October 30, 2011 1 Comment
Effective leadership in mental health social work requires robust evidence about the effectiveness of social work practice and the confidence to articulate it both within the profession and beyond.
To be an effective social work leader in a multi-disciplinary team alongside health colleagues, we need to engage with the professional agendas of other disciplines. Research evidence about intervention effectiveness is one agenda that just doesn’t go away and social workers need to engage with it now, perhaps more than ever before.
When I teach on Approved Mental Health Professional (AMHP) training courses I find that experienced social workers struggle to articulate the evidence base for their practice. Admittedly, this is partly because there is not an abundance of research evidence to cite. But there is also a high level of ignorance about what evidence there is. The blame for this does not lie in the practitioners themselves, but in the systemic failure of social work in the UK to develop and articulate its evidence base.
Without a robust body of evidence to support its interventions in mental health services (and what there is has largely been adopted by other professionals), mental health social work has largely been reduced to statutory and bureaucratic functions. It is difficult to be a social work leader in mental health services when other disciplines define your role.
The personalisation agenda is perceived by many social workers as a further threat to their role, and merely a vehicle to further roll back the welfare state. However, perhaps it can be an initiative which social work can use to develop effective practice and empower people to take meaningful control over their care. By developing evidence about effective practice in this field, social work could perhaps provide professional leadership over this initiative in the same way that we do in the AMHP role.
I’ve written before about how mental health services are increasingly shaped by National Institute for Health and Clinical Excellence (NICE) clinical guidelines, which are themselves shaped by randomised controlled trials. Well, the same is happening in primary mental health care.
Last week I was teaching on an Increasing Access to Psychological Therapies (IAPT) course, which uniquely includes a module on social inclusion. It is well known that GPs feel that they are predominantly dealing with social problems during consultations which usually result in the issuing of a prescription for an anti-depressant. A new army of primary care mental health workers have been employed to resolve this, armed with evidence-based interventions such as cognitive behavioural therapy and problem solving. However, these workers battle with entrenched social problems with few weapons in their armoury. (Sorry about the war metaphor, but it is an apt simile for the current situation).
When asked why this was so, the primary care mental health workers I were teaching replied that social interventions were just not a priority in the absence of evidence of their effectiveness. They would merely ‘signpost’ the person to another agency or source of help and leave it at that. As well as illustrating the need for evidence to support social interventions in a healthcare setting, this provides a further example of practice which social work could effectively lead.
But it first needs to resolve its systemic failure to develop and articulate evidence about the effectiveness of social work interventions. Qualifying training for social workers needs to include teaching on how to understand and articulate the evidence base which currently exists. Post-qualifying training needs to provide practitioners with opportunities to undertake their own research. Social work academics need to develop intervention research programmes and the whole profession needs to foster a research culture which allows new findings to become readily translated into practice. This will not only enable us to hold our own in discussions about our practice with health colleagues. It will support what many of us came into the profession to do: to lead the battle against social problems.