I qualified as a social worker in 1981 and always knew I wanted the privilege of a career in mental health care. Now, many years on, a survivor of sorts, retired from fulltime professional roles but still very much active in this area, I can indulge in the luxury of looking back.
The good things then included plenty of nurses, social workers, psychiatrists and psychologists getting to know their patients well and providing a range of treatments including the beginnings of cognitive therapy, as we called it then. There were enough inpatient places, and sometimes people were admitted to have a change of medication monitored or to give carers a break.
The world of mental health care seemed very much a world on its own, but within that I recall loads of colleagues with real dedication and curiosity about their work, and patients and families with bags of courage, stoicism and humour – necessary tools in their “recovery” repertoire.
The not-so-good things spring very easily to mind too. My base was in the grounds of a 600-bed psychiatric hospital, a few miles outside a large city. Patients had their own library and chapel still, but spent most of their time in bed or wandering the endless corridors.
Staff, especially the all-powerful consultants, were keen to experiment, perhaps too keen… One ward in the 1970s had gone completely medication free. The project had brought ideological splits (still often present today, deep down) out into the open, with disastrous results. Many patients suffered unnecessarily, their despair analysed but rarely addressed.
In the late 1980s on my ward, there continued to be a daily “community meeting”, where if someone said the tap in their communal bathroom wasn’t working, the staff afterwards would examine the statement at length as evidence of some underlying anger or resentment, but would never, as I remember, fix the tap.
1990: NHS and Community Care Act
For most adult care social workers, this marked the start of the long slow death of social work, and the brutal shift to care management – or social work as rationing and protecting ever scarcer resources.
1999: National Service Framework for Mental Health
The introduction of Crisis Resolution and Home Treatment, Assertive Outreach, Early Intervention in Psychosis, Carer Support, Suicide Prevention – with clearly laid out national implementation timetables and the money to make it happen!
OK, the new services seemed to find most of their evidence base from Australia, (and it wasn’t as strong as was often claimed), but it came close to what service users and families wanted.
2008: Financial crash
A global phenomenon, but it quickly reached everywhere including into mental health budgets. It precipitated the crisis-fuelled atmosphere of the last ten years, where crisis becomes so persistent that it takes on the guise of “the new normal”.
There are good things to be seen if you look hard enough. Newer services like Early Intervention in Psychosis and psychological treatments for the mental health aspects of long term conditions are reaching the right people and doing so in ways that are properly resourced and effective.
In many other ways, in the name of efficiency, needs-based services have been replaced by “pathways”, and individual support by groups. Thresholds for specialist mental health care have been consistently (and covertly) raised, and the families I know have been bereft of support for themselves and their loved ones.
So let’s say – celebration of the NHS is okay, but it’s a celebration of battling against the odds, rather than of any sort of victory.