4 The social work role in mental health services
4.1 Mental health specialists
Social workers are often regarded as the chief proponents of the social model of mental health. Because of the value-base of social work, they are also often seen as being in a strong position to challenge inequality and address the consequences of stigma and discrimination in mental health. In this section you will see how other professionals are increasingly expected to emphasise similar goals in The Ten Essential Shared Capabilities for mental health professionals.
As well as the need for all social workers to have knowledge and skills in mental health, some social workers choose to specialise further so that they acquire a more in-depth level of knowledge about mental health/illness and can take on more specialised roles within mental health services. One good example of a specialised role is that of Mental Health Officer in Scotland (known as Approved Social Worker in England and Wales at the time of writing). Mental Health Officers are qualified professionals employed by a local authority who have undertaken specialist training under appropriate legislation. This training enables them to have substantial powers alongside other professionals, for example to assess someone with a view to making an application for admission to hospital. While these statutory powers are clearly a very important part of the role undertaken by many social workers who specialise in mental health, they make up only a tiny part of what these social workers do on a day-to-day basis.
The roles that mental health social workers undertake have changed considerably over the past twenty years, particularly since the implementation of the NHS and Community Care Act 1990. This Act resulted in an increase in the range of settings in which people with mental health problems are to be found. In simple terms, Community Care legislation resulted in a rapid shift from an emphasis on hospital-based care to care in community-based services such as day hospitals and day centres, supported accommodation, and user-led drop-in services. The graph below provides a graphic illustration of these trends in Scotland and gives you a good idea of the speed and extent of the changes.
For most social workers who specialise in mental health, their work now centres on assessing the needs of service users, formulating care plans to meet these needs, and either directly providing appropriate help and support or ensuring that it is provided by others. These tasks are normally carried out within the context of a multidisciplinary team, in which social workers work closely alongside other professionals. Known in mental health services as the Community Mental Health Team (CMHT), these groups of professionals are at the forefront of the delivery of services in the community for people who have been diagnosed with a mental illness and/or assessed as having specific mental health needs. CMHTs are expected to perform the following main functions:
advise other professionals such as GPs on the management of mental health problems;
provide care and treatment for those with mental health problems which are likely to be resolved within a certain timescale (‘time-limited’ disorders);
provide care and treatment for those with more complex and enduring mental health needs.
Department of Health, 2002
The exact way that CMHTs are organised and managed, and the kinds of professionals that work in them, vary quite widely. However, generally speaking, you could expect a CMHT to include the following kinds of professionals or some combination of them:
support workers (including ‘STR’ workers: Support, Time and Recovery)
community psychiatric nurses
mental health officers / approved social workers
Activity 8: Understanding professional roles
Do you know what each of the professionals listed above actually does and the qualifications or background they have? This activity helps to ensure you fill any gaps in your knowledge or refresh the knowledge you already have. Spend some time looking up definitions of the occupations above, either in books by setting aside some time in a library, or via the internet if you prefer. You may well have come across relevant information for this activity from Activity 2. In any event, make sure you have basic knowledge about each of these occupations.
One of the distinctions that can be made between the different professionals listed above is between those who have received medical training and those who have not. This is particularly important when bearing in mind the discussion about models of understanding in mental health in Section 1.3. Traditionally, the biomedical model of understanding mental health is associated with psychiatry and nursing, while social models have been linked with social work and other social care workers. This distinction has been used to explain much of the conflict which takes place between members of inter-disciplinary teams, particularly social workers and psychiatrists (Miller, Freeman and Ross, 2001).