‘Why I could not accept an honour from this government’ – by former mental health social work lead

Mark Trewin was, until recently, mental health social work lead at the Department of Health and Social Care. But earlier this year, he turned down the offer of an OBE from the government he had served. Here, he explains why

Mark Trewin, formerly mental health social work lead at the Department of Health and Social Care (Photo: Rethink)
Mark Trewin, formerly mental health social work lead at the Department of Health and Social Care (Photo: Rethink)

Earlier this year, I received a surprise email from the Cabinet Office informing me that the prime minister was intending to put my name forward to the Queen for an OBE due to my ‘services to mental health’.

It only took me a few minutes to consider this and to quickly respond by politely refusing to accept this honour.

So – why did I do it? It was clear that my mother was going to give me a hard time, and nobody wants that. I support social workers and social care professionals getting awards and I was very happy to congratulate any friends and colleagues recognised for their hard work in this year’s honours. I was also very grateful to whoever had put my name forward. The rather negative ‘empire’ issue with these honours is currently subject to an enthusiastic campaign for change, so that would not necessarily have prevented me from accepting it.

‘A very personal decision’

This all felt very personal for me, however. After a long career in mental health services across the NHS and local authorities, I have spent the last few years trying to improve and develop social care mental health services nationally. This has involved working across a range of government agencies and it is this experience that has meant that I just could not accept an honour from the government at this time.

My view is that any tiny amount of progress or improvement that I have been involved in or have observed has mostly been achieved by working around the government not with it or because of it.”

This is an administration that has not valued or understood the role of social care and local authorities in mental health and has not taken the action needed to fund, reform or develop it and improve the lives of people who use these services.

In fact, people living with mental health issues have had a much more difficult experience over the decade that this government has been in power, as the recent reports by Professor Michael Marmot have shown.

Social housing has reduced, whilst homelessness increases. The disability and work -related benefit system has become much more complicated and difficult to access for people with mental health issues. The funding of social care services that support people to live in their communities has substantially reduced, and the essential partnership working with the NHS and other agencies has become much harder to achieve.

Social care’s key role

Local authorities have a key role in commissioning and delivering community and crisis mental health services – including a range of issues that the government identifies as a priority. They commission many of the essential community groups and services that keep people well at home. They run the approved mental health professional service that assesses people in crisis. They provide community social work teams that deliver people’s rights under the Care Act. They are essential to keeping children and young people out of hospital and supporting them into adulthood.

Social care is a vital part of reducing the use of out-of-area placements, providing supported housing that keeps people in their own home and ensuring that people receive the positive personalised support they need to live successfully and independently in the community. Key parts of the NHS long term plan cannot be successfully delivered without social care – especially the brilliant community mental health framework currently being rolled out across the country.

Much of this information on the need for reform to the funding and organisation of social care has been made clear to the government by a range of social care experts, organisations, service users, carers and community or charity leaders. Recently, a group of social care leaders wrote to the prime minister and the previous secretary of state to outline the importance of social care reform and funding that includes a positive vision for all age groups and an integrated workforce plan.

NHS and civil service support

It is not just those involved in social care who feel passionately about this. Colleagues in NHS England, the Health Foundation and NHS Confederation have put forward eloquent and evidence-based arguments for mental health social care to be funded and reformed to act as an equal partner, working with them to modernise mental health services.

Many civil servants working across government recognise the need to improve the role of social care in mental health and actively try to achieve this. The proposals to reform the Mental Health Act clearly outline the need to fund and reform social care if the positive changes suggested are to be implemented.

The response of the government has largely been to ignore all of this advice and evidence.”

Mental health developments and funding are largely based around the NHS. The long-heralded social care reform has been stalled for some time. If a version of it does appear later this year, as has been promised, it appears increasingly likely that it will mainly concentrate on the financial reform needs of older people and the protection of their assets.

If this is the case, this will be a waste of a brilliant opportunity to reform and develop mental health social care to provide the personalised, community-based support that people want. Older people are very important, but half of the social care budget is spent on adults of a working age and young people entering adulthood and we cannot forget them.

Positive – but small – steps

There have been some positive steps forward. The reform proposals for integrated care systems go some way towards improving joint working. The Breathing Space legislation has given some relief to people with mental health issues in financial debt. The Think Ahead programme has supported people to make a positive move to mental health social work in their careers. We successfully argued for some resources to expand AMHP training.

Whilst these small steps are welcome, social care needs a major injection of funding to support people with mental health issues, backed up by fundamental long-term reform that places people who use services at the heart of their own care and support.

People with mental health issues, autism and learning disabilities have a right to live fulfilled, independent lives with their families and in their communities. Young people with disabilities have the right to enter adulthood with the support they need to live their best lives.

Mental health is much wider than health and social care services. The relationship between disability benefits, social and healthcare needs radical reform. The Money and Mental Health Policy Institute has brilliantly outlined these issues and what needs to change.

Housing is a major issue within mental health. The lack of good-quality social housing and supported accommodation, together with the rise in homelessness, have been major national issues.

Every day, local authorities are trying to support people through complex systems that do not always help the people who need support. Access to work, no recourse to public funds for asylum seekers, support for carers and the complexities of aftercare under section 117 of the Mental Health Act all need to be reformed and simplified.

Frustration

As someone who has had a small role in trying to highlight these issues, I feel a great deal of frustration at the lack of progress.

No government can resolve all the problems placed before it, especially with a pandemic to deal with, but this government promised to ‘sort out’ social care and has made a firm commitment to reforming mental health.

Local authorities, their partners and experts by experience know exactly what need to change and how to develop the services for the future. The government needs to trust them and provide the funds and supportive national infrastructure to make this happen.

Why government is not supporting social care

I am often asked why the government seems so slow to support social care in mental health when the issues are clear and the advantages so obvious.

The answer is complicated. Many of the civil servants working on housing, social care or mental health policy have a good knowledge of the issues and regular contact with sector leaders. They produce draft plans and reports that are largely welcomed.

The issue appears to be that these are not always reflected in final policies and funding arrangements once the Treasury, Cabinet Office, special advisers, ministers and Number 10 have had their say. Within these offices, knowledge of the issues are weaker and decisions tend to revert to areas where politicians feel comfortable – funding the NHS or resolving issues for older voters.

There is also a wider responsibility for the sector to make a clear argument for social care to be about positive and innovative resolution of the issues facing government and voters. Too often, our message has been one of overwhelming and negative crisis rather than one of hope and change – as the Social Care Future team has effectively pointed out.

I did not feel that I could accept an honour where so little progress has been achieved and so many people continue to struggle.”

I had not been successful enough in my efforts to persuade the government of the vital role of social care to feel that such a reward was appropriate at this stage.

‘Prove me wrong’

My challenge to the government now is to prove me wrong. We have a new Secretary of State who has the opportunity to put right some of the mistakes of the past. Let’s have a social care reform plan before the end of this year that is creative and radical, that includes mental health, younger people and autism and that is designed with people who use services to genuinely improve the lives of all those people with mental health issues currently struggling within the system, and the hard-working professionals who work with them.

Mark Trewin is a mental health social worker. He is writing in a personal capacity.

36 Responses to ‘Why I could not accept an honour from this government’ – by former mental health social work lead

  1. Dee de Bruin July 9, 2021 at 2:51 pm #

    Well done to you Mark Trewin for standing by your principles on this. More needs to be said.

  2. James Wooding July 9, 2021 at 2:59 pm #

    Respect.

    Perhaps others in the health and social care sectors will have as much integrity. Perhaps not.

  3. peter durrant July 9, 2021 at 3:00 pm #

    Well done Mark Trewin. Great courage and a principled response. Peter Durrant. Long retired community community/social worker for three local authorities..

  4. Pat Rich July 9, 2021 at 3:18 pm #

    Well said

  5. Mauereen Lightley July 9, 2021 at 3:29 pm #

    Very well said I have great respect for your decision. Social care, I reference to Social Workers Solicitors and local Authority’s have totally lost their way, across the Board. My heart breaks for the Children and Families, Damaged by the result of Hapless Botched infestigations that cause great harm to children and Families. As an experienced SW I am astounded and shocked how low the bar is set for Families in need in the UK today. Shame on those lecturers leaders, trainers and every one who employs or train Social Workers. Most importantly my heart burn’s for the Children and Families separated and damaged by the SW system in this country, at the present time. Of course there are areas where good practice is in place, However, no one is learning from those areas of Expertise. My fear is we are producing a generation of lost children and Parents.

  6. Sharon Shoesmith July 9, 2021 at 4:34 pm #

    Excellent piece. I shall call you Sir Mark Trewin for talking truth to power. This must be the beginning of others speaking up in such a frank way.

    • Harry July 16, 2021 at 8:50 am #

      But if Mr Trewin was a “Sir” he would be part of Establishment power rather than the citizen radical “speaking truth to power.” The less we venerate ‘honours’ and the more we celebrate and embrace our citizenship the more likely we are to recalibrate power structures. But I am just a practitioner social worker so probably don’t understand the nuances that come with being part of the boss mob in social work.

    • CAROL ANNE FARQUHAR July 22, 2021 at 10:36 am #

      Agree – nice one Mark, great you have made a stand here

  7. Rose Thompson July 9, 2021 at 4:47 pm #

    I am strongly agree with everything said in Mr Mark Trewin statements of not accepting the OBE he is a person of conscience and awareness of service led changes and he understands the need for such changes to be delivered in a manner that keep mentally ill people in their home and in their communities. With ghetto appropriate services, funding and assessments community Social Work led team can carry out their work.

  8. David Minto July 9, 2021 at 5:41 pm #

    Great example. Wish more SW leaders had the same moral compass.

  9. Kenny Edgar July 9, 2021 at 5:47 pm #

    I am so pleased that we have someone at your level; fighting for services with quality; services to be improved entirely for all and fighting for the rights of our users too. Well done you for abiding by your principles and being so upfront and honest with it .

  10. Phillip Briggs July 9, 2021 at 6:06 pm #

    Good for Mark, there seems to be so little integrity these days that it comes as a very welcome surprise to when someone makes a stand on a point of principle.

  11. Mark Monaghan July 9, 2021 at 6:20 pm #

    Full respect to you Mark, we met in London way back and you impressed me at a meeting then. A number of lesser people would have taken the honour in a bid to potentially feather their nest. You didnt and have greater integrity.

    Why take an award from people whose aim is opposite to what we do?

    All the best

    Mark Monaghan

  12. Neil Sanyal July 9, 2021 at 6:24 pm #

    Thank you Mark for your integrity, and for all the hard work you did in that role. I only came across you briefly, in connection with the AMHP Leads response to the White Paper. I think you would have been entitled to mention the massive austerity budget cuts made back in 2010 by Osborne and Cameron, which resulted in 2500 mental health inpatient bed closures nationally and nearly £17 billion loss of income for adults and children’s social services across England and Wales since that time. These have had massive effects on mental health social care.
    It took a global pandemic catastrophe to make this government spend the sums of money they should have been spending 10 years before!

  13. Hilton Dawson July 9, 2021 at 8:31 pm #

    Congratulations to Mark Trewin for his decision to reject the honour & for this thoughtful & brave piece.
    As a politician & a social worker I’m uncomfortable with ‘areas where politicians feel comfortable’ as an explanation of why Govt isn’t supporting social care
    My last efforts to influence were a decade ago but I think it’s ‘Whitehall’ which doesn’t really ‘get’ social work & that must be to do with the culture, backgrounds, experience of some very able & intelligent people within civil service& policy making.
    Fundamentally, I think it’s part of a very English establishment aversion to ‘people centred’ thinking & a failure to appreciate social work which goes back to Seebohm.
    Where politicians are responsible is over the failure of any political party to really grasp how deep the London-centred inertia really goes.
    I’ve been working for devolution of these key decisions to the regions of England, quite convinced that we won’t get real change until there’s a fundamental challenge to all the old ways of thinking & being – & social work has to be part of that
    Are things better in Scotland, Wales & NI ?
    Maybe ?

  14. Rani July 10, 2021 at 7:26 am #

    No doubt it’s a comfort to beleive that at some point in the future there will be no negative associations to such ‘honours’. Those of us from the former colonies beg to differ. My uncle was hanged by the British Empire for fighting for independence. Never likely to forget that. Apart from this, for a profession that claims to value equality, inclusivity, community, the enthusiasm for separating the “Enobled” from mere citizens is galling. Perhaps I missed the bit where platitudes have replaced committment.

  15. Paul Rimmer July 10, 2021 at 7:31 am #

    Excellent article with a nice parting shot.

  16. Old Dinasaur July 10, 2021 at 8:39 am #

    Splendidly put Mark! The entire social system has needed an overhaul since 1990 when I qualified and is worse than ever, as the tragic pandemic stats have highlighted. The entire perception needs to change, recognition for unpaid carers, poorly paid care staff and social workers breaking under the strain – the list is endless and the catastrophic consequences for people desperate for help is obvious. This government seems to see health and social care as a waste of money, until useful for a soundbyte with those naughty service users all trying to defraud the system. I’m preaching to the converted I know but for sure Mark, your mother will applaud you for making a stand – I certainly do, as a disabled old sw who still has some fire in my belly.

  17. David B July 10, 2021 at 5:12 pm #

    Really enjoyed this and appreciate the principled stance Mark has taken. Nice one

  18. MS M SANDERSON M July 11, 2021 at 12:14 pm #

    So true very true from a social worker working in children’s mental health services

  19. Jane Allison July 12, 2021 at 10:54 am #

    It’s good to know that there are some principled people amongst us still. Thank you for taking a stand. I’m not sure that the government will hear that, but if there were more people like you, then perhaps this country would be a different place to live in.

  20. Nick Sorge July 12, 2021 at 4:58 pm #

    Beautifully written, factual information by a man of principal.

  21. Vincent Docherty July 13, 2021 at 9:42 am #

    This was a life and social work affirming article to read. This social worker has effected positive change in so many people’s lives and it was that that has motivated the man not the gong.

  22. B July 13, 2021 at 12:43 pm #

    I totally agree, a clear devout Social Worker & humanist! not accepting honor from a system that we are having to contest with on a daily basis!

    from a fellow Bradford Mental Health Social Worker

  23. Janice Uttley July 13, 2021 at 12:55 pm #

    Hi Mark you are truly awesome. Well written.
    From a colleague for many years.

  24. Karl July 14, 2021 at 7:17 am #

    Right analysis, wrong conclusions. The remedies sought can only be piecemeal if the social structures on which benefits policy, housing provision, person centered care and so on are based on inbuilt inequality. New Labour made their attempt at the kind of piecemeal reforms suggested here while also being “relaxed about people being filthy rich” so ultimately increase in child poverty, underfunded public services and the privatisation of social care provision and of the NHS was the inevitable results. Change the way social relations are formed in an unequal society and justice, respect, dignity, having a stake in political decisions, decent local services and the rest can be our reality. Lastly by definition the honours system is divisive irrespective of the Empire associations. Separating the honoured from us plebs diminishes our value as citizens. I don’t think accepting the principle of being honoured is “speaking truth to power.”

  25. Alison July 16, 2021 at 9:06 am #

    Laudable though it is for an insider to criticise the system they previously propped up, it amounts to nought if under different circumstances Mr Trewin would have been happy to be set above the rest of us. We all work in unstinting ways to be the best social worker we can be. ‘Honours’ are dished out on subjective criteria, they don’t recognise excellence. I have a caseload of 32, I spent months without adequate PPE trying to support people isolated and despondent. I can’t quatify the number of times I have been reprimanded for attending PiP appeals and never mind the unpaid, untaken back overtime. Thousands of us do this day in day out. So no apologies for my impolite comments. I stopped taking notice once the probability of accepting the OBE was half justified.

  26. Loveworthy Chiguvo July 16, 2021 at 2:12 pm #

    Well done Mark, you are a social worker at heart!

  27. Sue Owen July 16, 2021 at 4:25 pm #

    Bravo!
    Also as a social worker who has worked for many years in a CMHT and as an AMHP. The job that I trained for has been impossible to deliver, following decades of cuts in services – lack of psychiatric beds, closure of Day Care services and the ludicrous changes in the benefit system.
    Lots of spin from various sectors in recent times on the importance of acknowledging mental health issues but where is the finance to deliver anything – other than lip service???

  28. Larry July 16, 2021 at 9:06 pm #

    Do not agree with you at all Alison. Whatever the more bleeding heart social workers might think, we are not all equal. Some of us are better at what we do, some pretty useless as the many Ombudsman reports show. I have no problems with bring honoured by our Monarch. The arguments about Empire connotations are fairly inane in my view. It’s about time social workers stopped being naive. We are nothing if we continue to wallow in our supposed outsider status. Let us embrace those powerful bodies that want us to be part of their circle. The more Establishment embedded we are the more influence we can have and be rewarded with better status to boot. The reality is that most social workers are likely to be Conservative voters so denying this is just silly. I hope Mark reconsiders his refusal. Our Regulator is run by a Lord so why turn down an OBE?

  29. Peter Hughes July 17, 2021 at 9:02 am #

    Universal Credit to be cut, food banks usage at record levels, childrens education prospects bleaker than ever, end of furlough scheme to result in higher unemployment, Deprivation if Liberty now routine, waiting times for care assessments ever lengthening, NHS cancelling treatments with cancer care at lowest numbers in decades, a lame to useless SWE obsessing over bureaucratic minutiae, Macallister care review ignoring impact of poverty while castigated social workers for being authoritarian incompetents, council finances in dire straits. One person refusing to accept a tainted ‘honour’ who might say yes if offered it in the future generates applause, warm fuzzy feelings, pride and becomes the definition of “speaking truth to power.” No wonder social work is in the sorry state it’s in and ever more detached from the realities of living in austerity UK. On the road to irrelevance and we bleat on about being a “profession.”

  30. Claire Ormond July 17, 2021 at 11:12 am #

    We are on the verge of insurance based public services and the push for small “small government” social restructuring will gather pace once all pretence of health based pandemic response is abandoned to business interest lobbying. Planned economic austerity doesn’t recognise what are defined as “mistakes” here. So no, there will be no moment of revelation when Mr Trewin is proved wrong by the Prime Minister or the Health Secretary. Worse of all is the pride some social workers feel in being offered an MBE by Brexit Britain. Says all that needs to be said about the vacouity of “our” activism.

  31. Pauline Hunt July 17, 2021 at 4:19 pm #

    Well said Mark, a bigger Percentage of mental health care and support is delivered by social care, more funding is essential to safeguard both users of the services and the staff who provide the care.

  32. John Harkness July 20, 2021 at 9:08 am #

    Man criticises the politicians and the bureaucracy he served and turns down a bauble he might accept if offered it by another chum. Social workers beside themselves with frenzied adulation equating a personal decision with something akin to a prophet dispensing wisdom and prostrate themselves in devotion. Meanwhile our society spins on a reality of austerity, food banks, unemployment, failing services, a chaotic education system, young carers still ignored, inequality, racism, class prejudice, structural oppression, poverty, failed health and social care embedded as daily reality but gets just a shrug of the shoulders by the “profession”. Gestures, hashtags, self affirming echo chambers, ‘heroes’ and ‘warriors’ engaging in ‘activism’ within permitted polite boundaries does not equate to “speaking truth to power”. I am so glad that in 2 months I will be retiring from this impotence parading as leadership.

  33. Colin July 27, 2021 at 12:12 pm #

    Where would we be without the feel good marshmallows though John Harkness?

  34. Terry July 29, 2021 at 11:36 am #

    Who knew that a State approved “honour” could become a socialist award recognising the more worthy if it was handed out by Keir Starmer. Empire medals for a just society? Still not doing it for me.