams cannot access case information kept on NHS information systems
  
• Disintegration has led to duplication of tasks and a breakdown in joint working
  
• Social workers feel “cut off” from the additional knowledge and training that came from working directly with health colleagues

One social worker who had worked in an integrated team for seven years before being pulled out by their local authority said that social worker and community psychiatric nurse caseloads had risen after the break-up of the multidisciplinary team.

“Often people are getting several visits from different team members whereas they had one person before”, the social worker said.

Another social worker who had been moved to a local authority social work team after being based in a multidisciplinary team said that “generic teams are not meeting the needs of community”.

“I feel that disintegration was one of my county’s worst ideas to date – it is failing service users and failing professionals. I am going to look for another job in an area where they are still integrated,” the respondent said.

One respondent who had been pulled out of a multidisciplinary mental health team to be redeployed to generic adult services said they “feel deskilled and not valued” as they are “not allowed” to practice some of the therapeutic mental health work they are trained in.

“All the focus [in my generic adults team] is on assessing and commissioning services using personal budgets. I have gone from being a skilled professional provider of a service and valued team member to being a petty bureaucrat and rationer of services provided by unqualified others,” the social worker said.

“My colleagues without exception feel similar and I have yet to meet a service user who thinks that the new system is an improvement”.

A more positive view

Yet social workers in other areas, albeit a minority of respondents to the BASW survey, did feel that being reassigned to generic social work teams had positive implications for their jobs. These included renewed contact with other social workers and an increased awareness of community services.

“I feel more confident in my practice as a social worker since moving from the location where the multidisciplinary team was based together,” one respondent said.

Familiar concerns emerged over the marginalisation of social workers who are based in multidisciplinary mental health teams too.

One respondent said they were frustrated that the social model of care is being “ignored and ridiculed” and said social workers in their team felt “forced to comply” with clinical approaches to mental health treatment.

One social worker trained as an Approved Mental Health Professional (AMHP) said being pulled out of an NHS-based team had helped boost social workers’ “independence” from clinical teams.

Another respondent, who had worked in multidisciplinary settings but had recently been working in a local authority team, said: “There is a positive difference in autonomy, professional accountability and standards of recording in this setting. I would recommend independence from health offices and culture, personally, and I see no need for a lowering of standards as a result”.

‘Systems matter more than structures’

Joe Godden, professional officer at BASW, said that the snapshot survey highlighted the need for local authorities to have “well thought out” plans in place if they are going to pull social workers out of integrated teams.

In some cases this hadn’t been the case, with councils withdrawing their social workers without consultation with staff or service users, said Godden.

“By all means we need to look at how we’re doing things and we know that some integrated teams weren’t working well – so just because there is an agreement for joint working doesn’t automatically bring the benefits of integration. 

“But these things need to be reviewed properly and any decisions done carefully, with proper consultation. People tell us that one month they were in a multidisciplinary team and the next month they were told that was stopping,” Godden said.

“In cases like that, where it is poorly planned, then staff don’t understand why and they won’t be on board. My personal view is that it is not the structures here that are important, it is the processes and how they are implemented. Arrangements need to be in place for things like communication and information sharing,” he added.