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The Past, Present and Future of Mental Health Social Work The Past, Present and Future of Mental Health Social Work SHULAMIT RAMON SHULAMIT RAMON Centre.

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Presentation on theme: "The Past, Present and Future of Mental Health Social Work The Past, Present and Future of Mental Health Social Work SHULAMIT RAMON SHULAMIT RAMON Centre."— Presentation transcript:

1 The Past, Present and Future of Mental Health Social Work The Past, Present and Future of Mental Health Social Work SHULAMIT RAMON SHULAMIT RAMON Centre for Mental Health Recovery Centre for Mental Health Recovery University of Hertfordshire University of Hertfordshire s.ramon@herts.ac.uk s.ramon@herts.ac.uk

2 The Historical Roots of MHSW The Historical Roots of MHSW The 1920: The Tavistock and the Hackney Jewish Child Guidance Clinic 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 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: Generic social work: A.Mental health Issues in working with children, their parents, adults, and older people (Fishher, Newton & Sainsbury, 1984) 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) 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) 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 parallel we need to ask what has been the formal and informal role of MHSW in the major policy shifts within mental health: in the major policy shifts within mental health: The move to introducing community care in the field of 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) The De-institutionalisation programme (Ramon, 1992, Stanley, Manthorpe and Penhale, 1999) A Unique Role? MHSW within the NSF (1999) (Rapaport, 2005) A Unique Role? MHSW within the NSF (1999) (Rapaport, 2005) Integration : social workers as team leaders of mental health services (Shears, 2009) Integration : social workers as team leaders of mental health services (Shears, 2009) Within the current focus on user and carer involvement Within the current focus on user and carer involvement

4 Social Work and its complexities: Social Work and its complexities: Street bureaucrats, managerialism, and psychosocial professionalism. 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. 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 Social work as a semi profession; the anti- theoretical and anti-research stance

5 Mental health social work as a contextualised and multifaceted activity Mental health social work as a contextualised and multifaceted activity Conceptual innovations 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). 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). 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: 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: 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) 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) Initiating wellbeing and peer support service in primary care (Changing Minds, Northampton, 2007)

6 MHSW - a tradition of innovatory practice 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). 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). 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). 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 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 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). 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) Family group conference (Essex social services, 2003)

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

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

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

10 But continued negation of: 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; 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 Users hardly recognise social work mental health as a factor in their lives; lives; Social workers do not recognise the need to re-negoriate their relationships with users and carers; Social workers do not recognise the need to re-negoriate their relationships with users and carers; Policy is not only coming from above; Policy is not only coming from above; Research is not unimportant for practice Research is not unimportant for practice

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

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

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

14 References References Barnes, M. & Bowl, R. (2000) Taking over the asylum: Empowerment and mental health. Basingstoke: Palgrave. 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. 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 75-91. 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 75-91. Essex Social Services (2003) Family Group Conferences in Mental Health, Essex Social Services, Chelmsford. 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. 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. 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, 1553-1571. 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, 1553-1571. Hennelly, R. (1990) Mental Health Resource Centres. In: S. Ramon (ed) Psychiatry in transition: British and Italian experiences. London: Pluto Press 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. 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. London: Family Welfare Association. 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, 191- 203. Manthorpe, J. Illiffe, S. Eaden, A. (2005) Timely Responses to Dementia. Journal of Social work, 5,2, 191- 203. Mitchell, R. (1993) Crisis intervention in practice: The multidisciplinary team and the mental health social worker. Aldershot: Avebury 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 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, 85-121. 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, 85-121. Ramon, S. (2003) (ed) Users Researching Health and Social Care: An Empowering Agenda? Birmingham:Venture Press. 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, 101- 112. 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, 101- 112. 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, 108-122. 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, 108-122. 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, 155-170. 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, 155-170. Rapaport. J. (2006) New Role in Mental Health: The Creation of the Approved Mental Health Practitioner, Journal of Integrated Care, 14, 5, 37-45. Rapaport. J. (2006) New Role in Mental Health: The Creation of the Approved Mental Health Practitioner, Journal of Integrated Care, 14, 5, 37-45. Rapaport, J., Manthorpe, J. (2009) Fifty years on: The Legacy of the Percy Report. Journal of Social Work, 9,3, 251-267. Rapaport, J., Manthorpe, J. (2009) Fifty years on: The Legacy of the Percy Report. Journal of Social Work, 9,3, 251-267. 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 45-58. 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 45-58.

16 Reith, M. (1998) Community Care Tragedies: APractice Guide to Mental Health Inquiries. Birmingham: Venture Press. 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 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. 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 Smith, R. (2008) Social Work and Power. Basingstoke:Palgrave Macmillan Stanley, N., Manthorpe, J. & Penhale, B. (1999) (eds) Institutional abuse. London: Routledge. 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. 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. 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: 673-687. Walker, S. (2003) Social work and Child Mental Health: Psycho-social Principles in Community Practice. British Journal of Social Work, 33: 673-687. 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, 127- 136. 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, 127- 136.


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