Ross Hymas
Social Work with Adults – Andrew Maynard
20/10/2014
Care program approach – what is it? How it work? What is it for? Look at it – on VLE. Has to be
demonstrated in assignment.
Lots of stuff on VLE this week – for you to access in own time.
Legislation looked at last year is relevant for this module.
Mental health is too broad to do for assignment – narrow it down.
Next week will have someone talk about disability.
Intro to Mental Health
Define mental health:
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Mental condition that may be detrimental to wellbeing.
Undiagnosed condition you don’t know much about
Cognitive impairment – not allowing to function ‘normally’
Perception and reality is disorganised – potential paranoia
Psychological well-being affects daily activities and how you perform.
Historical perspective:
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Saints, witches/madmen
Madness – possession by the devil
1377 – remained first specialist institution until mid 17th century
Poor law 1603 – outdoor relief or workhouse, some prvate madhouses, some charity for the
pauper lunatics.
17th century began to look at models and how to deal with ‘madness’
The enlightenment period – people started to challenge concepts. Started to be more aware
of what’s around them that relying on what was told.
Medical treatment – not like today, not fully understanding mental illness.
‘madness’ = not part of society.
Biological model – physical imbalances.
Moral treatment – periods of lucidity – sometimes ‘normal’ not constantly ‘mad’
Asylums – segregated until cured and then let back into society.
Starting to think about the environment and it’s factors.
1801-1844 class issues driving interest.
Funding always problem
1845 lunatics asylums act – mandatory to be incarcerated in showed signs of ‘madness’.
1845 Act – foundations for medical model
1846 – first use of word ‘psychiatry’
1895 – General Medical Act – “insanity is purely a disease of the brain”
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Ross Hymas
Social Work with Adults – Andrew Maynard
20/10/2014
Two world wars – shift of understanding:
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Questioning biological model
Freudian psychoanalytic methods introduced
Focus on neuroses not just psychoses – difference? Neuroses = overwhelmed in situations,
allowing environment to affect. Psychoses = hear voices, hallucinations etc.
Development of outpatient services
1948 NHA provision and funding of MH issues.
Tranquillisers introduced – first tablets came out can change mood/affect how behave.
Social model of control. Majority of woman given tranquillisers – why? Putting stigma on
society (men gave out tranquillisers – run social construction) women more likely to present
themselves with a problem – men don’t talk about it.
Optimism – aspirations hat asylums could be run down. – running asylum was extremely
expensive – dangerous in terms of social economy.
Make distinction between history and now – demonstrate progression in how people were treated.
Legal framework (see slides)
MHA 1959:
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Responding to advances in medication
Concerns regarding institutionalisation – unable to regain position in society.
1983:
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Built on principles in 1959
Approved SW – power to section people (additional training)
Strong framework for admission – need clear reason as to why admitted to hospital –
criteria.
1960s-1970s – scandals, in hospitals, work of sociologists such as Goffman on
institutionalisation, “anti-psychiatrists” – take more of a social approach, not ‘labelling’ as
lunatics – beginning of debate between medical/social model. Considering social aspects as
well as medical. Goffman pushing boundaries back with regards stigma.
1975 – getting better services – ‘part 3’
1992 – Christopher Clunis killed Jonathon Zito – scared people ‘shouldn’t be in community’
How many people were murdered that year? – Clunis killed one person = uproar, why? Felt he
shouldn’t have been let out into society
Anxious about patients’ rights – should they be locked up or allowed in society.
Care Programme Approach – please read – receive help from secondary mental health services.
Anyone who is vulnerable gets help.
Supervision registers
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Ross Hymas
Social Work with Adults – Andrew Maynard
20/10/2014
MCA 2007
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AMHP – problems with ASW – what is the difference? Don’t have to be SW – any leading
professional can be an AMHP
Who is involved in MH?
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Family carers
SW
AMHP - Need certain level of experience to do this
Nearest relatives
MH advocates – represent the patient and protect their rights.
Responsible clinician
S12 – approved doctors with training in diagnosing and treatment of mental disorders. Need
certain level of experience to do this
Admission to hospital:
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Informal – voluntary
Subject to DoL – MCA 2005
Compulsory admission – section 2/3 of MHA 1983 – applies to children as well
Have to have understanding of the law to work effectively in practice.
Have you got capacity? – fundamental
Discharge:
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Informal – no restrictions
Discharge via relatives
Hospital Managers review
Mental health tribunal – appeal the decisions made by professionals
Community patients:
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S17 – leave – RC (responsible clinician) must consider a CTO if leave over 7 days.
S117 – after care – LA – has to make provision for you after come out of care
Community Treatment Order
S41 – restriction order – social supervision
Key themes in mental health:
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Social inclusion
SU/carer participation
Care v control – controlling people’s lives(SU has no say) Care (SU has say)
Risk
Partnership working/collaboration
Joined up government – legal interaction
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Ross Hymas
Social Work with Adults – Andrew Maynard
20/10/2014
1 in 4 have a mental health problem – they think it’s more as men don’t like to speak out about it.
more men commit suicide – don’t talk it through. Women more sociable – talk things through.
What models are used in MH?
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Medical model
Social model
Person centred
Strengths
TC
Behavioural
Crisis
Solution focused
Psychodynamic = looking into their childhood – anything substantial?
Bio – psycho – social = holistic – understand that it’s a combination of factors.
Recovery = seminal to MH.
Homework – read up on these models
Major forms of mental illness:
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Schizophrenia
Mood disorders (e.g. depression)
Organic disorder (e.g. dementia)
Dual diagnosis (e.g. depression & a learning disability or mental disorder and substance
misuse)
Recovery model:
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Holistic
Social inclusion
It’s possible to recover from severe mental illness
Journey not a destination – could go on for years – at their pace.
Positive attitude
Not to go back to where you were – the here and now (contradicts psychodynamic model)
Support networks – important
Integrated legislation – recognise other professionals may be working with them
Flexible services
Stress – vulnerability model - see slides on VLE
No one model can explain the complexity of MH
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Not a model of causation – gives hopes
SU led
Not about being ‘symptom free’ – about managing them. Can have a MH condition but still
hold done a job.
Not an end state – always evolving
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Ross Hymas
Social Work with Adults – Andrew Maynard
20/10/2014
- Finding meaning and purpose in life
- Regaining control over one’s life
- May differ in different cultural contexts
- Recovery rates higher in non-western societies where there is less stigma and people are
expected to take on valued social roles (Tew).
Exercise:
Case scenarios – Mental Capacity/Best Interest Decisions
One:
What are the issues?
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Mrs Brown doesn’t want to go into home
She’s had a fall – could be confused because of this
Mobility
Confusion
Personal care needs – needs help
Assessment wasn’t done in home
Do you think Mrs Brown has capacity to make this decision?
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Yes
Why?
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Lived independently up until the fall
Fall could’ve triggered something
MCA = assumed to have mental capacity until proved otherwise
Who should take responsibility for the assessment of capacity?
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SW
GP
Who else should be involved?
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Family
Mrs Brown
Care or Control?
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Care – because has capacity – shouldn’t go into a home
Mrs Brown can’t weight bare – problem? Talk to her about it.
Two:
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Ross Hymas
Social Work with Adults – Andrew Maynard
20/10/2014
What are the issues?
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Possible abuse from guys in pub
Possible illegal activity
How do we support him in doing right thing?
Do you think that Joe has capacity to decide whether to be involved with these men?
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Yes to make decisions
Does he know what he’s doing is wrong?
If you do, why?
If not, why not and how have you reached this decision?
What other concerns might you have about Joe’s situation and how might you address these?
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Getting paid cash in hand – affect benefits?
Who would you involve?
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Key worker
Explain the risks
Care or control?
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Care
Three:
What are the issues?
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Consultant is asking colleagues to sign consent form
Can’t communicate verbally
Severe learning disability
Moved from long term care into her own home
Do you think she has capacity?
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Yes
Who should be involved?
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Herself
Support workers
SW
Who should be decision maker?
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Doreen
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Ross Hymas
Social Work with Adults – Andrew Maynard
20/10/2014
Have other concerns?
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Consultant is the problem
Care over control
Four:
What are the issues?
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Overdose
Given medication by neighbour
Potential for financial abuse
Capacity?
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Yes
Neighbour has best interests?
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May have but not realise what she’s doing.
All real case ^^ have to deal with these on daily basis.
Different models:
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Social model
Medical model
Social dynamic theory?
Recovery model
Person centred
Psychodynamic
Bio/psycho/social
Strengths
Stress vulnerability
Behaviourism – CBT
Crisis intervention
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