Critical analysis of essential elements of good social work practice in relation to working with families where there is evidence of mental health

Introduction

Social work practice in families that evidence mental health involves an understanding and application of theory, good practices, legislation and policy that are relevant to the situation. It is also noteworthy that social work practice will differ in situations involving older parents and adult children from those involving parents with minor or young children. This essay focusses on social work practice in families where the parent has a mental health issue and is also parenting a minor child.

Legislation and policy

In families that depict mental health problems for the parent with minor children, certain laws and policy are applicable. These create the wider legal framework within which the rights of persons with mental health issues and the responsibilities of the social work practitioners are provided. These are discussed in this section.

Parenting with a mental health issue is a challenging task for the individual parent with the mental health issue. A parent may have to cope with the challenge of dealing with a mental health care issues while coping with parenting. Mental health issues for parents also have implications for the minor children within the family where such children are in the care of their parents. There may be concerns that the parent with the mental health issues may not be able to provide proper care to their child. There may be further concerns about the impact of mental health on the children within the family, which may include concerns about stress or possibility of mental health problems being passed on to the children within the family. A social care practitioner will have to work with the family and provide help to the family to deal with their situation.

One of the most important directions with respect to adult social care come from the recently enacted Care Act 2014, which provides that adult social care should involve helping people seek support in anticipation of their needs. The aim of the law is to prevent and reduce dependency on higher intensity care and support services by tackling the problem at an earlier stage. From the perspective of social work practice, the Care Act 2014 requires a focus on choice and control of the individual as well as the concept of proportionality which relates to the right to enjoy the utmost possible independent lifestyle (Parker, 2017, p. 55). With respect to parents with mental health issues, the Care Act 2014 focusses on allowing parents to be primary care givers for their children, unless they have a condition that puts the children at risk in their care. For this purpose, the Care Act 2014 also requires the social workers to make assessments for adults. However, this has to be done in a flexible manner while respecting the core obligations of social work in this context. The core focus is on the needs of the individual and the outcomes expected by him (Parker, 2017, p. 55). Therefore, the individual must be allowed to have control over their lifestyle. The focus is on well-being, care and support planning and assessments (Parker, 2017, p. 48).

An individual who has a mental health issue is not necessarily incapacitated from making choices or decisions for himself. This includes parents with mental health issues. However, there may be parents who may lack capacity to make decisions. The Mental Capacity Act 2005 (MCA 2005) defines the legal framework that is applicable to social work in the area of mental health practice with such individuals. The MCA 2005 provides the definition of mental capacity as well as provides the statutory powers and duties in situations which provide the need for intervention for the best interest of such persons. Mental health conditions such as autism, severe and clinical depression, psychological, schizophrenia, etc. would be considered to be subject to the provisions of the MCA 2005 under specific situations (NHS, Autism spectrum disorder - Adults with autism , 2016). In the context of parents with mental health issue, they may come within the purview of the MCA 2005, if they are unable to make decisions for themselves due to an impairment in the mind or brain or any disturbance in the mind or brain, even where such impairment is temporary, provided that at the time such decision needs to be made, there is an impairment (MCA 2005, s.2). It is important to note that the application of MCA 2005 may lead to the deprivation of liberty for individuals and at times deprivation of liberty safeguards (DOLS) may apply to individuals and this may be contested by the family. Therefore, regard to the law as well as the jurisprudence of the courts is important to ensure correct practice.

Where a child is in a family where a parent has mental health issues, social workers have to be aware of the challenges that this may provide to the child and such families are to be identified by social workers as needing early help or support (HM Government, 2015). The Children’s Act 1989, Section 11 provides a duty for the local authorities to identify families that need adult social care services (HM Government, 2015, p. 58).

The Children and Families Act 2014 applies where the parent is incapable of looking after the child or the child is at risk from some harm in the home environment. In such cases, the child may have to be placed in foster care. The Act requires that the child be first placed in family or friend carer’s custody instead of in a foster-to- adopt arrangements.

The Health and Social Care Act 2012 has also ensured that parity is given to physical and mental health (Allen, Carr, Linde, & Sewell, 2016). However, despite the passage of this law, it is considered that mental health issues remain marginalised and stigmatised in both the social services as well as society (Allen, Carr, Linde, & Sewell, 2016). In the context of social work practice, it is noteworthy that professionals may find that mental health services are not given as many resources as given to other areas of health and care (Allen, Carr, Linde, & Sewell, 2016). It is also observed that people with serious mental health needs may be more likely to live in poorer housing and have poorer physical health, be unemployed or socially isolated (Allen, Carr, Linde, & Sewell, 2016).

Evidence base for practice

Evidence-based practice (EBP) refers to “health practitioners applying the best currently available research evidence in the provision of health services. In other words, EBP challenges practitioners to “do things right” and to “do the right things” (Waddell & Godderis, 2005, p. 60). In other words, evidence-based practice involves a process wherein the practitioner uses well-researched interventions as a background with which he combines his own clinical experience and ethics, the preferences and culture of the individual for the purpose of identifying the appropriate treatment and interventions for the individual (Waddell & Godderis, 2005). In social work practice, EBP helps to identify, select, and implement interventions for individuals.

Research in this area involves research relating to improvement of services designed to support the mental health and well-being of children and families (Palinkas, et al., 2008) and need and encouragement for innovative practices in mental health (Mendel, Meredith, Schoenbaum, Sherbourne, & Wells, 2008).

Research has shown a variety of different models have been proposed to summarize factors at multiple levels of the social and organizational context that potentially influence the process of translating research into effective improvements in practice (Glisson & Schoenwald, 2005). Some models focus on the importance aligning community stakeholders with the inter-organizational agency environments (Glisson & Schoenwald, 2005).

Despite the scholarly research that suggests that evidence based practice is beneficial, there are also criticisms against it, particularly, that evidence based practice is difficult to implement (Waddell & Godderis, 2005). In social work, there are criticisms against evidence-based practice which emanate from the difficulty for social workers to transform the research into viable practices (Bellamy, Bledsoe, & Traube, 2006).

In context of social work and mental health, the barriers against evidence based practice relate to the time taken between research development and dissemination of evidence and the transformation of the information to practice settings (Bellamy, Bledsoe, & Traube, 2006). There is also a problem with the lack of support and training social workers and practitioners (Bellamy, Bledsoe, & Traube, 2006). At the same time, there are also evidence of effective interventions but there needs to be a dissemination of programs and other research findings which can prove to be beneficial to the social work practitioners (Bellamy, Bledsoe, & Traube, 2006). Interventions may include vocational or work based support, help with household or daily activities and therapeutic interventions (Social Care Institute for Excellence, 2012).

There is a significant shift in social work practice towards supporting adults in their parenting roles when they have mental health needs. Generally, families need support in such situations so that they can continue to live together and parents can look after their children without losing their parental responsibility. The think child, think parent, think family initiative focuses on processes that are focused on the entire family. Therefore, assessments are also done while taking care to include the family (Social Care Institute for Excellence, 2012a). These interventions help parents with mental health issues to live more fulfilling lives while also looking after their children (Social Care Institute for Excellence, 2012a).

EBP is gaining ground in social work practice (Bellamy, Bledsoe, & Traube, 2006). EBP in social work practice treats clients as informed participants. The practitioner seeks out practice-related research findings regarding important decisions and shares the results of such a search with clients.

A recent report that adds to the evidence base for practice was funded by the King’s Fund and it provides an analysis of integrated care for mental and physical health from the perspective of the patient or service user; an overview of areas where integrated care is needed; innovative service models being developed at this time and also information on the barriers at for the implementation of certain models (Naylor, et al., 2016). As per this report, integrated care is essential so as to provide health and care services so that the various needs of an individual are met in a manner that is coordinated. Integrated care allows the integration of health care with social care and in this way a coordinated response to an individual’s needs may be provided by health and social care providers. For example, an adult individual with mental health needs may also be a parent to a minor child, where he would require health care and both he as well as the child would require social care and support. Integrated care may help create a more structured and coordinated response to the needs of the individual as well as the children. This is especially significant in mental health care because, in this area, the coordinated effort is required to answer the medical, social and psychological needs of the affected individual and family (Naylor, et al., 2016). The Care Programme Approach responds to individuals with complex needs, such as a parent with mental health needs (Rethink Mental Illness, 2015). A social worker may be a CPA care coordinator, who helps manage care plans.

The evidence base for health and social care agencies remains sparse at this time (Cameron, Lart, L., & Coomber, 2014). This impacts on the outcomes for social care work in the area of mental health and children.

Theory

A theoretical framework that is applied in mental health work is the bio-psycho-social approach. This approach emphasises on biological elements and grants a subordinate role to social and psychological factors (Tew, 2011). A difficulty with this approach is that it disrupts the parental care giving as it is applied in cases where people have to be detained under DOLS for the safeguarding of their interest. In context of parents with mental health issues with children, DOLS has a disruptive effect. Where such disruption is inevitable, the bio-psycho-social approach helps create a holistic and supporting environment for people who are detained under the DOLS process (Hewitt, 2009). Recently, the bio-psycho-social approach has been suggested particularly for practice involving social care involving mental health because health is the product of biological, psychological and social processes, and therefore, the assessment and management of mental health should be from that perspective of mental health only (Naylor, et al., 2016).

Research suggests that parents with mental health issues may become over dependent on medicinal drugs or even be prone to self-medication or alcoholism, which may have a negative effect on any children in their care (Swartz, et al., 1998). Under such circumstances, it is theorized that parents may not be competent to look after their children (Swartz, et al., 1998). In such situations, parents may even lose emotional contact with their children, which may have a very negative impact on the child (Danson, Macias, Gold, Barreira, & Fisher, 2008). However, social workers have to be careful not to develop such prejudices about parents with mental health issues.

Social care has come to be structured in such a way that ensures that a family in which an individual is suffering from mental health issues will not see an intrusion or intervention by the Local Authority in a way that is oppressive. Therefore, social work practice has to be anti-oppressive. An anti-oppressive practice sees a social worker questioning their value and ethics. Therefore, a social worker should have a commitment to learn new skills, be morally inclusive and display competency in social situations (Parker, 2017, p. 58).

One area where oppressive practices may be seen is in social work in multi-ethnic contexts. Social work practice in multi-ethnic settings requires a theoretical framework that allows social workers to work within such settings with sensitivity to issues involving human diversity (Dominelli, 2002). Social workers should approach individuals in a way that is culturally sensitive (Healy, 2014). This would require consideration to different factors that may lead to oppression, such as, gender, race, socio-economic status, etc. This needs a critical reflection by the social workers of self in practice as well as the service users’ experiences of oppression (Healy, 2014). Cultural, structural, institutional and personal obstacles will have to be overcome by the individual in order to gain greater control over their lives (Healy, 2014).

Simply ethnocentric and Eurocentric explanations of emotional and psychological development will not provide the adequate solutions to the problems associated with the development of the ethnic minority groups (Walker, 2012, p. 162). Social workers can use an empowerment model of practice that is also anti-discriminatory with the work involving a multi-disciplinary approach that enables the social workers to create a practice model that is culturally inclusive in nature (Walker, 2012). There is a need to create a social work practice for the ethnic minorities that challenges stereotypes and racism, where the social work staff is encouraged to stop and think about their assumptions so that they can rise above these assumptions in trying to help the families and children dealing with mental health issues (Walker, 2012). These assumptions may relate to race and culture and are in many cases preconceived.

Elements of good practice including how practitioners can address issues of anti- oppressive practice.

Good practice in mental health, especially under the MCA 2005 involve taking into consideration the interest of the individual concerned as well as the family. At times, this may require a balancing of interests as between the individual and members of the family.

Social workers must have regard to any signs such as unexplained bruises or injuries may be a sign of a possible physical abuse or self harm (SCIE, 2015). In any case, such signs are to be taken seriously by the social worker. In case, there are children involved then the signs may be taken as serious indications that the children may also be at risk of harm. Therefore, social workers may also be required to report any such indications to the local authorities also.

Social workers must also have regard to the Mental Health Act Code of Practice (2015) while dealing with a person who is mentally unwell. The Mental Health Act Code of Practice (2015) provides five important principles, each of which is to be considered before important decisions relating to an individual’s treatment or care can be taken (Jackson, 2016). The first principle provides that the least restrictive option must be chosen for the individual and the purpose of the treatment should be to maximise the freedom of such a person. In other words, the decision to detain a person under DOLS authorisation must be the last option to be applied only if it is not possible to treat the person without detaining them.

The second principle provides that there must be a focus on empowering families, carers, and other responsible people and increasing their involvement in the treatment of a person. In other words, removing children or adults that need safeguarding from the society of their family should be the last option to be applied only if best interests of such a person demands it. The third principle is that the respect and dignity for the patients and their families should always be considered first. The fourth principle is that the best practices must guide the process of DOLS authorisation. The fifth and final principle is that different social services should work in tandem with each other in the interest of efficiency and equity (Jackson, 2016, p. 324). In general, non-restrictiveness in the management of behavioural disturbance is considered to be a good practice (Department of Health, 2015).

In social work practice, an area of oppressive practice may be the drive to completing forms within specified guidelines and oppression may be provided by the pace of assessment being beyond what the family can cope with at the period in time (Walker, 2012, p. 122). Instead, a social worker can exhibit best practice in allowing families space and room to complete assessments at a more comfortable pace.

Conclusion

Social work practice in families is complex and social workers are required to show a lot of compassion for the problems and challenges that families face in the event of a member of the family suffering from mental illness. The legislations and policy are in place to provide a broad legal and best practices framework. In this essay, the laws and policy with respect to social work practice with families involving older parents and an adult child with mental health problems was considered. Best practices in social work require that as far as possible individuals are helped to gain control over their lives. An anti-oppressive approach in social work allows social workers to help people overcome personal, cultural and structural challenges.

Non-restrictiveness is an important best practice. An individual should be allowed to live an independent life and make decisions for themselves. Even where parents with mental health issues live at home with their children, they may still have the mental capacity to make decisions for themselves and their children. This should be respected by the social workers unless there are indications of self-harm or risk to the children within the family home. Assessments done by the social workers can clarify these issue to a great extent. However, as per best practices, assessments should always be done by keeping the children and the family first.

People with mental health issues are not necessarily mentally incapacitated. However, at times they may need help and support, which may be provided by their social workers and local authorities. At the same time, the right of individuals to make their decisions, live with their families and be carers for their children must be supported as long as there is no risk to the children concerned.

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