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Essay: Should service users/carers be able to challenge traditional models of service delivery, welfare funding & strategic social work policy

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  • Should service users/carers be able to challenge traditional models of service delivery, welfare funding & strategic social work policy
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Historically, Social work has been identified as one the “helping” or “caring” professions as it is dedicated to helping people meet their needs and advance their potential in an endlessly changing society (Thompson, 2015). Social policy takes into consideration policy which aims to promote the welfare of citizens as well as their social well-being. The origins of Social work began as a philanthropic serving movement but, later developed into a scientific field. Consequently, the make-up of social work needed to be more specific and formed with characteristics which would enable a unique description of its practice amongst other “helping” professions and the social sciences. By recognising and defining it as both a science and a profession, we acknowledge elements in Social work such as the existence of specific methods, philosophy, policy, politics, ideologies values and ethics (Mizrahi and Davis, 1996). Furthermore, Social work is recognised as having a social function which is provided by the department of social welfare (Kirst-Ashman, 2012). Within this ever-changing society, we recognise that this role is in a constant state of development, like everything else in society, by what we fleetingly describe as social dynamics (Magstadt, 2014).

The aim of this paper is to investigate and perhaps, challenge the notion of service users and carers having a voice in challenging traditional models of service delivery, welfare funding as well as strategic social work policy. It is essential to ponder on the statement; this assignment will draw together relevant policy regarding vulnerable adults within Adult Mental Health, which have predisposed social work practice or perhaps have created a gap. Subsequently, critically analysing the core elements of these polices that have developed over a period and why policy makers have decided to create and develop these policies based on social problems, these policies should be distinguished from individual need. To provide a counter dispute, I will deliver evidence to convey if at all, these policies do take into consideration disadvantages and social injustice within our, continuously changing society. Lastly, drawing together core elements within this assignment to conclude on the statement.

Like many professions, Social work draws on received ideas from social and human science disciplines, the professional knowledge gained by Social workers forms between institutional construction, social problems and the tradition within the Social work discipline (Thompson, 2000). The diversity of social work represents a great challenge for social work research, education and practice in the rapidly internationalizing and globalizing world. The concept of this can be challenged successfully through insight into philosophical and historical understanding of the characteristics of a country, welfare regime, specific traditions of welfare systems and the position and role of Social work. Research into the philosophy and history of social work strengthens this understanding through analysing the conceptual and genealogical fundamentals of the traditions of Social work. Undertaking research within specific areas contributes to the theoretical self- conception of social work which is necessary for the development of social work as a modern profession.

Historical Content

Before the Reformation, it was considered a religious duty for Christians to look after those in need. The Dissolution of the Monasteries ordered by Henry VIII between 1536 and 1540 led to dramatic religious and social change. Leaving many poor people without a place of refuge, after the Reformation many of the old values were lost and it became necessary to regulate the relief of poverty by law. Previously, parishes “Overseers of the poor” were responsible for collecting poor rate from local householders and distributing poor relief to those in need (Slack, 1995).
Various laws were passed to deal with the prevalence of poverty during that era. It should be noted that, The Poor Laws Act 1601 was the most comprehensive and significant Act of the Old and Poor Laws during the reign of Queen Elizabeth I (Drinkall, 2011). The birthing of trade unions became legalised in 1824, when an influx of factory workers merged together with various associations to achieve better wages and working conditions, the objective for employees focused on protection and promotion. Before 1834, the cost of looking after the poor in England was increasing each year this, cost was paid for by the middle and upper classes in each town through their local taxes. In comparison to the previous Poor Law the New Poor Law ensured that the poor had a place of refuge in workhouses, were clothed and fed (Battersby, 2016 p.5). Children who entered the workhouse would receive some schooling. However, in return for this care, all workhouse paupers would have to work for several hours each day. Although, the Poor Law was supposed to be in the best interest of vulnerable people it can be debated that poor people were treated less favourably and harshly to the point of which genuinely poor, would voluntarily enter the Workhouse (Bangura, 2010). Which would suggest injustice within the English society at the time.
Arguably, not all Victorians shared this point of view, Richard Oastler, spoke out against the new Poor Law, calling the workhouses ‘Prisons for the Poor’(Evans, 2014).The poor themselves hated and feared the threat of the workhouse so much that there were riots and violence within northern towns (Battersby, 2016 p.6). Poor people could receive help, if they were prepared to leave their homes into the workhouse, a condition which was implemented to deliberately deter people from asking for help unless they were desperately in need (Madan, 1967).
Likewise, there was a real suspicion amongst the upper and middle classes in the view that they were paying the poor to be lazy and avoid work (Lowe, 2017). The 1834 Poor Law Amendment Act and the Workhouse came into power as a measure to reflect the changes in society the New Poor Law was centred on the workhouse and introduced the principle of less eligibility. Jones (1990, p.13) defined the Poor Law Amendment Act as “one of the great watersheds in English social policy”. As a critic to the previous, Poor Law the focus was based on agricultural context within local parishes relief that were proving insufficient and incompetent with societal needs and demands. Furthermore, this was due to the changes from industrialisation urbanisation and agriculture. The core dispute during this era was the Fabian Society, established in 1884 to campaign for state intervention to tackle the prevalent social problem and economic inequalities which its members contended had failed to be addressed by the capitalist markets of the nine-tenth-century Britain.
Interestingly, the state welfare emerged in the nine tenth century to adopt the functionalist approach which considers solving social problems and promoting stability through social policy. This notion coincided with the events which took place in the nine tenth century when the government interceded and engaged with meeting and addressing welfare matters of industrialisation and urbanisation. The government were then forced to act in order to meet with societal needs and demands that contributed to social problems in the population.
It is important to acknowledge the shift, within history. In today’s twenty-first century era, councils hold responsibility for providing social care to their residents. Each council pays for the social care services it provides within the allocated budget (Greve, 2016). The coinage councils are required to spend on services and provisions they provide come from three main sources: business rates, council tax and money directly from government (Norton, 2015).A distinction, similarly, to criteria from the Old Poor Law has been put in place by councils between social care provided for children (under 18) and adult social care (anyone over the age of 18) (Mandelstam, 2005). It would be rather, cynical to presume equality within provision of care and services to service users and carers. The concept that “some people have access to more energy than they need, but many do not have access to enough” highlights discrepancies and perhaps reflects the existing chaos in social policy. Within the social work context Pinker (1982) references the notion of Social workers have no mandate to work in contradiction of the system that employs them, and it is unjust to use service users’ difficulties to transform the politics of welfare.

Adult Mental Health

Given the fact that, policy is an extensive and broad topic area that varies from country to country. This section of the assignment will mainly focus on Adult Mental Health policy within the UK context. It is imperative to highlight the potential limitations of this assignment as policies within the UK are wide spread. Therefore, the assignment does not permit, enough capacity to explore explicitly everything that could be potentially relevant. Consequently, the assignment will concentrate on the foremost aims of key policies that have emerged within the area of Social work practice. Alcock (2014, p.2) defines social policy as a “term used to refer to the actions taken within society to develop and deliver services for people in order to meet their needs for welfare and wellbeing” it is imperative to highlight a correlation between the Social work profession and Alcocks (2014) definition.

Participation and involvement of carers and service users have become a significant subject in current Social work policy, research, education and practice. A repetitive pattern has been acknowledged as within the past two decades there has been a noticeable increase in the involvement of service users and cares regarding provision of health and social care. Service users and carers have been involved with matters such as; individual care planning, review, service delivery and in addition, the development and planning of services (Warren, 2007 p.2).
Understandably, social care and mental health are going through periods of rapid transition, which has mainly been driven by external forces and the prevalence of mental health becoming an epidemic as well as the enormous financial burden to society and the economy according to Sahakian, Malloch and Kennard (2010).There has been significant advances in placing service users at the heart of mental health services (Mersey Care NHS Trust Online). The National Service Framework for mental health (1999) stated that despite the importance and prevalence of mental illness within the UK, it has not received the necessary attention, hence the Government’s decision to act swiftly in prioritising the matter. One of the guiding principles and values of “people with mental health problems can expect that services will involve service users and carers in planning and delivery of care; be properly accountable to the public, service users and carers’ (National Service Framework for mental health 1999).
The notion of meeting the needs of service users and their carers links with Social work’s long-standing relationship of the ‘Person-Centred’ practice and theory (Murphy et al, 2013). Implementing this model within the field of adult mental health permits and creates a platform where adults and carers emerge to discuss or perhaps challenge assessments, treatments, care providers, legislation and sections.
Furthermore, the model promotes a positive working relationship between service users, carers and Social workers. As suggested by Parrott (2003) social relationships between professionals and service users must be considered. This implies that it a compulsory component within practice, as the foundation in which relationships are built upon mutual respect and trust. However, Trevithick (2012) boldly challenges this notion of the ‘Person-Centred’ method as, centring the focus on the service user is not necessarily the same concept. The model does not diminish from recent developments in legislation which reference providing ‘Personalised’ care for people (Care Act 2014). The mention of legislation, similarly, identifies a significant yet, relevant correlation between policy and Social work, with regards to its implications on the roles and responsibilities of the profession. Brammer (2011) concurs with this concept of policy and legislation often having implications, predominantly to the roles and responsibilities of Social workers, who work within statutory frameworks. WHO (2012) agenda recognises the values of incorporating the study of mental health within college and university programmes as part of the curriculum as well as understanding mental health from view of a service user or carer with a livid experince.
Bee et al (2015) implies the need for professionals to adopt a new mindset rather than traditional view of service users and care specifically, regarding mental health. Processionals need to demonstrate readiness and capacity to implement change with the idea of partnership involvement with services users and cares during the care planning process. This is likely, to reduce service users and cares feeling stigmatised and marginalised and is a meaningful and innovative style to practice which, influences practice and promotes equality and recovery. Again, this concept contests with traditional views held by professionals in authority of service users having control of their lives even, with an impairment such as, mental health. The idea of recovery and responsibility being at the heart of service users and carers challenges psychiatric assumptions
Presently, there are several platforms which encourage and promote the emerging perspectives of service users. The Hearing Voices Movement (HVM) is one to mention as the platform promotes and empowers adult’s who are mental health survivors/ service users to educate and enlighten people about auditory and verbal hallucinations in place of being an expert within their own experiences (Corstens et al., 2014). Furthermore, this platform creates a platform for improvement in service delivery, the development of service user and carer-led initiatives and qualitative research. Murphy et al (2013) deliberates on the concept of ‘self’ being a method which promotes independence and choice.
Similarly, to the HVM movement is the Mad Pride (MP) service user led-initiative which focuses on a unique area, of education (LeFrançois, Menzies and Reaume, 2013).The movement embraces the need for social change through re-educating individuals about their understanding of mental health, challenging prejudices and discrimination towards people with a psychiatric illness as well as thought-provoking language used to describe those with a mental health illness. this theme of emerging perspectives challenges the status quo of psychiatric services users being incapable and rather viewing, the movement as a celebration for those with the condition (Haigh, 2016) With this, service user-led incentives contribute to the development of mental health policy in challenging ancient psychiatric dominance and stigma. Furthermore, service user’s perspective emerging promotes and raises awareness of ‘recovery’ and ‘peer support’ this notion stems from mental health service users/survivors stereotyping (Beresford and Russo, 2016).
Whilst there is evidence to suggest service user participation exists and that there are movements within social care provision and services that have implemented these changes within practice, to enhance service delivery and encourage services user’s involvement. There are flaws within this concept such as; poor information exchange and insufficient opportunities for participatory decision making. Even with these movements it is important to highlight discrepancies and inconsistencies within practice as service users and carers are still feeling marginalised during the care planning process (Jakobsen and Severinsson, 2006). The Care Quality Commission (2009) and Healthcare Commission (2008a) both agree on the concept of there being a shortfall of service users and carer involvement holistically within inpatient and community settings. It can be contested that government policy remains inconsistent in tackling the social issue or perhaps, acknowledges the issue as being and individual matter rather than a social issue.

The psychiatric survivor’s movement is yet another service user led initiative, the movement empowers service users to acknowledge themselves as survivors of interventions by psychiatry this concept coincides with the strength-based approaches used within practice to promote recovery. The Hearing voices movement, Mad Pride and Psychiatric Survivor movements have a reoccurring theme of having the input of services users and their carers having a voice within treatment, care-planning and recovery.

Government officials could reduce adult hospital admissions, expenditure on the economy and social care provision through service user led initiative.

The on-going issue remains, the marginalisation, stigma and discrimination associated with people with mental health problems (DoH, 2016). Public education has been used to reduce this stigma; through the impact strategy, the Department of Health have created an initiative to working with the voluntary sector, service users, Mental Health Media and the Royal College of Psychiatrists to educate the public better about mental illness (National Service Framework for mental health,1999). Between 1997 and 1999, the Government spent over £2.5million on mental health promotion and public information nationally (National Service Framework for mental health ,1999).
It should be noted that carers are key partners who play a pivotal role in looking after service users of mental health services (Department of Health 2015, National Service Framework for mental health 1999). According to the Five Year Forward for Mental Health, the single largest cost of dealing with mental health problems is linked to the support provided by carers, with their contribution valued at over £14billion per annum. This again, reinforces the importance of carers and the need for organisations within the health and social care setting to take into consideration their best interest, needs as well as integrating their opinions and views into policies and legislations. In recent years, additional funding has been allocated by Government to provide support for carers (DoH, 2016). Although carers play a key role in the lives of service users, it can be very stressful for both the physical and mental health of the carers themselves.

The Care Act 2014 applies to those carers above 18years old and replaced any previous law and provides local authorities with the responsibility “assess a carer’s needs for support, where the carer appears to have such needs” (DoH,2016). The Care Act 2014 allows local authorities to assess the needs of carers and what the impact of caring is having on them. Due to the contribution being made to the local community, most local authorities do not charge for the support provided to carers. Carers under 18years of age are supported under the Children and Families Act.

Approved Mental Health Professionals (AMHPs) work on behalf of local authorities to carry out a variety of functions under the Mental Health Act (CQC,2018). Social workers constitute a great proportion of AMHPs, although the implementation of the Mental Health reforms in 2008 allowed the introduction of non-social workers

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