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

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

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. 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 75-91. • 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, 1553-1571. • 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.

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