“White Social Workers’ pejorative assessment of black families and the reinforcement of racist stereotypes through their intervention are central to the ‘social working’, i.e. social control, of black families and form the major avenues through which they ‘clientise’ black people.” (Dominelli, 1988)
While keeping the above statement in mind this paper will discuss how assessment can be effective in assessing need and managing risk for all users. It will do this by looking at how problems and conflicts are addressed and in what ways this might be effective for users of mental health services.
Assessment is a process that all users have to undergo in order to determine what services they might be entitled to and how their needs might best be addressed. Social workers who specialise in the area of mental health are bound by the 1995 Act which defines their responsibilities to people with mental or physical disabilities.
Disability is defined as a physical or mental impairment which has a substantial and long-term adverse effect on ability to carry out normal day-to-day activities (Brayne and Martin, 1999:460).
The Human Rights Act of 1998 is phrased in such a manner that local authorities now have a duty to act in ways that are conversant with the Act. Social workers help people with mental health difficulties to deal with the problems that they face. It is the social worker’s duty to help organise care and support for people with physical disabilities, with learning disabilities, and with mental health problems. This duty begins with an assessment of need for services, it is only once such an assessment has taken place that social workers and local authorities will be able to decide whether they can help with that need.
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In the 1980s the Tory Thatcher Government brought market policies into the health service that included what is known as ‘care in the community’ this meant that large numbers of psychiatric hospitals were closed. This resulted in those who were mentally impaired, along with a small number of psychotic patients being discharged into the community. They did not receive proper treatment and a number of incidents created public unrest. Thus, whenever a social worker makes an assessment for someone with mental health difficulties they have a duty to do so with the concept of also assessing any risk that they feel users might face or that they could pose to society. Under the 1990 NHS and Community Care Act (circular LAC (92) 12 any needs assessment that a social worker undertakes needs to take into account the following:
- The capacity/incapacity of the person being assessed
- Their preferences and aspirations
- Their living situation
- Any support they might have from relatives and friends
- Other sources of help
With regard to people with mental health problems and with other disabilities, just because local authorities have a duty to find out about such people in their area and offer help, does not depend on a client’s request for services rather it requires the social worker to carry out an assessment of anyone in that group who might be eligible for services (Brayne and Martin, 1999). Once an assessment has been carried out and the client’s needs identified then social workers have a duty to help people with mental health problems obtain the benefits that they are entitled to. The social worker also has a duty to ensure that the client is in accommodation that is suitable to their particular needs. The authority may need to provide extra support to enable a person to continue living in their own home or they may need to arrange a move to residential accommodation or long term hospital care. Thus working with this client group is a large and varied field and social workers are faced with a number of different duties in this respect. These duties and responsibilities are further defined under legislation and policy relating to the needs of people with mental and or physical disabilities.
A social worker whose clients are in one of the aforementioned groups may find themselves visiting clients in a number of different settings. It may be the client’s home, hospital, residential accommodation, or sometimes at the social worker’s place of employment. Generally the social worker will act as part of a team dealing with a number of different cases and in each one will need to be aware of the general legislative framework as it applies to that particular client group. Social workers are required to write reports on every case that he/she is engaged with. This will then be seen by their supervisor and by the care management team. This helps in addressing client needs and determining a care package. It is also a way of determining whether the social worker has done their job in the best way possible i.e. a way that empowers the service user and gives them some say in the decision making process. This is especially relevant where mental health is concerned as there has been some speculation as to whether social workers and other mental health professionals deal with service users in ways that are non-prejudicial.
Some research tends to suggest that over the last fifteen years those who use mental health services have been treated in a prejudicial way. This is because (and Government debates are also at fault here) this group of users have tended to be defined in terms of the risk they constitute to themselves and the wider society. This is despite all the evidence supporting the view that those with mental health problems are not generally a risk to society. Langow and Lindow (2004) argue that such a concentration on risk means that an individual so defined runs the risk of having decisions concerning their lives taken out of their hands. This is certainly borne out by government policy proposals regarding people who are considered to be a risk to themselves or others. Langow and Lindow (ibid) maintain that this concentration on risk means that social workers and other mental health workers often find it hard to distinguish the reasons why someone may behave in an aggressive manner. Is it due to psychotic behaviour, or is it just that they feel disempowered or feel themselves as having been subject to racial abuse? The danger here is simply to err in favour of the psychosis rather than believing they have to take the risk that someone would not pose a threat to the rest of society. Service users are often not aware that they are being assessed in this way. The fact that staff might consider users to be a risk to others however, could have serious implications for that person’s future.
Dilemmas and Conflicts
It is not always easy working with people with mental health problems. A social worker may undertake an assessment and then find that the client does not want the help that is on offer. This really can be problematic as the legislation implies that local authorities must make an assessment of needs once mental health problems or disability have been identified. This further implies that they will produce a care package to address those needs. If a client refuses to allow a social worker entry then they are not able to do their job and undertake an assessment or provide services as required by the legal framework. If an assessment is made then the social worker has to try and identify areas where family and friends can help the person. When such arrangements break down and there are no alternatives in place then problems may arise. Thus a person who may previously have been assessed as being able to remain in their own home may later have a need for either supported living (particularly in the case of people with mental health problems or learning disability) or for residential care. If a person is deemed unfit to live alone or is a problem to others then the social worker has a duty to call in the medical officer of health who then has to obtain an order from the magistrates court. Removal to residential accommodation then involves the social worker in another set of rules as to how the accommodation is financed. This is also pertinent to regular inspection of such accommodation and other welfare services that the client is entitled to.
Clearly there are a growing number of legal and policy requirements that a social worker must adhere to when dealing with specific client groups. Mental health is an increasingly problematic area because new regulations are coming up all the time and the wording is not always clear or precise. This means that the social worker’s job can be a minefield as they try to adhere to the needs and wishes of the client and yet remain within the legislative framework.
Factors that Promote and Limit Service User Involvement in Decision Making
Current debates on the needs and rights of services users show that although there has been a move to ensure individual’s rights to equality of service, some service users still face discrimination. Under these circumstances it is vital that power imbalances between service users and professionals be acknowledged and the contributing factors addressed. Once they come to such an acknowledgement the parties can then work together to minimalise any factors that contribute to the marginalisation and exclusion of some service users (Carr, 2004). Some of these issues might include the fact that there is still a tendency for some professionals to ignore service users’ views or to at least misinterpret them. This means that instead of being enabled through greater user participation, service users may end up feeling further disempowered. Institutional barriers have to be overcome, and the continuing use of professional jargon can also serve to exclude service users from the decision making process. Carr (2004) found that service users often saw such gaps as a disempowering and exclusionary factor, but, once aware of this fact, most professionals were more than happy to try to modify their language in order to encourage greater service user participation.
It is sometimes very difficult for people with mental health problems to communicate their needs in a way that is fully understood by the professionals trying to assess them. There is a need for different models and levels of participation depending on the service user’s circumstances. Some service users will be so empowered by participation that they will go on to be involved in how services are delivered, still others are not able to be truly involved at any recognisable level without the intervention of a third person. Thus advocacy is an important element of lower levels of service user participation. An advocate can help to empower people because service users will then have someone who is impartial, who can inform them as to what is available in terms of services and support and who will promote their best interests among other professionals and make sure that their wishes are made known. Carr (2004) notes that the service user movement has been instrumental in promoting the rights of people’s entitlement to as ordinary way of life as is possible. People with mental health problems may have multiple and complex needs, nevertheless under the 1998 Human Rights Act, they are entitled to be treated with dignity and local authorities have a duty to abide by the requirements of this Act (Moore, 2002).
Ethical and effective social work should involve a thorough assessment of the needs of users with mental health problems and a care package that takes their problems and wishes into account. This should be tailored to suit an individual’s needs and there should be room for changes and adjustments if the care package is not to become an imposition (Kerr et al, 2005). Where a person is not fully cognisant of what is happening then anti-oppressive practice should involve the use of an entirely independent advocate.
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Effective social work is client centred and this is achieved through the social worker’s own reflective practice. If criticisms and accusations of prejudicial attitudes are to be avoided then it might be argued that advocacy, coupled with reflexive and effective social work practice should bring an end to service user disempowerment and become one that assesses need and manages risk in a way that is beneficial for both users and professionals.
Brayne and Martin 6th ed. 1999 Law for Social Workers London, Blackstone Press
Carr, S. 2004 Has Service User Participation Made a Difference to Social Care Services? London, SCIE
Department of Health (2002b) Information Strategy for Older People (ISOP) in England. London: Department of Health
Dunning, A. 2005 Information, Advice and Advocacy for Older People York, Joseph Rowntree Foundation
Langow and Lindow. 2004. “Mental health service users and their involvement in risk assessment and management” Findings, Joseph Rowntree Foundation
Leason, K. 2005 “Fear and freedom” Community Care April 14th 2005 p. 32-34
Moore, S. 2002 3rd Edition Social Welfare Alive Cheltenham, Nelson Thornes
Ruch, G. 2000 “Self and social work: Towards an integrated model of learning” Journal of Social Work Practice Volume 14, no. 2 November 1st 2000
Disability Discrimination Act 1995 http://www.drc-gb.org/thelaw/thedda.asp
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