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November 2015

The intellectual rigour of mental health social work

Frances Turner, a Cambridge graduate and qualified social worker who is supporting Think Ahead’s programme development, explains how top graduates can use their skills to support people living with mental health problems.

After completing an undergraduate degree in French at the University of Cambridge in 2007, I found myself in an unusual position. While many peers were keen to move into fields such as banking, law, or consultancy, I had my heart set on something rather different – a career in social work, which would later lead me to work in the field of mental health.

While many fellow graduates understood how rewarding this line of work can be – and, of course, that the job requires high levels of empathy, resilience, and strong communication skills – many struggled to understand the level of intellectual rigour the job would require.

As I’ve found throughout my years in practice, the intellectual demands of mental health social work are just as challenging as other popular graduate routes. A successful social worker must demonstrate, amongst other things, strong analytical skills, problem solving abilities, and intellectual vigour. This is one reason why I now work to encourage our country’s top graduates to join me in supporting people with mental health problems.

Applying legislation

A major intellectual challenge is understanding the legislation relevant to people living with mental ill-health. Understanding the implementation of the Mental Health Act, the Mental Capacity Act, and Deprivation of Liberty Safeguards, are crucial aspects of the job. Often laws can seem simple enough in theory, but applying them to an individual’s situation isn’t quite so easy.

For instance, under the Mental Capacity Act there is a specific test to see if someone has the capacity to make a particular decision for themselves. The person has to be able to show they can understand the information relevant to the decision, retain that information, use the information to make their decision, and communicate what their decision is. That may sound straightforward – but if you go out and speak to someone who is confused, their speech is impaired and their cognition is fluctuating, judging whether they have capacity is really complicated. That judgement can have massive consequences, it’s the difference to them making a choice themselves, or the state making that decision on their behalf. It could be something as big as where they can live, or should they have contact with someone who is being abusive towards them – genuinely life-changing decisions.

Winning arguments

Influencing and convincing others is a key part of a social worker’s role. This might be through writing concise reports, or it could be in meetings about one of the adults you are supporting. You need to be confident in synthesising your arguments and asserting your views. Differences often arise between professionals about the best way to support an individual – which can lead to some interesting debates within a multi-disciplinary team.

You may be asked to submit evidence to the Court of Protection, which makes judgements in the best interests of people who lack capacity to make particular decisions for themselves. You might need to write a report for a Mental Health Tribunal, which has the authority to decide whether people should be discharged from a period of compulsory detention in hospital. Or you may put a case to a local funding panel, advocating that a particular service should be funded for someone with whom you are working. It’s not enough to have a point of view, or to simply understand the debate. You need to express your thoughts in really persuasive language in an environment where you are being cross-examined.

Thinking creatively and strategically

You also need to be able to think creatively, bringing forward a range of ideas on how you support a person towards recovery, when they may have been in the system for so many years that people have given up on them. Your interventions should be evidence-based – something the new Think Ahead curriculum focuses heavily on. You should also be able to draw on the expertise of other team members, such as psychiatrists, nurses, psychologists and occupational therapists, which requires strong knowledge of different professionals’ roles.

If you are in a managerial or strategic role you are required to go further. In my role as the Lead for Adult Safeguarding I regularly organised training and shared the latest research about how my fellow professionals could best support adults who were vulnerable to abuse and neglect, because of their mental health needs, to stay safe.

Ethics and politics

Considering the ethics of your decisions doesn’t sound as challenging on paper, but every day social workers make really tough decisions with people about the things that matter most to them, at the most difficult points in their lives. That is something that you simply cannot do without a high level of self-awareness and the ability to reflect on your own personal and professional values, and how they affect your practice.

For example, many social workers progress to become Approved Mental Health Professionals (AMHPs), who can, if necessary, recommend people’s detention in hospital without their agreement  under the Mental Health Act. These judgements are taken in highly stressful circumstances, and social workers must be absolutely sure that they’re making the best decisions they can.

If you go on to become a senior manager in mental health services, you are responsible for engaging with the local and national political agenda around mental health, and for building more strategic relationships with senior managers for partner agencies in your area to ensure that local residents always receive the support they need, whatever their situation.

Altogether mental health social work is an incredibly intellectually challenging job, with real rewards for those who are confident enough to enter the field. I’m certainly glad I made that choice.