Is it possible for one MHSW to contribute on the frontline to the implementation of (SWfBMH) (2016) in the political organisation that I worked in – the Community Mental Health Team, using mental health social work professional development, integration & multi-disciplinary team working and professional leadership as a priori themes? An Individual Action Research Study and collaborative inquiry in one locality mental health service. . / Daly, Jacob.

2022. 213 p.

Research output: ThesisDoctoral Thesis

Published

Abstract

In the study I looked at whether it was possible for me on the frontline to contribute to the implementation of Social Work for Better Mental Health, (SWfBMH) (2016) using three a-priori themes identified in SWfBMH (2016) as the lens to engage with the activities in the study. These three themes were, Mental Health Social Work (MHSW) and professional development, MHSW and multi-disciplinary-teams / integration, and, MHSW and professional leadership. The three themes interconnected in the study. I approached the study from a practice leadership perspective from my own frontline role from where I was in and between organisations. My interest in the study was linked to the observation over the years that there seemed to be limited opportunities for colleagues including myself who hold practice leadership aspirations from a career perspective but not necessarily drawn to management leadership roles. I therefore make a distinction between practice leadership roles and management leadership roles in my study.
An important element of the study was how I engaged with others as part of the research process through collaborative inquiry in and between systems. These interactions were an important element in helping me facilitate changes in some locality systems. The methodology used in the study was individual action research, collaborative inquiry and critical reflection. Forty-people collaborated in the study to varying degrees over a period of four-years. The study existed within the context of my work as a senior mental health social worker, Approved Mental health professional (AMHP), and a best interests assessor (BIA) in one community mental health team (CMHT).
The individual action research and collaborative inquiry method used in the study, was based on McNiff, 2010 & 2013, first model for individual practice-based action research and is located within a qualitative research paradigm. This methodological approach is identified by McNiff as being appropriate for individual action researchers conducting practiced based research from within their work setting.
The analytical approach I used in the study was a narrative approach and was linked to the literature reviewed in relation to the study question (and) thematic conceptual understandings related to the themes including systems theory; Bourdeau’s concept of Habitus in relation to power; Foucault’s micro-physics in relation to understanding power; and Habermas’s understanding of participation and power. The study findings were looked at through each of these as a lens. Central to the analytical framework in the study was my own personal values and ethics, and the way that these interacted with the study question through critical reflection. This approach to critical reflection was a key component in the construction of the methodological framework and formed a central role within this. The feedback process included formal, informal feedback and critical friends. From this process developed what McNiff (2010/2013) refers to as ‘cold living theory’. Cold living theory was a way of understanding my own practice through critical reflection in relation to the three a-priori themes and the process led to the development of new practice, i.e., cold living theory in practice.
The main findings in the study were that it was possible for me as a frontline MHSW to contribute to the implementation of SWfBMH (2016) using the three a-priori themes as a guide for critical reflection. I achieved this on the frontline as a practitioner through the exercise of informal practice leadership within systems and between systems where relationships between myself and others in the process were predominantly heterarchal (informal relationships with opportunities (planned and unplanned) and not ranked within the organisation(s)). The majority of activities I engaged with were within systems that can be identified as ‘teams without walls” where individuals across different systems came together with a common purpose.
Different funding streams within systems and the potential opportunities within these diverse funding streams to help promote practice leadership initiatives in mental health social work was also something which emerged during the study. The link between service commissioning and MHSW activity was identified as an avenue which has a key place in determining what MHSW’s do in practice . Opportunities to recalibrate MHSW with public health and wellbeing strategies and the Care Act 2014 were available within different systems in the study. Funding streams in the locality existed but were not accessed fully in the locality because people were frequently unaware of their existence.
I also found through the action research process that there were informal systems leaders who were health colleagues, in the Trust, who were promoting the professional development of MHSW within their teams as a distinct professional and not an extra pair of hands to fill health staff vacancies. I identified this as important because it was not a policy that was top down driven, but rather, bottom up leading to change in workforce planning strategies in the trust in this locality. Whilst MHSW Trust colleagues in the study may have felt invisible within the Trust system, they did not feel invisible within the teams they worked in. Their line managers (NHS Trust staff), actively sought to recruit MHSW’s and promote their professional identity within their teams. As part of the action research process, I also came across a significant problem within the chrono systems of the eco-system of the study, where efforts to engage people who use services and carers were limited. I completed some analysis around this and reached the conclusion that systemically, this was not a priority for agencies at a macro/exo level (but), that this needed to be seen within the context of austerity, service transformation, service cuts and models of practice governed by targets, outcomes and payment by results. In my analysis , I reached the conclusion that if strategically this was not seen as a priority for systems on the macro / exo levels, then, on the micro / meso-level, this helped explain why MHSW’s had difficulties engaging with co-production using strengths based, asset-based approaches on a micro-level. Service delivery in the study operated within a system of strict time limits, scarcity of resources and reduced finances with an emphasis on moving people on. This finding highlighted how influences of non-policy dimensions within the eco-system in the study locality did have an impact on what MHSW’s do on the frontline and how they engage with people who use services and carers. It also helped me to understand that part of the difficulties in successfully incorporating SWfBMH (2016) are to do with non-policy dimensions of the eco-system in this study and the positive or negative influences that these dimensions can have on MHSW activities.
As part of the study process, I identified that Local Authority MHSW in the study locality had no professional occupational framework that they were operating out of including the Professional Capabilities Framework. I was able to see a direct link between this and no visible career structure for local authority employed MHSW’s. However, conversely, Trust employed MHSW’s in the study had clearer career structures which were embedded within the NHS Agenda for Change career structure. MHSW’s employed by the Trust were able to climb to the highest level of the organisation and hold a number of senior leadership positions in this Trust. There were no MHSW’s in any senior leadership positions within the LA structure. In looking at this more broadly, as part of a scoping exercise, I identified that the LA in this study is not alone in not having the PCF or indeed any framework underpinning career development for LA MHSW’s (Daly, 2020). However, I also concluded that there are many different frameworks available and it was therefore important to have some clarity for MHSW irrespective of who employed them. Some effort to combine the PCF with Agenda for Change with SWE Standards as a background, was considered by me as one possibility worth considering.
Finally, by the end of the study, I could see from the literature, in particular the chronological development of psychiatric social work and mental health social work, over the last two-hundred years, that the relationship between social policy and legislation is a key driver in terms of what MHSW’s do in practice and MHSW is largely shaped by this process particularly for social workers employed by local authorities. However, the non-policy dimensions within the eco-system in this study and the influences that these can have on frontline MHSW practice, are also identified as important. These include interdisciplinary professional and organisational influences on mental health social practice including professional socialisation from a clinical perspective. Some acknowledgement of this as part of the professional development of MHSW going forward is required so that history does not repeat itself. The introduction of the care Act 2014 and the increased numbers of local authorities withdrawing their MHSW’s from integrated teams, and the rise of NHS Trusts employing MHSW’s direct has some similarity to the Universal Healthcare Reforms of 1948 and Younghusband (1959) and ‘two-types of MHSW’. Only one type survived and something was lost. The past has something to share so that similar mistakes do not reoccur with the splitting of MHSW in different directions, or, the demise of one area at the expense of another. In the study some consideration is given to avoiding this going forward.
Key words: Leadership, Professional, Integration, Teams, CMHT, Power, Authority, Systems, and Development

Original languageEnglish
Supervisors/Advisors
Publication statusPublished - 15 Mar 2022

ID: 44715701