Black, Asian and minority ethnic social workers are less represented in NHS mental health services than in the rest of the profession, research has found, prompting a sector leader to say it must do better on race.
Department of Health and Social Care mental health social work lead Mark Trewin made the comments after the release of an analysis of the mental health social work workforce in NHS trusts, part of a project he is overseeing to support the development of the profession in the health service.
The national workforce stocktake of mental health social workers in NHS trusts found 18% of 1,551 whole-time equivalent (WTE) practitioners whose ethnicities were known were from Black, Asian or minority ethnic groups, as of September 2019.
This compares with 22% in local authority children’s services and 25% in adults’ services at the same date, according to, respectively, the Department for Education’s children’s social work workforce census and the annual social services workforce report by NHS Digital.
As with other areas of social work, Asian people (5%) were underrepresented in the NHS mental health workforce compared with the English and Welsh population as a whole (8%). The equivalent figure for children’s services and adults’ services was 6%.
And while Black or Black British practitioners (9%) were overrepresented in NHS mental health services compared with the population (3%), the was below the proportions for social workers in council children’s (12%) and adults’ services (15%).
This is despite the significant overrepresentation of Black people in the mental health system, particularly in inpatient services and in relation to restrictive interventions. In 2018-19, Black or Black British people were four times more likely to be detained under the Mental Health Act than white people and eight times as likely to be subject to a community treatment order.
The findings follows news that Black and ethnic minority representation on the latest cohort of the Think Ahead programme (17%) – the fast-track scheme to train mental health social workers – lagged behind that of other routes into the profession.
Sector ‘needs to do better’ on race
Trewin said that while social work was very good at attracting a diverse range of people, mental health can do better and “needs to do better” in relation to workforce representation.
“One of the things about social work is we are very well trained about anti-discriminatory practice, we probably have the best understanding of racism and anti-discrimination of any profession.
“That makes it even more ironic that we have the same problems as every other sector,” Trewin said. “Like with other sectors, the higher you get into management, the less diverse it gets.”
He added: “We need to really review how we’ve dealt with this in the past and have a different future. There’s a lot of challenge coming around that, around the opportunities for Black people to go into management and about the commitment and understanding of social work.”
Trewin’s comments come with issues to do with race under the spotlight within the profession in the light of the killing of George Floyd and the Black Lives Matter protests that followed.
Social work ‘must continue to reflect’ post-George Floyd
This has involved calls for social work heads to show active leadership in improving the profession’s response to Black, Asian and minority ethnic people, and in tackling racism and discrimination within the workforce. The issue was raised in open letters this week from interim chief social workers for adults, Mark Harvey and Fran Leddra, and children’s chief Isabelle Trowler to practitioners and students.
They said, that following Floyd’s killing and the protests that followed, the “scenes and structural issues brought to the surface have caused us to reflect on our profession’s role in adequately tackling racism and oppression in our services and communities. As one of the most diverse professions in the country, we must continue to reflect on our own practice and actions. We must ensure we continue to uphold our social work values, challenge discrimination and oppression, advocating for those colleagues and communities who experience it within our sector.”
Trewin, who works alongside Harvey and Leddra in the DHSC, said developments were now underway to bring about change, citing the chief social workers’ plan to develop a race equality action plan and NHS England’s work on developing a patient and carer race equality framework to improve reduce inequalities in services. This was a recommendation of the 2018 independent review into the Mental Health Act.
“I’m very supportive of what the chief social worker’s office is doing right now, there’s work underway developing a race equality framework which will cover everything including mental health, while we’ve also been working with NHS England on the issues relating to the Mental Health Act review,” Trewin added.
Significant variations in practitioner numbers
The stocktake was carried out by the NHS Benchmarking Network for Health Education England, as part of a wider project, overseen by Trewin, to develop the role of social work in mental health services.
Undertaken at the start of the year, it was designed to provide a comprehensive overview of the mental health social work workforce in the NHS, and draw comparisons with the local authority workforce. The latter was assessed in a separate exercise in 2017 by the NHS Benchmarking Network and the Association of Directors of Adult Social Services.
Unlike other areas of social work, the employment of practitioners in mental health is split between councils and NHS mental health trusts, with some also seconded from local authorities to the NHS, through a range of partnership arrangements designed to foster integrated mental healthcare.
The report identified 2,894 whole-time equivalent (WTE) mental health social workers working within the 55 mental health trusts in England, with 2,211 directly employed by NHS trusts and the remaining 683 (24%) employed by external organisations (typically local authorities). This compares with about 5,000 employed by councils.
Within this, there was significant variation between areas, with the number of NHS-employed WTE social workers per 100,000 population ranging from 0 in seven trusts to 22, with an average accross the country of four, compared with ten per 100,000 population in local authorities.
Regional analysis found high rates of NHS-employed practitioners in the North West and low rates in the South East with variable provision in other regions, including the South West and London, though in the latter capacity overall was low.
The report said the extent to which practitioners were employed by trusts “may point to legacy commissioning arrangements and differential levels of baseline investment and capacity”.
The study found that while 27% of trusts directly employed all social workers in their local multi-disciplinary teams, 12% said this was done through “partnership models” – implying staff were employed by councils – and 61% through a mix of both.
In a webinar introducing the research last week, Stephen Watkins, director of the NHS Benchmarking Network, said that areas where NHS employment was low were likely to be those in which most mental health practitioners were employed by local authorities, though the research does not quantify total numbers of practitioners across both types of organisation in each area.
Lack of NHS-employed AMHPs
The findings also identified a lack of data on NHS-employed approved mental health professionals, with just nine out of 55 trusts able to quantify the number of AMHPs they employed, which amounted to three WTE practitioners per 100,000 population.
This compares with seven per 100,000 population employed by local authorities identified in the 2017 research, indicating that councils are much more likely to employ AMHPs than trusts,
This is not surprising as AMHPs are warranted to practice by local authorities, which are also under a duty to ensure sufficient numbers of AMHPs within their areas.
The stocktake also indicated the NHS mental health workforce was younger than its local authority equivalent, with 32% aged over 50, compared with 38% within councils in the 2017 study.
Trewin suggested that councils may be more attractive places to work for more experienced practitioners because of greater numbers of opportunities at senior level.
The report also found that – as with local authority mental health practitioners – those in the NHS were more likely to be men than the social work profession as a whole.
Overall, among 1,721 social workers for whom data was available, 24% were male, compared with 28% in the 2017 local authority research. By contrast, 86% of local authority children’s social workers and 82% of council adults’ practitioners were female, as of September 2019, according to official figures.