This essay aim is to explore the changing and unique role of social workers in relation to adults living with a mental health disorder. With one in four people affected, mental health problems represent a real concern in the UK, in general, and in Wales in particular, carrying an economic and social cost of £7,2 billion in Wales itself (Cyhlarova, McCulloch, McGuffin & Wykes, 2010). Experiences and perceptions of users of mental health services will be discussed according to contemporary research. Current legislation and governmental measures, unique to Wales where possible, will be examined.
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People diagnosed with a mental health disorder such as depression or anxiety, schizophrenia or bipolar disorders are often treated in adult acute mental health units, mainly in National Health Service (NHS) hospitals (British Medical Association, 2017)). Since the publication of Health building notes (HBN) in 1996 Mental health policy has changed its perspectives, from large, isolated mental health hospitals to community-based treatment. The publication of Adult mental health services ‘A national service framework for Wales’ by the Welsh Assembly Government in 2002 conducted to significant development of the adult acute mental health services (Welsh Government, 2016). An important role in the establishment and funding adult social services had the NHS and Community Care Act 1990, which put the accent on replacing the institutional care with the community services (Blewett, Lewis & Tunstill, 2007).
NHS and (Local authority) LA’s number one priority is to make sure that their services meet the National standards highlighted in the Code of professional practice (Gilburt, Rose & Slade, 2008). However, a recent literature review revealed different results. A review of research evidence by Quirk and Lelliot (2001) showed negative experience of patients in adult psychiatric units. In contrast, a research conducted by Gilburt, Rose & Slade in 2008 investigating life experience of 19 patients on mental health wards in the UK, using focus group and face-to-face interviews found that patients encounter both positive and negative experiences. On the positive side, patients felt that they were safe in the hospital. On the other hand, “ineffective and negative communication, a lack of trust, a lack of safety in terms of staff as ineffective in preventing violence, and as perpetrators themselves, and the use of coercion by staff” were perceived as negative experience (Gilburt, Rose & Slade, p.1, 2008).
The introduction of the Mental Health Act 2007 (MHA07) (Wales), which superseded The Mental Health Act 1983, represented a major transformation of mental health social work in Wales (Mackay, 2012). Pilgrim (2007) argued that, compared to the Mental Health (Care and Treatment) (Scotland) Act 2003 which adopted ‘a rights-based approach’, MHA07 focuses first on the safety of the individual, resulting in more social work ‘risk-averse’ practice. Unique and pioneering Walsh mental health policies and legislation like Mental Health (Wales) Measure (MHWM) 2010 (nawm 8) and Together for Mental Health (TFMH) – A Strategy for Mental Health and Well-being in Wales (2012) showed a clear interest and engagement in the achievement of multiple action plans established by the Government. For instance, the MHWM (2010) is an important tool for both NHS and LA in improving mental health, particularly by initiating local primary support services for enabling mental health patient to be treated within their community sets. Subsequently, TFMH, introduced in 2012, offered a ‘10-year strategy for improving the mental well-being of all residents of Wales as well as improving the care and treatment for those experiencing mental health conditions, their careers and families. In addition, The Social Services and Well-being (Wales) Act 2014 and The Wellbeing of Future Generations (Wales) Act 2015further promote the population’ well-being by introducing new objectives and monitoring how these are achieved (TheWelsh NHS Confederation, 2017).
In the last two decades, social work practice has been illustrated from an international perspective which paid considerable attention to the connection between social work and social justice. This was possible through the adoption of specific international legislation such as the Human Rights Act 1998 (Blewett, Lewis & Tunstill, 2007). Nevertheless, as Payne (2006) stressed, such change did not happen without effort: “it underlines the tension between social work’s claim to achieve social improvement between individuals, who have personal rights because of their humanity, and sociality, whereas the social work profession defines itself as valuing social justice” (Payne, 2006, p. 84, cited in Blewett, Lewis & Tunstill, 2007).
A large majority of guidelines, including the international definition of social work, have its origins in the ethical principles of social work highlighted in the ‘Code of ethics for social work (2014)’ (British Association of Social Workers, 2014). Social workers contend with multiple changes occurred between individuals and their environment. Their goal is to empower individuals to develop their abilities, improve their lives and encourage normal functioning. Problem-solving goes along with social change and refers principally to human relationships. Therefore, social workers are to ensure the wellbeing of the individuals they work with. They campaign for empowerment and liberation of people and are particularly concerned with the most disadvantaged and vulnerable individuals, those living in poor conditions as well as with the most oppressed ones (Hare, 2004).
In the last 20 years, the social work practice has been impacted by increased discrimination and, therefore, it had to deal with changes occurred in the service users’ life (Blewett, Lewis & Tunstill, 2007). People leaving with a mental health illness often confront stigma and discrimination in their workplace, neighbourhood or school. To illustrate this, the first national campaign to fight stigma and discrimination encountered by adults leaving with a mental health problem, the Time to Change Wales (2018), emphasized the negative attitude of public towards people leaving with a mental health illness (TheWelsh NHS Confederation, 2017).
The unique role of social workers, to serve both the individual and the society, can often lead, particularly in the mental health sector, to ‘tension between a loyalty to the service users on the one hand and to the service agency and public authorities on the other’ (Askheim, 2003, p. 235 cited in Jupp, 2005). For example, Audini & Lelliott (2002) research showed significant differences in detentions under the MHA 1983, with black people six times more likely to be detained than white people.
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Studies conducted in the NHS in Wales into the satisfactoriness of the delivery of Welsh language in the mental health showed poor progress (Misell, 2000). However, with only 5.5 per cent being allocated to research in the mental health field there is a lack of available research in Wales. For example, research available in England, such as the psychiatric morbidity survey, there are non-existing in Wales, therefore, important information on contemporary issues confronting mental health services are unavailable. However, out of a few related pieces of literature was stressed that mental health can have a substantial impact on life expectancy. A survey conducted in 2011 illustrated that people suffering from an acute mental health disorder are more likely to die earlier than the overall population (Mental Health Foundation, 2016).
Moreover, worldwide research and signals from users of mental health services in Wales highlight the necessity of mental health services delivered in Welsh because of the native Welsh speakers need to express their feelings in their first language, which otherwise may be difficult if not impossible in some cases to communicate (Misell, 2000).
Due to limited resources, Mental health services face serious difficulties in delivering interventions throughout Wales, especially in rural areas, where services are not enough represented (Welsh Institute for Health and Social Care, 2014). Relevant research emphasized the significant role of distance in the continuity of care in mental health. In maintaining a good mental health, the delivery of services must be appropriate to the needs and, importantly, delivered at the right time. (Wales Centre for Health, 2006).
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