Mental health social work in Northern Ireland and the Republic of Ireland: challenges and opportunities for developing practice

Drawing on their experience of mental health social work in Northern Ireland and the Republic of Ireland, the authors examine the impact of current legislative and policy change in both jurisdictions. The paper applies Lorenz's theoretical framework to develop a comparative analysis of how global and country specific variables have interacted in shaping mental health social work. The analysis identifies linkages between factors and indicates similarities and differences in mental health social work practice. The paper highlights emerging discourses in this field and explores the impact on practice of developments such as de-institutionalisation, community care, and ‘user rights’ versus ‘public protection’. The article concludes with a review of key challenges facing social workers in both jurisdictions and identifies opportunities for developing mental health social work in ways that can positively respond to change and effectively address the needs of mental health service users and their carers. The analysis provides an opportunity to evaluate Lorenz's theoretical framework and the paper includes a brief critical commentary on its utility as a conceptual tool in comparative social work.     

Serious business or ‘any other business’? Safeguarding and child protection policy in british rugby league

State‐funded national governing bodies of sports in the UK now have a mandate to produce, disseminate and embed child protection policies. This warrants an analysis of the impact of such policies, particularly in the context of reaching their target audience and having some early influence on the practice of sports clubs' members in their dealings with children. The authors are undertaking a large research project, which aims to fully evaluate the UK Rugby League's child protection policy. This paper reports findings from an evaluation of the initial implementation of the policy and explores its presentation, delivery and impact within UK rugby league clubs. We argue that the Rugby League should be commended for its initial approach to child protection policy and make specific recommendations to enhance this long‐term project. We conclude that if a broader community of interest concerns itself with the safeguarding of children there is likely to be a greater impact on a social problem of this kind. Sport can have a key role to play in this community because it reaches so many people.     

Good enough decision‐making? Improving decision‐making in adult protection

This paper examines decision‐making in adult protection based on arrangements operating in a local authority social services department and discussion generated in a specialist training intervention. The paper seeks to identify ways in which approaches to decision‐making can be made both more effective and more user centred. The need for good information for efficient and effective decision‐making is highlighted, along with the need for user involvement for the production of positive and valued outcomes. The paper looks at how user centred arrangements can be put into practice and discusses the potential for advocacy, outlining possible approaches for adult protection casework. With local authority social services departments struggling to implement No Secrets (2000), with adult protection a key social care competence and with the implementation of PCP and similar approaches a priority (Valuing People, 2001), it is important to improve decision‐making in adult protection in ways that are not only time and resource efficient, but place service users and their advocates at the centre of related processes.     

Editorial

In recent years the imperative to involve service users and carers at every level of care, service and policy development has been extended to include involving users and carers in the training of health and social care professionals. Guidance on how this is to be achieved in practice is, however, limited. This paper describes work undertaken to explore how an Approved Social Work Programme in the north of England could involve service users and carers more fully and develop an integrated approach to service user and carer involvement in this and other social work programmes. Following a review of the literature in this area, the results of a series of meetings with individual and groups of service users and carers are presented, together with a survey of ASW programmes. It then goes on to consider the implications for service user and carer involvement in the new social work degree.     

Live to 70 Years and Older or Suffer in Silence: Understanding Health Insurance Status Among the Elderly Under the NHIS in Ghana

Ghana has introduced a National Health Insurance Scheme (NHIS). Embedded in the NHIS is a policy to exempt poor and vulnerable groups from premiums and user fees. There has been some debate as to why the start-off age for exemption among the elderly is 70 years. Ghana has a shorter life expectancy than middle- and high-income countries and its current age of retirement is 60 years. This study explores the financial and social implications of continuing to charge premiums to people aged 60 to 69 years. Based on the analysis of data from a representative household survey, it is recommended that the exemption policy should be expanded to include all vulnerable elderly persons, regardless of age.     

Constructions of ‘vulnerability’ in comparative perspective: Scottish protection policies and the trouble with ‘adults at risk’

This paper places Scottish adult support and protection (ASP) policy in the context of debates about the nature of ‘vulnerability’ and its usefulness as a defining concept in law and social policy. It examines the construction of ‘adults at risk’ in ASP policy, using a comparison with the construction of children in Scottish child protection policy, on the one hand, and women in Scottish domestic abuse policy, on the other, to illuminate the nature of the vulnerability that ASP considers itself to be addressing. It then problematises this construction, drawing both on the social model of disability and on an ethic of care. It concludes that current ASP policy remains underpinned by unhelpful assumptions about disabled people, older people and people with mental or physical health problems. A more inclusive understanding of vulnerability would be more empowering to these people and others, in policies concerned with mistreatment and abuse.     

Working with Violence,the Emotions and the Psycho‐social Dynamics of Child Protection: Reflections on the Victoria Climbié Case

In recent years, attention to the psychological and emotional aspects of doing child protection has been largely ignored in the literature and squeezed out of understandings of welfare practices. This paper argues for the establishment of a coherent psycho‐social perspective at the core of social work education and practice and in inter‐professional child protection work more generally. Central to this must be recognition of the complexities of service users, especially the challenges of working with resistant and often hostile ‘involuntary clients’ and the impact of violence and other health, safety and contamination fears on the capacities of workers and professional networks to protect children. These issues are grounded in a critical analysis of the Victoria Climbié case and the Laming report into her horrific death which, despite its strengths, presents rational and naïve solutions to what must be understood as often irrational and inherently complex psycho‐social processes. A psycho‐social reading of the case permits us to explain the unexplainable in how Victoria's abuse was missed. The general implications of these arguments are drawn out for education, training and practice.     

‘Providing a Link with the Real World’: Learning from the Student Experience of Service User and Carer Involvement in Social Work Education

Social work has long placed an emphasis on involving users and carers in the education of practitioners, an emphasis driven by service users and carers themselves, the value base of social work, and by policy and legislation from successive governments and regulatory bodies. Recent changes in regulation and professional standards in social work suggest a continuing commitment to service user and carer involvement. This paper argues that in order to ensure a sustainable commitment, there needs to be greater evidence of the value and purpose of such involvement. Whilst there is a considerable body of literature on this issue in social work education, little focus is on any impact on current and future practice of social work students. The paper discusses a research project addressing this issue from the perspective of social work students. Findings suggest that the involvement of service users and carers in their training was perceived by students as overwhelmingly positive, should be enhanced and that they believed that these experiences were taken forward in their practice. The paper also identifies key points that could inform best educational practice.     

Meeting immigrant health challenges: An integrated model in New York City

New York City has traditionally been the portal to America for millions of foreign‐born immigrants. Current immigration echoes this past. Each year, tens of thousands of immigrants and migrants enter New York City. These individuals and families come from diverse cultures and health care systems which continue to impact on their health care needs. How can New York's health care system provide culturally sensitive and epidemiologically informed health services to these immigrants? In 1990, with a grant from the Aaron Diamond Foundation, an interdisciplinary group of professionals established the New York Task Force on Immigrant Health. This paper will describe the work of this unique multi‐disciplinary organisation as it seeks to address issues of health status and service delivery to immigrant populations. The paper will discuss specific issues and strategies with respect to a) the development of data bases, b) ethnographic investigations, c) cross‐cultural and structural barriers to care, d) the creation and analysis of models to integrate traditional and Western bio‐technical health care, and e) the informing and transforming of public policy and programs to result in more linguistically appropriate, culturally sensitive and effective health and social services. The successes of the New York Task Force on Immigrant Health, in a relatively brief period of time, provide both a model and a stimulus for other localities and nation‐states interested in preventing illness and improving the health status of their diverse populations.     

Medicare Funded Mental Health Social Work: Better Access to What?

ABSTRACT

Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Scheme initiative (Better Access), is an Australian Federal Government scheme aiming to improve access to mental health services. Accredited mental health social workers have been involved in the delivery of services under Better Access for more than a decade. In this time, there have been significant changes in the field of mental health services, with consequent increases in size and costs for Better Access. Better Access now represents public spending of more than one billion dollars per annum, yet there is no ongoing account of its impact. In this paper we consider the policy chronology and evaluation of the program, using current available data to question the impact of Better Access on both the service system and the nature of mental health social work practice. This case highlights the importance of a clear articulation of the scope of mental health social work, and ongoing monitoring of the impact of policy in a policy environment increasingly characterised by individualised funding and service delivery structured according to the principles of New Public Management.

IMPLICATIONS

• Social workers' increasing involvement with Better Access has reshaped the scope of mental health social work practice.

• The impact of Better Access on outcomes for service users and mental health social work is not currently a focus of research attention.

• Better Access is a case study illustrating the potential of the policy context to directly shape social work practice, therefore critical engagement with the impact of Better Access is an essential professional imperative.

     

Childhoods in Policy: A Critical Analysis of National Child Protection Policy in the Philippines

This article investigates policy in the Philippines relating to the protection of children, which, despite policy efforts in this space, and growing evidence of child maltreatment and its impact, remains unexamined by the literature. It examines constructions of childhoods utilising a critical policy analysis of national policy documents concerning children's welfare and protection. Analysis finds conflicting representations of children's agency, defining children as ‘becomings’, but also as rights holders and social actors, viewing children as both embedded in, and reliant on, family, consequently detailing important insights into Filipino policy‐making and society.     

Sexualised Culture and Young People’s Sexual Health: A Cause for Concern?

There is no unified body of knowledge relating to the impact of sexualised culture upon adolescent sexual health. Despite this, concern and public outcry that children are growing up in a cultural milieu saturated with sexualised images exists. Where opinion changes, is not on the existence of sexualised culture, but the nature of its impact upon individuals. The media is often cited as negatively influencing sexuality and sexual behaviours of young people. Current public health policy reflects this belief. In an attempt to re-orientate public health discourses this paper reviews recent literature and research on the relationship between sexualised culture and young people’s sexual health in the UK. It provides an introduction to the evidence and its application within public health policy in the UK. It illustrates a typology of risk and harm and argues that the field is defined by inadequate methodology, covert moralism and one-dimensional interpretation. It identifies a need to expand definitions of young people’s sexual health to include a focus on activity and participation including pleasure, performance, and capacity in order to inform public health and social policy.     

Toward an organic policy sociology

According to many, sociology is facing a crisis of relevance. Of particular concern is sociology's inability to impact policy. Sociologists, who should be the go‐to on major policy issues have been sidelined as other social scientists take up roles as policy advisors. Recent efforts aimed at encouraging public engagement have focused on disseminating research and producing more policy‐relevant knowledge. These are welcome resources, but they reflect a deep ambivalence toward policy sociology and a tendency to conflate participation in public discussions with policy impact. In contrast, this essay draws on recent findings about the power of policy experts to develop an organic policy sociology. Organic policy sociology depends on co‐designing and carrying out research with policymakers with whom we share critical and professional commitments. By working collaboratively with policymakers, sociologists can foster equity‐promoting policy, change how policymakers understand social problems, and improve how citizens experience policy on the ground. To that end, I offer six orienting strategies for developing and maintaining organic policy sociology projects, from finding the right partner to assessing the impact of our work.     

Millennium Development Goal Achievements and Policies in Education and Health: What Has Been Learnt?

This article reviews the effectiveness and efficiency of key policy instruments for MDG (Millennium Development Goals) achievement, focusing on the role of demand‐ and supply‐side factors in education and health‐service utilisation. It comes to the following conclusions. First, specific policy interventions can have a considerable impact on social‐service utilisation. Second, demand‐side policies have proved extremely effective in the education sector, but may need more consideration in the health sector. Third, policy effectiveness and efficiency are highly dependent on initial conditions and the specificities of the respective policy. Fourth, complementarities between MDG targets are likely to be very important.     

Research,policy and funding – academic treadmills and the squeeze on intellectual spaces1

In recent years, there has been a great deal of collective rumination about social scientists' role in society. In the post‐1997 UK context, public policy commitments to ‘evidence‐based policy’ and ‘knowledge transfer’ have further stimulated such reflections. More recently, Michael Burawoy's 2004 address to the American Sociological Association, which called for greater engagement with ‘public sociology’ has reverberated throughout the discipline, motivating a series of debates about the purpose of sociological research. To date, most such contributions have been based on personal experience and anecdotal evidence. In contrast, this paper responds directly to Burawoy's suggestion that we should ‘apply sociology to ourselves,’ in order that we ‘become more conscious of the global forces’ driving our research ( Burawoy 2005 : 285). Drawing on an empirical research project designed to explore of the relationship between health inequalities research and policy in Scotland and England, in the period from 1997 until 2007, this paper discusses data from interviews with academic researchers. The findings suggest that the growing pressure to produce ‘policy relevant’ research is diminishing the capacity of academia to provide a space in which innovative and transformative ideas can be developed, and is instead promoting the construction of institutionalized and vehicular (chameleon‐like) ideas. Such a claim supports Edward Said's (1994 ) insistence that creative, intellectual spaces within the social sciences are increasingly being squeezed. More specifically, the paper argues we ought to pay far greater attention to how the process of seeking research funding shapes academic research and mediates the interplay between research and policy.     

Developing Anti‐oppressive Ethics in the New Curriculum

This paper describes the development of an anti‐oppressive ethics and values module appropriate for the new social work degree. It is contended that there has been insufficient attention paid to ethics teaching in social work education generally in the UK, and in particular there has been:

• ?failure to develop discrete modules on ethics and values in social work;

• ?minimal critique of conventional ethics with social work values that take oppression and diversity seriously;

• ?insufficient use of recent feminist ethical contributions relevant to social work;

• ?limited development of interprofessional ethics teaching that take service user and social work values seriously; and

• ?neglect of ethical decision‐making guides that can encompass legal, ethical and social work values.

The paper proposes a rationale for an anti‐oppressive ethics module that will enable traditional ethical theories to be placed within an anti‐oppressive social work values context, and aim to provide students with a more adequate guide for decision‐making. The module will be developed in consultation with service users and interprofessional colleagues. It will take into account the British legal and policy framework, the General Social Care Council code of practice, as well as the Quality Assurance Agency for Higher Education requirements, but placing them within an anti‐oppressive framework drawn from the authors' current and previous work in this area, and will have special reference to recent feminist moral philosophy. The authors have recently been re‐located into a Faculty of Health and Applied Social Studies and will be developing the new module on ethics in consultation with health lecturer colleagues specialising in ethics with the aim of developing interprofessional co‐operation and sharing of perspectives between staff and students. They write with long experience of both practising and teaching social work, and with diverse experiences of ‘race’, gender, class, and also being both service users and providers.     

Out of the wilderness and into the fold: the school nurse and child protection

This paper argues that there has been a major change since the mid‐1980s in the extent to which other workers involved in child protection recognize the value of the contribution of school nurses. Evidence for this is drawn from a longitudinal study in an English shire county using a vignette approach to explore workers' perceptions of the handling of child protection issues. While in part the greater recognition of the role of the school nurse can be attributed to the adoption of child protection procedures, this provides only a partial explanation. School nurses in the 1990s were better qualified and more experienced, while other workers such as school heads and social workers recognized the need to work with others, such as the school nurse, in order to meet their own objectives. The paper concludes that there is a case for more formal recognition of school nurses in child protection because, like health visitors, with whom they have a follow‐on colleague relationship, they are often the most significant health workers for children who may be neglected or abused. Copyright © 2000 John Wiley & Sons, Ltd.     

The effect of unemployment on children and adolescents

Unemployment is a stressful life event that affects not only the job loser, but also impacts the person's social network. This network includes family members. However, most of the research on unemployment has focused on the effect of job loss on the former worker. This paper reviews this limited literature in order to identify what the potential impact of unemployment is on children. The reason for doing so is to add to the knowledge base that has demonstrated that economic policy decisions have a substantive effect on many aspects of societal health and wellbeing. Information on what these effects are in regard to children and families might serve to inform decision makers in developing appropriate social policy. This information is also an aid that would help professionals in the planning and delivering of needed services.     

Family support and the role of social work: Renaissance or retrenchment?

In recent years there has been a renewed interest among European social workers in providing family support in the growing area of child and adolescent mental health. As the European Union enlarges and embarks on the development of social policy, the opportunity arises to learn from experience in each member country and share knowledge. This paper reflects on the British experience where professional social work practice has attempted to shift from a residual child protection stance, towards a more preventive and supportive mode. This paper examines a range of family support policy and practice interventions with particular reference to models of assessment, methods of support, and measures of effectiveness. The conclusion is that there is in Britain a renaissance in indirect, voluntary, non-governmental family support more usually associated with continental European countries. However, this is on the basis of limited empirical evidence of long term effectiveness, and could, paradoxically, contribute to the retrenchment of professional social work throughout Europe, as enlargement puts economic pressure on countries to cut costs and reduce the scope of professional social work activity.     

The Changing Value of the Child – A Review of the Literature Regarding Social Perceptions of Sick and Dying Children

This article reviews the literature pertaining to the changing value of the child in England since the 19th century, highlighting the relative policy neglect of contemporary sick and dying children. The review discusses the relationship between the value of the child, social constructions of childhood and social policy. The review demonstrates how the value of the child has altered from one of utility to a contemporary position of sacralisation, illustrated by mortality statistics as a measure of associated policy impact. However, large reductions in mortality rates conceal the more complex picture of contemporary child health. Children die each year from life‐limiting and life‐threatening disorders. Moreover, technological developments increasingly allow children to live longer with such conditions, albeit with ever more complex ill health. Such children are therefore dying over protracted periods of time. However, they are largely absent from policy, which tends towards standardised outcome measures which may not reflect the needs of this minority group. Therefore, although contemporary constructions of childhood focus upon sacralisation, reflecting psychological value to parents and society, the most vulnerable child members of society remain neglected in policy and service provision.