Snapshots in Practice – Promoting
Social and Economic Equalities in
Mental Health Social Work
Kerry Cuskelly
Mental Health Social Worker
World Social Work Day March 2013
Mental Health Social Work
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Disclaimer! This presentation contains the thoughts of
one team from one area. We do not presume to be
speaking for all mental health services and social
workers.
Context – Vision for Change
 Other parameters/considerations –
Human rights frameworks, Global
Agenda for Social Work, Mental Health
Commission, IASW code of ethics, CORU
code of ethics, social model of mental
health
 The MH teams
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A Vision For Change – The Social
Model of Health and Mental Health
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Chapter four: “Belonging and Participation: Social
Inclusion”, “Community development models of mental
health are particularly useful in the provision of mental
health services to culturally diverse groups. Services
need to reach out actively to communities to find
alternative paths to channel support to individuals and
families”.
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Chapter eleven: “General Adult Mental Health
Services”, “...A large body of evidence identifies the
community as a key setting for health promotion
activities. The WHO123 emphasizes the importance of a
person-centred approach to community development
where the focus is on developing the social, economic,
environmental, and cultural well-being of communities, in
particular its marginalised members”.
A Vision For Change – The Social
Model of Health and Mental Health
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Chapter thirteen, “Mental Health Services for Older People”,
“Social support is a key resource for older people. Self help, support
networks and volunteering have been identified as protective factors
against poor mental health as well as helping people recover from
stressful life events like bereavement. The evidence suggests that these
interventions are most successful when linked closely with other
community development initiatives. It is recommended that evidencebased beneficial and effective programmes for older adults should be
implemented”.
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A clear indication of the importance of the inclusion of the social model
of mental health and community development approaches in mental
health is articulated in chapter 2: “Mental health problems affect
society as a whole. This emphasis on the social importance of
mental health (and therefore the importance of a society-wide
response to mental health) is increasingly emphasised by the
World Health Organisation (WHO): ‘for all individuals, mental,
physical and social health are closely interwoven … As our
understanding of this interdependent relationship grows, it
becomes ever more apparent that mental health is crucial to the
overall well-being of individuals, societies and countries.’ (p.
7)”
What the Continued Cuts Have
Meant for Mental Health
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In our MH services –
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Three day centres (2 general adult, 1 rehab)
have closed down in the past 3 months (On
paper they are open, in reality they aren’t).
Home care packages have been eviscerated
(On paper they were restored to 2012 levels, in
reality they aren’t).
Home help does not exist anymore (On paper it
does, in reality it doesn’t).
There is no day hospital or day centres at all for
older persons (approx. 26,000 people/400 open
caseload).
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What the Continued Cuts Have
Meant for Mental Health
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There is only one older persons MDT to cover all of our
catchment area.
There is only one rehabilitation MDT to cover all of our
catchment area.
There is a constant bed crisis in the general adult acute
inpatient unit.
There is only 1 social worker on the older person and rehab
team when there should be 2.5 SW posts on each team.
There is only 1 social worker on all the general adult teams.
All new CMH staff that began in 2013 are not being given any
office equipment with which to do their jobs due to “budget
curtailments”.
There is no service user representation on the area
management team.
A growing issue with homelessness and mental health
A growing issue re. Housing and mental health
Continued Challenges Ahead
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This is all happening in the context of –
The service plan for the area was published two weeks ago. It
outlines the key challenges to progressing MH services in our
area in 2013 The number of retirements will be an issue.
Improvements will be necessary to support delivery of services
and prevent unplanned bed closures below the national target
levels or disruption to community services.
Due to staff shortages meeting legislative requirements might
be an issue.
In order to reduce the amount of people using inpatient
services additional staff is needed to fill the additional
community posts.
If these staff are hired providing adequate supervision might be
an issue as they will mostly basic grade posts.
Nursing home placements have been identified as the place for
long stay MH service users to go to with staff being redeployed
“elsewhere” when this occurs. However, nursing home beds
remain in short supply.
How Can We Promote Social and
Economic Equalities in This Context?
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It’s getting much harder. But we are fighting back by….
Using peer supervision and informal supervision
to theorise our work and experiences.
 Building a strong, united, collective social work
team.
 Building alliances with other H&SCP’s to build
strong, united and collective MDT’s.
 Challenging the rhetoric of “there is no money”.
There is money, it’s just being diverted to
places other than frontline staff and the
frontline services which service users depend
on.
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How Can We Promote Social and
Economic Equalities in this Context?
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Using the social model of mental health –
viewing mental health issues not as something
that is a “disease” or a “chemical imbalance in
the brain” but rather viewing mental health as
connected to many outside aspects on one’s life
– poverty, abuse, discrimination, trauma,
bereavement etc.
Using the “Social Determinants of Health”
(Dahlgren and Whitehead, 1991) as a guide for
this work.
Challenging the gaping hole in communication
between management and staff/service users.
Social Determinants of Health
How Can We Promote Social and
Economic Equalities in this Context?
Using Direct Action –
Home Care Package campaign in the last quarter of 2012.
PCSW and MHSW worked together to mobilise SW’s in North
Dublin. Also, mobilised as many service users, families and
home help staff as possible. Collected over 300 signatures for
petition. Handed these in with the 10,000 other signatures
collected. Marched with home help staff, SU’s and families on
demonstration on November 24th. Campaign succeeded in
getting home help hours reinstated to Jan 2012 levels.
 Building alliances/relationships with community organisations
eg. During home help campaign, very positive relationship
made with Older and Bolder who supplied us with tons of
postcards, posters, info to hand out to people re the cuts to
home help. They also intended on working with us re. mental
health and older persons after the campaign. Unfortunately,
their funding has been ended so this piece of work will not
happen.
 Using grassroots groups like the Social Work Action Network
(SWAN) as safe spaces in which to challenge the continued cuts
to services and the injustices we see first hand every day e.g.
we marched under this banner in the November 24th
demonstration.
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Questions?
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Thank you!