Social Work and Mental Health

Malcolm Golightley, Robert Goemans

• Publisher: Learning Matters
• Year: 2020
• ISBN:
  9781529712735
• Edition: 7
• Topic: Sozialwissenschaften
• Subtopic: Sozialarbeit

With 1 in 4 people experiencing a mental health problem in any given year, mental health is a more important part of social work training than ever before, and all successful social workers need to understand the core values, skills and knowledge that underpin excellent practice in a modern mental health system.

Written as an accessible introduction to the complex issues around mental health, this book has become a classic in its field. Law and policy are clearly outlined while the authors give space to important ethical considerations when working with the most vulnerable in society. There are clear links between policy, legislation and real life practice as well as a wealth of learning features.

1 Values and Ethical Mental Health Social Work

Achieving a social work degree

This chapter will help you to develop the following capabilities from the Professional Capabilities Framework (2018):

• Professionalism
  Identify and behave as a professional social worker committed to professional development.
• Values and ethics
  Apply social work ethical principles and values to guide professional practices.
• Knowledge
  Develop and apply relevant knowledge from social work practice and research, social sciences, law, other professional and relevant fields, and from the experience of people who use services.
• Critical reflection and analysis
  Apply critical reflection and analysis to inform and provide a rationale for professional decision-making.
• Skills and interventions
  Use judgement, knowledge and authority to intervene with individuals, families and communities to promote independence, provide support and prevent harm and enable progress.

It will also introduce you to the following standards as set out in the 2019 social work subject benchmark statement:

• 5.3 Values and ethics.
• 5.5 The nature of social work practice.

Introduction

The World Heath Organization (WHO) describes mental health as:

a state of well-being in which the individual realizes his or her abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.

(WHO, 1999, p1)

This definition sought to define the concept in more positive terms than those usually associated with mental illness – seeing mental health as not just the absence of ‘illness’. Good mental health encompasses a range of both positive and negative emotions: we would expect a ‘mentally healthy’ person to be able to express happiness, sadness, fear, excitement, disappointment, etc; all, of course, within the limits of what we understand as appropriate based on our cultural or social norms: at different times and in different places and for different people (e.g. for women and men) the range of acceptable emotions will be different.

Mental illness is harder to define, with many definitions focusing on medicalised understandings of emotional distress. However, as discussed in the next chapter, the concept of ‘madness as disease’ is based on poor science and little convincing evidence. The Mental Health Act avoids such controversy with a vague definition of mental disorder as any disorder or disability of mind. Social workers should be used to working in the grey areas of complexity and uncertainty, aware of the fact that what many people see as simple concepts are usually far from simple, and able to apply critical and analytical thinking to understand how different groups are disadvantaged by different ways of defining social issues. In navigating such murky waters, values and ethics become vital for deciding what direction to sail in.

This chapter examines the relationship between values, ethics, contemporary social work and social care practice in mental health services. Mental health services are at a crucial stage with recent moves towards more person-centred and psycho-socially oriented services, influenced by personalisation, the recovery model, creative use of psycho-social interventions, preventative services, and a focus on service-users’ and carers’ voices being heard (many of these being further promoted in the Care Act), halted through unprecedented cuts to service budgets, forcing a retrenchment back to long waiting lists, a focus on risk and few interventions other than medication. At the same time, the social work profession is appearing to be going through an identity crisis, with the loss of the College of Social Work, development of ‘fast-track’ specialist courses, the development of a new regulator, teaching partnerships, and the Knowledge and Skills Statements providing a watered-down alternative to the Professional Capabilities Framework.

Approximately one person in six at some time in their life will experience mental health problems that are sufficiently serious for them to seek help from a professional. It is usually the General Practitioner (GP) who is the first port of call and they in turn will refer people to the various agencies whose remit is to provide mental health services. These services include health and social care agencies within a variety of systems of integration, but usually utilising social workers alongside other professionals such as nurses. Some GP practices have social workers attached to them and this often means that these workers will be doing direct work with service users, working in the community alongside other mental health professionals, or be working in a psychiatric hospital. Social workers also come across mental health problems in addition to the ‘presenting problem’ that led to referral in the first place.

Basic facts

The following are extracted from a government guide for ‘health professionals’ Wellbeing and mental health: applying ‘All Our Health’ (Public Health England, 2018).

• One in 6 adults report having a common mental health problem within the last week.
• 551,000 people (approx. 1.5% of adults) have what is considered to be a ‘severe mental illness’.
• Around 30% of people with long term physical health conditions also have a mental health problem.
• The poorest fifth of the UK population are twice as likely to have a mental health problem as a person on an average income.
• There were 4,451 deaths by suicide in England in 2017. Men are 3 times more likely than women to die of suicide.
• People with a ‘severe mental illness’ have a life expectancy 20 years less than the general population.
• Poor mental health has an economic and social cost calculated at £105 billion per year.
• The employment rate for people in contact with mental health services is 67.4% lower than the employment rate for the general public.

Of course, you need to treat all such statistics with caution, but even if there are some discrepancies with the above, they still show mental health to be one of the most pressing issues that we as a society are facing, and you and I as social workers are working with.

International mental health strategy

In November 2018, the Organisation for Economic Cooperation and Development (OECD) and the European Union (EU) published their annual ‘Health at a Glance’ report. This report focuses heavily on promoting mental health in Europe as one of its key topics:

Good mental health is a critical part of individual well-being, and the foundation for happy, fulfilled, productive lives. However, this chapter finds that more than one in six people across EU countries had a mental health problem in 2016. Living with mental ill-health means that individuals are less able to succeed at school and work, are more likely to be unemployed, and may suffer worse physical health. For some, mental illnesses lead to premature mortality: over 84 000 people died of mental health problems and suicides across EU countries in 2015.

The report goes on to consider the economic burden of mental illness, which it calculates as 4% of GDP or over 600 billion euros, before looking for innovative ways of preventing mental illness.

The EU also funds a project called the ‘EU Compass for action on mental health and wellbeing’. This project collects examples of good practice and produces reports into relevant issues for mental health in Europe. The most recent report, from 2017, focused on the priority areas of ‘mental health at work, in schools and prevention of suicide’. You can access their reports at https://ec.europa.eu/health/non_communicable_diseases/mental_health/eu_compass_en

The World Health Organization also funds research and analysis of mental health, and has produced ‘The European Mental Health Action Plan 2013–2020’. This plan promotes seven objectives, discussing the evidence for why these are important and considering how they can be addressed:

• Objective 1. Everyone has an equal opportunity to realize mental well-being throughout their lifespan, particularly those who are most vulnerable or at risk
• Objective 2. People with mental health problems are citizens whose human rights are fully valued, respected and promoted
• Objective 3. Mental health services are accessible, competent and affordable, available in the community according to need
• Objective 4. People are entitled to respectful, safe and effective treatment
• Objective 5. Health systems provide good physical and mental health care for all
• Objective 6. Mental health systems work in well coordinated partnership with other sectors
• Objective 7. Mental health governance and delivery are driven by good information and knowledge.

Mental health strategy in the UK

Each of the countries that make up the UK is responsible for developing its own strategy for dealing with mental health problems. The most important policy documents are listed below (all of these will be available on the relevant government website).

England

• 2012 – Suicide prevention strategy for England
• 2014 – Mental health crisis care concordat
• 2014 – NHS five-year forward view
• 2015 – Future in mind: promoting, protecting and improving our children and young people’s mental health and well-being
• 2016 – Implementing the five-year forward view for mental health
• 2017 – Review of the Mental Health Act
• 2018 – Mental Health Units (Use of Force) Act

Scotland

• Mental health strategy 2012–15
• Suicide prevention strategy 2013–16
• Mental Health (Scotland) Act 2015
• 2017 – Mental Health in Scotland – a 10-year vision

Wales

• 2012 – Together for mental health: a strategy for mental health and wellbeing in Wales
• Mental Health (Wales) measure 2010

Northern Ireland

• 2011 – Service framework for mental health and wellbeing
• 2014 – Regional mental health care pathway: ‘You in mind’
• 2015 – Towards a better future: The trans-generational impact of the troubles on mental health

The strategy for England

Following the general election of 2010, the newly formed Coalition Government published No Health without Mental Health: A cross-government mental health outcomes strategy for people of all ages (February 2011), which, alongside the Implementation Framework of July 2012, set out the key objectives of the government’s approach to mental health. One of the central objectives of this strategy was the concept of parity of esteem, which means that mental health conditions should be given equal priority and value to physical health conditions.

The objectives in this strategy were updated in the NHS Five Year Forward View, which was published in October 2014 and highlighted how far we are from achieving these objectives.

Mental illness is the single largest cause of disability in the UK and each year about one in four people suffer from a mental health problem. The cost to the economy is estimated to be around £100 billion annually – roughly the cost of the entire NHS. Physical and mental health are closely linked – people with severe and prolonged mental illness die on average 15 to 20 years earlier than other people – one of the greatest health inequalities in England. However only around a quarter of those with mental health conditions are in treatment, and only 13 per cent of the NHS budget goes on such treatments when mental illness accounts for almost a quarter of the total burden of disease.

An independent mental health taskforce, chaired by Paul Farmer, Chief Executive of Mind, was tasked by NHS England to assess the state of mental health services in the NHS and set a strategy for improvement. This taskforce was independent of government and involved representatives of health and care organisations as well as people with experience of using services or as carers, and published their report The Five Year Forward View for Mental Health: A report from the independent mental health taskforce to the NHS in England in February 2016. This was followed in July 2016 by NHS England’s Implementation Plan which sets out the actions it proposes to take to deliver the Five Year Forward View proposals.

The implementation plan identified the following common principles that should be followed as local areas develop plans to meet the set objectives:

• co-production with people with lived experience of services, their families and carers;
• working in partnership with local public, private and voluntary sector organisations, recognising the contributions of each to improving mental health and well-being;
• identifying needs and intervening at the earliest appropriate opportunity to reduce the likelihood of escalation and distress and support recovery;
• designing and delivering person-centred care, underpinned by evidence, which supports people to lead fuller, happier lives; and
• underpinning the commitments through outcome-focused, intelligent and data-driven commissioning.

In addition to this strategy, there have been a few other important initiatives that have had an impact on how mental health services are delivered. One example is the Mental Health Crisis Care Concordat, which was agreed in 2014 and obliges services to work together to provide better care during crisis or emergency situations. While there has been no new money attached to the concordat, local multi-agency agre...

Table of contents

• Cover
• Half Title
• Publisher Note
• Title Page
• Copyright Page
• Contents
• Acknowledgements
• List of Abbreviations
• Acknowledgements
• Series Editor’s Preface
• Introduction
• 1 Values and Ethical Mental Health Social Work
• 2 Social Work Practice and Mental Health
• 3 The Policy and Legal Context for Practice Part 1: History and the Mental Health Legislation
• 4 The Policy and Legal Context for Practice Part 2: Mental Health Tribunals: Mental Capacity
• 5 Working with Vulnerable People Mental Health in Children, Adolescents and Young People
• 6 Working with Vulnerable People Adults who are Short-term Service Users
• 7 Working with Vulnerable Peoples Adults who are Long-term Service Users
• 8 Working Across Organisational and Professional Boundaries
• Appendix 1 Professional capabilities framework
• Appendix 2 Subject benchmark for social work
• Glossary
• Bibliography
• Index