Interprofessional working in mental health

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BA Social Work

A critical analysis of Inter-professional Working in Community Care

This assignment aims to critically analyse the working relationship between mental health and social care professionals. It is argued barriers exist between these two key providers of services that prevent service users receiving the best care. (Milburn A 2000).

This working relationship can be defined as inter-professional working and this assignment will examine what these barriers involve, why they have developed, how they might be overcome and what the implications for service users and Approved Social Workers (ASW’s) if increased inter-professional working is required under government policies as is expected.

McDonald (1999 p123) proposes inter-professional working to be when multi-disciplinary professionals work in highly integrated teams where the team priorities are the strongest influence upon the individuals work decisions,

Therefore, teamwork theories will be analysed to highlight what factors are necessary for success, and what are the possible difficulties that may inhibit co-operation between health and social care professionals, and how this impacts on their practice.

Finally, whether or not inter-professional working is empowering for the service user will be critically analysed.

People with mental health problems are at the centre of a complex network of services provided by a range of organisations and professionals. For people detained under the Mental Health Act 1983 this is especially true, and for whom social services and health each have explicit statutory responsibilities. (SSI 2001)

The Government has stated they are committed to reforming the current mental health legislation and have published a white paper giving details of these reforms. (BASW 2001)

The complexity of mental health services requires inter-professional working at all levels of strategic planning, management and delivery of services. The National Service Framework for Mental Health has raised the profile of the need for effective collaboration between these two agencies and the Health Act 1999 introduced provision for greater flexibility in commissioning services and the pooling of their resources. (DoH 1999/2000)

Current mental health legislation contained in The Mental Health Act 1983 requires ASW’s to protect the rights of individuals facing admission to hospital against their will or sectioning.

Central to the ASW role is their ability to look at all aspects of need and consider the social context of the service user. (MHSIG 2001)

However, the mental health white – reforming the mental health act, proposes other mental health workers could undertake this important role. Consequently, approved social workers are facing changes to their role not least the loss of their exclusive role within mental health services. Wellard (2001) believes this is causing increased tension between health and social workers that may increase working barriers still further.

Similarly, Sheppard (1996) argues that managerialism due to a narrow administrative definition of tasks is wearing away at a social workers discretion and autonomy leading to insecurity’s that do not equip workers well to further grow and adapt into partnership roles.

The number of formal admissions to hospital under the Mental Health Act 1983 has increased from 18,000 in 1990/91 to 26,700 in 2000/01 (DoH 2001). Consequently, it could be argued the implications for service users if they lose the independent voice of the ASW might be even more compulsory admissions as health workers err on the side of risk management instead of rehabilitation.

But the government maintain the reforms will enhance the rights of individuals, for example by the setting up of independent tribunals, however, Johnson (2001) argues the primary objection of the reforms to be protecting the public at the expense of the rights of the individual, consequently the role of the ASW should be strengthened and not lost.

However, the reforms are controversially proposing establishing community treatment orders under which patients in the community could be subject to compulsory treatment.

The implications of this involves civil rights issues that health workers may not be able to advocate independently from the psychiatrist who is more powerful than them in their profession, should they take on responsibilities currently done by ASW’s.

Furthermore, if the boundaries of someone’s work is changing this may result in resistance as the worker feels their professional knowledge is being ignored or undermined. This resistance may affect their professional ability or their own mental health.

Furthermore, in dealing with complex mental health problems the need to be cognisant of other contextual issues is second nature to social workers. Whereas health workers who work to the medical model of illness may not have the skills to look at any contributory factors.

This may result in increased distress to the service user not least from getting caught in the ‘revolving door’ scenario– the service user comes in gets a quick ‘fix’ then sent on their way only to return again because contributory factors have not been addressed e.g. a dysfunctional family life.

When Asw’s undertake statutory obligations there needs to be a clear understanding that it is in his or her best interest. Should this responsibility be assumed by health workers their aims might be different, as social workers might advocate reasonable risk-taking and self-determination, health workers might make purely clinical judgements based on risk (BASW 2001p3)

However, in response to this argument it is argued the Human Rights Act 1998 will protect service users facing compulsory admission to hospital or compulsory community these would only be undertaken by well-trained professionals with reference to the Human Rights Act 1998. (Reforming the mental health act 2001)

It is not just ASW’s who may feel de-skilled and de-motivated through role changes, mental health professionals too may feel threatened, as they do not have the same dominance they previously had since the implementation of community care legislation that required a move towards a corporate approach. (Mechance 1991)

Furthermore, mental health workers might be reluctant to undertake compulsory admissions and take on ASW responsibilities as it might compromise their therapeutic relationship with the service user.

Given these tensions between the workers it could be argued there is wariness about working together even though, the Social Services Inspectorate (2001) found the most common method of delivery of approved social work services – 38% to be through a muliti-disciplinary model. Given these tensions it could be argued the services currently  being provided cannot be effective.

It could be argued the tension in the situation stems from ASW’s defending their ‘territory’ but Hitchon (2001) believes the crucial issue to be how strong the individual making the decision is professionally, not which profession they stem from, and that they feel they have status within the decision-making group.

Historically, the psychiatric professions have held most of the power in mental health services. This power stems for being able to define illnesses, who is diagnosed as having them, determining their treatments, treating people against their will in hospital, to organise services and spend huge budgets and the ability to select who can or cannot have these powers. (Watkins et al 1996 p350)

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This power has remained unquestioned and this is arguably because it is seen as being benign – for the good of society and individuals in society.

In contrast a social care approach believes that many mental health problems are not symptomatic of a disease. Rather it is an indication of social and psychological factors that cause distress.

Given this it could be argued that because these factors are complex all professionals involved in mental health services have something to offer, the implications of this impacts upon the type of services that should be offered, the understanding on which they ...

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