Bring the social model of health into clinical healthcare settings to aid recovery of mental illness and distress

Parliamentarians and social workers are jointly calling on the Government and NHS Trusts to recognise the social factors of mental health distress and promote the social model of health within new mental health legislation.

The call is one of nine key recommendations launched today from an All-Party Parliamentary Group (APPG) on Social Work and the British Association of Social Workers (BASW), who co-developed a new inquiry – Social Workers and a New Mental Health Act, in response to the Independent Review of the Mental health Act 1983.

The inquiry looks at the integration of health and social care, and how social workers’ role can be enhanced in new legislation, in order to uphold the human rights of children and adults suffering ill mental health.

Social work promotes the importance of social connections and creates crucial alliances with vulnerable adults to support them to overcome barriers that restrict life choices. 

“The recommendations in the report affect people across the country - and could have a positive impact on their lives and those of their families. Simple things like funding to visit relatives placed away from home could make a tremendous difference,” says the APPG chair, Alex Cunningham MP.

BASW CEO, Dr Ruth Allen, said: “Social workers are key to integrated mental health services and often provide the social support that is most meaningful to service users and families. They promote human rights and justice for service users and tackle social barriers to wellbeing such as lack of employment and housing.  As the majority of Approved Mental Health Professionals, they protect rights and make decisions about psychiatric detention or less restrictive alternatives.  Legislators should take this opportunity to emphasise social workers’ roles and potential in new legislation and guidance”.

The report also highlights the decline in the number of multi-disciplinary teams across the country with fewer local authorities and health providers working together.

The APPG believes the Government needs to investigate this decline, promote best practice and encourage greater cooperative working.

“It is also crucial that there is a better understanding of the role of social workers in the system including their unique duties and I hope the report helps achieve that,” added Cunningham.

Another key recommendation is that a social worker should review patients every six months (after the initial six-month period), while all children being cared for in hospitals under the Mental Health Act should receive regular formal reviews of their needs

Currently, after an initial six-month review, individuals’ cases are required to be reviewed only once a year and not necessarily by an appropriately trained professional; nor is there any specific duty to review the needs of children placed in hospitals under the Mental Health Act.

The full report and recommendations can be found here.

The inquiry was established in response to the Independent Review of the Mental Health Act 1983, published in December 2018.

The final report of the review set our four principles that should underpin new legislation:

  • Choice and autonomy – ensuring service users’ views and choices are respected
  • Least restriction – ensuring the Act’s powers are used in the least restrictive way
  • Therapeutic benefit – ensuring patients are supported to get better, so they can be discharged from the Act
  • People as individuals – ensuring patients are viewed and treated as rounded individuals

The APPG proposed to look at the role that social workers play in upholding these principles and how that role could be enhanced in new legislation.

Social workers play a pivotal part in both children and adult’s mental health services, but this isn’t always recognised in policy or in legislation to the detriment of service users, patients and their families.

The inquiry was presented to the Department for Health and Social Care, who will prepare the Government’s response to the Independent Review and subsequent legislation.

Preet Kaur Gill, the Member of Parliament for Edgbaston, said:

“For too long now, those suffering from mental ill-health have been treated in isolation, with little regard given to the wider context of their life. As a former social worker, I know the importance of looking at the other factors that contribute to a person’s health and wellbeing, whether that’s familial, societal or environmental factors.

“The recommendations outlined in this report place the individual and their family at the heart of their own care – embedding treatment within the context of their life. Family support is an integral part of the social model, and where appropriate, an individual’s family can be involved at every stage, from assessment through to treatment and recovery.    

“It is time that we recognised the vital role that social workers can play in shifting our focus towards more radical, innovative and preventative practices – practices that can run alongside treatment, but that are currently lacking in the medical model.”

Cat Smith MP, Member of Parliament for Lancaster and Fleetwood, said:

“Social work is incredibly important and rarely gets the airtime it deserves in Parliament. The APPG’s report shows we have a real opportunity to fully recognise and enhance the role of social work and mental health professionals within legislation to create positive outcomes for individuals struggling with mental health illness.”  

Three evidence hearings were held, overseen by Alex Cunningham MP chair of the APPG for Social Work who was joined by a cross-party team of Parliamentarians. Written evidence was also received from social workers, universities and local authorities. All the written evidence and summaries of the evidence hearings can be found at www.basw.co.uk

The full list of parliamentarians:

Alex Cunningham MP Shadow Minister for Housing (Labour)

Cat Smith MP Shadow Minister for Voter Engagement and Youth Affairs (Labour)

Preet Kaur Gill MP Shadow Minister for International Development (Labour)

Earl of Listowel Francis Hare (crossbencher)

Baroness Tyler of Enfield Claire Tyler (Liberal Democrat)

Kevan Jones MP (Labour)

Baroness Watkins of Tavistock (crossbencher)

Full recommendations:

  1. New mental health legislation should open with a definition of the social model and the importance of addressing the social determinants of mental illness alongside the biological and psychological determinants, explicitly naming social workers as the key professionals doing this work.
  2. Ministers should ensure that the team preparing new mental health legislation also produces guidance on how it is intended to interact with the Mental Capacity Act, the Care Act, the Human Rights Act, the Equality Act and the Children Act.
  3. CQC should be mandated to provide an annual report to Parliament on the progress of health and social care integration in Trusts as well as between children’s services and children’s mental health services. This should include input from both the Chief Social Workers.
  4. Social work leadership on Trust and CCG boards is necessary to ensure vital improvements in integrated approaches overall including crisis responses when people may be subject to the MHA  e.g. reducing and better managing use of s136, provision of age appropriate places of safety, holistic assessment of people in crisis and provision of alternatives to admission.
  5. New mental health legislation must have greater regard to both health and local authority resources to ensure compliance with legislation and human rights, including ensuring that local areas introduce a minimum number of AMHPs linked to population base.
  6. CCGs should be held transparently accountable for their duties under Section 140 of the current Mental Health Act or its equivalent in new legislation, making sure that there are enough beds, enough children and young people’s beds, and that AMHPs know where they are.
  7. People detained under Section 3 of the Mental Health Act should be reviewed by a social worker in accordance with the recommendations of the Independent Review of the Mental Health Act 1983 whilst all children being cared for in hospitals under the Mental Health Act should receive regular formal reviews of their needs by a social worker, as is the case for all Looked-After-Children under the Children Act
  8. Families and carers of all people detained away from home because of a lack of local provision should be provided with financial support from their home Trust for frequent visits in order to comply with Article 8 of the Human Rights Act - the Right to Family Life.
  9. A national data set on the number of Mental Health Act assessments (not just admissions), their outcomes, the age of the people assessed, their ethnicity and discharge rates should be established as part of the DHSC Mental Health Services Data Set.