Critically explore the care context in which social work operates, demonstrating an understanding of sociological and social policy concepts, drawing examples from practice.
What constitutes social work is largely defined by the state and by Government policies. That is to say it defines the legal framework through which the responsibilities of social workers are defined. These refer to the people that social workers have a responsibility towards, how those responsibilities should be carried out, and the broader framework which underpins social work practice (Brayne and Martin, 1995). The general legislative framework as it applies to social work practice actually applies to the local authority that employs social workers, but, nevertheless it is part of the general legal guidelines under which social workers engage in practice. This paper will look at practice and the framework within which social workers operate from the perspective of users with mental health problems. The Local Authority Social Services Act 1970 states:
Every local authority shall establish a social services committee, and …there shall stand referred to that committee all matters relating to the discharge by the authority of- (a) their functions under the enactments specified in the first column of Schedule 1 to this Act
This paper will explore the problems that many users with mental health problems encounter and it will consider how policy and its resultant initiatives can impact on the lives of services users. This discussion will be set within the context which welfare services are delivered in Britain.
It is difficult to give a definition of the rights and responsibilities of social workers without some way of ensuring that these are fulfilled. At the very least everyone has the right to be protected from abuse and to be treated with respect. This is extremely difficult when current Government discourses, while expressing concern for those with mental health problems, then employ discourses which ignore factors such as race, gender and class and social circumstances, that are pertinent to any proper understanding of a person’s condition. Hannigan and Cutliffe (2002) are of the opinion that the medical model of health, which locates disability in the pathology of the individual, is flourishing in mental healthcare and under the terms of the 1983 Mental Health Act this often results in medical treatments that may involve, for example, the use of drugs or electro-convulsive therapy without the person’s consent.
In Britain the law has a definition of mental disorder, which includes four separate conditions: mental illness, mental impairment, severe mental impairment, and psychopathic disorder (Pilgrim and Rogers, 1999:9).
The first of these conditions is not defined. The second two conditions refer specifically to people with learning difficulties. The final condition refers to people who may be antisocial, unusually aggressive, and who may pose a threat to themselves and those around them. It is assumed that this legal definition accords with psychiatric definitions of mental disorder when this is not necessarily the case. It is within this context that mental health workers, and often approved social workers also, are left to determine the conditions under which a person may or may not be detained under the terms of the 1983 Mental Health Act (Pilgrim and Rogers, 1999).With regard to people with mental health problems (for whom similar provisions for those with other disabilities apply) Schedule One of the Local Authorities Social Services Act of 1970 is relevant and states that local authority social services should make proper provision for those who are mentally or physically disabled. It would seem that contrary to the terms of the Act the legislative framework does not make such a provision in that it uses unclear definitions with which a social worker operates. It is a context which disenfranchises those who are already at a social disadvantage. Studies on inequalities in health suggest that that class, gender and race determine how a person is treated in a care context.
In the mental health arena there are a number of studies (e.g. Pilgrim and Rogers, 1999) which tend to suggest that black males are particularly disadvantaged in this area. Section 136 of the 1983 Mental Health Act gives the police the power to detain someone for 72 hrs in a safe place if they are considered to be a danger to themselves or other people, and irrespective of whether they have actually done anything. Some research (Bean et al, 1991) has shown that under this section Afro-Caribbeans are two and a half times as likely as whites to be detained in this manner. Giddens (2001) maintains that in many of our social structures an aura of institutional racism still operates. It is arguably the case that this affects the treatment of black males with mental health problems and necessitates the social worker exerting particular care in this context in deciding whether a person should be detained under the Mental Health Act or whether they are fit to be left to care in the community. Since the Human Rights Act of 1998 local authorities have a duty to act in ways that are conversant with the Act. Social workers help with the problems faced by people with disabilities. When working with people with mental health problems or other disabilities social workers need to be aware of the Human Rights Act and the Community Care Act of 1990. Social workers are faced with making decisions concerning what defines a person with disabilities and also how to define their needs. The community care system is not straightforward and the legal requirements often not precise. If a social worker prescribes the wrong form of care e.g. detainment under the Mental Health Act when a person does not really fulfil that criteria, they could be infringing that person’s human rights. Policy needs to be carefully and more clearly formulated in the care context so that social workers can effectively carry out their duties to service users.
This paper has attempted to explore, in too few words, the care context within which social workers operate. It has done this from the perspective of someone working in the mental health arena. The care context of mental health is fraught with problems which are, or can be, exacerbated by the legislative framework. In many respects social workers from all backgrounds face similar difficulties and there is no ‘right’ way, in many senses the contemporary care context is suffused with the view that ‘you’re damned if you do, and damned if you don’t.
Bean, Bingley, Bynoe et al. 1991. Out of Harm’s Way:Mind’s Research into police and psychiatric action under section 136 of the Mental Health Act. London, Mind.
Brayne and Martin 6th ed. 1999 Law for Social Workers London, Blackstone Press
Mandelstam and Schwehr 1995 Community Care Practice and the Law London, Jessica Kingsley
Disability Discrimination Act 1995 http://www.drc-gb.org/thelaw/thedda.asp
Giddens, A. 2001 4th ed. Sociology, Cambridge, Polity Press.
Hannigan B and Cutcliffe J 2002 “Challenging contemporary mental health policy: time to assuage the coercion?” Journal of Advanced Nursing, 37(5), 477-484, London, Blackwell Science, 2002
Pilgrim, D. and Rogers, A. 1999. A Sociology of Mental Health and Illness. Buckingham, Open University Press.