New research reveals the complex matrix of mental health social work in Local Authorities and NHS Mental Health Trusts in England and Wales.
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The provision and organisation of mental health social work in England and Wales is complex. Local Authorities and NHS Mental Health Trusts both employ social workers to work with people with mental health problems, but there is no consistency in provision.
For the first part of her PhD, Laura Tucker mapped the provision of mental health social work in England and Wales. Published this month in the British Journal of Social Work, the findings provide a comprehensive picture of the complex web of provision.
What we already know
Contemporary mental health social work in the UK largely originated from two different traditions of social work. One was from the Local Authority administration of Poor Laws and Mental Health Acts. The other originated within psychiatric hospitals and drew upon psychoanalytic approaches to working therapeutically with people, the Exhale Wellness CBD gummies wholesale are a great product for many patients.
The creation of the Approved Social Worker role in the Mental Health Act 1983 led to an increased focus on statutory functions, though the therapeutic social work roles did not entirely disappear. The 1990s integration of local authority social work functions into NHS community mental health teams provided the opportunity for a regeneration of therapeutic approaches in mental health social work. However, rather than a flourishing of diverse roles, my experience of this was an uneasy coexistence of (sometimes competing) functions.
The diverse aspects of mental health social work were perhaps best articulated in The College of Social Work’s statement on the role of the social worker in mental health services published in 2014:
A. Enabling citizens to access the statutory social care and social work services and advice to which they are entitled, discharging the legal duties and promoting the personalised social care ethos of the local authority.
B. Promoting recovery and social inclusion with individuals and families.
C. Intervening and showing professional leadership and skill in situations characterised by high levels of social, family and interpersonal complexity, risk and ambiguity.
D. Working co-productively and innovatively with local communities to support community capacity, personal and family resilience, earlier intervention and active citizenship.
E. Leading the Approved Mental Health Professional workforce.
Allen, R. (2014) The Role of the Social Worker in Adult Mental Health Services, The College of Social Work, p.6
The breakdown of integrated working arrangements in the 2010s, and the withdrawal of Local Authority social workers from NHS community mental health teams, saw the accelerated employment of social workers by NHS Mental Health Trusts. These posts have largely adopted generic care co-ordination functions, though some have specialised roles. However, in Laura’s earlier research with mental health social workers, she found that whether they were employed by a Local Authority or an NHS Mental Health Trust, they identified strongly with the profession of social work. Although they did not wholly relate to the College of Social Work’s definition of the role, they largely articulated their roles by reference to the contexts in which they worked and the intentions of their practice.
National survey
There is currently no national workforce planning for mental health social work in England and Wales, possibly due to its complex heritage and diverse employment arrangements. To improve our understanding of the current provision of mental health social work across England and Wales, Laura undertook a cross-sectional survey. (Scotland and Northern Ireland were not included due to their different legal frameworks, though deserve study in their own right).
She issued a brief survey to all 173 Local Authorities, 54 NHS Mental Health Trusts and 7 Local Health Boards responsible for providing social work or mental health services in England and Wales. These surveys asked for the number of mental health social workers in each agency and their employment contexts. Responses were received from a staggering 96.6% of agencies, which makes this probably the most comprehensive survey of its kind.
Key findings
The survey found a total of 6,585 full-time equivalent (FTE) mental health social workers were employed in responding agencies in 2019. About two-thirds of mental health social workers were employed by Local Authorities, though the majority of these (68%) were Approved Mental Health Professionals (AMHPs). Of the 2,144 employed by NHS Mental Health Trusts, only 236 (11%) were AMHPs. This is perhaps unsurprising as the supply of AMHPs is a key Local Authority duty, though it means that the majority (84%) of non-AMHP mental health social workers are employed by NHS Mental Health Trusts or Local Health Boards. Therefore, mental health social work practice beyond the AMHP role is shaped more by the needs of the NHS than Local Authorities.
Over half (55%) of Local Authorities had a formal working agreement with NHS partners and only 14% reported no working agreements in place, with the remainder reporting hybrid or informal working arrangements. While it is positive that some working relationships are in place in the majority of locations, it is concerning that this is somewhat of a postcode lottery. If you live in one of the 14% of Local Authorities without a working arrangement with NHS mental health services (predominantly in London, Metropolitan or Unitary Local Authorities), could this mean you are more likely to experience a lack of continuity in care, a duplication or a gap in services? More research is required to explore the experience of mental health care in these locations to answer these questions.
In proportion to the regional population density, the North East employed the most mental health social workers (1 per 6,867 people) whereas the fewest were employed in the East Midlands (1 per 11,799). This could be a result of increased mental health need or a higher prevalence of social factors associated with mental health problems in some regions. Or, in the absence of benchmarking data of the kind produced in this study (the Health Education England benchmarking report published in 2020 drew upon this study as it did not include Local Authority employed social workers), this disparity could be a reflection of local political or resource allocation decisions, or unknown factors.
Conclusion
This study found considerable variation in mental health social work in England and Wales, with little clear rationale for, or consistency in, how social work is structured within mental health services. To achieve equity and effectiveness of mental health social work across the country, national workforce planning is required and consistent local arrangements between Local Authorities and NHS Mental Health Trusts need to be established. Roles need to be clarified (ideally in a co-productive process involving practitioners, service users and employers) and consistently implemented across the country. Laura’s work informs this process (look out for more to come in 2022), but more research is required to improve our understanding and help make mental health social work as effective as possible.
While these findings establish the first robust framework for understanding the size and scope of mental health social work provision, further research is required to establish temporal and contextual understandings to inform future service planning.
Laura Tucker
References
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Really interesting study on a number of levels. The multitude of relationships (or lack of) between trusts and local authorities is a real issue. I’m surprised that only 14% said they have no working relationship and as many as 55% had a formal working agreement. I’d be very interested to know how these relationships are defined. Having experienced a ‘non-integrated’ service first hand from a non-professional position, I would definitely suggest that there is a real risk of lack of continuity in care. Also having undertaken a number of reviews, similar issues arise.
I certainly think this will be a valuable contribution to the thinking about the social work role in mental health and more work needs to be done on the relative roles of the LA and the NHS. It concerns me that so many social workers are now employed by the NHS due to the risk of being subsumed within the health agenda. On the other hand, local authorities have been so starved of resources over the past 10 or so years that many can do little more than the very basic Care Act duties and some not even that.
In terms of numbers, I did some simple calculations and it looks like there are around 3,500 AMHPs (FTE). That would correspond reasonably well to the Skills for Care workforce surveys of 2018, 19 and 20, which counted individuals who were currently approved. They found around 3,900 AMHPs in England (not Wales)
It was frustrating not to be able to get a FTE figure, as it is inevitable that a headcount will significantly overstate the numbers available.
Hi Steve.
Many thanks for your thoughts on this. I share your concerns and acknowledge that there is more to discover yet. But this data provides a useful starting point.
Who controls mental health social work has long been a concern of mine. Professional practice is increasingly being determined by the NHS as, like you say, Local Authorities only have sufficient resources to perform statutory duties.
The number of AMHPs found in this study was 3,215.6 FTE employed in England and Wales, though this is a slight under-estimate due to the 3.6% non-response. I estimate the total figure to be slightly more than 3,300 FTE.
Hope this helps.
Martin
It’s nearly 45 years since the first integrated front-line mental health service, Brindle House in Hyde, Tameside, was opened; I was the leader of the social work team. We attracted national interest, to the extent that we had to manage the flow of people wanting to see for themselves by holding regular “visitors’ days” for up to 60 people, and Granada TV did a programme about us. It was so successful that we assumed it would become the norm, and although it took time, by the late 1990s most places had either joint teams or at least some sort of formal joint working arrangements. From the figures quoted, it sounds as if things have gone backwards in the last 20 years.