Social Work and Mental Health in Scotland

Steve Hothersall, Mike Maas-Lowit, Malcolm Golightley

• Publisher: Learning Matters
• Year: 2008
• Print ISBN: 9781844451302
• eBook ISBN: 9780857252401
• Edition: 1
• Topic: Social Sciences
• Subtopic: Social Work
• Index: Social Sciences

Since the inception of the Scottish Parliament in 1999, mental health law, policy, practice and ethos have changed dramatically in Scotland. This book provides a thorough grounding in the key issues in mental health and presents a clear picture of the current Scottish mental health scene. By highlighting the skills and values that are necessary for contemporary practice, it helps students to develop their knowledge and understanding to enable them to deliver an appropriate and responsive service for people facing mental health challenges.

Chapter 1

Perspectives, ethics and values in mental health social work

ACHIEVING A SOCIAL WORK DEGREE

This chapter will help you to begin to meet the following (Scottish) Standards in Social Work Education (SiSWE) (Scottish Executive, 2003a), available at: www.scotland.gov.uk/library5/social/ffsw.pdf. Key Role 1: Prepare for, and work with, individuals, families, carers, groups and communities to assess their needs and circumstances. Learning Focus: 1.1 Preparing for social work contact and involvement. 1.2 Working with individuals, families, carers, groups and communities so they can make informed decisions. 1.3 Assessing needs and options in order to recommend a course of action. Key Role 2: Plan, carry out, review and evaluate social work practice with individuals, families, carers, groups, communities and other professionals. Learning Focus: 2.2 Working with individuals, families, carers, groups and communities to achieve change, promote dignity, realise potential and improve life opportunities. 2.5 Working with groups to promote choice and independent living. Key Role 3: Assess and manage risk to individuals, families, carers, groups, communities, self and colleagues. Learning Focus: 3.1 Assessing and managing risks to individuals, families, carers, groups and communities. 3.2 Assessing and managing risk to self and colleagues. Key Role 4: Demonstrate professional competence in social work practice. Learning Focus: 4.1 Evaluating and using up-to-date knowledge of, and research into, social work practice. 4.2 Working within agreed standards of social work practice. 4.3 Understanding and managing complex ethical issues, dilemmas and conflicts. 4.4 Promoting best social work practice, adapting positively to change. Key Role 6: Support individuals to represent and manage their needs, views and circumstances. Learning Focus: 6.1 Representing, in partnership with, and on behalf of, individuals, families, carers, groups and communities to help them achieve and maintain greater independence.

Introduction

Bud Powell, one of the great jazz piano players of the twentieth century, spent periods of his life in mental hospitals in Paris and New York. When asked by his friend and carer Francis Paudras about the source of his problems, he answered: I hope that your spirit will always be in accord with your being and installed in a strong and well balanced body (Paudras, 1998).

This chapter examines the relationship between values and contemporary social work practice in mental health services provision. This has a crucial role in relation to the people of Scotland who, in comparison to most Western countries, experience relatively poor mental health. For example, one study found it to rate 23rd out of 29 Western countries (WHO, 1998). This is manifested in a very high suicide rate, high recorded instances of deliberate self-harm and high prescription rates for anti-depressant medication (Scottish Executive, 2007a, 2007g). Out of an awareness of this, mental health services in Scotland have been in a process of major transition since the inception of the Scottish Parliament in 1999 in an attempt to produce a service that is appropriate and responsive to service user needs. This theme of change is introduced in this chapter and followed through in the rest of the book.

The chapter also deals with what is meant by mental illness and mental health and the importance of understanding what various diagnoses mean, and the implications of adopting medical models is assessed. A complementary perspective that incorporates the impact and relevance of factors such as gender, ethnicity and age is also explored. Overlaid onto these are discussions surrounding broader social and structural factors which often manifest through social exclusion and isolation. These are also themes that will be developed throughout the book.

Values and ethics are at the heart of culturally competent and ethically sound professional practice. This means that social workers should be able to value and understand their own culture and be able to work in a sensitive manner with people from other cultures. To become culturally competent requires empathy, understanding and accepting of differences (Patel et al., 2003; Walker, 2003b).

According to the Scottish Government,¹ drawing on data from the European Commission (EC, 2005), approximately one person in four will experience mental health problems at some time in their life and many of them will seek help from a professional. It is usually the family doctor who is the ‘first port of call’. With more severe cases, they in turn refer people on to the various agencies whose remit is to provide specialised mental health services. These services include health, social care and social work agencies that are trying to work together to provide a seamless service for the user. Some GP practices have social workers attached to them and this often means that these workers will be doing direct work with service users, working in the community alongside other mental health professionals. Social workers also work in psychiatric hospitals and in specialist community mental health teams, some of which may have a specialist remit for children. Social workers outside the mental health setting also come across mental health problems in addition to the presenting problem that led to referral in the first place. Furthermore, there is a wide range of social workers in various voluntary services from social support services to residential and supported accommodation services.

Within this book we shall guide you through the various levels of service organisation and delivery.

What is meant by mental health?

The World Heath Organisation describes mental health as:

a state of well-being in which the individual realizes his or her abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community. (WHO, 2001, p11)

A strategy for the mental health of the European Union

In January 2005 the World Health Organisation held a conference for European Ministers to start a process of drawing up a framework for comprehensive action and political commitment to mental health. This led to a Green Paper which is intended to stimulate debate within Europe and to engage a broad range of institutions, health and social care professionals, the research community and service users in discussions about how best to improve public mental health.

The Green Paper outlines three areas for improvement:

• Mental ill health affects every fourth citizen and can lead to suicide, a cause of too many deaths.
• Mental ill health causes significant losses and burdens to the economic, social, educational as well as criminal and justice systems.
• Stigmatisation, discrimination and non-respect for the human rights and the dignity of mentally ill and disabled people still exist, challenging core European values.

The Paper goes on to describe how mental health is a growing challenge to the EU and supports the WHO view that, by 2020, depression will be the highest-ranking cause of disease in the developed world (WHO, 2001). Other statistics include the statement that:

Currently, in the EU, some 58,000 citizens die from suicide every year; more than from the annual deaths from road accidents, homicide or HIV/AIDS. (EC, 2005, p4)

Clearly there are significant inequalities within member states and the Paper proposes that a strategy would be focused upon the prevention of mental ill health, the improvement of the quality of life for people with mental health problems and the development of a mental health information and research system for the EU.

A word about terminology

There are different terms currently used to describe the same thing. You will hear terms such as mental distress, mental illness, mental disorder, mental health problems and mental ill health all used by professionals and policy-makers. In this book the following terms are used.

Mental disorder

This is the specific term used in mental health legislation as discussed and it has a precise meaning:

… mental disorder means any–

• mental illness;
• personality disorder; or
• learning disability,

however caused or manifested; and cognate expressions shall be construed accordingly. ‘S 328 (1) Mental Health (Care and Treatment) (Scotland) Act 2003’

Mental illness

We will discuss mental illness in detail below. Suffice to say here that it is a medical concept which embodies the notion that the mind has a normal range of functioning which can be upset by illness, much as the working of the heart can be damaged or disrupted by heart disease. The mind can be described as the brain in action. It is the process of thought, memory, emotions, sensations, dreaming and so on that constitute the brain’s daily activity. The relationship between mind and brain can be better understood if we think of it in relation to any physical activity of the body. We have already mentioned the heart. The brain is an organ, as is the heart. The heart beats to pump blood around the body. When we say that the mind is the brain in action, we can also say that the heart beat is the heart in action. There are diseases of the heart that are manifested in irregular heart beats (tachycardia, for example). Similarly, in the theory of mental illness, there are diseases of the mind, as the brain in action (schizophrenia, for example) as opposed to diseases of the brain itself (brain tumours, for example).

Personality disorder

It is outside the scope of this book to say much about personality disorder. Personality is a set of identifiable characteristics contained in a person’s psychological make-up. You could think of it as the face of the psyche, the outwardly recognisable border between the person’s inner world and other people. How it may be disordered or what may disorder it are subjects of great debate. For our purposes here, it is best to consider that we all have dysfunctional aspects of our personalities and therefore, some would argue, we all sit on the spectrum of personality disorder. However, personality disorder only becomes a serious issue when its maladaptiveness to relationships with others, with society and/or with the law attains a threshold worthy of clinical diagnosis. In diagnostic terms, there are many types of personality disorder such as anti-social, borderline and psychopathic personality disorders. Broad characteristics include things like difficulty in learning social rules and a seemingly selfish preoccupation with oneself, sometimes to the extent of only being able to relate to others for what personal gain can be extracted from the relationship.

We will briefly mention personality disorder in Chapter 4, in reference to mentally disordered people who break the law by committing criminal offences. There is a central issue around the diagnosis of personality disorder which has been problematic for those suffering from it and those who offer t...

Table of contents

• Cover
• Title
• Copyright
• Contents
• List of abbreviations
• Introduction
• 1 Perspectives, ethics and values in mental health social work
• 2 The legal and policy context (I): the Mental Health (Care and Treatment) (Scotland) Act 2003
• 3 The legal and policy context (II): support and protection of vulnerable adults
• 4 The legal and policy context (III): the law relating to mentally disordered offenders
• 5 Working with vulnerable people: mental health and disorder in children and young people
• 6 Working with vulnerable people: adults who are short-term service users
• 7 Working with vulnerable people: adults who are long-term service users
• 8 Working across organisational and professional boundaries
• Conclusion
• Glossary
• References
• Index