Presentation on theme: "Kerry Cuskelly Mental Health Social Worker"— Presentation transcript:
1Snapshots in Practice – Promoting Social and Economic Equalities in Mental Health Social Work Kerry CuskellyMental Health Social WorkerWorld Social Work Day March 2013
2Mental Health Social Work Disclaimer! This presentation contains the thoughts of one team from one area. We do not presume to be speaking for all mental health services and social workers.Context – Vision for ChangeOther parameters/considerations – Human rights frameworks, Global Agenda for Social Work, Mental Health Commission, IASW code of ethics, CORU code of ethics, social model of mental healthThe MH teamsThe guiding document is the Vision for Change (2006)As a social worker you are part of “two” team – the social work team in the wider sense and the multi-disciplinary team in the day to day sense. There are many issues that arise from this such as the fact that you are working with people who are coming from very different theoretical backgrounds to yours, the issue of power differentials on MDT’s, the continued dominance of the medical model approach, the individualist versus community/holistic approach to mental health, the many CMHT’s that do not have the full complement of staff etc.Human rights frameworks are hugely important in mental health – The UNDHR, the EUCFHR, UNCRPDWe are also bound by out ethical codes as social workers. Until now this was the IFSW code of ethics and the IASW code of ethics. From May 2013, it will legally be the CORU code of ethics.
3A Vision For Change – The Social Model of Health and Mental Health Chapter four: “Belonging and Participation: Social Inclusion”, “Community development models of mental health are particularly useful in the provision of mental health services to culturally diverse groups. Services need to reach out actively to communities to find alternative paths to channel support to individuals and families”.Chapter eleven: “General Adult Mental Health Services”, “...A large body of evidence identifies the community as a key setting for health promotion activities. The WHO123 emphasizes the importance of a person-centred approach to community development where the focus is on developing the social, economic, environmental, and cultural well-being of communities, in particular its marginalised members”.
4A Vision For Change – The Social Model of Health and Mental Health Chapter thirteen, “Mental Health Services for Older People”, “Social support is a key resource for older people. Self help, support networks and volunteering have been identified as protective factors against poor mental health as well as helping people recover from stressful life events like bereavement. The evidence suggests that these interventions are most successful when linked closely with other community development initiatives. It is recommended that evidence- based beneficial and effective programmes for older adults should be implemented”.A clear indication of the importance of the inclusion of the social model of mental health and community development approaches in mental health is articulated in chapter 2: “Mental health problems affect society as a whole. This emphasis on the social importance of mental health (and therefore the importance of a society-wide response to mental health) is increasingly emphasised by the World Health Organisation (WHO): ‘for all individuals, mental, physical and social health are closely interwoven … As our understanding of this interdependent relationship grows, it becomes ever more apparent that mental health is crucial to the overall well-being of individuals, societies and countries.’ (p. 7)”
5What the Continued Cuts Have Meant for Mental Health In our MH services –Three day centres (2 general adult, 1 rehab) have closed down in the past 3 months (On paper they are open, in reality they aren’t).Home care packages have been eviscerated (On paper they were restored to 2012 levels, in reality they aren’t).Home help does not exist anymore (On paper it does, in reality it doesn’t).There is no day hospital or day centres at all for older persons (approx. 26,000 people/400 open caseload).Bed crisis: (two weeks ago there was one night where there were 28 people in the acute unit with only 24 beds available).
6What the Continued Cuts Have Meant for Mental Health There is only one older persons MDT to cover all of our catchment area.There is only one rehabilitation MDT to cover all of our catchment area.There is a constant bed crisis in the general adult acute inpatient unit.There is only 1 social worker on the older person and rehab team when there should be 2.5 SW posts on each team.There is only 1 social worker on all the general adult teams.All new CMH staff that began in 2013 are not being given any office equipment with which to do their jobs due to “budget curtailments”.There is no service user representation on the area management team.A growing issue with homelessness and mental healthA growing issue re. Housing and mental health
7Continued Challenges Ahead This is all happening in the context of –The service plan for the area was published two weeks ago. It outlines the key challenges to progressing MH services in our area inThe number of retirements will be an issue.Improvements will be necessary to support delivery of services and prevent unplanned bed closures below the national target levels or disruption to community services.Due to staff shortages meeting legislative requirements might be an issue.In order to reduce the amount of people using inpatient services additional staff is needed to fill the additional community posts.If these staff are hired providing adequate supervision might be an issue as they will mostly basic grade posts.Nursing home placements have been identified as the place for long stay MH service users to go to with staff being redeployed “elsewhere” when this occurs. However, nursing home beds remain in short supply.Number of retirements in 2013 (particularly of nurses) will present particular challenge for mental health services. Replacement of essential staff grades and disciplines coupled with rostering and skill mix.Possible impact on ability to meet legislative and regulatory requirements where unplanned staff or service reductions are necessitated.Reductions in acute bed capacity is dependent on having additional community capacity in place which requires filling of additional posts from NSP 2013 allocation.Enhancement of community teams in line with NSP 2012/2013 Mental Health €35m initiatives presents challenges regarding supervision / management of new staff (many at basic grades).Availability of nursing home beds is critical in relation to moving existing clients from long stay wards and deploying staff from long stay services to other areas”.
8How Can We Promote Social and Economic Equalities in This Context? It’s getting much harder. But we are fighting back by….Using peer supervision and informal supervision to theorise our work and experiences.Building a strong, united, collective social work team.Building alliances with other H&SCP’s to build strong, united and collective MDT’s.Challenging the rhetoric of “there is no money”. There is money, it’s just being diverted to places other than frontline staff and the frontline services which service users depend on.
9How Can We Promote Social and Economic Equalities in this Context? Using the social model of mental health – viewing mental health issues not as something that is a “disease” or a “chemical imbalance in the brain” but rather viewing mental health as connected to many outside aspects on one’s life – poverty, abuse, discrimination, trauma, bereavement etc.Using the “Social Determinants of Health” (Dahlgren and Whitehead, 1991) as a guide for this work.Challenging the gaping hole in communication between management and staff/service users.
11How Can We Promote Social and Economic Equalities in this Context? Using Direct Action –Home Care Package campaign in the last quarter of PCSW and MHSW worked together to mobilise SW’s in North Dublin. Also, mobilised as many service users, families and home help staff as possible. Collected over 300 signatures for petition. Handed these in with the 10,000 other signatures collected. Marched with home help staff, SU’s and families on demonstration on November 24th. Campaign succeeded in getting home help hours reinstated to Jan 2012 levels.Building alliances/relationships with community organisations eg. During home help campaign, very positive relationship made with Older and Bolder who supplied us with tons of postcards, posters, info to hand out to people re the cuts to home help. They also intended on working with us re. mental health and older persons after the campaign. Unfortunately, their funding has been ended so this piece of work will not happen.Using grassroots groups like the Social Work Action Network (SWAN) as safe spaces in which to challenge the continued cuts to services and the injustices we see first hand every day e.g. we marched under this banner in the November 24th demonstration.