1. Sheffield Perinatal Mental Health Service
“I’m depraved on account I’m deprived” The interface between health and social care
Jan Cubison
Sheffield Perinatal Mental Health Service
I stated in my abstract for this workshop that I will present a personal journey of working as a social worker. However, the quote about being depraved doesn’t refer to me personally, or at least I don’t think it does!
This quote is straight out of West Side Story, a popular film in the 1960s that tells the story of two rival gangs in New York and the violence that went on amidst their deprived lives.
This quote was also a question on one of my finals papers for my degree in sociology. It was followed by “discuss”. What it wanted was an argument about the nature v. nurture debate or bad v. sad debate, both of which were pretty topical at that time. I knew the arguments well, having completed my dissertation on maladjustment and deprivation, not a very PC expression these days.
What follows is a romp through the decades of my social work practice.

2. A romp through 4 decades 1970s Nature v. nurture 1980s C/conservatism
1990s Integration of health & social care
2000 on…
The 1970s had an emphasis on welfare rather than justice, linked to a view of mental health as the product of environment (the nurture versus nature debate). The laissez-faire economics of the 1980s took a less liberal view of social welfare, with a renewed call for justice and medicalisation of mental health. The 1990s see the move to community mental health teams, with doctors still dominant, despite the introduction of Care Programming requiring health and social care assessments on everyone referred to the team.

3. 1960s Child care officer 1968 Seebohm Committee
Recommended that the specialist areas of local authority social work should be fused
Single community based response to the range of needs that individuals, families and communities presented
Probation still separate
I went to university wanting to be a social worker, but expecting to be a child care officer. However, whilst I was there, Seebohm produced his report and so I came out of university as a generic social worker.

4. 1970s Generic social work 1969 Children and Young Persons Act
1970 Chronically Sick and Disabled Person Act
1970 Local Authority and Social Services Act
This was the ‘70s, the welfare state was strong and within social work, at least, there was a lot of sympathy for young offenders as being victims from deprived backgrounds rather than perpetrators. One of the major innovations of the changes during the 1960s was the introduction of the concept of intermediate treatment , as part of the 1969 CYPA, which sought to give young offenders positive experiences and role models as a means to changing their behaviours. We,as social workers, were given a lot of freedom and a relatively large budget to provide exciting activities that were supposed to turn the youngsters away from offending. Eg Regents Park Zoo

5. Health
Health was another country

6. Mental Welfare Officer
The 1959 Mental Health Act encouraged the development of community care
End of moral defect, lunacy and mental deficiency
psychopathic disorder had to be “susceptible to medical treatment”
1913 Mental Deficiency Act which brought in the concept of moral defect and feeble minded
“Nothing in this section shall be construed as implying that a person may be dealt with under this Act as suffering from mental disorder ... by reason only of promiscuity or other immoral conduct"
"psychopathic personality" came to mean both "abnormal" and "antisocial
Had to be treateable
Riff would not have received any treatment

7. Debate “mad or bad – or sad?”
60s R.D. Laing “The Divided self”
T.Szasz “The myth of mental illness” 1960
Strong debates between role of social worker as radical activist for social change or social police
Autonomy of the medical profession
There is also a very serious ethical issue about imposing change
even if it could be done. With mental illness, the Mental Health Act 1983 allows and indeed
obliges us to treat people against their will where they are a danger to themselves or others.
In such cases psychiatrists are attempting to restore that person to how he is normally and
the law insists that there must be a reasonable chance that the person will respond to
compulsory treatment.
Psychiatrist “It is my hospital and I will smoke if I want to”
Joint work in East end of London doing family therapy

8. Cycle of deprivation 1970s dissertation
Explanation of structural factors leading to cycle of poverty and poor mental health
Politicised to blame behaviour of parents for passing on poverty and deprivation to their children

9. 1980s Individualism Making money High unemployment
1983 Mental Health Act
Approved social workers

10. 1990s Back to specialisation
1989 Children Act emphasised need for partnerships with
1990 National Health Service and Community Care Act introduced internal market
1994 Diploma in SW replaces CQSW
Social workers - Adult or Children
Victoria Climbie Feb 2000
C Clunis

11. 2000
2000 new post working with pregnant and new mothers with mental health problems
Employed by NHS Trust
Across mental health and child care

12. 2000 and on… Set up and manage small perinatal mental health service
Little health treatment for personality disorders
Social workers offer support and behaviour modification
Training in therapies

13. 2003 Development of treatment services for personality disorder
National Institute for Mental Health in England Personality disorder: No longer a diagnosis of exclusion Policy implementation guidance for the development of services for people with personality disorder
2003 Development of treatment services for personality disorder
Multiagency teams
Psychological therapies available across primary and secondary care
NICE guidance

14. Borderline personality disorder Antisocial personality disorder
Issue date: January 2009
Borderline personality disorder
Borderline personality disorder: treatment and management
NICE clinical guideline 78
Developed by the National Collaborating Centre for Mental Health
Issue date: January 2009
NICE clinical guideline 77
Developed by the National Collaborating Centre for Mental health
Antisocial personality disorder
Treatment, management and prevention

15. What works well between health and social care?

16. What does not work well between health and social care?

17. How can the interface between health and social care be improved?

19. Joint work in perinatal mental health
All cases discussed jointly – psychiatrist & social worker
Joint care antenatal clinic
Joint training
Multiagency meetings
Joint CPA / CIN meetings
Involve service users, volunteers
Postcode, ethnicity audit

20. NICE guideline:Pregnancy and complex social factors due Sept 2010
Rigorous methodology
Dearth of evidence
SCIE involved
Not joint guidance
Health employs specialist midwives in domestic abuse, safeguarding children, asylum seekers, teenage pregnancy, substance misuse

21. Integration of research and practice
Research traditionally led by health
RCTs – ‘gold standard’
Social care research often qualitative

22. National Institute for Health and Clinical Excellence (NICE)
NICE is an independent organisation
Their work is underpinned by the need for:
transparency
collaboration
involvement of stakeholders
NICE provides national guidance, sets quality standards and manages a national database to improve people’s health and prevent and treat ill health.

23. Social Care Institute for Excellence (SCIE)
Registered charity
On line database
Joint NICE and SCIE guideline
Parent-training/education programmes in the management of children with conduct disorders July 2006 (TA guidance)
Dementia Supporting people with dementia and their carers in health and social care Nov 2006
Looked after Children September 2010

24. The White Paper, Equity and excellence: Liberating the NHS July 2010
"no decisions about me without me“
NICE to develop quality standards for social care
NICE on a firmer statutory footing, securing its independence and core functions
Extend NICE remit to social care
care services minister Paul Burstow has made clear “SCIE ... continue to have a role but it won’t be the same role they played directly alongside NICE in the past
“With the increasing importance of coherent joint arrangements between health and social care, the standards will cover areas that span health and social care. We will expand the role of NICE to develop quality standards for social care. The Health Bill will put NICE on a firmer statutory footing, securing its independence and core functions and extending its remit to social care.”