To 1980

British developments

Duly authorized officers were unqualified social workers based in the hospitals mediating between the hospital and the community, the client, and his or her family. This figure was replaced in the 1959 Mental Health Act by the mental welfare officer, and social services had a mental welfare section alongside child welfare, and health social work until 1972. Both the duly authorized officer and the mental welfare officer concentrated more on sorting out benefits and discharge arrangements than on counselling. The latter was the prerogative of qualified social workers, based in child guidance clinics and outpatient departments.

Qualified psychiatric social workers were the élite of the profession up to 1972. Although a small group in number (600 by 1960), (4) they began an academic journal in 1948 which became the prestigious British Journal of Social Work in 1970.

The importance of understanding and responding to mental distress issues in all branches of social work was accepted by most members of the profession and by those responsible for training. In comparison to other branches of social work more of the mental health social workers became the lecturers and researchers.

Following the Seebohm Report of 1968, the different sections of social services were amalgamated in 1972 to the large departments we know today. Psychiatric social workers campaigned for this, as they wanted to secure the power of the profession. By that time the number of unqualified psychiatric social workers had been reduced, while that of the qualified subgroup increased. All field workers were expected to be qualified, while the great majority of residential workers remained unqualified.

In addition to administrative amalgamation social workers were asked to move to generic teams, i.e. to work with different client groups and not to concentrate only on one client group. This was justified by the wish to adopt an holistic approach to users of social work and not to have a number of social workers working with one family according to the different problems which the family and its members faced. Fisher et al.(5) offer a comprehensive description of the implications of this approach for mental health social work.

American developments

The most significant American policy changes included the following.

1. The Mental Health Centres 1963 law, which stipulated the development of those centres as the core of the future mental health system. The federal government was to provide seed money supplemented by state government contribution. The centres had to be multidisciplinary and included social workers.

2. The gradual closure of psychiatric hospitals took place from the end of the 1960s and throughout the 1970s. Most of these patients were resettled in group homes, and provided with day centres.(6)

These developments meant that the service core was shifted from the hospital to the community, which also included psychiatric wards in general hospitals and private closed facilities. Community mental health centres have reduced the leadership from psychiatrists often employed on a sessional basis (primarily because fees are so costly). Centres are more likely to be led by psychologists, social workers, or nurses.

The widespread development of the for-profit private sector in mental health which dates from the 1970s applies to hospital beds, residential facilities, and outpatient services funded through private health insurance. The private sector does not run community mental health centres as there is no profit.

There is also a well-developed not-for-profit private sector in the United States, which is often more innovative than the public sector or the for-profit sector. It offers drop-in centres, crisis facilities, and rehabilitation services (e.g. therapeutic communities, group homes, independent living schemes, and education and employment schemes). However, this voluntary sector exists on a low budget and on yearly renewed contracts for staff.

Many professionals in the United States, including social workers, have opted since the 1980s for half a post in the public sector and half in private practice, as a way of maintaining both professional autonomy and a higher income than they would receive if they worked only in the public sector.

It is estimated that 40 million Americans are not insured and therefore would not be entitled to a range of services, or at most would be entitled to a poorer quality of service.

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