Social workers need to define their practice

Published by The Guardian Social Care Network on 30th January 2012:

If I was an undergraduate social work student writing an essay on what mental health social work is, I might cynically answer: “It’s what you’re told to do”. To date, we have been too reliant on others – employers, policy makers and health services – to define our practice.

At a time when the prime minister is talking about integrating health and social care, the opposite is happening in NHS mental health services. Social workers are increasingly being pulled out of integrated mental health services by their local authority employers to concentrate on policy priorities such as safeguarding vulnerable adults and setting up personal budgets.

There is nothing new in these developments. If you explore the history of mental health social work in the UK, it has largely been shaped by policy or statute. For example, mental health social workers have been defined by their role in assessing people for compulsory detention, until 2007 when this role was opened up to other mental health professionals under a reform of the Mental Health Act.

Mental health services are now being increasingly shaped by the National Institute for Health and Clinical Excellence (NICE) clinical guidelines, which recommend interventions with randomised controlled trial evidence of their effectiveness. This approach to policy makes sense, but has led to evidence-biased practice with more easily-measurable medical and psychological interventions taking provenance over ‘messy’ and complex social interventions.

Our difficulty as a profession to define our identity and role has had a profound impact on my career in social work. As a practitioner I saw how psychiatrists and psychologists in the community mental health team I worked in had a clear professional identity and could justify their practice on the basis of evidence for its effectiveness.

Social workers, however, typically work with the most complex cases where either medical or psychological interventions don’t tend to work, or social factors such as poverty, poor housing or ineffective social networks are predominant. The effect of evidence-biased practice in mental health services is that social workers are increasingly being appointed on their ability to deliver psychological interventions rather than their ability to solve social problems.

Almost 10 years ago I left frontline practice to help to develop evidence about the effectiveness of social work and social care interventions. I see this work as important in helping us to define our own future. However, if we want to be able to articulate and evaluate our interventions in a way which would be recognised by NICE guidelines, this means undertaking randomised controlled trials of social interventions.

Many social workers baulk at this idea, but we should again look at our history. Although by no means commonplace, trials of social work interventions did take place in the UK in the 1960s and 1970s.

My journey from practice into academia has brought me to a point where I’m about to pilot a social intervention which, pending positive evaluations and success with future funding bids, may lead to perhaps the first social work-led randomised controlled in mental health services for many years.

The Connecting People Study (funded by the National Institute for Health Research School for Social Care Research) is developing and articulating an intervention model for workers to help people to improve their social connections. Based on principles of co-production and social capital theory, the model emphasises a shared focus for a worker and an individual on the goal of engaging beyond mental health services.

We will be piloting the intervention model and associated training in twelve agencies in England and evaluating both its effectiveness and cost-effectiveness. Although results will not be available until 2014, you can keep up to date with the study on its the website or here on my blog.

If I was to take a less cynical approach to the question ‘what is mental heath social work?’, I could say that it is the only profession working in NHS mental health services which holds social justice as a core value. I see my contribution to the profession as developing and evaluating interventions aimed at reducing social inequalities in mental health.

Systematising practice in this way may be an uncomfortable culture shift for social work, but it may be necessary in order to demonstrate the effectiveness of our practice. Championed by The College of Social Work, we perhaps now have a unique opportunity to shape our own professional identity and role.