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MENTAL HEALTH OFFICER SERVICES: STRUCTURES AND SUPPORTS
ANNEX 2: MENTAL HEALTH OFFICER SURVEY, SWSI 1998: THE WAY AHEAD
The following is extracted from the concluding section of the SWSI report in 1998 (page 10, paragraphs 60-70).
The results / findings from this survey raise important questions about MHO deployment, workloads and training. It is evident that effective MHO deployment is already a complex task and one that is likely to become more so in view of the number of major changes that social work services are experiencing and will experience in the months ahead.
The settings in which most statutory work was processed by MHOs were in the community. This suggests there is as a shift in focus away from work in hospitals. This is appropriate in view of the reduction in psychiatric hospital beds and the development of CMHTs and CCTs. However, the pace of change needs careful handling. The more recent annual report of the Mental Welfare Commission 1997-98 highlights the concern of many psychiatrists about the reduction in the number of social workers in psychiatric hospitals.
The majority of authorities are planning to increase the numbers of MHOs in CMHTs and CCTs in social work departments. In the light of the White Paper "Designed to Care" we recommend that authorities should also consider placing MHOs in or attaching them to Primary Care Trusts. These will typically comprise community hospitals and mental health services as well as networks of general practices in local health care cooperatives.
Most authorities reported MHOs being placed in criminal justice teams where least statutory work is processed. This might suggest they could be more effective elsewhere, or it could be that they are using skills appropriately, but in other ways. For example, they may provide specialist expertise and consultancy advice to colleagues supervising offenders who have a mental health problem, or forensic input at the point of custodial remand or sentence to assist the management of an offender and to reduce associated risk.
SWSI's recent review of community disposals 1 and the use of custody for women offenders identified problems in the availability of mental health services for these women and in the provision of information to the courts and others about their mental health. This is not a problem confined to women and there are issues about mental health assessments for may offenders appearing at court. Criminal justice teams require a relevant mix of professional expertise to ensure mental health expertise is available. However, local authorities should examine their existing arrangements to ensure that:
- MHO expertise in criminal justice teams is appropriately available and used, and
- These MHOs are able to gain sufficient experience to maintain their competence and confidence.
How MHOs work with mentally disordered offenders and children and families with mental health problems will change with the policy review on mentally disordered offenders and the possible introduction of other initiatives in child and adolescent psychiatry. Local authorities will need to continue to review the mental health expertise in offender / criminal justice teams and child care teams to ensure it takes account of these initiatives.
All local authorities should review the data they collect on MHOs' work. At present this is varied and incomplete. Authorities require robust data about current MHO activity, including information about all detentions where MHOs are involved and the numbers of Social Circumstance Reports completed. In this survey, fewer than one-third of authorities reported collecting data on guardianship. All authorities should be collecting this information as a matter of course. Authorities should monitor workloads and evaluate trends over time. This will help them plan future deployment changes.
The training of MHOs will need to be revised in the light of changing roles. The training should continue to include legislation and knowledge of severe mental illness, but also skills in multidisciplinary working as well as policy and service developments. Another important change should be further development of training with other professionals, such as community psychiatric nurses and others, to encourage better joint working.
We will shortly be consulting on the future of education and training of social work services staff and there will be an opportunity to consider the education and training of MHOs in this context.
The results of this survey suggest some authorities are already developing a much wider role for MHOs than involvement in compulsory admission to hospital. For instance, in the CPA they are being used to give advice, support, consultation and they are involved in developing both policy and services. Increasingly MHOs are being used to access a range of services and develop and manage care packages after discharge from hospital. However, fulfilling legal requirements is essential and, although consultation and advice to other areas of the social work department is necessary, authorities should deploy MHOs primarily so they can fulfil these requirements.
Mental health issues occur across all social work areas and MHOs can have a key role to play, using their expertise to inform risk assessments in community care settings, child care and child protection work and criminal justice services. There are, therefore, difficult decisions to be made about deployment. All authorities should continue to review the deployment of their MHOs in the light of legislative changes, the implementation of the mental health framework and the development of other policy initiatives such as those mentioned above to ensure their MHO expertise is put to best use.
1 Women Offenders: A Safer Way, The Scottish Office, 1998.
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