Social Care and Mental Health in the 21st Century

Jenny Graydon, CEO of GAMH on Social Care and Mental Health in the 21st Century

Social care workers in the field of mental health today are faced with a potentially bewildering array of theoretical frameworks and models on which to base their practice.

The nature of mental health or mental illness itself remains a controversial subject. Professional opinion remains divided on whether a broadly medical or social explanation of mental health is more convincing. This can lead to a confusing “it is probably a bit of both”. Whether it is indeed a bit of both or either or neither, as social care workers we have to ask “how does any explanation of mental health or illness help me provide a better service to the people I support?”

Having some framework of ideas on which to base our practice is important though, and for a number of reasons.

Firstly, models for practice contain statements of the values we are committed to and should demonstrate in our working relationships with people we support and our colleagues. Through all the challenges and demands made upon us in a changing and unpredictable world, our values should be what we return to as practitioners or managers. If we believe that people who use mental health services should be “included in all decisions that affect them” for example, then there should be concrete and consistent evidence in our own practice that this is the case. It is too easy to discard such values when the going gets tough, alleging that someone’s mental ill health prevented them being able to make any decisions about their care. People skills are the core of social care practice, especially in mental health. Without mutual trust there is no genuine relationship with another person and without consistency trust is impossible to build.

Secondly, some understanding of WHY we practice in the way we do is important if we are to deliver a consistently good service over time to all the people we support and not just some people some of the time. Practice models and frameworks of ideas will help us do this because they help us think and reflect on how we are doing our work. Social care workers in mental health are some of the best practitioners of all but their skills can go unrecognised because they have ‘low visibility’ – what people observe them actually doing is talking to and being with people – that’s not real social care work is it? Being able to state with some confidence that talking to and being with people in particular ways will support them to achieve certain goals becomes more likely if our practice is based on more than just trial and error.

Having said that, while having some theoretical basis for our practice is important, there is of course a danger that good practice in the real world is badly served by an over reliance on competing explanations and prescriptive statements. This is especially true in mental health. Every year or two social care workers are exhorted to adopt the latest new thinking on the best way to design services or develop practice. Many of these new ideas are rebranded versions of earlier ones but this is not recognised or acknowledged. At various times we have been persuaded to accept that good practice should build on Normalisation, Person Centred Planning, various Outreach Models, Floating Support, The Clubhouse Model, Community Development, Recovery and Peer Support Models and so on.{mospagebreak}

If we become so committed to one way of seeing mental health practice that we stop evaluating the relative strengths of each approach then the use of ideas as the basis for our work has ceased – we have stopped thinking for ourselves, we are following a recipe. This is to do the people who seek assistance from us a great disservice.

Slavishly following one approach to social or health care in mental health is to assume that all people who use our services are the same, and of course they are not. One of the greatest challenges to mental health services today is to genuinely recognise this and design services and develop practice accordingly. Social care workers being so close to the people who need or want support in relation to their mental health are ideally placed to rise to this challenge. In some important ways we can make the biggest or the most immediate difference to people who use mental health services.

The challenge we face is to really address inequality. Inequality in mental health. Our general health, our mental health and ‘well being’ do not arise in a vacuum. Human beings live in a social world and have particular social backgrounds and characteristics – each of us has a social identity. It is now recognised that our economic position, gender, age, ethnicity, sexuality and so on do not simply affect our life chances and health but also our experience of using health and social care services.

There are some aspects of living in our society that seem to make it less likely that we will be healthy. The way our society is organised means it works to the advantage of some people and disadvantage of others. These disadvantages seem to repeat themselves over time for particular groups so that patterns of disadvantage become hard to change because they become part of how we expect the world to be.

When people from disadvantaged groups in society need help with their health they find that services are often not designed in ways that make them easy to find, easy to use or understand. They are not accessible and not sensitive to different needs. Services are designed for people who fit the majority, the average, the statistical ‘normal’ and the well informed. But services are delivered to people by other people, including us, the social care workers and managers. We have control over how we practice. We can make the service we deliver more appropriate to the people and communities we work with, even if it is badly designed. We can begin by ridding ourselves of stereotypes of people with mental health problems and by refusing discrimination against people on whatever grounds. We can begin to build a more inclusive mental health practice. With the new mental health legislation and the National Programme for Improving Mental Health and Well-Being in Scotland, both of which acknowledge a Social Justice and Equality agenda for mental health, we have never had a better opportunity. We must not let the chance pass us by.