What does a Mental Health Social Worker do?

I think there’s a lot of misunderstandings about what I actually do at work. What do social workers who are in mental health services do? What do social workers who work in adult services do?

I hope by reading, some people get to learn a little of my day to day role but I also thought it might be useful to set it out more explicitly.

I’ve worked in adult services and I’ve worked, as I do now, in mental health services but I’ve never worked in childrens’ services so I can’t comment at all about the work that is done there. This is my attempt, not to explain social work as a whole, but to explain the bit of social work that I’m familiar with.

I work in a multidisciplinary Community Mental Health Team. We have a consultant psychiatrist attached to the team as well as a few (the amount fluctuates!) other doctors. We have occupational therapists, clinical psychologists, assistant psychologists, community psychiatric nurses and of course, social workers. We always seem to have students around, whether psychology trainees, OT students, nursing students or social work students (and even some medical students pop in occasionally).  I sit opposite a psychologist and between an OT and a nurse.

Although no week is typical, I’ll give a few examples both of the generic role and the way that social work fits into a mental health setting, in England, at least (because I’m not sure if there are differences in Scotland, Wales and Northern Ireland).

Work is allocated for ‘care co-ordination’. Care co-ordination is akin to what we would have called ‘care management’ in Adult Services although there are some differences and responsibilities under the Care Programme Approach.  It basically means we take responsibility as a kind of ‘key worker’ for individuals who are ‘taken on’ by our service.

Allocation should be done on the basis of appropriate professional expertise so for some issues that have a more ‘social work’ tilt about dynamics, organising personal budgets or residential placements might be preferred as allocated to social workers, some that are more rehabilitation orientated might be allocated to an Occupational Therapist and more medical or medication management might be allocated to a CPN but that is a very broad brush to paint and in practice – most people are a mixture of all the different needs and so are allocated generically. If I have need a of specific OT assessment for one of the people that I am care coordinating, I will ask one of our OTs and similarly, I care coordinate one person who receives a monthly depot injection from one of my nursing colleagues.

So what is care coordination/care management about? Well, we start by working with and on a care plan and this should be led by the user of the service. If there is a carer involved it would also involve them and we put together plans. In my service which works predominantly with older adults, there may well be care services needed and this is now all delivered through personal budgets so I would take someone through the supported self assessment questionnaire, the resource allocation system and develop with them and/or their carers, depending on capacity issues on a support plan and way that services would be delivered. This would be reviewed and implemented in partnership.

I will also arrange respite placements  and services when they are needed and review services as they are delivered.

Alongside this, I would also be responsible for monitoring any changes in mental state and might provide some brief therapeutic interventions mainly through basic CBT type models according to additional training which has been given in the NHS Trust I work in as they are trying to ‘skill up’ all care coordinators!  When I meet with someone, my discussion ranges for more broadly than about their care needs specifically. Sometimes it is about sourcing and finding ideas, services and people that might be able to help, namely through group work which is run across the service or through referrals to specific psychologists attached to the team. Sometimes it is much more difficulty to quantify – and log – and record.

I work with carers and work through carers’ assessments and services such as they are. Often I feel one of the most important aspects of my work is carer support as we rely so heavily on some carers. I might liaise with different organisations on peoples’ behalf if they can’t manage or need some assistance. Sometimes I help with Attendance Allowance or Disability Living Allowance claims but there are council teams that do that so it would only be in circumstances when I might know someone particularly well and be concerned that someone who doesn’t know them that well might ‘underplay’ some of their needs.

Sometimes it is about liaising with creditors, gas and electricity companies, housing etc with various degrees of success. I like to think of myself as an advocate at times.

Although at times, I am very far from an advocate. I am subject to specific ‘terms of reference’ of my job and have no control over things like budgets that can be assigned to various people with various needs. I would ‘present’ the needs of service users I work with to various internal funding panels so on that basis I need to advocate clearly.

We have to review the services that are in place regularly. I would attend meetings at day hospitals and on wards when I am allocated to people who currently attend or are inpatients.

I work to plan and organise discharges from hospitals both the psychiatric hospitals and the general hospitals when people whom I am allocated to are inpatients. There are some very obvious time limitations on these pieces of work and no-one wants anyone to be in hospital any longer than they have to – but equally no-one wants someone to be discharged from hospital before they are well enough to be – which is another very important consideration.

I conduct safeguarding investigations as well. Alerts come up with what can be surprising frequency and there are prescribed procedures through which we approach these investigations. It’s hard to generalise as they can be very different. Interestingly most of my recent ones have involved residential services in some way or another. I think I’ll come back to the process of investigating abuse in another post as it is altogether a subject in its own right. We tend to get more of these investigations in older adults services than occur in the working age adult services.

I am an Approved Mental Health Professional (AMHP). That means that I am on a rota to carry out Mental Health Act (MHA) Assessments . There is an important difference between a Mental Health Assessment which is a more generic term for an assessment of someone’s mental health and a specific ‘Mental Health Act Assessment’ which is a formal assessment under the 1983 Mental Health Act which can result in a compulsory admission to hospital without consent.

The role of the AMHP could be a post all of its own and it probably should be so I’ll condense here for clarity because it has increasingly become a part of my day to day role. I organise and arrange these assessments by arranging for ambulance service and doctors attendance (there have to be two medical recommendations written by doctors – one should know the patient (usually their own psychiatrist or GP along with an independent doctor who has had additional training). I also attend a magistrates’ court to obtain a warrant to enter if it is likely that we would not be allowed access to a property. I  arrange police support if necessary and would also organise a hospital bed if necessary.

There are legal forms to complete and I have an obligation to be mindful and respectful of legal rights and human rights when involved in these processes.  I am obliged to attend a specified amount of ‘legal updates’ every year to maintain my approval as an AMHP and every five years I have to be ‘reapproved’ which involved me taking a legal test and submitting some reflective pieces and examples of my work as well as carrying out a set number of assessments per year (no problem with the numbers – I’ve done the requisite annual number in the past week!).

I’m also a BIA (Best Interests Assessor). This means I have specific duties and responsibilities to carry out assessments under the ‘Deprivation of Liberty Safeguards’. Again, that probably demands a post or two of its own. Suffice to say that every so often I am called out to do a specific type of assessment on this basis.  I had to attend additional training to be able to do this and have to attend update workshops and training to retain my approval.

Apart from the things I’ve listed, my job involves other pieces of work. I write social circumstances reports for tribunals. I occasionally have been involved in assessments and writing reports for Guardianships and in taking part in the process of approving or extending a Community Treatment Orders. I frequently carry out Capacity Assessments for various reasons.

I’m a practice assessor too so when I have a student, well, I have a student to supervise. I tend to enjoy having students around. It does create more work though and there’s no recompense in terms of reduction of caseloads! And the universities and local authorities wonder why we can’t offer as many statutory placements!

My work is often one of juggling and trying to prioritise and reprioritise on the basis of risk management. What is more important for me to complete on any given day.

I haven’t even mentioned data input or writing case notes but takes a fair bit of time. We have regular audits of our ‘productivity’ – we have to input our ‘outcome measures’ and re-input them regularly so our management overlords accept that we are actually spending our time at work, working effectively and not just twiddling our thumbs and playing Facebook games.

The amount that we have to ‘report back’ is, of course, growing at an exponential rate.

So that is my job – as briefly as I could manage and I have missed out some of the million subtleties that might change on a day to day basis.

I generally enjoy it. I love the variety that is thrown my way on any given day. Some days it frustrates me and there are rarely enough hours in the day to get what I want done, done. This may explain some of my frustration with the bodies who all say they ‘speak for social work’.  Have they explained the role of social work outside child protection? Would you know, if you are not involved in the ‘system’ what a mental  health social worker actually does?

But really, that’s another fight for another day. For now, well, I need to go to work!

But I had over to you, dear reader. Is there anything that surprises you? What you expect? What have I left out – as I’m sure I have missed a lot of things!

Of Snowiness

Really it was a fairly busy day yesterday. The person I had been scheduled to visit and had completely expected to be out when I called was actually in. Of course, he wouldn’t let me in but we managed a fairly useful chat through the front door and kitchen window. He had some choice words about ‘social workers’ but although I had clearly introduced myself (when he levered the front door open to see my face) he seemed quite happy to continue shouting in my direction for a while. At least we’ve tracked him down and he has agreed to further visits – hopefully beyond the front door but I’m happy to work it either way!

I also popped in to another visit that I had scheduled where there were some unexpected local difficulties with various care package issues over the Christmas holidays and a carer who had had some personal difficulties and I wanted to check that everything was in place and working as best it could.

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It started snowing when I made my way back to the office. By the time I arrived I resembled a snowman – completely covered in a sheet of white. And cold.

We joked amongst ourselves about having difficulties getting home but relying on the Transport for London website, I happily assured everyone that there were no problems on public transport. When one of the  less optimistic nurses muttered about having to spend the night in the office if it snowed too much, I happily said that if that were the case, I would walk home –it’s only 5 miles after all (I checked the distances on Google!).

As the snow began to fall more heavily and was obviously settling, we were told to leave early if necessary. That was at 4.30pm. Oh, how I cursed my previous jauntiness. One traffic jam, one broken bus, a long walk, a tube journey and another walk later, I arrived home just about 7.45pm.

The worst part was definitely trying to walk on what quickly became sheet ice.

The most inappropriately funny part was when the bus driver told us to stop moving around on the bus in case it started sliding downhill.

The stupidest part was that I didn’t just get the underground to start with and that I even made an attempt on the bus.

But you live and learn.

Away Day and Old Acquaintances

As I was wandering around the office, stretching my legs, I fell upon a conversation between one of the social workers who works in a different locality team and her manager about the possibility of a whole team ‘team building away day’.

Of course this was too good an opportunity to miss. My view of an away day will always be a trip to a theme park or the zoo but unfortunately that wasn’t quite what was being proposed – it was more of a ‘sitting in a room and discussing’ type of team-building that was being proposed.

I thought paintballing sounded quite fun – we could split on a geographical basis or in our own type of geeky way, discussed a possible football match between ‘social model’ v ‘medical model’ with the doctors and nurses against the social workers and psychologists (as one of our clinical psychologists piped up at this point that she was very good at football!).

Of course this led to a discussion of which team would ‘claim’ the occupational therapists.. (I think we would because they are quite athletic and the social workers – if my colleagues will forgive me – are probably the least.. erm.. athletic.. to put it kindly).

Of course outside of my imagination, what is likely to happen is that the away day will consist of us all sitting in one of the Trust or Council offices discussing team dynamics and trying not to raise the issues that really need to be discussed.

image szlea at Flickr

Through various convoluted means that would be way too complicated to explain, today, I am going to an event at which my first practice teacher from my first placement as a social work student will be present. I qualified in 2000 and my first placement was in a local authority older adults community care team in 1998/9.

It was the first experience that I had in a statutory setting and I had a wonderfully kind and supportive practice teacher. I remember I was the first student she took as she was completing the practice teaching course as I was studying.

She was exceptionally thorough and has consistently been an inspiration to me of ‘how I would like to be at some point’. My second placement was a little less happy but fortunately, I had the experiences of the first placement to inspire me and carry me through. Through my own laziness really, we never kept in touch – although we said we would in that way you do when things come to an end – that and the fact that I left the country pretty soon after I qualified.

I saw her name though, on the distribution list for the invitations to the event. I wonder if she noticed mine. She’s probably had lots of students with and around her since so I’ll be one among many. I am not at all sure what I’ll say or even if she’ll recognise me after 10 years.

If ever though, there was a point for reflection of where I’ve come in these last ten years, it will be today..