Practice patterns British practice patterns

None of the approaches outlined above is practised in a pure form within everyday British mental health social work. Other important influences affect practice in the real world, including the following:

• the considerable impact of legislation on the role of mental health social workers

• the placement of mental health social workers within welfare bureaucracies

• the wish to encompass both the psychological and social dimensions within any given intervention is a source of richness and complexity, which nonetheless is likely to dilute the degree of rigour of the application of any theory

• their individual and collective lack of commitment to any one approach

• their wish to use themselves 'spontaneously', i.e. in the least premeditated way (in part due to Rogerian influence).

Within current British mental health social work a curious mixture prevails, in which psychodynamic understanding is often applied, but rarely practised. It is more likely that a task-centred approach will be applied in addition to sorting out the clients' entitlement to benefits and legal obligations.

In a minority of practices within mental health projects both group work and community work may be used. Some social workers coming from the social role valorization perspective have pioneered user groups and user involvement in planning and monitoring services, applying self-directed group work approach. (34) This is aimed at the following:

• enabling clients to change their perceptions of themselves and their living conditions

• empowering them to take control over their lives

• encouraging structural change.

Between 1960 and 1990 social workers have initiated the following changes.

1. Successful attachment to primary care was established as early as 1965, with the social workers, their clients, and the general practitioners expressing satisfaction with this way of working. Nevertheless, this form was largely abandoned owing to the focus on statutory responsibilities.

2. The Barnet intensive crisis intervention, which focuses on early intervention in the natural environment of the client, with relatives, friends, and neighbours as much as with the identified patient/35» was begun by a social worker in 1974. 3. Social workers pioneered the collective user involvement approach during the early 1980s, (36> some years before it became fashionable in wider circles.

The majority of mental health social workers now work with adults. They are engaged either as approved social workers and/or as care managers, working as part of multidisciplinary community mental health teams. While they may offer counselling and advocacy as part of their professional repertoire and strategies, the emphasis is increasingly on assessment and co-ordination. They work less and less with those who have mild mental health problems, and more and more with those with a severe mental illness. Proportionally, social workers work more with the latter client group than any other mental health profession. (37)

A minority of social workers now work with children and their parents within the multidisciplinary setting of child and family consultation centres. They provide counselling and liaison with other sections of social services departments. Increasingly, child protection issues come to the fore in their work.

The approved social worker

The approved social worker as a legal category was developed by Larry Gostin, the legal adviser of Mind (the largest national British voluntary organization in the field of mental health) in the 1970s and early 1980s, and the British Association of Social Workers as a complementary measure to the psychiatric perspective within the different facets of the amendments to the 1959 Mental Health Act in 1983, which was also to include advocacy functions.

Social workers were seen as suitable professional figures who would represent the psychosocial angle in parallel to the psychiatric view in the following instances:

• assessing people when an application has been made for a compulsory psychiatric admission to hospital

• the follow-up to such an admission

• mental health review tribunals (established within the 1959 Mental Health Act)

• work with the nearest relative.

Each of these tasks calls for somewhat different knowledge and skills, as well as emphasis and use of a range of more generic skills. (38> In each task social workers are asked not to replicate the psychiatric assessment but to compliment it. For example, they have to look for the least restrictive alternative to the hospital before they can recommend a hospital admission, rather than diagnose mental illness.

Training to become an approved social worker requires 60 days of academic input and supervised practice. Individual social workers can take it up after 2 years of post-qualification work experience. This compares with 2 days training for general practitioners and 1 day for psychiatrists.

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