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BASW’s response to NHS England Consultation on Medium and Low Secure Mental Health Services (Adults)

BASW’s response to NHS England Consultation on Medium and Low Secure Mental Health Services (Adults)

The British Association of Social Workers (BASW) is the independent and member-led professional association of social workers in the United Kingdom. We have over 22,000 members and we are part of the international community of social work and as such are active members of the International Federation of Social Workers (IFSW) and its European Region. We have offices in each of the four countries of the UK. BASW England have a group of professional members who focus on issues affecting social work with adults and a sub group of that group who focus on issues relating to social work with people with a learning disability. We also have groups focusing on forensic social work and social work with people with mental health problems. This response is a composite of the views of these groups. The consultation asks some specific questions.

General points:

The commissioning documents are broadly welcomed and seen as a detailed and purposeful attempt to improve the lives of people placed in secure accommodation.

BASW England would like to raise some general points and some specific points;

a) NHS England commission and pay for people in secure accommodation and this creates a structural / financial tension with non secure services that are paid for by councils and / or local NHS commissioning. The tensions between national and local commissioning cannot be underestimated particularly in relation to budget allocation, decision making, bureaucracy and fragmented commissioning processes.

b) BASW members welcome the aspiration to support people to move from secure accommodation to community services in a timely manner, this has implications for the commissioning of community services in terms of finding suitable housing and suitable community support services. The lack of affordable housing generally is a problem in society, this is exacerbated by problems associated with placing people who have been detained under the Mental Health Act, who may have had challenging behaviour and may also have criminal records. (Securing accommodation for certain types of crime such as sex offences and arson is particularly difficult). There needs to be a commissioning strategy for housing. Recruiting and retaining high quality staff for community services with skills in working with people who have been placed in, or are at risk of being placed in secure accommodation is also extremely challenging.

c) It is acknowledged that the commissioning documents are being developed specifically for the purpose which they set out, nevertheless we feel that unless there is at least acknowledgement or reference to the wider societal context and issues associated with supporting people who may be at risk of being admitted to secure accommodation, or are ready to be discharged to services commissioned by CCGs or local authorities then it will be difficult for the commissioning policies for secure accommodation to meet their aims and objectives.

d) For people with a learning disability, autism, or neuro-developmental disorders admission to a medium or low secure unit should be made with the upmost care. The capacity for people with these conditions to cope with significant change, particularly to facilities that are often far removed from their communities is almost inevitably traumatic and can create the vicious circle of a downward spiral, with people responding negatively to the change and therefore potentially escalating behaviour challenges and placement needs.

e) It is a proposal that for those people with a learning disability who are accommodated in secure accommodation or are being considered for secure accommodation that the “Named Social Worker” role be implemented. Social workers were part of the clinical team in hospitals for people with a learning disability and it is our view that similar arrangements need to apply for medium and low security forensic facilities.

f) BASW have concerns that there may be a perception in the sector that people have to move sequentially from ‘medium secure’ to ‘low secure’ to ‘locked rehab’ and then to the ‘community’. This perception could be part of the problem that keeps some people in secure, forensic beds longer than is necessary and creates the vicious circle that the longer people are placed in secure settings the harder it is to move people on to non secure settings in the community.

There is a social work Professional Capabilities Framework for Forensic Social Work

The framework provides good detail about the standards that social workers working in the area of forensic social work need to adhere to.

CLICK HERE to read the full response.