Decline in social care component of Community Mental Health teams

A Swansea University research project investigating the structure and effectiveness of community mental health teams has found that service users may be lacking the support from social workers that they require.

The research, commissioned by the National Institute for Health Research Service Delivery and Organisation Programme (NIHR SDO), and carried out by Professor Peter Huxley and colleagues from the College of Human and Health Sciences in Swansea University, looked primarily at the composition of community mental health teams across the UK and how the structure of these teams is developing – something which has never before been explored in such depth.

The study discovered that there is wide variability in the composition of community mental health teams, which are made up of social workers, support workers, nurses, psychiatrists, psychologists, and occupational therapists. The social care composition ranged from 0% to 88% of the team.

Several key findings have been identified.

Professor Huxley explains further: “The study found that workforce planning for mental health teams remains ad hoc across the UK, with little regard for local patterns of need.  It also suggests that workforce composition is determined more by supply and historical factors, than by need or demand.  This has big implications for clinically led commissioning in England and partnership working in Wales. “Our survey of service users strongly indicated the need for social inclusion and services aimed at promoting social inclusion through help with employment and leisure activities, for example. However, where local authorities retain separate budgets, there are fewer social care staff in community mental health teams available to offer this support. In England 8% of teams had no social worker and 4% had no support workers – and in Wales these figures were 13% and 8.7% respectively.

“This is a serious problem, as the presence of a greater proportion of social care staff in the team is associated with a higher quality of care, but our research, and national statistics show that the number of social and support workers in these teams is declining. The recent Chief Nursing Officer’s 2010 review of mental health nursing services has also recognised the need for community mental health services to embrace a social and holistic approach to users needs and that mental health nurse training should reflect this. Nevertheless, while this is helpful, it provides a supply orientated solution rather than a demand orientated approach based on user need, provided by experts in the social aspects of mental health and mental health care. It is to be hoped that the social work degree will increase the supply of highly trained social workers available to mental health services, but sadly another study undertaken by us suggests that the mental health content of social work training remains limited.” 

The SDO funded study also suggests that, at this time of economic instability and severe cuts in local government spending, integration in health and social care is particularly vulnerable.

Professor Huxley said:

“As a result of this research, we have identified that workforce planning needs to be improved dramatically before service users of community mental health teams begin to suffer from the lack of dedicated social care and support.

“On a positive note, we have identified the beneficial impact of the involvement of social workers and support workers in these teams, as well as the enhanced quality of care perceived by people using the services of community mental health teams when social care is taken into consideration.

“As the Government reviews spending across the UK, this is an excellent time for the NIHR to deliver this research and for action to be taken regarding the structure of the community mental health workforce to ensure that service users’ social needs are not neglected.”

It is hoped that the report will contribute to improved mental health workforce planning across the UK, so that community mental health services can provide a rounded and comprehensive approach to service users’ expressed needs.