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Social work inquiry: Service users suffering as traditional social work replaced by “managing crisis”

The need for a relationship-based approach to social work practice is greater than ever but public sector cuts are reducing the role of social workers to little more than one of “managing crisis”.

That was the message to MPs from social workers working in mental health at the final All Party Parliamentary Group on Social Work inquiry into the state of the profession.

Practitioners expressed frustration at a shift in emphasis from a psychosocial model of helping clients to a “medical and legal” approach in recent years that does not benefit service users.

One social worker with 30 years experience in mental health said practitioners need to be allowed to get back to doing what they have “historically done and know what to do”.

“It’s about helping people take control of their lives, not just at the point where they are suicidal,” she said. “The need for a relationship-based system approach hasn’t gone away, in fact the need is as strong as ever.”

The social worker warned there was a danger of practitioners “mirroring” the disempowerment faced by service users.

“If we as social workers are stressed, people who are having emotional difficulties won’t trust that we will listen and do something about it. So you have a mirroring of the social workers feeling disempowered. These things are mirrored within service.”

The mental health social worker was giving in-depth evidence to the fourth inquiry into conditions facing social workers following BASW’s State of Social Work survey in 2012, revealing the deep impact of cuts to services on frontline provision.

She cited funding cuts as responsible for limiting the ability of social workers to do traditional longer-term person-focused social work, telling MPs that amendments to the 2007 Mental Health Act, which put the focus on risk reduction, had exacerbated the challenge.

“The 1983 Mental Health Act was a solid piece of legislation [but] when we come forward to the 2007 Act it is very different. It is risk-driven.

“I really see how the previous model worked – it is what social work is about, which is respect for listening and understanding. It used psychodynamic approaches rather than a medical legal approach, which is what dominates now, and it meant that you could understand how you empower people to change.

“You have to move with the times, but what you lose and what social work can and should offer is that psychosocial approach. Austerity makes that harder. But the more you talk to service users and families, the more you find they want timely access to psychological therapies.”

Another social worker in a community mental health multi-disciplinary team expressed concern at the use of performance monitoring for staff as part of a target-driven NHS model.

“It is a business model in terms of how to measure outcomes, which doesn’t fit with social work principles at all. Sometimes you are managing crisis throughout the whole week. We don’t have ways of measuring the outcomes at the moment and the outcomes imposed on us are quantitative measures, which is not what social work is about.

“We are dealing with people’s lives and events in their lives that are very difficult to put a figure on. They may have a history of six years of social and personal difficulties which they haven’t dealt with and now you are supposed to go there and deal with it quickly.

“It is not going to happen. Just getting into their house and having a conversation with them – that may be the outcome. It is not measured, but it is an outcome.

“They [the user of a service] have developed some trust with a professional and in the future they will think ‘I had a good experience so my experience of contacting mental health services can be positive’.

“You maybe saving £500 a night for an inpatient stay but you have no way of proving it. Do NHS trusts consider that a good enough outcome? I don’t think so.”

A social worker with a mental health home team, based in London, said the crisis in social work was being imposed upon the profession because of problems within other services.

“The work we take on in dealing with crisis is never really our crisis. It is a housing crisis, or a crisis of engagement with services, or some another crisis.

“We are facing resource issues. There seems to be no light at the end of the tunnel and it is clear that as cuts continue social workers will be pushed out, apart from performing statutory roles.

“How does that impact on a service user’s experience? It is quite clear where that will go. But for me the important thing at this stage to my career is to be hopeful.”

After listening to evidence from social workers, Paul Goggins, a Labour MP for Wythenshawe and Sale East, said it was vital the profession became “a bit more hardheaded” about measuring its outcomes. He added that it would be difficult to survive in any profession where, even “if you are lucky”, you are just managing a crisis situation.