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.     

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.     

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.     

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.     

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.     

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.     

The Field Social Work Implications of Residential Child Care

Summary The workloads of field social work staff vary markedly, andlittle is known about the ‘burdens’ imposed by differentgroups of clients or cases. The research study reported hereset out to examine the extent to which field social work involvementin residential child care varied between individual childrenand to attempt to explain that variation in terms of the characteristicsof children, the characteristics and workloads of staff andtheir teams, the packages of services received by children andtheir families, and some general features of the residentialplacements. Field social worker involvement was measured interms of the number of contacts between ‘caseholders’and ‘case’ and the total amount of time spent onthe case over a three month period. The observed variationsin these two indicators were found to be significantly associatedwith the characteristics of cases and other factors. Indeed,these characteristics explained almost two-thirds of the variance.The empirical results have a number of policy implications whichare discussed under six heads: supply constraints, caseloadweighting, fieldwork organization, coordination and monitoring,out-county placements and travelling time, and comparative costings.     

Implementing Care Management: Issues in Relation to the New Community Care

Correspondence to Professor Jane Lewis, All Souls College, Oxford OX1 4AL Summary The official guidance on the new policy of community care emphasizedcare management as the means of securing needs-led services,together with user empowerment and choice. This paper uses datafrom eighteen months intensive fieldwork in five local authorities,first, to examine the very different interpretations of caremanagement in these authorities; secondly, to examine two majorsources of difficulty in the implementation of care managementsystems—the simultaneous development of purchaser/providersplits, and the tension between needs and resources—and,finally, to draw some conclusions about the implications ofcare management for social workers.     

Case Management and Care Management in Community Care

Correspondence to Prof. Peter Huxley, Mental Health Social Work Research Unit, Department of Psychiatry, Mathematics Building, Oxford Road, Manchester University M13 9PL. Summary This paper reviews the purpose of case management, its introductioninto the UK, and its central components. While case managementhas empirical referents which have been developed over manyyears (largely in the USA) care management has, until recently,had none. The paper examines different models of case managementin terms of organizational structure, content, and outcome assessment.The importance of the distinction between clinical and administrativecase management is emphasized, especially in work with mentallyill persons. The review of existing evidence suggests that inorder to produce effective intervention services must have clearlyidentified objectives, closely specified target groups, interventionswhich match the objectives, and employ related outcome measurements.Some of the current issues in the implementation of care managementare considered.     

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.     

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.     

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.     

Accommodation and Employment: A Survey into the Circumstances and Expressed Needs of Users of Mental Health Services in a Northern Town

Correspondence to Barbara Hatfield, Mental Health Social Work Research and Staff Development Unit, University of Manchester, Department of Psychiatry, Mathematics, Tower, Oxford Road, Manchester M13 9PL. Summary A sample of 120 mental health service users in a Northern Townwas interviewed about satisfactions and expressed needs in arange of life domains. Most of the 120 users were male, in theolder age ranges, and not in current partnerships. Most hadservere and long-term conditions. Living situations includedhospital wards, hostels, a group home, living with family orfriends, and living alone. The domains of accommodation andemployment are discussed in this paper. The majority of peopleexpressed themselves as ‘satisfied’ with their accommodation,although a sizeable monority were not satisfied. Lack of choiceof alternatives emerged as an underlying feature of ‘expressedsatisfaction’. A sizeable group expressed the need forhelp in obtaining employment, particularly those living in thecommunity. It is argued that for consumer choice to have a realisticmeaning, people with severe mental illnesses need the experienceof choice from more than one alternative.     

Adolescents in Care and their Social Workers: A Research Note

Summary There has recently been an increasing concern that young people,and especially those in residential care, should be encouragedto express their views, and that the views expressed shouldbe used in improving the care which they receive. The publicationof the Who Cares? booklet (Page and Clarke¹), and the emergenceof ‘Who Cares’ groups and the ‘Voice of theChild in Care’ organisation, is evidence of this concern.In sympathy with these developments has been a study of adolescents'perceptions of social workers, and a part of this research hasincluded a pilot study of the views of adolescents living intwo family group homes.     

Factors Predicting Admission of Elderly People to Local Authority Residential Care

Correspondence to Dr Ian Sinclair, Director of Research, National Institute for Social Work. Mary Ward House, 5–7 Tavistock Place, London WCIH 955 Summary Successful community care may partly depend on identifying thoseat risk of entering residential homes and targeting servicesto them. This article is concerned with how this identificationcan be achieved. It considers a sample of old people livingalone. in touch with home helps or social workers and followedup for between two and four years. The research examined thefactors likely to produce admission, and used discriminant analysisto predict it.     

The Experience and Practice of Approved Social Workers in Northern Ireland

Correspondence to Dr Roger Manktelow, School of Social and Community Sciences, University of Ulster Magee College, Derry, BT48 7JL, Northern Ireland. Summary This article reports on the first extensive survey of ApprovedSocial Worker (ASW) activity under the Mental Health (NorthernIreland) Order 1986. The integrated health and social servicesorganizational structure, the adverse effects on individualmental health of the legacy of thirty years of civil conflictand the move from hospital to community care are significantfeatures which have influenced the delivery of mental healthsocial work services locally. The practice and experience ofASWs was surveyed by postal questionnaire and user and carerexperience of compulsory hospital admission was investigatedby a series of focus groups. The study revealed that two-thirdsof ASWs had experience of acting as an applicant in compulsoryhospital admission during the past two years. Nearly half (42per cent) of these ASWs had reported experience of between oneand five admissions and one-tenth had completed over twentyadmissions in the two-year period. In only a small minorityof cases did joint face-to-face assessment with the GeneralPractitioner (doctor) take place; nearly half of ASWs reporteddifficulties in obtaining transport; and only one-fifth of ASWshad experience of acting as a second approved social worker.Half of ASWs reported experience of guardianship, either asapplicant or in making the recommendation. Both service usersand carers reported a lack of understanding about the role ofthe ASW and complained about the lack of alternative resourcesthat ASWs could use to prevent hospital admissions. These findingsare discussed and a number of recommendations are proposed forimprovements to approved social worker practice.     

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.     

Child Protection: Balancing Paternalism and Partnership

Correspondence to Martin C. Calder, Child Protection Unit, Salford Social Services Department, Avon House, Avon Close, Little Hulton, Manchester M38 OLA Summary There have been a great many protracted and heated debates aboutthe practice of state intervention and control of family lifein recent years. Indeed, the Children Act (1989) was draftedafter the Cleveland Inquiry highlighted the lack of consulationwith parents and the lasting effects of ill-considered intrusioninto family life, and embraced the philosophy of partnership.Social workers operating in the child care and child protectionareas need to balance the contradictory notions of paternalismand partnership, in the knowledge that they will be pilloriedby the popular press when they get it wrong. This paper attemptsto contrast the two concepts in their philosophical and socialwork contexts, and moves on to recommend frameworks for helpingto balance them when they are operationalized. It is essentialto consider this particular debate in the wider political andeconomic contexts, particularly where uncertainty and the lackof resources are ever-present features.     

User-Practitioner Transactions in the New Culture of Community Care

Correspondence to Nicky Stanley, Lecturer in Social Work, University of Hull, Hull HU6 7RX, UK. Summary This article describes the findings of a research project whichexamined the views and practice of social workers undertakingassessments in one local authority following the implementationof the NHS and Community Care Act 1990. While the assessorsexpressed dissatisfaction with some aspects of the new systemof care management, overall they appeared to be taking the newculture on board. Managers were consistently more enthusiasticthan practitioners. Both groups saw needs-led assessment, userchoice and keeping users in their own homes as central objectivesof care management. The shadowing of ten community care assessmentsallowed the degree to which these objectives were realized inpractice to be explored. Users' experience of the new culturewas also studied. The user-practitioner transactions observedsuggest that those users who were able to articulate their ownneeds forcefully were most likely to be able to exercise choice.It is argued that the new culture of community care embodies‘consumer choice’ rather than ‘user choice’.