- Author:
Jef Smith
My local branch of the British Association of Social
Workers is holding a meeting in the spring to discuss
‘Specialisation and the Social Services’. Only months
after Seebohm set us off on mixed caseloads, social
workers are asking whether there are not groups of
clients who require a more intensive knowledge, a
particular package of skill, a specialised approach that
the generic worker cannot command. After the final
extermination of the Poor Law’s pattern of dealing
with all clients in multi-purpose workhouses, it took
more than two decades for opinion to move away from
the priority categories which the legislation of the late
1940s defined. Is the pendulum moving back now
after only a couple of years? With swings of this
speed, the social services could find themselves
accused of being on a roundabout of ephemeral
fashion.
The picture is not quite so desperate. First, the
Seebohm Report never said dogmatically that every
social worker should carry a total range of cases.
Rather, it argued much more reasonably, that every
department - and, by implication, every decentralised
area team - should command the skill and resources to
handle any sort of client. Social workers are talking
much more these days about generic teamwork than
generic caseloads. Nor is it to be assumed that the
pattern of specialisation that might emerge from the
present confused picture would look anything like the
random groupings of clients served by the social
services of the sixties.
The new specialties are more likely to cover quite
specific, small fields like adolescent immigrants, oneparent families, the elderly confused, or children in
foster homes, with opportunities for staff to work with
a particular group for some months or a few years
before returning perhaps to a more generic workload.
Alternatively, or probably concurrently, specialisation could be by method of work; already many social
services departments have posts calling for expertise
in community development, research, volunteer
organisation, group work and planning. What we are
seeing is not another attempt to divide the social
service territory into neat and mutually exclusive
client-groups, but a flexible recognition of the sort of
areas that could require specialist attention once we
have the basic general practice operating satisfactorily.
Unconvincing package.
All this is critical for mental health, an area of
specialty that even the most loyal Seebohmists will
concede has suffered in the short term. Mental health
was never, of course, a very convincing package on its
own. At best it involved two sorts of work - with the
mentally ill and mentally handicapped respectively that had little overlap and called for quite different
skills and resources.
There are indications that the handicapped are at
last getting something of the attention their often
desperate situation demands, among the public and
professionals alike; for the rest of this piece I will
concern myself with the mentally ill (I’ll quarrel with
the terminology later), a group of clients who have
been treated by the present government with a sad
and surprising disdain. If White Papers can sometimes prolong the gap before action, vague circulars
and memoranda from the DHSS, which is all we have
had on services for the mentally ill for the last two
years, do not constitute even an approach to policy.
The psychiatric problems of the mentally ill are
characterised by being inextricably interwoven with
their social, familial and economic problems, a
complexity for which the pre-Seebohm jungle of
services made no allowance. A mother taken to
hospital by a mental welfare officer had to contact two
other departments of the same Council to arrange
accommodation for an elderly relative and her school
age children; now the whole job can be undertaken by
a single social worker who will do a much more
effective job for being obliged to see the problem whole.
Nevertheless it is hard to deny that the best psychiatric social workers had built up a range of expertise
which has certainly been dissipated in the transitional
period. Now that the excuse of the pressures of the
change-over is wearing thin, what ought we to be
demanding of social workers as an essential reassertion of the peculiar skills of working with the
mentally ill?
The first aptitude to be rediscovered concerns not
the mentally ill themselves but the range of other
caring staff with whom the social workers need
contact and understanding - doctors, psychologists,
nurses, therapists of all kinds - each group has its
professional pride and susceptibilities. The social
worker comes into contact with most of these and
must understand and respect their roles. He must
know too about the hospital, the setting in which they
work, an institution which can affect its inmates, sane
and mad alike, with a strange insanity all of its own.
Between this odd and artificial place and the perhaps
harsher reality of the wider community, the social
worker must be a lively link, for the patient must
always be working towards leaving the hospital,
perhaps the hardest task of his recovery.
Relating to institutions of this sort - children’s
homes, boarding schools and prisons have many
similar characteristics - calls for unique skills, for the
challenge is one of gaining the confidence of the
establishment and its staff while remaining an
outsider able to bridge the re-entry gap with the
patient. The hysterical resistance of many medical
social workers to the possibility of their transfer to
local authority employment demonstrates how seductive can be the regime of an institution and how
challenging - even frightening - is the world outside.
But it will be with the society beyond the hospital
walls that the social worker must deal. Treating
psychiatric disorder can no longer be seen as a process
for medical specialists alone, and, for a potentially
sick or recovering client, the attitudes of relatives,
workmates and neighbours to mental illness in
general and to this manifestation in particular may
well be critical. In all of these circles social work
intervention is possible though social workers must
admit that their operations in the past (and therefore
the bulk of their present skill) have been in work with
the immediate families of patient.
The techniques relevant to wider flfelds of educative
and community work are still being worked out, but
whether it is helping a tenants’ association to set up a
visiting service for its frail old people or meeting with
a protest group campaigning against the siting of a
hostel for the disturbed young or talking with work
colleagues of a client to interpret otherwise inexplicable behaviour to them, the social worker must be
learning new skills to help forge a more caring
community.
One area of the work of social services departments
has attracted particular and unfavourable mention
over the last year - their emergency night-time and
weekend service. Social workers have protested at the
inadequacy of the pay and compensation for being
‘on call’ and, in a number of local authorities, have
refused to operate the service for a period. Their case
is complicated and has been the subject of protracted
and confused negotiations, but it was certainly
significant that this was the chosen battleground for
the first concerted action by social workers to withdraw their labour.
Being on call causes strain out of all proportion to
the number of cases handled or the gravity of the
matters dealt with. At all hours of the night a duty
social worker can be telephoned and required to make
a snap judgement which he would never take without
careful thought and consultation during office hours.
In no field are the decisions so onerous as in the
mental health sector where the action to be taken can
include the separation of fighting couples, the counselling of a potential suicide or the compulsory admission
of a dangerous patient.
Whatever the outcome of the dispute over payment,
social workers clearly must develop greater confidence
to cope with such emergencies, and departments
must review their support and information systems
to ensure that duty social workers are not left exposed
to pressure without access to the necessary advice and
information. The sorts of skills and back-up required
have wider relevance than just to overnight problems;
they apply in all of the many crisis situations with
which social workers deal, crises which can so easily
be intensified by fumbling efforts or false reassurance,
but which can, if properly dealt with, be used to
stimulate real growth and change in clients otherwise
beyond the range of help. We have long recognised in
theory that an emergency can be a point of positive
new departure in the life of a disturbed person, but
we are still far from developing the tools of rapid
diagnosis and aid which we need to utilise our clients’
crises confidently.
So the mental health worker must call on a wide
range of skills from community development to
psychotherapy. In this context it is worth reasserting
the relevance of casework, that much maligned
technique of helping people by means of a relationship
which is personal but professional. That it needs to be
reasserted is a sign of the modishness of social work
practitioners who, in their anxiety to escape from a
theoretical basis which tended to place the responsibility for change exclusively on the individual client
and his psyche (‘blaming the victim’ as it has been
graphically expressed), have moved sharply away from
the use of close and personalised relationships. What
we need urgently is a clear understanding that casework and psychotherapeutic techniques can be radical
in their application, just as community work, of
course, can be conservative.
The complexity of services from the point of view
of the client makes the willingness of social workers
to relate on an individual counselling basis all the more
necessary. Seebohm may have simplified structures
marginally but the hospitalised patient will still find it
difficult to wend his way through the respective
functions of the general practitioner, the outpatient
clinic staff, the variety of’helping people’ he meets on
the ward, and the whole range of representatives of
relevant organisations and voluntary bodies in the
community. Who, except the social worker, can
integrate this experience? Or, to put it more aggressively, who will make sure that at each stage the patient
really gets the service to which he has a right? This is
surely a job which radical social workers can tackle
with enthusiasm.
Seebohm presented social service professionals with
their biggest challenge on the mental health front. An
area of work for which medical supervision was
previously thought essential was transferred to the
control of workers with backgrounds largely in the
social sciences. The opportunity was presented for a
completely new approach to what, for lack of developed sociological terminology, we still call mental illness.
This step was not taken in isolation, but as one
move in a process away from the medical explanation
of what happens to people when they need help to
cope with the stress of life. Has it ever really helped to
say that people with breakdowns are ‘sick’ any more
than it helped other cultures and ages to describe
them as wicked or devil-possessed or divine. Social
work, it is true, has yet to come up with a more
satisfactory model, has even to find a language free of
the smell of medicine with which to talk about the
phenomena we witness.
The challenge is a large one - to devise environments more therapeutic than hospitals, treatments
less repressive than drugs, a theory of mental disturbance less scapegoating than that resorted to at present,
a community more caring and accepting than the one
most patients currently experience. The results of the
experiment are of importance to more than just the
social workers.
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See https://www.ncbi.nlm.nih.gov/pmc/about/scanning/
Social Work
Jef Smith
My local branch of the British Association of Social Workers is holding a meeting in the spring to discuss ‘Specialisation and the Social Services’. Only months after Seebohm set us off on mixed caseloads, social workers are asking whether there are not groups of clients who require a more intensive knowledge, a particular package of skill, a specialised approach that the generic worker cannot command. After the final extermination of the Poor Law’s pattern of dealing with all clients in multi-purpose workhouses, it took more than two decades for opinion to move away from the priority categories which the legislation of the late 1940s defined. Is the pendulum moving back now after only a couple of years? With swings of this speed, the social services could find themselves accused of being on a roundabout of ephemeral fashion.
Skill and resources
The picture is not quite so desperate. First, the Seebohm Report never said dogmatically that every social worker should carry a total range of cases. Rather, it argued much more reasonably, that every department - and, by implication, every decentralised area team - should command the skill and resources to handle any sort of client. Social workers are talking much more these days about generic teamwork than generic caseloads. Nor is it to be assumed that the pattern of specialisation that might emerge from the present confused picture would look anything like the random groupings of clients served by the social services of the sixties.
The new specialties are more likely to cover quite specific, small fields like adolescent immigrants, oneparent families, the elderly confused, or children in foster homes, with opportunities for staff to work with a particular group for some months or a few years before returning perhaps to a more generic workload. Alternatively, or probably concurrently, specialisation could be by method of work; already many social services departments have posts calling for expertise in community development, research, volunteer organisation, group work and planning. What we are seeing is not another attempt to divide the social service territory into neat and mutually exclusive client-groups, but a flexible recognition of the sort of areas that could require specialist attention once we have the basic general practice operating satisfactorily. Unconvincing package.
All this is critical for mental health, an area of specialty that even the most loyal Seebohmists will concede has suffered in the short term. Mental health was never, of course, a very convincing package on its own. At best it involved two sorts of work - with the mentally ill and mentally handicapped respectively that had little overlap and called for quite different skills and resources.
There are indications that the handicapped are at last getting something of the attention their often desperate situation demands, among the public and professionals alike; for the rest of this piece I will concern myself with the mentally ill (I’ll quarrel with the terminology later), a group of clients who have been treated by the present government with a sad and surprising disdain. If White Papers can sometimes prolong the gap before action, vague circulars and memoranda from the DHSS, which is all we have had on services for the mentally ill for the last two years, do not constitute even an approach to policy. The psychiatric problems of the mentally ill are characterised by being inextricably interwoven with their social, familial and economic problems, a complexity for which the pre-Seebohm jungle of services made no allowance. A mother taken to hospital by a mental welfare officer had to contact two other departments of the same Council to arrange accommodation for an elderly relative and her school age children; now the whole job can be undertaken by a single social worker who will do a much more effective job for being obliged to see the problem whole. Nevertheless it is hard to deny that the best psychiatric social workers had built up a range of expertise which has certainly been dissipated in the transitional period. Now that the excuse of the pressures of the change-over is wearing thin, what ought we to be demanding of social workers as an essential reassertion of the peculiar skills of working with the mentally ill?
A lively link
The first aptitude to be rediscovered concerns not the mentally ill themselves but the range of other caring staff with whom the social workers need contact and understanding - doctors, psychologists, nurses, therapists of all kinds - each group has its professional pride and susceptibilities. The social worker comes into contact with most of these and must understand and respect their roles. He must know too about the hospital, the setting in which they work, an institution which can affect its inmates, sane and mad alike, with a strange insanity all of its own. Between this odd and artificial place and the perhaps harsher reality of the wider community, the social worker must be a lively link, for the patient must always be working towards leaving the hospital, perhaps the hardest task of his recovery.
Relating to institutions of this sort - children’s homes, boarding schools and prisons have many similar characteristics - calls for unique skills, for the challenge is one of gaining the confidence of the establishment and its staff while remaining an outsider able to bridge the re-entry gap with the patient. The hysterical resistance of many medical social workers to the possibility of their transfer to local authority employment demonstrates how seductive can be the regime of an institution and how challenging - even frightening - is the world outside. But it will be with the society beyond the hospital walls that the social worker must deal. Treating psychiatric disorder can no longer be seen as a process for medical specialists alone, and, for a potentially sick or recovering client, the attitudes of relatives, workmates and neighbours to mental illness in general and to this manifestation in particular may well be critical. In all of these circles social work intervention is possible though social workers must admit that their operations in the past (and therefore the bulk of their present skill) have been in work with the immediate families of patient.
The techniques relevant to wider flfelds of educative and community work are still being worked out, but whether it is helping a tenants’ association to set up a visiting service for its frail old people or meeting with a protest group campaigning against the siting of a hostel for the disturbed young or talking with work colleagues of a client to interpret otherwise inexplicable behaviour to them, the social worker must be learning new skills to help forge a more caring community.
One area of the work of social services departments has attracted particular and unfavourable mention over the last year - their emergency night-time and weekend service. Social workers have protested at the inadequacy of the pay and compensation for being ‘on call’ and, in a number of local authorities, have refused to operate the service for a period. Their case is complicated and has been the subject of protracted and confused negotiations, but it was certainly significant that this was the chosen battleground for the first concerted action by social workers to withdraw their labour.
Being on call causes strain out of all proportion to the number of cases handled or the gravity of the matters dealt with. At all hours of the night a duty social worker can be telephoned and required to make a snap judgement which he would never take without careful thought and consultation during office hours. In no field are the decisions so onerous as in the mental health sector where the action to be taken can include the separation of fighting couples, the counselling of a potential suicide or the compulsory admission of a dangerous patient.
Exposed to pressure
Whatever the outcome of the dispute over payment, social workers clearly must develop greater confidence to cope with such emergencies, and departments must review their support and information systems to ensure that duty social workers are not left exposed to pressure without access to the necessary advice and information. The sorts of skills and back-up required have wider relevance than just to overnight problems; they apply in all of the many crisis situations with which social workers deal, crises which can so easily be intensified by fumbling efforts or false reassurance, but which can, if properly dealt with, be used to stimulate real growth and change in clients otherwise beyond the range of help. We have long recognised in theory that an emergency can be a point of positive new departure in the life of a disturbed person, but we are still far from developing the tools of rapid diagnosis and aid which we need to utilise our clients’ crises confidently.
So the mental health worker must call on a wide range of skills from community development to psychotherapy. In this context it is worth reasserting the relevance of casework, that much maligned technique of helping people by means of a relationship which is personal but professional. That it needs to be reasserted is a sign of the modishness of social work practitioners who, in their anxiety to escape from a theoretical basis which tended to place the responsibility for change exclusively on the individual client and his psyche (‘blaming the victim’ as it has been graphically expressed), have moved sharply away from the use of close and personalised relationships. What we need urgently is a clear understanding that casework and psychotherapeutic techniques can be radical in their application, just as community work, of course, can be conservative.
Complex services
The complexity of services from the point of view of the client makes the willingness of social workers to relate on an individual counselling basis all the more necessary. Seebohm may have simplified structures marginally but the hospitalised patient will still find it difficult to wend his way through the respective functions of the general practitioner, the outpatient clinic staff, the variety of’helping people’ he meets on the ward, and the whole range of representatives of relevant organisations and voluntary bodies in the community. Who, except the social worker, can integrate this experience? Or, to put it more aggressively, who will make sure that at each stage the patient really gets the service to which he has a right? This is surely a job which radical social workers can tackle with enthusiasm.
Seebohm presented social service professionals with their biggest challenge on the mental health front. An area of work for which medical supervision was previously thought essential was transferred to the control of workers with backgrounds largely in the social sciences. The opportunity was presented for a completely new approach to what, for lack of developed sociological terminology, we still call mental illness. This step was not taken in isolation, but as one move in a process away from the medical explanation of what happens to people when they need help to cope with the stress of life. Has it ever really helped to say that people with breakdowns are ‘sick’ any more than it helped other cultures and ages to describe them as wicked or devil-possessed or divine. Social work, it is true, has yet to come up with a more satisfactory model, has even to find a language free of the smell of medicine with which to talk about the phenomena we witness.
The challenge is a large one - to devise environments more therapeutic than hospitals, treatments less repressive than drugs, a theory of mental disturbance less scapegoating than that resorted to at present, a community more caring and accepting than the one most patients currently experience. The results of the experiment are of importance to more than just the social workers.
Disclaimer
The historical material in this project falls into one of three categories for clearances and permissions:
While we are in the process of adding metadata to the articles, please check the article at its original source for specific copyrights.
See https://www.ncbi.nlm.nih.gov/pmc/about/scanning/