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The Past, Present and Future of Mental Health Social Work

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1 The Past, Present and Future of Mental Health Social Work
SHULAMIT RAMON Centre for Mental Health Recovery University of Hertfordshire

2 The Historical Roots of MHSW
The 1920: The Tavistock and the Hackney Jewish Child Guidance Clinic MHSW in the Psychiatric Hospitals: The Duly Authorised Officer; Mental Welfare Officer (The Percy Report (Ramon, 1985, Rapaport and Manthorpe, 2009), Psychiatric Social Worker Generic social work: A.Mental health Issues in working with children, their parents, adults, and older people (Fishher, Newton & Sainsbury, 1984) B.The negation of mental health needs in generic social work and in current specialised services (child protection, adults with disabilities, older people) (Stanley and Penhale, 1999, Manthorpe et al, 2005) From ASW to AMHP: Handling Risk (Barnes et al, 1990, Hatfield, 2008, Reith, 1998, Rapaport, 2006)

3 In parallel we need to ask what has been the formal and informal role of MHSW
in the major policy shifts within mental health: The move to introducing community care in the field of mental health The De-institutionalisation programme (Ramon, 1992, Stanley, Manthorpe and Penhale, 1999) A Unique Role? MHSW within the NSF (1999) (Rapaport, 2005) “Integration” : social workers as team leaders of mental health services (Shears, 2009) Within the current focus on user and carer involvement

4 Social Work and its complexities:
Street bureaucrats, managerialism, and psychosocial professionalism. Value system focused on the right of troubled individuals to respect, self-determination and social support, yet with a social mandate which includes both care and control. Social work as a semi profession; the anti-theoretical and anti-research stance

5 Mental health social work as a contextualised and multifaceted activity
Conceptual innovations paying attention to institutional abuse, child and elder abuse, and the strong connection between abuse and mental ill health (Stanley, Manthorpe & Penhale, 1999). self-directed groupwork highlighting the possibility of putting together community development with empowerment principles (Mullender & Ward, 1991). Social inclusion: an emphasis on partnership working with users, and their involvement in policy making, training and research (Barnes & Bowl, 2000; Ramon, 2003; Beresford, 2005). Social inclusion: anti-discrimination in its implications for ethnic minorities, disabled people, women and poor people (Walker, 2004). Social Inclusion: The strength approach and the recovery model (Rapp, 1992, Wallcraft, 2005, Ramon, 2007) Initiating wellbeing and peer support service in primary care (Changing Minds, Northampton, 2007)

6 MHSW - a tradition of innovatory practice
establishing attachments of social workers to primary care, beginning in a Kentish Town practice in 1966 (Brewer and Lait, 1978). the Barnet Intensive Crisis Intervention Service, pioneered by social workers and psychiatrists in 1974 (Mithcell 1993). Self Help for isolated mothers, established by social workers at the Family Welfare Association in Tower Hamlet (Knight, 1978). the Chesterfield Support Network, established by Derbyshire social services in 1982 (Hennelly, 1990). the first user policy forum in the UK - the Camden Consortium - established by Iris Nutting, then team leader of Camden social services in Friern Barnet hospital in North London (1984). the Building Bridges project, which attended to the needs of parents with mental illness and their children in different, and imaginative ways (Diggins, 2000, ScieDrive, 2005). Family group conference (Essex social services, 2003)

7 The Approved Social Worker (ASW) era: advantages and disadvantages
Developing psychosocial assessment at an acute crisis point Mutifaceted work with users, carers, and other disciplines Looking for the Least Restrictive Altenative to Hospitlaisation Balancing risk avoidance with risk taking (Foster, 2005) Giving up other mental health social work tasks

8 Current Dilemmas Everyday practice difficulties: e.g. police not coming out when its called Too few workers; Feeling marginalised and disempowered in the partnership trusts; Clients who do not seem to get better; The introduction of the AMHP and its significance for MHSW; Not enough resources, not enough of the type needed; Pressure to focus on risk avoidance at the expense of all other elements (Ramon, 2006)

9 Felt demoralisation and its underlying reasons
Expressed dis-satisfaction (Huxley et al, 2004; Reduced number of workers, increased caseload; Older workforce; Unhappiness with government policy: “in the name of integration” the introduction of AMHP (Rapaport, 2006); the narrowness of the role Negative public opinion (Wallace, 1985)

10 But continued negation of:
The focus on recovery and social inclusion is here to stay and requires a reconsideration of many taken for granted assumptions; Users hardly recognise social work mental health as a factor in their lives; Social workers do not recognise the need to re-negoriate their relationships with users and carers; Policy is not only coming from above; Research is not unimportant for practice

11 The price of the anti-theoretical, anti-research stance
Lack of knowledge of basic evidence; Readiness to accept as gospel largely uncorroborated claims Difficulty in using evidence to change practice; Inability to participate, initiate and apply research; Difficulty to be critical and reflective beyond the use of intuition; Unprepared for battle with other stakeholders

12 combine the best from the past with the promise of the future
A way forward: The challenge is to: combine the best from the past with the promise of the future without giving up the value base and the focus on maintaining the psychosocial link. in a way which is both strategic and practice oriented Reconstruction of the conceptual basis and practice Move away from focus on the pathological to strengths Move into genuine partnerships with users and carers Renegotiation of Power (Smith, 2008) Re-introduce community work as a method Use of CBT and SFT in everyday mental health social work Introduce project involvement for every mental health social worker, PAR methodology underlying each project, as a way to combine partnership, with evidence based innovation in practice

13 “Easily said than done”
Some of these tasks are short term, while others are long term Some require alliances and partnership inside and outside social work; Social work academics and researchers are natural allies. You can begin with the easy change target.. In praise of positive resistance At the end of the day, if MHSWs will not do lead this change effort, they will be confrtoned yet again with solutions imposed on them, often coming from sources which understand much less then they do about MHSW and for whom MHSW is of much less importance.

14 References Barnes, M. & Bowl, R. (2000) Taking over the asylum: Empowerment and mental health. Basingstoke: Palgrave. Brewer, C. & Lait, J. (1978) Can social work survive? London: Temple Smith. Diggins, M. (2000) Innovation as a way of professional life - the Building Bridges Project for parent-users of mental health services and their children. In: S. Ramon (ed) A stakeholder's approach to innovation in mental health services: A reader for the 21st century. Brighton: Pavilion Publishing, pp Essex Social Services (2003) Family Group Conferences in Mental Health, Essex Social Services, Chelmsford. Fisher, M., Newton, C., Sainsbury, E. (1984) Mental Health Social Work Observed. London: Allen and Unwin. Foster, N. (2005) Control, citizenship and "risk" in mental health: perspectives from UK, USA and Australia. In: S. Ramon & J. Williams. (eds) Mental health at the crossroads: The promise of the psychosocial approach. Aldershot: Ashgate, pp.30‑42. Hatfield, B. (2008) Powers to detain under Mental Health Legislation in England and the role of the Approved Social Worker: An analysis of the patterns and trends under the 1983 Mental Health Act in six local authorities. British Journal of Social Work, 38, 8, Hennelly, R. (1990) Mental Health Resource Centres. In: S. Ramon (ed) Psychiatry in transition: British and Italian experiences. London: Pluto Press Huxley, P. Evans, S., Webber M. & Gately, C. (2004) Survey of mental health social workers in England and Wales. Social Care Workforce Research Unit: London.

15 Knight, C. (1978) Neighbourhood support groups
Knight, C. (1978) Neighbourhood support groups. London: Family Welfare Association. Manthorpe, J. Illiffe, S. Eaden, A. (2005) Timely Responses to Dementia. Journal of Social work, 5,2, Mitchell, R. (1993) Crisis intervention in practice: The multidisciplinary team and the mental health social worker. Aldershot: Avebury Mullender, A. & Ward, D. (1991) Self-directed groupwork, London : Whiting & Birch Ramon, S. (1992) The workers’ perspective: living with ambiguity, ambivalence and challenge. In: Ramon, S. (ed) Psychiatric Hopsital Closure: Myths and Realisties. London: Chapman Hall, Ramon, S. (2003) (ed) Users Researching Health and Social Care: An Empowering Agenda? Birmingham:Venture Press. Ramon, S. (2006) Risk Avoidance and Risk Taking In Mental Health Social Work. In: Sapouna, L., Hermann, P. (ed) Knowledge in Mental Health: Reclaiming the Social, New York, Nova Publications, Ramon, S. Healy, B., Renouf, N. (2007) Recovery from Mental Illness as an Emergent Concept and Practice in Australia and Britain, International Journal of Social Psychiatry, 53, 2, Rapaport, J. (2005) The Informal Caring Expereince. In: Ramon, S. Williams, J.E. (ed) Mental Health at the Crossroads: The Promise of the Psychosocial Approach. Aldershot: Ashgate Publishers, Rapaport. J. (2006) New Role in Mental Health: The Creation of the Approved Mental Health Practitioner, Journal of Integrated Care, 14, 5, Rapaport, J., Manthorpe, J. (2009) Fifty years on: The Legacy of the Percy Report. Journal of Social Work, 9,3, Rapp, C.A. (1992) The strengths perspective of case management with persons suffering from severe mental illness. In: D. Saleeby (ed) The strengths approach in social work. New York: Longman, pp

16 Reith, M. (1998) Community Care Tragedies: APractice Guide to Mental Health Inquiries. Birmingham: Venture Press. Saleeby, D. (1992) (ed) The strength approach in social work. New York: Longman Shears, J. (2009) Synergy of Difference: Researching the Outcomes of the Integration of Community Mental Health Teams in Newshire. Submitted Ph.D., Faculty of Health and Social Care, Anglia Ruskin University. Smith, R. (2008) Social Work and Power. Basingstoke:Palgrave Macmillan Stanley, N., Manthorpe, J. & Penhale, B. (1999) (eds) Institutional abuse. London: Routledge. Stanely, N. Penhale, B. (1999) The Mental Health Problems of Mothers Experiencing the Child Portection System: Identifying Needs and Appropriate Responses. Child Abuse Review. Wallace, M. (1985) The tragedy of schizophrenia.The Times, December. Walker, S. (2003) Social work and Child Mental Health: Psycho-social Principles in Community Practice. British Journal of Social Work, 33: Wallcraft, J. (2005) The Place of Recovery. In: Ramon, S. & Williams, J. (2005) (eds) Mental health at the crossroads: The promise of the psychosocial approach. Aldershot: Ashgate,

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