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.     

Non-Statutory Mental Health Social Work in Primary Care: A Chance for Renewal?

Correspondence to Malcolm T. Firth, Honorary Research Fellow & Senior Psychiatric Social Worker, 'DEAL', Department of Psychiatric Social Work, 12th Floor, Mathematics Building, University of Manchester, Oxford Road, Manchester M13 9PL, UK. E-mail: malcolm.firth{at}mhsc.manchester.nhs.uk Summary The current status of evidence-based practice in the field ofmental health has led some to question the potential for innovationif social work practice is organizationally proscribed or reducedto a dogged adherence to methodological orthodoxy. Conversely,social work's value base is esteemed disproportionately to itsevidence base. Changing service contexts in the UK, particularlythe emergence of Primary Care Trusts as gatekeepers and commissionersof health and social care services, are providing opportunitiesfor social work to develop a new presence and purpose. The authorsdescribe their work in a small-scale service based in primarycare that anticipated these opportunities, by a retrospectivestudy of 120 cases. A new evidence base that derives directlyfrom practice is suggested as a way forward for social workeducation and training, as well as for service and professionaldevelopment.     

The Role and Achievements of a Professional Association in the Late Twentieth Century: The British Association of Social Workers 1970-2000

Correspondence to Malcolm Payne, Manchester Metropolitan University, Didsbury, Manchester Summary The formation in 1970, in concert with wider policy trends,and the work of BASW during its first 30 years are reportedand assessed. The structure, internal issues, finances, personnel,professional and social policy work and publishing operationsare considered together with contemporaneous commentary on itsachievements. Conflict around membership policies and its professionalassociation role in relation to trade union activities wereinherent in its formation. Professional achievements includedwork on accreditation of social workers, a code of ethics andthe ‘new professionalism’, including client participationand case recording. Policy achievements included work on reformof mental health and child-care legislation and campaigns onpoverty and social security and constraints on social servicesexpenditure. Internal conflict and financial insecurity havelimited BASW's impact. However, as a small professional associationin a developing field with other powerful stakeholders, it hasachievements where alliances with other stakeholders and commercialoperators are established and when internal finance and personnelare stable. Professionalization in relation to community activismand trade unionism remains an issue.     

Dying and Bereavement, Spirituality and Social Work in a Market Economy of Welfare

Correspondence to Margaret Lloyd, School of Social Work, University of Manchester, Oxford Road, Manchester M13 9PL Summary This paper examines the contribution of social work practiceto the care of people who are dying or bereaved. It considerscurrent challenges to traditional practice arising from societaland organizational change, reaffirming the importance of thesocial work role but arguing that, in order to face those challenges,social workers must broaden their perspective to incorporatea spiritual dimension. The paper draws on a research study conductedby the author.     

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.     

A Profile of Adult Placement Carers

Correspondence to Andrew Gage, Manchester City Council Social Services Department, Adult Homefinding Team, Fenham, 5 Moorfield Road, West Didsbury, Manchester M20 8UZ. Summary This study examines the social and personal characteristicsof the people providing support in their own homes (adult fostering)to people with severe learning disabilities. Comparisons aremade with the general population on social and personal areas.A typical carer is identified and the results lead into issuescurrently affecting carers. Links are drawn between carer characteristicsand service user quality of life which require further study.     

Informal Carers of Adolescents and Adults with Learning Difficulties from the South Asian Communities: Family Circumstances, Service Support and Carer Stress

Corrrespondence to Chris Hatton, Research Fellow, Hester Adrian Research Centre, University of Manchester, Manchester M13 9PL, UK. Summary On the basis of a total identification survey in two metropolitanboroughs, 54 people from the south Asian communities caringfor people with learning difficulties aged 14 or over were interviewedregarding family circumstances, service supports and levelsof stress. In general, families were living in circumstancesof material disadvantage and reported a high need for services,due to a lack of informal support and the considerable supportneeds of many of the people with learning difficulties. Carerawareness and receipt of specialist intellectual disabilityservices were, however, low. A lack of information and staffwith appropriate language skills, coupled with a general neglectof the cultural and religious needs of service users and carers,appeared to result in low service uptake and low levels of satisfactionwith services. Eight per cent of carers reported levels of stressindicative of psychiatric problems, and also reported high levelsof contact with health services. There was some evidence thatservices were not allocated according to need; carers with lowhousehold incomes reported higher levels of stress, but carerswith higher household incomes received a wider range of services.The implications of these findings for services are discussed.     

Beyond Retroduction? -- Hermeneutics, Reflexivity and Social Work Practice

Correspondence to Susan White, University of Manchester, Department of Social Policy and Social Work, Williamson Building, Oxford Road, Manchester Summary Over the last three decades qualitative research methodologieshave been in the ascent within social science. Yet social workevaluation studies have tended to be quantitative in nature,conventially relying upon the generation of criteria againstwhich interventions are retrospectively judged. The generationof such criteria inevitably depends upon pre-suppositions, whichin themselves go unresearched. As a consequence the .sense makingactivities on which social work interventions depend are renderedimmune from critical analysis. This reflects a broader tendencyfor social work to cling to naive realist epistemologies, whichare arguably obsolete within the interpretive paradigm in whichits activity is properly located. By examining the debates withininterpretive social science, this paper argues for an approachto social work assessment which avoids the pitfalls of naiveobjectivism and the nihilism of anarchic relativism, whilstretaining creativity, imagination and hope.     

Openness and Contact in Adoption: A Child-centred Perspective

Correspondence to Beverley Hughes, Senior Lecturer in Social Work, School of Social Work, Department of Social Policy and Social Work, University of Manchester, Oxford Road, Manchester M13 9PL. Summary This paper reports the findings of a study on the views of birthparents on openness and contact and, in the light of the findings,examines the current trend towards a presumption in favour ofdirect contact between birth parents, child and/or adopters.It argues for a child-centred approach which must discriminatemore clearly between the implications for the child of differentpost-adoption arrangements. The assumptions underlying a presumptionin favour of direct contact are critically reviewed.     

Parton, Howe and Postmodernity: A Critical Comment on Mistaken Identity

Correspondence to Carole Smith, School of Social Work,, Department of Social Policy and Social Work, Dover Street Building, The University of Manchester, Oxford Road, Manchester M13 9PL Summary In their contributions to the debate about social work, modernityand postmodernity Parton(1994) and Howe (1994) argue that therecent changes in social work practice can best be understoodas features of, or responses to, the postmodern social orderin which it is located. This has led, they argue, to an increasingfragmentation of the profession and an undermining of its formalknowledge base. We will argue here that, not only does suchan argument oversimplify the nuances of the ‘postmodernity’question, but it represents a misreading of the pressures affectingpractice at this time, which are more properly attributableto the operation of the discourses and ideologies of a particularphase of late capitalism and high modernity.     

Reading Social Work Competing Discourses in the Rules and Requirements for the Diploma in Social Work

Correspondence to Dr Beth Humphnes, Department of Applied Community Studies, Manchester Metropolitan University, 799 Wilmslow Road, Manchester M20 2RR Summary The changes which have taken place across all of social workeducation and practice in Britain introduce a new phase forthe profession in line with wider political and economic changesin the UK. The Rules and Requirements for the Diploma in SocialWork exemplify these changes, and the document containing themis a useful focus for an analysis of what is at stake. Thisarticle employs discourse analysis to examine the ideologicalfunctions of the Dip.S.W. regulations and their relationshipto wider social discourses, having in mind both the discipliningrole of discourse and its possibilities for transformation.It identifies a dominant regulatory discourse, and an oppositionalliberatory discourse which are in dialogue with each other andwith related discourses. The article considers the constructionof social work in the document in its surveillance, managerialist,competence-based functions. The analysis also looks for contradictoryvoices in these discourses and in CCETSW'. Welsh Language Policyand Equal Opportunities Statement, which might offer sites ofresistance and refusal. It is argued that the shape of the stagesocial work has entered into is not inevitable, and the destabilizingpotential of such an analysis creates a space for the imaginationof alternatives.     

The Care Programme Approach: Dimensions of Evaluation

Correspondence to Barbara Hatfield, Mental Health Social Work Research Unit, School of Psychiatry and Behavioural Sciences, University of Manchester, 12th Floor, Mathematics Building, Oxford Road, Manchester M13 9PL, UK. Summary The study examined the first six months of implementation ofthe Care Programme Approach (the CPA) at a psychiatric unitof a district general hospital. From an analysis of the researchliterature on case management, and from current policy, a frameworkwas developed which was used to analyse the implementation understudy. The framework included such features as: a keyworkeroffering a continuous relationship and co-ordinated care; assessmentand intervention over a range of ‘needs’; multidisciplinaryworking in the community; and involvement of user and carer.The objectives were to ensure continuity of care and reducehospital admission. The targeted service users were to be thosewith severe and enduring mental health problems. The study showsthat most of these features were achieved in the implementation,although there is no evidence that hospital admission was avoided.A number of factors were found to be associated with re-admission,and these are discussed in the light of the findings of otherstudies.     

What Makes for Successful Groupwork? A Survey of Agencies in the UK

Summary This paper reports the findings of a survey of Social ServicesDepartments, Probation Services and the major voluntary agenciesin the UK. The survey aimed to shed light on the factors whichpromote successful groups in social work and probation agencies.The survey did not attempt to map the extent of current groupwork.A questionnaire was piloted in a Social Services Departmentin northern England with social work and social care practitionersparticipating in ‘The Groupwork Project’, a trainingand development programme which continues to have as its aimthe establishment of a groupwork service in a mainstream socialservices agency. The survey was designed to be illuminativeand exploratory rather than conclusive. In this paper, the authorsreflect on the research process and on the findings of the survey.These findings point to the complexity of factors consideredsignificant to the success of a group, and to the importanceof contextual factors in establishing and sustaining a groupworkservice.     

Split in Two: Experiences of the Children of Schizophrenic Mothers

Correspondence to Jeni Webster, Lecturer in Psychiatric Social Work, University of Manchester, Department of Psychiatry, Williamson Building, Oxford Road, Manchester M13 9PL. Summary The children and families of 28 schizophrenic women were interviewedto assess the amount of burden they experienced in the formof disruptions and problems as a consequence of the schizophrenia.Different styles of coping emerged within the family patternsthat related to behaviours associated with schizophrenia, therole of the fathers, the stages of development of the children,and the adverse effects on the family and the children.     

Understanding 'Going Missing': issues for social work and social services

Correspondence to Malcolm Payne, Professor of Applied Community Studies, The Manchester Metropolitan University, 799 Wilmslow Road, Didsbury, Manchester M20 8RR. Summary Recent research about young people and adults who ‘gomissing’ raises important issues for social work and thesocial services. Large numbers of young people go missing eachyear, becoming vulnerable to exploitation and at risk of committingcrime and suffering from other social difficulties. Adults leavebehind families with practical and emotional difficulties. Adefinition of ‘going missing’ should focus on absencefrom social expectations and responsibilities. Five groups ofmissing person are identified: runaways, pushaways, throwaways,fallaways and takeaways, reflecting different social situationsin which going missing occurs. It is argued that going missingis one of a range of choices which people in difficulties maymake, depending on their approach to problems in their livesand the availability of opportunities. Effective local co-ordinationto focus on reasons for going missing, on reunions and returnsto residential care or home, and to provide emotional and practicalhelp to people ‘left behind’, are required, providedthat care is taken to protect people who go missing becausethey are subject to abuse and violence.     

What do Care Managers do?--A Study of Working Practice in Older Peoples' Services

Correspondence to A. Weinberg, School of Community Health Sciences and Social Care, University of Salford, Allerton Building, Frederick Rd Campus, Salford, Greater Manchester M6 6PU, UK. Summary This paper explores the principal activities of local authoritystaff undertaking the role of care manager. It is based on asample of staff in a social services department specializingin older people's services. Data were obtained by asking staffto complete a diary schedule in which thirty-four job relatedactivities were grouped into five broad categories on the basisof previous research. A 57 per cent response rate was achieved.Analysis of the data revealed several findings of note. First,excluding travel, care managers spent 64 per cent of their workingweek in direct and indirect user and carer related activities.Second, administrative tasks occupied 32 per cent of their time.Third, care managers spent 27 per cent of their time in assessmentactivities compared with 7 per cent in monitoring and reviewingactivities and 5 per cent in counselling and support. Fourth,care managers spent 4 per cent of their time liaising with healthstaff. These findings are discussed in the light of previousresearch and a shift is noted in the nature of the direct contactwith the service user. The methodological limitations of thestudy are explored and the implications of these findings forusers and carers and the development of care management arrangementsare discussed.     

A Model for the Comprehensive Assessment of Older People and Their Carers

Correspondence to Beverley Hughes, Department of Social Policy and Social Work, University of Manchester, Oxford Road, Manchester M13 9PL. Summary Although local authorities and social service departments arein the process of developing systems of assessment in relationto care management, there has been little debate about the principleswhich ought to underpin assessment processes, nor about thepurpose, scope, and content of comprehensive assessment witholder people. This article discusses these issues and proposesa framework for comprehensive assessment with older people andtheir carers, derived from development work with social workersin a number of local authorities. Of particular importance isthe need for comprehensive assessment to embody meaningful mechanismsfor user and carer participation and empowerment; to acknowledgenot only need and risk but strengths and resources; to regardthe older person as the centre of a network of personal, familial,and social factors which together determine her or his qualityof life and level of risk. The implications for practitionersare examined.     

From Hollis to the Orange Book: Developing a Holistic Model of Social Work Assessment in the 1990s

Correspondence to Margaret Lloyd, School of Social Work, University of Manchester, Dover Street, Manchester M13 9PL. Summary Amidst questioning of its essential identity, social work iscurrently developing new procedures and training programmesin assessment, traditionally one of its core activities. Thedemand for this redevelopment has been created by the changingprofessional climate in both probation and social work practice,in particular the response to legislative changes such as theNational Health Service and Community Care Act 1990. This paperexamines the established model of social work assessment inhistorical context and identifies its shortcomings for practicein the 1990s. It argues that despite the apparently diverserange of assessment tasks now undertaken by social workers andprobation officers, there remains an identifiable, common setof skills. Moreover, unless social work anchors these assessmentskills in a conceptual framework, retaining a sense of its ownhistory, the essential character of social work assessment willbe lost amidst mechanistic procedures and competing philosophies.This paper suggests a typology for making sense of the rangeof assessment tasks in current practice, arguing that this mustbe rooted in a holistic theoretical and philosophical model.The term ‘social work’ is used in its generic senseto include probation practice.     

On Patient Satisfaction in Cerebral Palsy Care

Correspondence to Professor W. G. Kernohan, Room 12J08, University of Ulster, Newtownabbey BT37 0QB Summary The value of managing teamwork in health care is well recognized.Yet, for a variety of reasons, it often fails to provide thedegree of support required. To investigate the capacity forall-round service provision in Northern Ireland, a survey wascarried out to obtain both quantitative and qualitative dataon the degree of social and health care support for familieswith a child affected by cerebral palsy, one of the most seriousorthopaedic disorders. Results suggest that, while clinicalmedical care is generally good, the role of social support inhealthcare management seems poorly defined, fragmented and variable.     

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.