Social work with people with mental illness, known initially as psychiatric social work, began in the 1950s at the six county psychiatric hospitals across Northern Ireland (Herron 1998). These hospitals were administered by the Regional Health Authorities, whilst the new psychiatric social workers were out-posted from the County Welfare Authorities. The introduction of generic social work under the Seebohm reforms into Northern Ireland in 1972 coincided with the establishment of the integrated Health and Social Services Boards (Campbell 1998). The consequent loss of specialist psychiatric social work training courses was much lamented by the psychiatric professions (Barr 2002) The Troubles
Major organisational changes took place in the early 1970s at the height of the civil conflict when much social work effort was effectively relief work (Manktelow 1998). As the Troubles continued over the next twenty-five years, a legacy of mental health problems was created which is only now being addressed (Fay et al 1999; Bolton 1998). Troubles-related violent bereavement, chronic stress, unresolved grief and addictive behaviours have caused high levels of long-term mental ill health in the local population (Manktelow 2002; Murphy 2001). Settings
Today, it can be seen that mental health social work has become an important professional activity which occurs at the three levels of prevention: in primary care settings, such as health centres and community resource centres; at the secondary level of prevention, in crisis intervention services, day hospitals, psychiatric units in general hospitals, psychiatric hospitals and specialist settings such as child, adolescent and family psychiatric services; and at the tertiary level, in rehabilitation and community support services (Manktelow 2002). Services
Over the last twenty years, mental health social work services have been delivered within a context of rapid changes in the pattern of service provision which has seen a reduction in the number of hospital beds, a reduction in the length of hospital admissions and a corresponding increase in the number of admissions (Rafferty, 1996). Moreover, the implementation of a new mixed economy of care and the purchaser/provider split has meant that mental health services are now provided by a multiplicity of agencies from the private and not for profit sector, as well as the statutory health and social services trusts. The implementation of community care for people with mental health problems has provided an enormous opportunity for mental health social workers to play a key role in the development and delivery of community services (Yip 2000; Stuart 1997). There are over 270 Approved Social Workers (ASWs) in Northern Ireland but concerns have been expressed about the ageing profile of this work population (Britton et al 1999). Although Herron (1997) has attempted to estimate the number of mental health social workers required to meet the mental health needs of the local population, this calculation is subject to a number of often complex policy factors. For example, the number of agencies providing mental health services in the mixed economy of care in Northern Ireland is difficult to estimate. PROFESSIONAL PRACTICE
Social workers utilise a range of interventions based on a social and interpersonal understanding of mental disorder. This social model emphasizes social factors and interpersonal relationships as explanations for behaviour and offers a distinct and holistic alternative to the medical model of mental disorder, which has a tendency to isolate the individual from family and environment (Tausig et al 1999). Mental health social workers are involved in the wider social environment – for example in working at the interface of health, housing, benefits and employment. In a study of social workers’ contact with other organizations and occupations, a sample of newly qualified social workers cited eighty organisations and...