The Mentally Handicapped and Their Professional Helpers

Summary This article discusses visits paid to fifty-three families witha severely mentally handicapped adult living at home, most ofwhom were also quite severely disabled physically. Varying reactionsto the services offered by general practitioners and mentalwelfare officers are described and those factors influencingthe generally poor opinion of mental welfare officers' servicesare discussed. The importance of the daily routine of the familiesis emphasized and the difficulty of the mental welfare servicein providing services or practical assistance which helps withthe daily routine. Finally it is suggested that the social servicesshould see a greater part of their work as helping and enablingthe community to do better, and with less strain, the caringit does already and that this means that the planning of servicesneeds to start from the locality in which the handicapped personlives     

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.     

Community Work with Immigrants

Summary The paper emerges from community work with an immigrant organizationin a government-sponsored Community Development Project overa two-year period. It discusses the various approaches to workingwith immigrants, including that of the local Community RelationsCouncil, reports an action research survey of immigrant need,and in particular assesses the ‘non-directive’ communitydevelopment approach to working with an immigrant organization.The implications of this study are discussed in relation tothe general potential of community work with immigrants     

Bibliotherapy in Social Work

Summary Bibliotherapy literally means the therapeutic use of literature.Many people will have experienced the power of literature orother art forms to offer new insight, to provide sources ofidentification, to stir the emotions, and to release feelings.In line with its current usage bibliotherapy can be broadlydefined as a technique whereby the worker seeks to utilise theseinteractive processes therapeutically so that those experiencingthe literature or other form of media can be helped towardspreventative, remedial and/or developmental goals. The literaturecan be either imaginative or didactic. It is the contentionof this article that Bibliotherapy is a useful additional toolfor social workers that can be used at the individual and grouplevel with both children and adults. Illustrations are takenfrom the ‘Wednesday Group’ which was set up by theauthor for elderly depressed patients using a bibliotherapeuticapproach, as well as from the wider literature on Bibliotherapy.     

Quality Control in Child Care

Correspondence to June Thoburn, School of Ecnomics and Social Studies, University of East Anglia, Norwich NR4 7TS Summary This article takes as its starting point recent evidence aboutpoor practice in child care social work. It identifies a largenumber of mechanisms for ensuring quality control, and considerswhy they appear to be having so little effect. The writer suggeststhat because of the complexity of cases and the need for direction,and also because of disagreements about what is ‘quality’in child care, bureaucratic or procedural mechanisms have seriouslimitations as the major means for ensuring good practice. Shefocuses on the statutory review as the solution most frequentlysuggested but concludes that too much is being expected of it. Whilst accepting the need for procedural, inspectorial, judicial,and political checks and for more appropriate resources forfamily support, she suggests that the main remedy for poor practicemust lie in professional mechanisms. These include increasedspecialization, more time, improved training, and consultation.The weight of evidence and the intractable nature of the problemmay call for drastic measures, such as the introduction of theApproved social worker(child care).     

Cost and Stakeholder Views: A combined approach to evaluating services

Correspondence to Jackie Powell, Department of Social Work Studies, University of Southampton, Highfield, Southampton SO9 5NH Summary This paper focuses on the decision-making process at a strategiclevel in the context of implementing a ‘community care’policy for older people with mental health problems. It is basedon the findings of an evaluative study of the implementationof one district health authority's strategy for the decentralizationof its mental health services for older people. The study wasan attempt to develop an evaluative approach which acknowledgedthe importance of cost, but also the need to include the viewsof the several ‘interested parties’, not least thosewho used the service. The reconciliation of what might be seenas the conflicting interests of the wider public for a carefulutilization of resources with the individual's needs for anaccessible and responsive service represents a major challengefor planners, managers and practitioners within the public sector.This paper argues the need for dialogue as the basis for partnershipbetween those with a primarily financial focus to their workand those more intimately concerned with individual needs.     

The Language of Siege: Military Metaphors in the Spoken Language of Social Work

Correspondence to Chris Beckett, School of Community Health Studies, APU, East Road, Cambridge CB1 1PT, UK. E-mail: c.o.beckett{at}apu.ac.uk Summary This article discusses the language that is used by childrenand family social workers when talking about their work, andspecifically the metaphors that such language draws upon. Thequestion of the relationship between language and reality thathas been raised by postmodernist theory is considered, but itis argued that it remains sensible to see language as ‘areflection of reality’, however partial. Drawing on ideasabout metaphor from other disciplines, it is suggested thatby identifying the sources of metaphors used in spoken languageit is possible to gain insights into underlying mental concepts.Metaphors in the language of social work are found to come fromseveral sources, including medicine, business and industry,but attention is drawn here in particular to terms with militaryconnotations, implying underlying conceptual metaphors thatequate social work with war. The implications of this are discussed.     

Conciliation: A New Approach to Family Conflict Resolution

Summary This article criticises the traditional ‘adversarial’approach to divorce and argues for new methods of conflict resolutionto reduce the destructive impact of divorce on the family asa whole, and to give higher priority to the needs of children.These methods need to be developed in conjunction with lawyers,so that conciliation can be integrated with legal proceedingsarising from separation and divorce. The article discusses therelevance of conciliation to different forms of marital breakdown,and attempts to define some of the main elements of the conciliationprocess.     

The Social Worker as 'Bad Object'

Correspondence to Dr Marguerite Valentine, 56 Osbaldeston Road, London N16 7DR Summary A ‘bad object’ has been defined as an ‘objectwhom the subject hates or fears, who is experienced as malevolent.A bad object may be either an internal or an external object’(Rycroft, 1988, p. 100). This paper explores the circumstancesin which public fears and anxieties over child abuse becomeprojected into the social worker. It discusses how social workersintroject these feelings, become a ‘bad object’,and how social services departments have developed a numberof strategies which defend against feelings of blame and responsibility.The exploration is derived from my own experiences and observations,and applies Kleinian psychoanalytic theory to studies of institutionaldefences.     

Infertility Counselling: The Need for a Psychosocial Perspective

Correspondence to Ken Daniels, Head of Department of Social Work, University of Canterbury, Christchurch, New Zealand. Summary The expectation of the vast majority of young couples is thatat some stage they will ‘have’ children. Infertilitymeans that that expectation cannot be met and this has personal,couple and social implications. Infertility counselling hasfocused primarily on the psychological or emotional needs ofthe couple. This paper argues that a psychosocial perspectiveis needed, with increased emphasis being given to the socialend of the psychosocial continuum. A case study is presentedto illustrate the range of psychosocial issues that can ariseand suggestions are made regarding how these might be respondedto. These include: responding to the emotional needs of thecouple, responding to the couple and their networks, utilizingself-help and support groups, contributing to an effective teamapproach, using a multi-role approach, being clear about thedifferent components of counselling, and contributing to thesocial policy and ethical issues. Social workers, with theirpsychosocial perspective, are seen to have a unique contributionto make to a more holistic approach to infertility counselling.     

The Use of Single Case Experimental Designs in the Evaluation of Social Work

Summary This paper seeks to identify the problems raised by the evaluationof social work in predominantly subjective and qualitative terms,arguing that this prevents the accumulation of the detailed,scientifically acceptable outcome-findings from day-to-day practicenecessary for the improvement of services. This in turn forcessocial work to rely far too much on infrequent, and not alwaysusable ‘bulletins’ issued by reviewers of large-scaleresearch. An alternative approach, complementary to the above, and basedon the application of experimental and quasi-experimental methodsto single cases is proposed. The author then discusses the likelyscope of these measures and also some of the practical problemsof using them.     

Beyond Social Constructionism: Critical Realism and Social Work

Summary Theories within the social and psychological sciences continueto shape social work practice. However, recent debates withinthese sciences on the shortcomings of ‘social constructionism’,and the attempt to overcome them through a critical realistposition, have so far failed to capture social work's attention.This paper provides a critical overview of these theoreticaldebates, highlighting the shortcomings of social constructionismfor social work. The critical realist challenge to social constructionism,as articulated by the British philosopher Roy Bhaskar, is consideredand its relevance to social work formulated in terms of a returnto ‘depth’ in practice.     

Social Work and System Theory

Summary The contribution of general system theory to the understandingof social work method in a generic situation is considered.An account of general system theory is given indicating howhuman systems differ from other systems, taking their placein a larger continuum. The implications of the theory for socialwork are then examined with special reference to four levels.First there is the philosophical level, the view it presentsof man and society, as compared with other psychological andsociological theories. Secondly its contribution to the perspectiveof social workers, making them aware of the range of systemsthey should be considering. Thirdly its contribution to practicein providing a model of the structure of systems as a guideto appraisal and intervention. In this connection the modelis related to Lippitt's ‘diagnostic orientations’.Fourthly its contribution to the understanding of social workprocess is examined. In the conclusion it is suggested thatit is the contribution to the third level that justifies theexpenditure of effort in absorbing the theory.     

Defensive Social Work

Correspondence to Nigel Harris, Department of Philosophy, The University, Dundee DD1 4HN. Summary Social workers with child clients face the possibility thatsome mistake or oversight of theirs could lead to a child abusetragedy, for which they may suffer opprobrium and blighted careers.How can they guard against such risks? This paper shows howsocial workers might use different types of ‘defensive’measure to protect themselves. These parallel the types of measureused by some doctors, particularly in the United States, facedwith risks of litigation on grounds of malpractice. Becausedefensive practices have undesirable consequences, it is importantto find ways to eliminate their use by protecting social workersby other means.     

Caring for the Elderly Widowed--the Burden on their Supporters

Summary This paper examines how caring for elderly widowed people affectsthe lives of their ‘familiars’. This study is partof a larger national study on widowhood in old age carried outby the Institute for Social Studies in Medical Care. The familiarstended to be the children of the widowed, particularly theirdaughters. Children of the widowed, again often daughters, weremore likely than other familiars to suffer life restrictionsbefore and after the death because of the care and support givento the deceased and the surviving spouse. In addition to theircaring role familiars were often committed to full or part-timeemployment and most also had their own families to support.The care they provide for the elderly is not always withoutcost. The contribution towards community care given by suchinformal helpers deserves greater recognition and the social,psychological and financial costs thus incurred merit greaterrelief. As the help is needed by a minority only of such informalcarers, adoption of a policy relieving them as far as possibleof the costs they incur, would not involve intolerable financialoutlays.     

The Psychiatric 'Caseness' of Clients Referred to an Urban Social Services Department

Correspondence should be sent to Dr. Peter Huxley, Mental Health Social Work Research Unit, Department of Psychiatry, Manchester University, Stopford Building, Oxford Road, Manchester M13 9PT. Summary Of 158 clients referred to two area offices and six generalpractice attached social workers, 141 weré interviewedusing standardized social and psychiatric research interviews.The General Health Questionnaire (GHQ) was completed by 138clients. Their social worker completed the Case Review Form.Scores of 5 or more on the PSE Index of Definition (for theclient) were used to indicate psychiatric caseness. Using IDscores of 5 or more, 53% of the sample were identified as ‘cases’.The GHQ (cut-off 4/5) identified 73% of the clients as cases;and the GHQ (cut-off 10/11) identified 51% cases. Morbidity was significantly greater in the general practicesetting. Social workers' judgement (about the presence or absenceof mental illness/emotional disorder) was not significantlybetter than chance in the identification of specific disorders,but was significant in relation to the whole sample. The results are discussed and further studies are being conductedusing more sophisticated judgements of ’caseness’,and extending the enquiry beyond an inner city population.     

Care Programming in Mental Health: assimilation and adaptation

Correspondence to Justine Schneider. PSSRU. University of Kent, Canterbury CT2 7NF. Summary Two years after the care programme approach in mental healthwas introduced there is still widespread confusion about itsmeaning and its relation to other changes in the arena of communitycare. This paper looks at how care programmes are being implementedand at whom they are being targeted. It also examines the relationbetween care management and care programming and raises somequestions about future developments in the light of communitycare reforms. It draws on data collected during 1992 from threecontrasting health districts, all of which had made considerableprogress in care programming. Sixty practitioners were interviewedabout the theory and practice of care programming. Their experienceis presented here in the context of a review of community careplans for 1992/93 which characterizes the responses of differentlocal authorities to the approach.     

The Use of TGroups in Training Social Workers

Summary It is suggested that T groups might be of value in Social Worktraining as a means of encouraging Social Workers to make greateruse of group techniques. T groups have been criticized on ethicalgrounds and for their tendency to produce psychological disturbancein predisposed individuals. In he context of Social Work trainingT groups have a dual function, promoting self awareness in theparticipants and increasing their knowledge of group dynamics.A procedure is described which emphasizes the necessity of focusingon group behaviour as opposed to individual psychopathology.It is believed that by doing so the psychological hazards arereduced. A brief outline is given of the manner in which materialproduced in the group sessions may illustrate theoretical materialintroduced elsewhere on the course     

Applying a community needs profiling approach to tackling service user poverty

Summary Poverty across the United Kingdom is a growing phenomenon. Itsimpact on the users of social work services is well documented.This paper puts forward the argument that poverty is a legitimatepart of the social work agenda rather than being seen as a complexproblem which is somehow outside the scope of social work agenciesand best left to politicians and policy makers. Social workpractitioners and managers must not only begin to accept andacknowledge that poverty is a social work issue but also tobegin confronting this challenge in a changing society whereexclusion, social inequality, racism and oppression deny peopletheir citizenship. The community needs profiling approach is proposed as a usefultool in addressing service user poverty whereby practitionersand their agencies can become more aware of the needs of usersand the communities in which they live. It is argued that, armedwith this knowledge, social workers have the potential to becomepart of the solution rather than remaining on the margins ofthe lives of poor people. Using evidence and ideas drawn froma range of community needs profiling research studies and texts,the author offers working suggestions for applying the approach.     

Mental Health and Social Justice: Gender, Race and Psychological Consequences of Unfairness

Correspondence to: Professor Michael Sheppard, Department of Social Policy and Social Work, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK. Summary It is not immediately obvious how social justice might relateto mental health. Mental health or ill health is, by some, thoughtto be inherent within the individual, whereas social justice,as its name indicates, resides within the realm of the social.However, where we understand social justice as, on the one hand,an issue involving equality and fairness, and on the other ashaving both material and symbolic dimensions it becomes clearthat there is an important link. In particular groups whichsuffer disadvantage and discrimination may be expected to sufferhigher rates of mental ill health. However, the key to understandingthis is by identifying the mechanisms by which this can happen.In order to do this it is necessary that we do not look at mentalhealth (or illness) in an undifferentiated way, since thereare different processes involved for different forms of mentalill health. We shall, therefore, look at this by focusing onthe issue of social justice through two significant relationships:gender and depression, and race and schizophrenia. We shallexamine the mechanisms which link these together, and show howthey are significant psychological consequences of social injusticearising in both material and symbolic form.