‘It’s time to give social work an equal presence in the mental health system’

By a locum social worker

For almost 10 years I have worked in mental health teams up and down the country. My posts have covered geographically dissimilar areas, yet across the board their rationale and medically-dominated paradigm of providing care have been markedly similar.

Social work may have a presence in NHS mental health services in terms of numbers and genders. However, the reality is that our profession – and the social model of mental health that underpins our practice – is marginalised in the service paradigm.

How can this be when mental health has such a social context? How many people do we see with mental health problems which propagate from difficult lives? Stress and trauma, physical illness, violence and abuse, relationships, poor housing, unemployment, welfare cuts. The list continues to grow.

Surely these vulnerable souls can’t just be patched up with happy pills, therapy and regular clinic appointments? Yet every day I am exposed to the chimes of the need for more therapy, medication changes and treatment. Far less attention and discussion is given to social interventions.

This disparity in the system is not confined solely to the people it supports. Inequality also pervades the staff team. Why are social workers not afforded the same opportunities for training as our nursing and medical colleagues? Why are we not part of ‘psychological forums of discussions for complex cases’? Why is there no presence for discussion or consultation when changes occur? Why does work with eating disorders not recognise the need for social reference yet such needs are linked to social circumstance?

This arrangement makes social work isolating, depreciating and unsatisfying. We are bestowed with nurse consultants but have no social work consultants to consult with. It is widely acknowledged that there is a dearth of such professionals. In invariable circumstances where teams are blessed with social work consultants, they are often directly employed by NHS trusts. How autonomous would this support and knowledge be?

One could ponder if this is under-representation is tantamount to discrimination. The very essence of social work is to challenge and try and help people improve their circumstances in their lives. Whilst we are rightly exposed to such challenges, why is the chance to improve circumstances not reciprocal in mental health? Why do we lack such opportunities for growth, greater integrity, knowledge and professional development?

Has anyone in their managerial wisdom wondered why re-referral rates are so high or why, at least in my experience, mental health referrals are increasing? Or perhaps why we have waiting lists for services of a year or more?

I work as a locum and strive to hold on to the very filament of the one-to-one relationship I have with the person and their family I try and support. I fear this will become increasingly weakened as we shift towards group working due to further financial curtailment.

Is it not about time to afford social work equal presence and reference within mental health services? A panacea perhaps, but one I believe can be realised.

A beleaguered social work locum  

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