The Great Tearing Asunder of Health and Social Care

This morning I came across a deeply depressing blog post entitled the non-exaggerated death of mental health social work.

There simply isn’t going to be such a thing as mental health social work within a multidisciplinary team.  Upset personally, terrified politically.  This Biopsychosocial model we’d all worked towards collectively, the idea that a person existed within a socio-political context, that a person was created from events as well as biological material, the knowledge of different social roles, power-differentials within caring relationships, the question of meaning and identity, all of these are lost.  While nursing staff have some training in these ideas, necessarily it is not the bread-and-butter of their training, nor should it be.  No professional can be completely holistic in the true sense.  That is why the multidisciplinary approach was conceived, and has been the backbone of Community Mental Health for over forty years.  It has now been undone in a matter of months and there appears to be no reverse gear.

This chimes in a nasty way with the sort of thing I’ve been noticing in my own neck of the woods.

Last month I blogged,

Relations between CAMHS and social services have historically been fairly poor. As the gulf widens, this relationship can only get worse. The risk is that it can turn into a game of pass-the-parcel with children. As soon as one service accepts responsibility for a child, the other service steps back…This isn’t spoken out loud, but there’s a sense if this trend continues we could move closer to an assumption that if a child is seeing CAMHS, they can’t have a social worker. And if they’re under the care of social services, they can’t have a service from CAMHS.

This certainly seems to be continuing. All the social workers in our CAMHS team are being pulled out, just like the ones in the blog post I read today. It seems to be pretty much unofficial policy in both health and social care camps that we are not working together to safeguard children.

Years of good practice about joined-up working between health and social care is being undone at a fast rate of knots, crushed beneath a merciless drive to control budgets. Health is now something that happens in one place, and social care somewhere else, and never the twain shall meet. It’s appalling.


5 thoughts on “The Great Tearing Asunder of Health and Social Care

  1. How sad. I don’t know what we can do about it…

  2. Technically it’s known as a Scheißesturm.

    It happens when you get a converging flow of narcissistic bankers and compliant and/or incompetent politicians. It continues until the number of nutters killing Ordinary Decent Folk (as opposed to their council house benefit scrounging scum neighbours) and dead kids start to accumulate embarrassingly.

    Then we have a big public enquiry and Guardian mediated round of mass hand-wringing. 2 years later the report is published and various political parties promise to implement the recommendations after they win the next election.

    Meanwhile Europe fragments into a score of hateful feuding homesteaders economically dragging Blighty back to the Victorian Era.

    At this point Ordinary Decent Folk notice that the patten of Society now matches at all levels and declares “It’s Nature’s Way”.

  3. It kind of makes the policy-talk of ‘integration’ ring hollow. While those who are more distant from reality bang the drum of integration the opposite is happening because the budgets are split and all are pressed. Grumble.

  4. In the late 60s there was a move towards creating a single, graduate profession comprising contemporaneous psychiatric nurses, mental welfare officers, psychiatric social workers, and occupational therapists working in the field of what was then lnown as ‘mental illness’ rather than ‘mental health’. This came from the work of Maxwell Jones at Dingleton Hospital and The Henderson Hospital. The working title of said putitive profession was ‘social therapist’ (which in fact is what Jones called graduate NAs at Dingleton but, like Topsy, it “just growed”). All such ideas were killed off after the T*r**s got in at the 1970 election and Keith Joseph invented the ‘District General Hospital’ with all NHS services subordinated to it.

    It’s too late to go back to that idea now, but it was one attempt at a holistic model of care. But here’s the rub: I would be most unhappy with a single model, even a “Biopsychosocial” one. Health and social care have been torn asunder before now and anally retentive managers refusing service to people in the care of another profession is nothing new.WWhat we do need is an envitonment in which any number of models can flourish on a ‘horses for courses’ basis. But, alas, Socrates is entirely right about clueless and spineless politicians.

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