Select an area of Social Work that interests you. Provide an investigation into the ways social workers practice in this are in England and compare it briefly to practice in another area of your choice. Social Work in Mental Health has often been associated with the power to compulsory detain people for admission to Mental Health institutions. This relationship and the role of Mental Health Social Workers has changed overtime, as government policy and wider social influences have impacted on the profession.
The effect has been an evolution in the role, setting, training and regulation of Mental Health Social Workers. The policy agendas that gave rise to this can be broadly compared to similar movements in Mental Health provision in the United States. Prior to the creation of the National Health Service in 1948 Mental Health in the UK was seen as a threat to public health and the emphasis was placed on containing the threat of Lunacy through the detention of people with Mental Health problems, rather than medical intervention (Pilgrim and Ramon, 2009).
To this day “the power to constrain, without trial those posing a putative future risk is only found in Mental Health services and in statutes to pre-empt terrorism (Pilgrim and Ramon, 2009, p. 274). Social Work in Mental Health has often played a key role in the process of compulsory admission to Mental Health institutions. Mental Health Social Work started as a profession in the 1920’s with the emergence on Psychiatric Social Workers (PSWs). They were represented by the professional body the Association of Psychiatric Social Workers, founded in 1929 which was instrumental in training and also kept a register of qualified PSWs.
Their training was heavily influenced by Psychodynamic theory as well as psychosocial theories of Mental Health. The 1959 Mental Health Act resulted in the creation of Mental Welfare Officers (MWOs) who gained responsibilities for the application of compulsory civil admissions, which had previously been held by magistrates. (Rapaport, 2005). PSWs and MWOs remained as the two types of Mental Health Social Work role until the Seebohm Report (1968) which led to a move towards generic Social Service and a move away from specialism in Social Work roles.
Its three core suggestions were that: 1. the current model of diverse and specialist services led to poor coordination and an inability to respond in a timely and efficient manor to evolving needs; 2. a single point of contact for those in need was viewed as philisophicaly preferential; 3. Services should be universally available and a single point of contact would reduce the stigma for those wishing to access services (Wilson et al. , 2008).
The 1970 Local Authority Social Services Act led to the creation of generic Social Services departments under Local Authorities and by 1974 all Social Work contracts had been transferred from NHS to these Local Authorities (Gould, 2010, p52). In 1970 The Association of Psychiatric Social Workers was amalgamated with several other Social Work professional bodies to create the British Association of Social Workers (BASW). The professional register the APSW had previously maintained was abandoned and in 1971 all Social Work training was overseen by the Central Council of Qualification in Social Work (CCETSW).
Many Social Workers found this generic training insufficient for the specialised, statutory duties they had to undertake as part of Local Authority teems (Rapaport, 2005). The 1983 Mental Health Act was bought in to resolve problems with the 1959 Mental Health Act that had reaffirmed the legality to detain people with Mental Health problems for hospital admission, but had not specified whether these powers included the ability to treat those admitted without an individual’s consent.
In the original 1959 act compulsory admission required either a recommendation from two medical professionals, one in an emergency, or an application to hospital management by a MWO or the patients closest relative. There was much concern to the possible abuse of this power through “nearest relative vested interests combining with medical power” (Rapaport, 2005, p 47). The BASW successfully lobbied for greater Social Work influence in the compulsory admissions process to balance these potential abuses of power.
As a result the 1983 Mental Health Act created the new Social Work role of Approved Social Worker (ASW). Provided with specific training, autonomy to challenge medical opinion and the remit to “carry out an early social assessment of the patients circumstances and investigate the feasibility of invoking alternative services or other measures to avoid hospital admission” (Rapaport, 2005, p. 48), Mental Health Social work was close to becoming a specialist role again; although many ASWs still carried generic caseloads (Rapaport, 2005).
A wider policy development that started in the 1960s under Enoch Powell, the Conservative Minister for Health, has been to move away from institutionalised care and the detention of people with mental health problems. This saw asylums closed and a higher proportion of people treated as outpatients. This move ran in parallel to a move towards a policy of care in the community, which believes that care should be available near to where people live, should represent the needs of the individual rather than the vested interests of professionals and that the introduction of market principles would develop a higher level of service.
These ideas formed the basis of the National Health Service and Community Care Act (1990) (Gould, 2010, p. 52). A key element of the community care agenda was the introduction of Care Managers which was based on research in the USA by the Personal Social Services Research Unit and implemented by the Department of Health.
Care Managers were responsible for assessing an individual needs for service then providing a package of care to meet these needs, a role that often fell to Social Workers. In parallel to this, and partly influenced by the public’s panic over the death of Isabel Schwartz, a Social Worker who was killed by Christopher Clunis, an equivalent to Care Management, the Care plan Approach (CPA) was implemented in Mental Health Services (Gould, 2010).
Since the introduction of the Mental Health Act 1983 Social Workers had increasingly been working within the NHS in multi-disciplinary Community Mental Health Teams alongside Psychiatrists, Psychiatric Nurses, Occupational Therapists and Psychologists. The introduction of the CPA, where any of these professionals could be a service users Care Co-Ordinator led to an erosion of the distinct role of the Social Worker. This was further compounded by the replacement of the ASW role by Approved Mental Health Practioners (AHMP) in 2007 (Rapaport, 2005).
Given to what is perceived as many the gradual reduction of the Role Identity of Mental Health Social Workers, the British Association of Social Workers and the College of Social Worker published “BASW/ CoSW report on Social Work in Multi-Disciplinary Mental Health Teams (2010) where they consider the role and importance of Mental Health Social Workers. Social Workers have a distinctive and beneficial skill set based on their history, values, and training and that uniquely qualifies them to work with Mental Health Service Users. Service Users stress strongly that they want support across the whole spectrum of their lives, with particular emphasis on overcoming social barriers to their recover” (p. 3) Mental Health services are often orientated to a medical model of Mental Health (although Social models are becoming more established). Social Workers are in an ideal position to promote a holistic approach to Mental Health within Medical teams, including psychological factors and wider social influences. Social Workers are trained to provide therapeutic interventions for example working with survivors of abuse.
They are able to provide practical support to overcome social these issues, for example resolving benefits and housing problems. Social Workers value base “which promotes dignity, human worth, and social justice” (p. 4) are vital in promoting Service User involvement as well as wider social inclusion which are both fundamental to recovery. Social Workers often fulfil the role of AMHP and bring a commitment to human rights which is fundamental when addressing issues of compulsory admissions.
Mental Health Policy in The United States of America has broadly followed a similar pattern to that of England. Prior to 1963 the main Mental Health provision was through state funded and administered asylums. This compares to the movement to deinstitutionalise Mental Health Services in England. Between 1963 and 1975 there was a shift to state funded community based care, where service users were treated as outpatients in the community, with inpatient care being provided as a last resort.
From 1976 there was a move to consolidate the balance between inpatient and outpatient care and ensue services which were provided by professionals that represented a varied view of Mental Health and were not ideological aligned to one way of viewing Mental Health. This can be compared to the movement within England towards multi-disciplinary teems. (Rich, 2013). PSWs, first Social Workers in Mental Health and had a strong professional identity, fostered through their training and professional body.
With the move towards generic social work after the Seebohm report , Mental Health Social Work as a distinct professional entity ceased to exist, being replaced by generic Social Work teems under Local Authority control. However, with the passing of the 1983 Mental Health Act, and the emergence of ASWs saw the reversal of this trend. Recent developments in Mental Health policy have presented a challenge to the distinct role of the Mental Health Social Worker, but can also be seen as presenting an opportunity for the continuation of a role with strong social work grounding in values, history and training.