No mental health without social care

This is the unedited version of the article published by The Guardian Social Care Network on 31st July…

The Government’s No Health Without Mental Health Implementation Framework published last week is all about translating vision into reality. It is a cross-sector action plan for achieving the Government’s six objectives:

• More people will have good mental health
• More people with mental health problems will recover
• More people with mental health problems will have good physical health
• More people will have a positive experience of care and support
• Fewer people will suffer avoidable harm
• Fewer people will experience stigma and discrimination

It is positively framed with a clear focus on early intervention, recovery, wellbeing, co-production and tackling discrimination, (with a little bit of choice and control thrown in for good measure). It even wants to tackle inequality, though how public services can narrow the gap between rich and poor is beyond me. This is an agenda which many mental health social workers will be happy to work to. But there is little in here which is new, original or inspiring, and it is riddled with missed opportunities.

Take personalisation as an example. A looming problem is the prospect of having parallel health and social care personal budgets for people with mental health problems. Personal health budgets are currently being piloted and this implementation framework envisages that they will be rolled out in mental health services. There is no mention of joining them up with social care personal budgets.

The Government’s mental health strategy provides an ideal opportunity to join up health and social care funding to provide a seamless service for people and facilitate integrated working, but it doesn’t go that far. If assessments, eligibility thresholds and care plans were genuinely integrated, and care was funded through a single personal budget (where possible), people using mental health services may be able to have more genuine choice and control.

As it currently stands, local authorities are rapidly withdrawing from their partnership agreements with their local NHS Mental Health Trust and putting their social workers in separate teams to focus on arranging personal social care budgets. Mental health social workers are being de-skilled and multi-disciplinary community mental health teams are losing a wealth of expertise in working with people with complex social problems, which may ultimately undermine what the mental health strategy aims to achieve.

When the Implementation Framework turns its attention to social services, it has little new to offer. For example, it has three points to make about adult services on p. 26:

• Use assessments to support independence and recovery – this is what social workers have been doing since the birth of the profession.
• Remodel existing support (another reorganisation?) to focus on early intervention, service integration, personalisation and recovery – its current focus on personalisation is leading to a rapid disintegration of health and social care, so I’m not sure how they are going to marry these contradictory trends. It says that reviewing eligibility thresholds for social care is crucial, but while there are separate eligibility criteria for health and social care services it is difficult to see how integration can be achieved.
• Provide access to individual budget and direct payments for people with mental health problems – this is what services are currently struggling to achieve but from our work on personalisation in mental health services we are finding that local authorities with strong partnership agreements and integrated working with NHS mental health services are most successful at delivering personalisation.

There is no mention of social work or social care practice, or the use of social interventions (at least in the section on children’s services there is mention of using evidence-based parenting interventions). This may reflect our inability to articulate and evidence what we do so that policy makers can reflect it in their strategies. Or it might be to do with our lack of political engagement and power. Or it might be associated with the worrying trend to marginalise social perspectives in mental health services, as the end of social work at the Institute of Psychiatry suggests.

It is great to see the contribution of the British Association of Social Workers and the Social Perspectives Network to this implementation framework. Let’s hope that in the future we will see the logo of the College of Social Work on documents such as this.