The Quality of Life of the Chronically Mentally Ill: A Comparison of Public, Private, and Voluntary Residential Provisions

Correspondence to J. P. J. Oliver, Lecturer in Psychiatric Social Work, Department of Psychiatry, University of Manchester, Rm 11.11, Mathematics Tower, Oxford Road, Manchester, M13. Summary A pilot survey was undertaken as part of a long-term investigationof the needs which people with chronic mental illness have forcommunity support. The main purpose of this preliminary exercisewas to develop relevant measures of need. particularly measureswhich give due weight to the assessments which chronic patientsmake of their own quality of life. Results have particular relevancein the light of the ‘White Paper’ on community care,Caring for People and the National Health Service and CommunityCare Act, 1990 because the survey considered patients' experienceof life in three distinct types of resettlement facility: thepublic, the private and the voluntary. While differences inregimes, the personal characteristics of residents and objectivequality of life were noted, no differences in subjective qualityof life (either in general or in specific domains of life) werenoted from one type of facility to another. These results andtheir implications are discussed.     

Bereavement: the Contribution of Phenomenological and Existential Analysis to a Greater Understanding of the Problem

Summary Theoretical approaches to grief and mourning have emphasizedthe instinctual and biological elements of a person's responseto bereavement. The behaviour of bereaved individuals has thereforebeen interpreted on the basis of these theoretical models. Thispaper argues that an appreciation of the social context in whichbereavement occurs leads to a fuller understanding of observedresponses in such a situation. It thus emphasizes the socialnature of individuals rather than their biological make-up andprovides a theoretical frame of reference in terms of whichthis may be understood. Such an analysis also has implicationsfor the kind of help which is seen to be appropriate to theneeds of bereaved people. It is suggested that social workersshould develop a greater understanding of this approach andthat, on the basis of this, they would then have a particularrole to play in relation to this area of need     

Birth Mothers and their Mental Health: Uncharted Territory

Correspondence to Janette Logan, Department of Social Policy and Social Work, University of Manchester, Oxford Road, Manchester Summary This article reports the findings of a study commissioned bythe Mental Health Foundation which examined the experiencesand needs of birth mothers who relinquished a child for adoption.Historically, birth mothers have been neglected in the Britishliterature; their experience is considered to have ended atthe time of placement. This research however, indicates thelong-term implications of relinquishment are severe—particularlyin relation to mental health. They demand that the complexityand uniqueness of relinquishment as a form of loss be more fullyunderstood, birth mothers' reactions to those experiences arenot pathologized and professionals learn to respond more positively.GP's in particular need to develop a more sensitive understandingof their needs and in so doing could prevent the medicalizationof some birth mothers.     

Children in Need? Listening to Children whose Parent or Carer is HIV Positive

Correspondence to Kay Tisdall, University of Edinburgh School of Social and Political Studies, Adam Ferguson Building, George Square, Edinburgh EH8 9LL, UK. E-mail: K.Tisdall{at}ed.ac.uk Summary International attention is being brought to the global HIV/AIDS epidemic. In contrast, HIV and AIDS risk being forgottenissues for those living in Scotland. Yet in 2002, numbers ofreported infections have begun to rise. Children and young peopleare even more likely to be affected by parental HIV now, asparents live longer and are able to have more children. Verylittle is known in Scotland about affected children and whethercurrent service provision meets their needs. This research projectsought to address certain of these gaps, by gathering quantitativedata from service providers and qualitative data from interviewing28 affected children and young people. The research found adearth in policies and services, and a failure to audit need.HIV education in schools did not acknowledge that pupils mightbe living with parents who had HIV illness. Children and youngpeople tended to be very involved in the health care of theirparent but none of them received direct support from healthworkers. On the whole the children and young people did notenjoy support from statutory social workers but appreciatedthe support and activities provided by workers in the voluntarysector.     

'The Social Worker as Bad Object': A Response to Marguerite Valentine

Correspondence to Nigel Thomas, Department of Social Policy and Applied Social Studies, University of Wales, Swansea, Swansea SA2 8PP. Summary Valentine's article in the British Journal of Social Work (Vol.24, No. 1, February 1994) examined the processes whereby socialwork agencies defend against feelings of blame introjected bysocial workers as a result of public projections of fear andanxiety about child abuse. One of these processes is claimedto be the increasing regulation of practice, exemplified bythe Childrens Act 1989. While welcoming Valentine's generalargument, this article argues that it contains a fundamentaland serious misreading of the Children Act.     

Older People and Access to Care

Correspondence to Denise Tanner, School of Health and Social Sciences, Coventry University, Priory Street, Coventry CV1 5FB, UK. E-mail: d.tanner{at}coventry.ac.uk Summary At the heart of a number of New Labour health and social policyinitiatives are stated concerns with supporting independence,preventing deterioration and extending access to services. Thisarticle examines the potential impact of these initiatives,including Prevention Grants (Department of Health, 2000b), theNational Service Framework for Older People (Department of Health,2001a), the Fair Access to Care Services Guidance (Departmentof Health, 2002a), and the Single Assessment Process (Departmentof Health, 2002b), on older people with ‘low level’needs who have increasingly been excluded from services targetedat those in high risk categories. Key standpoints for this analysisare research findings indicating what older people themselveswant from preventive services. Central messages, consistentwith those from other service user ‘groups’, arethe need for support services that enable older people to continueto exercise choice and control over their lives. New preventivemeasures are evaluated in the light of these findings and foundwanting. It is argued that recent policy initiatives are likelyto do little to widen access to support services for those withlow intensity needs, and, moreover, that the processes involvedin identifying those at future high risk will detract from ratherthan enhance citizenship. A more diffuse approach to preventionis advocated, based on mutuality, community development, andcapacity-building.     

Where has all the care management gone? The challenge of Parkinson's disease to the health and social care interface

Summary The delivery of health and social care has undergone massivechange in the UK in the 1990s. A key factor in the drive forreform was the failure of joint working arrangements betweenhealth and social services and the need to provide integratedcare for people who have overlapping health and social careneeds. This article draws on a research study investigatingthe community care provided to people with Parkinson's diseasein the wake of the 1990 National Health Service and CommunityCare Act. As a chronic progressive disease predominantly affectingolder people, the management of Parkinson's provides an exemplarof some of the key features of supporting people with continuingcare needs. This study found serious deficits in the assessmentand meeting of need, arising from weaknesses at the health andsocial care interface. The article concludes by consideringan approach which resources and supports the service user/carerin managing their own care pathway.     

Community Based Care for People with a Mental Handicap: A Family Placement Scheme in County Durham

Correspondence to Dr R. F. Drewett, Department of Psychology, University of Durham, South Road, Durham DH1 3LE Summary In 1984 a family placement scheme for people with a mental handicapwas started by Durham County Council Social Services Department.Thirteen were placed in ten families by the summer of 1988,when we interviewed all clients and carers in the scheme. Responses to the scheme were generally positive, both from thecarers and from the clients. All but two of the carers, however,had considerable previous professional experience with peoplewith a mental handicap, and generalizations from the experienceof this initial group of carers therefore need to be made withsome caution.     

Exploring the 'Need' for Family Centres: The Perceptions of Social Workers and Their Importance for Planning

Correspondence to Ms J. R. Fells, Wooster Arms, The Walk, Islip, Oxon OX5 2SD. Summary This article follows Gilbert Smith in questioning the usefulnessof some traditional ways of regarding need, which rely mainlyon surveying potential client populations in order to decidewhat provision a social services department ought to make. Itdescribes a small study which examined in detail what socialworkers meant when they said that certain families ‘needed’a Family Centre, and which also looked at the subsequent historyof the department's contact with those families in the absenceof such a resource. It is, therefore, based on looking at whathappened to families when the Centre was not provided, and onanalysing social workers' perceptions of the need they encountered. It is argued that, despite its limitations, such an approachcan give useful indications, not only of what services shouldbe provided but as to the specific way they should be offered.In view of the role played by social workers in assessment for,and allocation of, services, it is suggested that a clearerunderstanding of their perceptions is essential to achieve effectiveservice utilization.     

Medicalization of Social Workers in Mental Health Services in Hong Kong

Correspondence to Dr Kam-shing Yip, Associate Professor, Department of Applied Social Studies, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong. E-mail: ssksyip{at}polyu.edu.hk Summary Medical dominance is a crucial problem in social work practicein mental health services. This paper is an examination of theresponse of social workers to medical dominance in mental healthservices in Hong Kong. To explore the process and the effectsof medicalization of social workers, sixty-three social workersin various areas of mental health service settings were interviewed.Their reaction and daily performance in facing medical dominancewere analysed and evaluated. The findings show that facing medicaldominance was a common occurrence for social workers in variousmental health services in Hong Kong. Conflict existed betweenthe rationalization of medical knowledge by medical professionals,and social work rationalization of social work knowledge bysocial workers. The process of medicalization consisted of fivestages: ignorance of medical dominance, confronting medicaldominance, compromise with medical dominance, acceptance ofmedical dominance and internalization of medical dominance.The findings also show that medicalization was influenced bythe organizational and team context.     

Working in Multidisciplinary Community Mental Health Teams: The Impact on Social Workers and Health Professionals of Integrated Mental Health Care

Correspondence to Professor John Carpenter, Centre for Applied Social Studies, University of Durham, Elvet Riverside II, Durham DH1 3JT, UK. E-mail: J.S.W.Carpenter{at}dur.ac.uk Summary This study investigated the relationships between the organizationof community mental health services and professional and teamidentification, team functioning and the psychological well-beingand job satisfaction of staff working in multidisciplinary communitymental health teams (CMHTs). Staff in four districts in theNorth of England completed anonymous questionnaires on two occasions,twelve months apart. There were systematic differences in teamfunctioning, favouring teams in districts where mental healthand social care services were integrated. However, service organizationhad no evident impact on professional or team identificationor on outcomes for staff in terms of stress or job satisfaction.There were differences between social workers (n = 31) and healthservice professionals (n = 82) indicating that social workershad poorer perceptions of team functioning and experienced higherlevels of role conflict. Controlling for other factors includingthe study districts, role conflict was a significant predictorof stress and of job dissatisfaction, while role clarity promotedjob satisfaction. We conclude that support and supervision aimedat ensuring a social work contribution to multidisciplinaryworking should be provided in the course of establishing CMHTsand integrated health and social care services.     

The Effort Involved in Finding Employment for White-Collar Offenders

Summary Ex-offenders are notoriously difficult to place into employment.However, the efforts needed to help such clients find work varyenormously and an important question to consider is whetherit is more appropriate to help a larger number of clients bylimiting the amount of placing effort for each client or tocontinue to try to assist those who prove much more difficultplacing propositions. The present study indicates some of thepotential dangers in concentrating upon short-term aid and thefindings have relevant implications for other areas of socialwork where there is a need to ration efforts made on behalfof clients. The present paper also stresses that the difficultiesof while-collar es-offenders finding work have not been fullyrecognized by other comtnentators.     

Questions Raised for Local Authorities when Old People are Evicted from their Care Homes

Correspondence to Peter Scourfield, School of Community, Health and Social Studies, Anglia Polytechnic University, Cambridge CB1 1PT, UK. E-mail: p.scourfield{at}apu.ac.uk Summary Successive government policies have created a situation wheremost residential and nursing care is provided by the independentsector. It is in the nature of a marketized and privatized caresystem that homes will periodically close or change ownership.The physical and mental well-being of elderly residents experiencingeviction and relocation can be seriously damaged by the experience.No policy and practice guidelines have been issued from centralgovernment to cover how care home closures should be managed.Local authorities are therefore dealing with such events onan ad hoc basis. Understandably, the main emphasis is oftenput on actually finding appropriate alternative placements.Practices vary across different local authorities. This articleasks whether the necessary work required to minimize the harmfuleffects caused by the stress of relocation is actually beingcarried out properly. It also raises the questions of what exactlyshould be offered to older people when they are given noticeto quit, who is best qualified to do the work and whether caremanagement as it has developed within the ‘purchaser/providerframework’, is adequate to the task. In short, where cansocial work for older people be found when it is needed?     

Responding to Youth Crime in Scotland

Correspondence to Bill Whyte, Director, Criminal Justice Social Work Development Centre for Scotland, School of Social and Political Studies, University of Edinburgh, Flat 1FR, 31 Buccleuch Place, Edinburgh EH8 9LJ. E-mail: B.Whyte{at}ed.ac.uk Summary Scotland’s Children’s Hearings deal with young peoplewho offend within an integrated system dealing also with youngpeople in need of care and protection, on the assumption thatthe difficulties of both groups have similar roots in multiplesocial disadvantage and social adversity (Whyte, 1998a). A government-fundedstudy, one of the first since the system’s inception in1971, was commissioned to examine the social characteristicsof over 1,000 children and young people referred for offenceand nonoffence reasons. This paper describes the characteristicsof 465 of the young people who were referred specifically foroffending. It provides the first ‘official’ datain twenty-five years on young people in the system. The studyfound that most of those referred for offending had characteristicsstrikingly similar to those referred for nonoffence reasons,as predicted when the system was first established, and similarto those present in the general literature on young offendersfrom other jurisdictions. The study poses fundamental questionstaken up by the Scottish Executive’s review of youth crimeon how best to design systems and develop social interventionsthat can address offending and social disadvantage in an integratedway.     

Social Work with Huntington's Chorea

Please address requests for reprints to Rosemary Yale, Association to Combat Huntington's Chorea, 108 Battersea High Street, London SW11 3HP Summary All professionals with knowledge of patients suffering fromHuntington's Chorea (HC) or their relatives, living in a definedgeographical area, were interviewed. Our findings show thatin spite of multiple psychosocial issues from time of diagnosis,and even earlier, social work was offered at a relatively latestage or not at all. Some important tasks such as genetic counsellingwere often ignored or mishandled. Lack of knowledge about theissues inhibited good practice. Professionals failed to communicateadequately and, like HC families, experienced feelings of frustrationand impotence. We conclude that HC requires a team approachif families are to cope with the complex problems they face,and we make recommendations for a better service.     

The New American Social Work Gospel: Case Management of the Chronically Mentally III

Correspondence to Dr R. A. Cnaan, School of Social Work, University of Pennsylvania, 3701 Locust Walk, Philadelphia, PA 19104, USA. Summary Case management is currently the most popular mode of servicedelivery in the United States, especially in community programsfor chronically mentally ill people. Proponents of case managementclaim that it is cost-effective and that it assures provisionof necessary services to clients. In this paper I do not challengeits effectiveness but argue that case management neither empowersclients nor is it free of drawbacks. Given that many countriestend to model the United States, foreign social workers andother human service professionals should first examine the usefulnessof case management vis-à-vis their own cultural and economiccontexts, especially in the light of its many drawbacks.     

Mental Health and the Asian Communities: A Local Survey

Correspondence to Barbara Hatfield, Lecturer in Psychiatric Social work, Department of Psychiatry, 12th Floor, Mathematics Building, Manchester University, Oxford Road, Manchester M13 9PL Summary The survey of people from the Asian communities in ‘Milltown’included people who used mental health services, family membersof service users, and members of the Asian general public. Personaland social stresses of the group were explored, as were theirperceptions of the ‘causes’ of mental ill-healthand appropriate responses. Although most people saw family andsocial stress as central, a religious dimension was also prominent,in terms both of causes and treatment of mental ill-health.There was no evidence of rejection of mainstream services becauseof a choice on the part of Asian families or communities tobe self-servicing. A range of issues identified by respondentssurrounded the cultural acceptability of services in ‘Milltown’to Asian people. A lack of knowledge of service availabilitywas also apparent, with a heavy reliance upon GP services formental health care in the community. The findings of the surveyare compared with similar studies, where available, which focuson indigenous white British service users. Some findings arecommon; other issues are specific to this Asian group.     

Assessment and Action Records: Will they Promote Good Parenting?

Correspondence to Theo Knight, Department of Applied Community Studies, Manchester Metropolitan University, 799 Wilmslow Road, Didsbury, Manchester M20 2RR. Summary In this article the authors seek to provide a critical lookat Looking After children: Good Parenting and Good Outcomes(Department of Health, 1995). They welcome the sentiments underpinningthis major contribution, which recognizes the many disadvantagesfaced by children and young people who are looked after by localauthorities, and acknowledge that local authorities have notbeen positive parents of those in their care. The writers alsoacknowledge the thoroughness which has gone into the detailof the Action and Assessment Records contained in the abovepack. What is questioned is the normative view of parentingand family life which is seen to be at the heart of these documentsand the lack of consideration of the resourcing of action plans.The checklist approach is criticized for the way in which itwill enhance the bureaucratic nature of being in public care,which in turn affects the relative power positions of parentsand children in relation to the local authority and which willimpact on the development of a partnership model of care. Thewriters conclude that children and young people in care arebut one group of young people facing disadvantage and deprivationin British society. An examination of their plight and how toaddress it need to be based within a clear framework of children'srights and a recognition of the power adults hold over them.     

Stress in Social Services: Mental Wellbeing, Constraints and Job Satisfaction

Correspondence to Margaret Coffey, Liverpool Hope University College, Room AEW 098, Hope Park, Liverpool L16 9JD, UK. E-mail: coffeym{at}hope.ac.uk Summary The public sector is facing an impending shortage of staff,because young people no longer want to work in it and nearlya third of its workforce is over 50 years of age. Staff workingwithin the public sector report that stress is the biggest singlefactor affecting their decision to leave. This research notereports the findings of a recent study carried out in two socialservice departments in the north-west of England. The primaryaim of the research was to explore work-related stress, usinga ‘problem diagnosis tool’ to understand the stressorsexperienced by social services staff, and to inform the developmentof interventions aimed at reducing and/or eliminating them.This study used in-depth interviewing to develop a questionnaireincorporating a variety of measures to assess potential stressorsand mental well-being. The questionnaire response rate was 33per cent (n = 1234) and the results demonstrated statisticallysignificant differences between staffing grades. Staff workingwith children and families reported the highest levels of absenteeism,poorest well-being, and highest level of organizational constraints.Job satisfaction was low compared with established norms forvarious occupational groups. This grounded research baselineis a crucial step to inform specifically designed and targetedinterventions, which can be effectively evaluated from thisbaseline position.     

Support for and From Aging Mothers Whose Adult Daughters are Seriously Mentally Ill

This article discusses, from the grandmother’s perspective, the ways in which support is exchanged in families coping with serious mental illness. A strengths perspective was utilized to identify ways in which family members help each other. Employing a qualitative approach, this study focuses on interviews obtained from a sample of 22 aging mothers, aged 52–90, who are in contact with their daughters who have a mental illness. Grandmothers provided several kinds of support to their mentally ill adult daughters and to their grandchildren, who also supported the aging mother in numerous ways. As social workers seek to assist individuals with mental illness, it is important to assess the existing strengths of their intergenerational family context.