Abstract
The book is structured into three parts: a lead essay; seven responses to this essay from a range of practitioners and academics; and then some concluding remarks. This structure, to some extent, reflects the inclusive, relationship-based, collective approach the book is advocating for social work practice. In the first part Jeremy Weinstein, who worked as a social worker in London, before moving into academia and psychotherapy, provides the lead essay exploring the current issues for mental health social work. This essay leaves no doubt about the centrality of social policy for social work and the need to take a critical perspective on policy developments. Weinstein, using the examples of two policies from the Department of Health for England (No Health Without Mental Health and Improving Access to Psychological Therapies) highlights the tensions between these policies’ discussion of social justice, stigma and evidence, and the realities of the economic context and how they are being implemented in practice. Wilkinson and Pickett’s (2010) Spirit Level and James’ (2008) Affluenza are cited to illustrate the relatively unaddressed impact of inequality, materialism and alienation. Weinstein then draws on a range of perspectives to identify some of the key questions for mental health social work, such as the preoccupation with risk, the growing use of coercion and the ongoing dominance of bio-medical approaches. He also offers a range of possibilities for how social workers can respond to these complex issues including through alliances with service users, colleagues, teams and wider communities. An important aspect of this essay is the assertion of the need and benefit for work at the individual level. Taking a more critical perspective to the political and economic context of mental health social work could lead to a sense of futility about work at the individual level but Weinstein reinforces the need for it, as long as it actively relates to the wider context.
Part Two builds on the themes identified by Weinstein through responses from seven social work practitioners and academics. It is particularly heartening to see a response from a social work student, Colette Bremang. In the first response Helen Spandler discusses a range of key challenges for mental health social work. She argues for the need to further develop new understandings of mental health and more positive and therapeutic approaches to crises. She makes some really interesting points about the potential of personalisation and recovery to be misused, and the need to not just oppose but to ‘actively, creatively and constructively “do things differently”’ (p. 34). Jerry Tew argues for the need to recapture the ethos of social action, for social workers to perceive themselves and act as agents of change not just rationers of resources. He highlights an important paradox, that the need for a social action-based approach has never been clearer and is supported by the research and policy, but this is not being reflected in social work practice. June Sadd draws some important and powerful parallels between colonialism and the psychiatric system and explores some of the potential for mental health to engage more with the wider disability movement. Rich Moth frames his response around the idea of ‘diagnosis human’ to explore the managerialism, marketisation and medicalisation of mental health services. Des McDermott continues the theme of the need to understand mental health in its wider context and the importance of making connections and alliances to do this. Focusing on the recovery approach he illustrates the potential for policies to be framed in very positive and progressive language which distracts from an agenda focused on reducing public spending. Colette Bremang makes a straightforward and powerful call for better training in mental health on qualifying social work courses. Finally, Andy Brammer offers a front-line practitioner’s perspective on both the potential and concerns about the current developments in policy and practice.
In Part Three Weinstein offers some concluding remarks which urge caution about the use of jargon, acknowledge the extent of the challenges, but reassert the central role mental health social work should play in addressing these challenges.
There are two recurring themes in this book which seem particularly important. The first is the acknowledgement that, within mental health social work practice, time needs to be protected to reflect and be able to collectively address community and societal issues – these are core components of the role and, from these accounts, it does not sound like this is currently possible for many practitioners. The second theme is that the evidence for the approaches advocated in this book is growing and becoming increasingly convincing. I agree with the political, philosophical, moral and ethical arguments for a fairer society with better services but, for those who don’t share this perspective, the detailed economic and effectiveness cases are needed. Within social work generally we maybe need to further develop those cases. I would certainly recommend reading this book and it is directly relevant to everyone involved in mental health including mental health social workers at all levels.