Day: August 22, 2021

Some pointers for a Labour policy on adult and child mental health by LSWG Committee member Dr Rob Murphy

Dr. Robert J. MurphyBA (Hons), MSc, PhD, Dip Soc Admin, CQSW,

  Dip Stress Management Training

Rob is LSWG co-ordinator on Social Work and social services for adults and children with mental health difficulties

Date:               20.7.2020

Labour Party website – ‘mental health a national priority’


            800,000 children living with mental health disorders according to the Children’s Commissioner

            100,000 children denied mental health treatment each year

            4,500 fewer mental health nurses, chronic shortage of consultant psychiatrists


            Enhanced training bursary for nurses

            Bed cuts force children to go to non-local beds sometimes hundreds of miles from home

            Early intervention is the key to prevent or intervene in cases of abuse, neglect, trauma – i.e. Adverse Childhood Experiences (ACE)

            Extend school counselling services – to help better integrate mental health services with education and give young people somewhere to turn

            Poor mental health arises not just in schools but also in our communities, families, and online

            Poverty leads to injustices such that you are 3x more likely to develop mental health problems, and have higher rates of suicide, addictions and deaths from overdoses. Poverty results in health inequalities.

            Plan for happiness and wellbeing? – Future Generations Wellbeing Act which determines that ‘health in all policies’, ‘health equality audits of all government decisions’

The website cites LSE research which estimates the annual cost of mental ill-health at £105 billion

The website also states that research has shown that half of adults with mental health difficulties had symptoms at aged 14 yrs and yet only 8% of mental health budget is allocated for the treatment of young people.

The Labour Party is committed to tackling the issue of staff shortage crisis, through guaranteeing the rights of EU nationals working in the UK, reintroducing nurses’ bursaries, and lifting the NHS pay freeze

Review of the MHA Sir Simon Wessely DHSC 2018

A few significant conclusions:

            Increasing rate of detentions under the MHA

            Patients’ voice lost or ignored

            Services bureaucratic, uncaring, and coercive

            Over-representation of BAME people detained under MHA

            Questioning how people with learning disabilities and autism are examined/assessed

            Questioning the application of international standards of human rights

The Review noted that:

            49551 detentions under the MHA were recorded in 2017/18

            There was a 40% increase in detention from 2005/06 to 2015/16

            Black people were 4x more likely than White people to be detained under the MHA

            More Black patients, especially young Black men, were subject to Community Treatment Orders (CTO)

            Black people are 8x more likely to be subject to CTOs than White people

            For Black people as service users they experience coercion, stigma, racism, and discrimination amounting to institutionalised racism according to research carried out by Frank Keating and published in 2002 and quoted in this Review

The Review’s recommendations:

            There is a poor standard of care and support in mental health services

            The services ought to be more rights-based and reflect the 4 key principles and values of dignity, respect for persons, mutuality, and reciprocity

The Review concludes that the lack of dignity and trust inspires fear of getting worse and not better when compulsorily admitted to hospital

The new underpinning principles ought to reflect choice and autonomy such as:

            Shared decisions in care plans and treatment

            Statutory advance choice documents (ACD)

            Medication – service users’ wishes taken into account

            Patients entitled to challenge treatments

            Patients can request a second opinion (SOAD)

            Allow a patient to consent in advance to admission ie agree to become a voluntary patient at a future point which then removes the need to use the MHA

The role of the Nearest Relative is also highlighted with a recommendation that this is changed to a Nominated Person (NR)

A number of other issues are raised such as the use of police cells as a place of safety and whether the NHS ought to commission health services in police custody.

In relation to the criminal justice system the role of Magistrates’ Courts is questioned in relation to the remand for assessment of a person under Section 35 of the MHA and for treatment under Section 36 of the MHA

I raised issues which I consider important in the email and papers I circulated previously, including:

The commodification of children’s mental health which is resulting in the increased labelling of children at school has to be a priority. I can agree with the need for a counselling service in each school, but the role of learning mentors is a preventive step which is prior to counselling and a role which is of tremendous benefit for the child, their family, the teachers and the school’s academic targets. 

No one is born with ADHD, OCD, PTSD, bi-polar disorder, schizophrenia or any other psychiatric diagnosis or psychological disorder or condition. These ascriptions are applied by professional experts when a child or adult is deemed to be eligible for these relatively expensive services. Once the child or adult has crossed the threshold into the diagnostic system the door of ‘normality’ typically closes behind them, and they take on the symptomatic identity attributed to them.

I think it is ironic that the Review of the MHA should highlight the need for the implementation to reflect international standards of human rights when the 1983 MHA was itself primarily concerned with trying to establish a balance between civil liberties and compulsory treatments. Social workers as ASWs had a crucial role to play in the preservation of a person’s civil rights and liberties and prevent unwarranted detentions. The irony is that the increasing emphasis on finite and ‘available’ resources, driven by economic goals and unburdening the state and the taxpayers, has resulted in eligibility criteria which preclude, for example, the use of voluntary admission to hospital.

This Review is ironically very familiar because it repeats the dilemmas faced by those who wrote the 1983 Act and demonstrate that the fundamental issues have not changed in relation to legislating for madness in society!

So I think the Labour Party can usefully focus on the requirement for all schools to establish the role of learning mentors as a preventive mental health measure and to supplement this with a school counsellor, recognising a clear distinction in role which will be reflected in remuneration. This is one of the best means of allocating resources which will be of great benefit as a preventative mental health measure.

I also think that the Party needs to develop a strategy for tackling the evident institutional racism within the mental health system in all its features. This must include reducing the number of compulsory detentions and treatments of BAME people, as well as addressing the specific discrimination of young Black men in relation to the use of CTOs, the use of coercion, and the use of antipsychotic medication as a form of restraint and treatment.

The Party must also develop policies which focus on service users’ rights to contribute and even determine the type and quality and features of services and resources which are designed to meet their mental health needs.

I think the use of statutory Advance Choice Documents is fraught with legal, moral and professional pitfalls.

I also think the use of CTOs needs a fundamental review to establish who is using it and in what circumstances.

I also have question marks about the use of personalised budgets in mental health and I wonder how social workers are using them.

I also have fundamental questions about how the Mental Capacity Act is being used in the mental health system but also in relation to older people and people diagnosed with dementia and Alzheimers Disease.

I also think the use of the Nearest Relative has always been controversial, and I am concerned about the implications of changing this role to a Nominated Person role.   

The role of the police in the use of mental health legislation has always been fraught and more has to be done about ensuring that anyone who has to be involved in a potential suicide, domestic violence, and use of compulsory admissions to hospital for treatment or assessments of people in the community and the use of police cells as a place of safety have to be evaluated and effective and constructive policies developed.

I would like to see more evaluation of the use of antipsychotic medication especially in relation to its long-term use, because it has damaging effects on major organs particularly the liver, heart and brain.

I would like to see ECT banned as a method of psychiatric treatment.

I think we need to develop a clear mental health role for social workers.

I think that the Approved Mental Health Social Work role is fundamental to upholding the civil rights of people who are being assessed under the MHA, but I think this is a role that ought to have more credibility and extend more positively into a broader role in relation to children and families.

Food for thought! Where do we go from here?

Sent to Labour Shadow lead on mental health services Dr Rosena Allin-Khan May 2021

A Labour Adults’ Social Work Service: Briefing by LSWG (February 2021)

This briefing focuses on social work with adults and is a companion paper to that which focused on social work with children and families. Both are from the Labour Social Work Group and are addressed to Labour MPs, councillors, and policy makers. They share similar aims and principles.

Keir Starmer, in his 2020 Conference speech set out a narrative for a Labour government, linking it with Labour’s past achievements and emphasising the centrality of family and community. Labour created the rights-based welfare state including publicly funded and provided social services.

In contrast, there is every indication that the Tories will continue the direction of travel outlined in this paper, specifically: 

  • Fail to meaningfully explore ways to adequately fund local authorities
  • Continue, against all the evidence, to maintain the stance ‘public sector bad private sector good’ by continuing to replace local authority services for adults with lower quality and (often) more expensive for-profit providers
  • Further reduce access to publicly funded social services for adults with care and support needs
  • Expect (even) more of family carers
  • Fail to provide vital funding of independent living support for people with disabilities
  • Continue to ‘lose’ (minimise and under-fund) the social work service within the catch all umbrella of ‘social care’
  • Manipulate the character of the social work profession so that social workers are – effectively – reserved for ‘investigative roles’ such as ‘safeguarding’. Opportunities to engage supportively and therapeutically with adults and their carers are already very limited and the well-established preventive aims of social work seriously reduced. This, coupled with the neo-liberal narrative, undermines social workers’ historical public service ethic, political awareness, therapeutic knowledge and skills; commitment to advocacy, promotion ofrights, personal choice and social justice; and capacity to challenge discrimination. Their role working in, and with, communities has all but disappeared.  
  • Fail to recognise that effective social work with adults:
    • Means understanding complex relationships, establishing trust, judging risk, managing conflict and facilitating individual and community capacities. These are not ‘jobs’ anyone can do.
    • Requires the ability to work with a diverse range of needs, wishes and ages. A coherent new policy approach to adult social care must complement and interrelate with this aim.   

This briefing focusing on adult social work aims to:

  1. Make suggestions on immediate action Labour should be taking to protect social work services for adults & their families and prepare the ground for a more sustainable social work workforce & a more comprehensive coherent service for adults  
  2. Summarises the context of social work with adults after 10 years of Tory cuts and neo-liberal assaults on democratically accountable services.

What Labour could be saying and doing now

Labour national and local politicians, policy makers and social workers must take every opportunity to change the narrative about social work with adults and work towards bringing adult and children’s social workers together within re-unified Local Government Social Services functions. Links with measures to combat poverty and engage with social and health inequalities are as necessary now as they ever were. Whilst greater integration with the NHS is critical for adults’ wellbeing, it will only be effectively achieved if parity of funding and esteem is accorded comprehensive social care services. 

The essential components of an integrated approach and a new narrative are:

  • Reject the Tory government-imposed fragmentation of political accountability for vulnerable people who need social services assistance & appoint a Shadow Minister and team for Adults and Children’s social services, working closely with the Shadow Housing, Communities & Local Government, Health, Home Office, Social Security, & Equalities teams.
  • Challenge the relentless privatisation of care services. Privatisation often costs more and yet provides a lower quality service for users & family carers (care homes are a good example). There is also little accountability for poor quality care.  
  • Challenge the stigmatising narrative that adults who are eligible for support from their local authority have somehow ‘failed’ to be ‘independent’ and are unable to manage their own lives and affairs.
  • Challenge the terminology of ‘risk’ and ‘eligibility’that permeates social work with adults through the prioritisation of processes and procedures e.g. ‘safeguarding’ and ‘interventions’. Social work is a much broader activity than this and is handcuffed by a narrow statutorily determined role.
  • Continue to challenge the now widely criticised model of care management and place emphasis on strengths based approaches but acknowledge that these require proper funding of public services to be effective (local authorities, social care services, housing, universal services such as libraries, primary care, and social security benefits) 
  • Engage meaningfully with individuals and organisations who give voice to the experiences of service users and carers. Ensure users and carers can effectively influence policy changes and resourcing decisions & encourage local authorities to embed the practices of co-production & co-design into their structures and operations.   
  • Re-engage with social work as a therapeutic profession. Social workers could and should be a source of help, support, understanding and advice rather than ‘the last resort’ for those who are desperate or are abused/neglected.
  • Recover social work as a profession that promotes citizen’s rights and entitlements, challenges discrimination, and addresses health and social inequalities: inequalities have widened significantly over the last decade shortening lives, deepening disadvantage & eroding well-being. These inequalities have been amplified by the Covid pandemic.    
  • Re-engage with social work as a profession that is accessible to the public and can work preventively – embedding social workers in communities where they are recognised as a resource, where they get to know local people, services and networks, and build trusting working relationships with others such as GPs, housing officers, & the neighbourhood police. Social workers have traditionally been drivers of integrated, coordinated responses to community development & advocates for community groups & citizen led initiatives.
  • Commit tothe provision of a well-trained, stable, research minded & experienced workforce: as promoted by Croisdale-Appleby in his report, Re-visioning social work education, 2014). This requires moving away from shorter specialised (in Children and Families and mental health only) pre-qualifying social work programmes and developing systemic incentives to enhance retention of adults’ social workers, offer opportunities for specialisation e.g. in dementia care, learning disabilities, mental health and post-qualifying development.
  • Commit to the provision of high-quality specialist roles required in law: Approved Mental Health Professionals (over 90% are social workers) and Best Interests Assessors/Approved Mental Capacity Professionals
  • Ensure that family carers are proactively offered an assessment of need and that this assessment is done by a social worker. Increasingly local authorities are outsourcing carers assessments to third sector carers agencies with limiting contract requirements (charities usually). Whilst many do a good job, the agency has no responsibility for the cared for person; this practice contributes to greater system fragmentation, corrodes sustainability & corrupts the independence of charities.
  • Ensure that local authority eligibility criteria are based on need and not budget caps and that adults who meet the criteria to receive support (who by definition have complex needs) are offered a social work service. Skill is needed to explore issues of rights, choice, need & wish.
  • Commit to engaging with health partners structurally in relationship to improvements to health and social care systems. Although most adults’ social workers work closely with health partners their perspectives & distinctive contribution to multidisciplinary working and patient outcomes are rarely visible in strategic planning or in ‘new’ models of care e.g. Vanguards. Social work tends to be lost under the catch all umbrella of ‘social care’.   
  • Acknowledge that means testing of access to publicly funded social care is ineffective & inefficient as well as discriminatory & commit to taking steps towards developing universal social services to which citizens have a right when they need them.
  • Commit to a coherent offer in terms of support services across the country. The social care system is very complicated & is a challenge to navigate. Providers vary in terms of quality, provider type (private/charity), costs and availability & there is widespread confusion about what is provided/funded by the NHS, the LA, and what users need to pay for. This commitment should include reengagement with local authorities as – sometimes – more appropriate providers of community and residential care services for working age & older adults with care and support needs (currently, LAs provide very few services directly).

Social work with adults: the context

The 2014 Care Act provides the legal framework for adult social care. Whilst it is regarded – broadly – as a positive and timely piece of legislation, its capacity to deliver on its aims have been severely undermined as it was introduced during a period of austerity. The Tory administration wants to (continue to) reduce public spending whilst simultaneously improving outcomes for users and carers.

We are still waiting for the long promised Green (or White) Paper on the future of adult social care. There have been more than 10 well researched, evidence-based, financially mindful, politically informed, strategic & comprehensive proposals for sustainable adult social care services over the last decade. One of the (still) most relevant is the Kings Fund/Barker Independent Commission on the Future of Health and Social Care in England published in 2014.

Adults’ social workers work with older people with (often chronic) health conditions, people with learning or physical disabilities, mental health problems, dementia, addiction or substance misuse issues and ‘other adults’ with care and support needs. They also work with the family members and others who provide unpaid care. As a consequence of tight eligibility criteria adults’ social workers tend to only see people with complex needs, often at a crisis point, who have few resources. This ‘late in the day’ model means that opportunities to act preventively, and in a way that offers a sustainable cost-effective response, are (often) lost. 52% of publicly funded adult social care services is provided to older people; 48% is for ‘other groups’ of adults. About 8% of users receive a personal budget. It is important to recognise that there is a cross-over between adults’ social work and child and family social services. A significant proportion of parents seen by a social worker have chronic physical and/or mental health problems, a learning disability or a substance misuse problem.

There are estimated to be 8.8m adult carers in the UK, a figure that is increasing due to the growing number of older people with care and support needs living in the community. The carer population is diverse; it incorporates increasing numbers of older people who may have their own health problems, younger adults, and mid-life carers who are often obliged to give up paid work to care.  

More adults (10.9m in 2019) who have care and support needs now self-fund ie they (or their family) pay for privately organised support services. There is a growing group of adults who cannot afford to self-fund but who do not meet local authority eligibility criteria for publicly funded support. Self-funders receive little, or no, assistance in making care related choices despite the complexity of decisions and the, often considerable, costs involved.

Since 2010 central government grants to local authorities have reduced by 40%. The current level of expenditure on adults’ social care services is below the 2010/11 level, despite increasing demand. Key impacts include:  

  • The number of adults in England receiving state-funded social care fell from around 1.3m in 2012/13 to 841,000 in 2018/19; of these two thirds are older people.
  • In 2017, Age UK reported that 1.4m people aged 65 years & over did not receive the help they needed with ‘essential daily living activities’ such as bathing; a significant proportion received no help at all. Older people on low incomes are most affected.
  • If services to adults with care and support needs are reduced, carers are obliged to ‘pick up the care tab’; services for carers are also reduced:
  • The number of carers receiving any local authority funded services fell from 308,160 in 2017/18 to 297,300 in 2018/19
  • Only about 10% of carers receive an assessment of need (mandated in the Care Act)
  • More than 90% of all local authorities respond only to needs that are ‘critical’ or ‘substantial’; in 2018/19 only a quarter of people who approached their local authority for help received (some level of) a social care service.
  • It is routinely reported in the British Medical Journal, and evidenced in research, how damaging cuts to local authority budgets have been to the health and wellbeing of adults, how costly lack of social care is to the NHS (e.g. increased admissions to hospital), and how inefficient a lack of joined up planning and working is for all parties. This is linked to calls for a national social care service.
    • A number of trusted organisations have described ‘adequate funding’ for social services as ‘not prohibitive’ (eg: LGA, Kings Fund, Centre for Welfare Reform); they also argue that it would help contain escalating NHS costs.

It is noteworthy that five times more older people are living in poverty in the UK now than was the case in 1986; the highest rate in Western Europe. In 2017/18 in England 2m older people lived in poverty; of these 1m lived in severe poverty. Also, 6m older people lived in fuel poverty.

What next?

In the context of a widely acknowledged crisis in social care – and heightened public awareness due to the Covid crisis of the large number of people who rely on social care – the time is ripe for the Labour Party to engage with a radical review of the sector and, as a key part of this, reimagine the critical role social work with adults and their families could, and should, play. Some would even suggest that what is called for is the present-day equivalent of the 1969 Seebohm Report which laid the foundation stones of generic local authority social services departments and a universal model of care and support.   

Sent in March 2021 to Labour Shadow team at Health and Social Care (Jon Ashworth, Liz Kendall, Rosena Allin-Khan) and to Steve Reed Shadow Local Government Minister

A Labour Child and Family Social Work Service: Briefing from LSWG (2021)

This briefing from Labour Social Work Group to Labour MPs, councillors and policy makers:

  1. makes detailed suggestions on immediate action Labour should be taking to protect child and family social services and pave the way for more comprehensive policies  
  2. summarises the context of child and family social services following 10 years of Tory cuts and ideologically based attacks on democratically accountable services.

What Labour could be saying and doing now

Labour national and local politicians, policy makers and social workersmust take every opportunity to change the narrative about social work with children and families and work towards bringing adult and children’s social workers together within Local Government Social Services Departments. Links with measures to combat poverty are as necessary now as they ever were.

The essential components of an integrated approach and a new narrative:

  • Reject the Tory government-imposed fragmentation of political accountability for vulnerable people who need social services assistance and appoint  a Shadow Minister and team for Adults and Children’s social services, working closely with the Shadow Housing, Communities and Local Government (DHCLG), Health, Home Office, Justice, Social Security, Health, and Equalities teams.
  •  Privatisation costs. It costs more andyet provides poorer services.
  • Challenge the terminology of the  social work industry’. Social work is a public service
  • Call for a move away from the discourse of  monitoring and surveillance of children and families through child protection processes and procedures, and ‘interventions’
  • Social workers could and should be a source of help rather than threat to children and families.
  • Rather than remote monitoring and surveillance, embedding social workers in communities where they are recognised as a resource, where they get to know children and families and networks, and also build trusting working relationships with others such as teachers, doctors, health visitors and neighbourhood police officers, can start to turn the ship away from more and more children being taken from families and with fewer families left without help or hope.
  • Foster and residential care provided within communities and neighbourhoods by local councils and with family services and centres to help and assist families when the going is tough.
  • A well-trained, more stable and more experienced workforce –moving away from too fast and too fragmented initial social work education and training promising quick promotion into management and maintaining a focus on retention and post-qualifying development
  • Whenever we speak about austerity we should say ‘politically-chosen austerity’ as it does not have to be this way. It would, for example, also be sensible and correct to speak about track and trace in England as not ‘NHS Track and Trace’ but ‘Serco Track and Trace’.
  • Always refer to us as children and families social worker NOT child protection social worker.
  • Speak about community social work to reclaim what have  become the too fragmented organisational structures within many children’s social services, with children being passed between workers and teams.

Why this approach is necessary and urgent

Keir Starmer, in his 2020 Conference speech, set outa narrative for a Labour government, linking it with Labour’s past achievements and emphasising the centrality of family and community. Labour created the rights-based welfare state including social services provided by democratically accountable local authorities. The 1989 Children Act, which had cross-party support was strengthened during the Labour years of 1997-2010. Alongside the reduction of child poverty, services to young families were strengthening through the highly successful Sure Start Children’s centres, improvements were made to services for children and families in the community and for children in care.  But since 2010, Tory austerity policies have seen the numbers of children living in poverty escalating, and year on year growth of children in need of social work services and needing to be protected or to come into care. These have also been years when damage and fragmentation of child and family services caused by vicious cuts to local government funding have been compounded by ill-though-through ‘initiatives’ to support government ‘innovations’ and experimentation usually involving ‘outsourcing’ to private businesses. Local authority services and social work expertise have been reduced, especially in the ability to provide its own residential and foster care services. In house research, training and human services teams have been replaced by consultants paid ‘over the top rates’ for their ‘off the cuff’ solutions barely adapted to the particular circumstances of each local authority.   

There is every indication that the Tories will continue this direction of travel:

  • Fail to even look for, a system for adequately funding local government; continue to substitute adequate and reliable funding to all local authorities with one-off ‘innovations’ grants to reward ‘compliant’ authorities and ‘punish’ those who struggle (usually those in areas of deprivation) by imposing new models of ‘governance’ such as ‘Trusts’.
  • Continue, against all the evidence, to maintain the stance ‘public sector bad private sector good’ by running down directly provided local authority services and replacing them with lower quality and more expensive private-for-profit run businesses.
    –   The 2014 changes in statutory regulations created the platform which now allows any statutory children’s social work services to be contracted out to private commercial companies. International consultancy firms have been in discussion with the DfE about how they can be encouraged to take on children’s social work.
    –  Almost 40% of foster care placements in England are provided through private for-profit foster care agencies with ownership and profit-taking frequently transferring between opaque international venture capitalists with no commitment to the UK or to its children.
    –  And three quarters of children’s residential care in England is now provided by profit-making private companies with a third of local authorities directly providing no children’s homes themselves.
  • Use the proposed ‘care review’ to rewrite the 1989 Children Act to fit with their service-shrinking agenda by removing the rights of parents, children and carers to a quality and carefully regulated social work and care service.
  • Manipulate the character of the social work profession through selective funding of social work qualifying and post qualifying education so that those providing services become technicians and no longer have the public service ethic, motivation, knowledge and skills to help those who need their services to insist on their rights and challenge unfairness and discriminatory practices.

    Discussed with Labour Shadow Education team February 2021