Adult social work

1. SOCIAL WORK WITH ADULTS
Legal and Historical Context
There has beenanincreasingprominence of adultmental healthproblemsingeneral, which
istriggeredbythe perceivedimpactsto the societycausedbythe acts of individualswithpersonality
disorderandthe enactmentof controversial legislationon mental health (Singh, et al., 2017). There
have also been consistent efforts by the Government to rewrite the 1959 Mental Health Act. The
efforts have drawn the attention of health professionals considering the need for a new policy to
reshape adult mental health practice (Jennings, 2019). As debates surrounding the MHA unfold,
societyishavingdifferentperspectives of mental health problems. Traditionally, practitioners and
policymakersthoughtthatmental healthproblemslike personality disorder and psychopathy were
resistant to clinical intervention (Keown, et al., 2018). This framing was dominant until the late
1990s (Keown, et al., 2018). In this regard, the framings of personality disorders emerged with
increasing debates on the MHA to position such mental health problems as treatable.
A comprehensive review of laws that govern mental health in England took place with the
introduction of the 1959 Mental Health Act. The Act was updated in 1983, where the aim was to
strengthenthe protectionof adultswithmentaldisorders andallow practitionerstosupervise those
that were being attended to outside the hospital setting (Keown, et al., 2018). According to the
Mental HealthAct, individual’sconsentshouldbe usedasthe basisof mental health care. However,
there are two provisions for compulsory treatment. First, the Act gives doctors and social workers
the authority to detain patients within the hospital setting either in the long or short-term during
which the individual is assessed for treatment. In cases of emergencies, two doctors working for
different organisations and a social worker should be involved in making decisions to detain the
patient (Jennings, 2019). The Act also gives Criminal courts the powers to recommend the
assessment or treatment of accused or convicted criminals. Further amendments were made to
MHA 1983 that saw the adoption of MHA 2007 (Singh, et al., 2017). The 2007 Act allowed
communitytreatmentof individualsunder the supervision of professionals, increased the range of
professionals permitted to initiate detention and abolished the treatability test that excluded
compulsory treatment of persons whose conditions were regarded as untreatable (Keown, et al.,
2018).
The recentamendmentswere consideredafteradebate intwoareas.Firstwas the issues of
treatmentanddetentionof individualsperceivedashaving severe personality disorders. The major
concernwas aboutallowingforpreventive detentionof personswhose mental problemscould push
themto commit serious crimes but were yet to do so. This was after debates triggered by the 1992
incidentwhere ChristopherClunis,whowas diagnosedwithparanoidschizophrenia, killed Jonathan
Zito (George, 2019). In this regard, the death of Zito changed the nature of debates around mental
disorders. There was a shift from patient care towards protecting the public. However, the 1996
Michael Stone incidentwasthe final straw onthe debate (George,2019).Stone was dischargedfrom
care on grounds that his condition was not treatable. This sparked outrage among the public and
political class, leading to criticism of community care policy for dumping dangerous individuals in
needof support. Michael Stone’s case triggered the second issue behind the recent amendments,
which saw the need to enact laws for compulsion in the treatment of individuals whose stay in
hospital was deemed unnecessary (Keown, et al., 2018).
With the introduction of detentions of a particular group of people with severe mental
health disorders under the Mental Health Act 2007, the Care Programme Approach (CPA) was
introduced to facilitate their support after being discharged from hospital (Penhale, et al., 2017).
Under section117, the people qualifiedtoaccessfree aftercare were togetthishelpunder the CPA,
especially if their detention was under the Mental Health Act. The UK’s social care had been
sufferingfromsystemicunderfunding.CPA, therefore, came into effect in a period of austerity and

2. the majority of institutions run by the government were going through deep funding cuts. In this
sense,the Coalitiongovernmentcame upwithastrategyto directextrafundingtowards social care.
The Care Act 2014 also stood out as a legislative masterpiece by introducing the first definite
solutiontosocial care problemsinthe UK and passing through parliament in the most collaborative
manner (Barnes, et al., 2017). In the Care Act 2014, practitioners were allowed to use person-
centred approaches to assess and attend to people with mental disorders at an early stage of the
illness(Penhale,etal.,2017). It is therefore importantforsocial workerstoconsiderthe potential of
powerimbalanceswithpatientsasaway of maintainingcommunicationandrespectingtheirwishes
and feelings.Inthissense,social workerswill show accountabilityfortheirprofessional practice and
make decisions aligned with the rights of individuals.
As Approved Mental Health Professionals (AMHPs), social workers have the vital role of
implementing the Care Act alongside other associated regulations such as CPA and Mental Health
Act 2007. The main focus of the professionals under the Act includes the protection of rights and
freedom of every individual by employing the least restrictive approach to meet the individual’s
needswithinthe boundaryof the law(Allenetal.,2016). To realize the objectivesof the profession,
the acts require thatsocial workersbe accorded high training on mental health legislation. Despite
the broad concern of rights and freedoms, AMHPs have power under the autonomous civil law to
detainindividualsevenforlongperiodsinthe hospitalsaccording to assessment results. Due to the
extensive andstrictnature of the social workand mental healthguidelines, the services of AMHP in
England are reportedly under stress for sustainable staff and favourable working conditions.
Notably,the legislationforsocial workwithadultswithmental hasevolvedtoinclude the bestethos
in the field.
Practice and Theory
Social workis highlyregarded as a helping profession with its main objective being to help
individuals meet their needs and in turn improve their lives (Michailakis & Schirmer, 2014). For an
effective response to the needs and demands of patients, social workers must be equipped with
diverse knowledge. This raises concerns and controversies over what constitutes the knowledge
base in social work. Social work professionals must learn theoretical knowledge as it serves as a
frame of reference and in the assessment of mental health cases, helps in causal explanation,
facilitatesthe planningof interventions, and is used to evaluate outcomes (Michailakis & Schirmer,
2014). In thisregard,theoriesinsocial work are general explanationsthatcanbe backedbyscientific
evidence. Also,theoriesare usedtoexplainhumanbehaviourslike the interactionbetween humans
or certain stimuli. On the other hand, social work models give a perspective on how to implement
theories. With the practice models at hand, social workers are assumed to possess blueprints for
helping individuals regarding the underlying social work theory.
The SystemsTheoryoffersanexplanationof humanbehaviourasthe productof interrelated
systems. Systems like society, families, and organizations must be put into consideration to
understandandhelpcare users (Michailakis&Schirmer,2014). The systems theory assumes that all
systemshave arelationshipthatformsanorderedwhole withthe individual systems affecting each
other. In social work, the Systems Theory helps in the development of a holistic view of patients
within particular environments and its application is best in situations involving multiple systems
that connect and influence each other (Michailakis & Schirmer, 2014). When dealing with adults,
social workerscan employthe theorywhere the contextualunderstandingsof the users’ behaviours
can be used to determine the most appropriate intervention. In this regard, social workers have
manyinterventionsavailable at their disposal, whose applications vary, but all of them are used as
part of the Systems Theory.
One commoninterventionisthe recoverymodel. Patientsassume thatthe recovery process
isabout controllingtheirlivesasopposedtobeinginanelusivestate of returntonormal functioning

3. (Jacob, 2015). This perspective pays no attention to a full resolution of the symptom of mental
illnesses but rather puts emphasis on the ability to become resilient and control one’s life: this is
what constitutes the recovery model. The recovery model argues against the treatment or
management of symptoms and instead advocated for a focus on building resilience amongst
individuals. There is evidence suggesting that strategies that encourage self-management and
conformto the recoverymodel have positive resultsfor individualscomparedtomodelsthat rely on
the users’ physical health (Slade & Longden, 2015). An analysis the main themes that dominate
researches aligned with the recovery model identified the dominant themes to be risk, identity,
control, optimism, and responsibility (Khoury & Rodriguez, 2015). These themes are a clear
indicationthatthe availabilityof qualitysocial care canhelp individualsintheirrecoveryeitherinthe
hospital setting or in the community.
There isa general assumptionthat itisimpossibletolive awithinthe confinementof mental
health services. Besides, individuals prefer being in contact with non-mental health facilities and
receivingnatural supportovercontactingformal mental health services (Carbon & Correll, 2014). In
this regard, gradually reducing the contact between patients and formal mental health services,
alongside increased access to natural community supports can successfully enhance someone's
recovery froma mental illness. On the other hand, the recovery model is non-linear, which means
that individuals must access services when needed. The model makes it difficult to replace
ineffectiveservices thatare critical to the deliveryof mentalhealthservice. Jacob (2015), therefore,
believes that the reduction in formal services is overlooked as a way of supportive recovery.
Besides the recovery model, a solution-focused approach tends to be more oriented to
patientsinthe shortterm. Apart fromidentifyingdifficulties,italsoenhancesthe adoption of users’
resources to help them cope with difficulties (Franklin, 2015). The approach involves the idea that
changinga sectionof the user’sroutine sequenceislikelytoalterthe entire system.Thisidea makes
the solution-focusedapproachtobe collaborative asitrequires social workers and patients to work
together.Consideringthatthe focusof this approach is on specific behaviours that can be achieved
in the short term as suggested by the client, clients may end up focusing on secondary problems
rather than the underlying issues like self-esteem. Also, the patients can conclude that the
intervention is complete even before the social worker decides so.
Social workers should consider using theoretical models and perspectives together.
Currently,the recoverymodeliscommonly used to create a narrative of individuals’ capabilities. It
meansthat regardlessof the severityof the mental illness, individualscanimprove their functioning
and lead productive lives (Jacob, 2015). The adoption of the recovery model in mental health
systems helps social workers to rethink how services ought to be provided to users with severe
mental disorders. Similarly,the systemneedstofocus more on a solution-focused perspective. The
managementof individualsfromasolution-focused perspective is one approach that is in line with
the principles of the recovery model. In this regard, the solution-focused perspective tends to be
effective when dealing with individuals with severe mental disorders. The investigation and
assessmentof the effectivenessof the recovery model andsolution-focusedperspectiveshouldhelp
determine their reliability and validity. This can be achieved by investigating the impact of factors
that encourage or prevent recovery put against their cultural backgrounds.
Diversity, collaboration and conflict
Diversity
Mental illnesses tend to encompass many conditions that differ from physical illnesses. It
meansthat the twocategoriesalsohave differenttreatments.However,the diversityof bothmental
and physical illnesses and their treatments results in many challenges on how to address a case of
dual diagnosis(Gerard,2010). Professionalscanconsiderone tobe more serious over the other. For

4. instance,effectivemanagementof mental illnessesalongside substance use disorder is challenging.
The fact that they occur concurrently complicate their assessment and treatment. Difficulties in
diagnosis result from the lack of clarity over which problem presents the most severe symptoms
(Hallett,2015). Giventhatmost hospitalsreserve mentalhealthservicesforindividualsexperiencing
severe problems,apersonpresentinga dual diagnosis with less severe mental health issues is less
likely to be attended to (Gerard, 2010). Instead, the person may be referred to as an alternative
service. On the other hand, an individual with severe mental illness may end up with their
problematicsubstance use beingignoredforitsminoreffect.Itistherefore importanttorealise that
regardlessof dual diagnosis,the servicesforthe two conditions do not overlap. It requires the joi nt
effortof professionalsfrombothfieldsconsideringthatone it is not easy finding professionals with
skills in both fields.
Another aspect of diversity affects the issue of gender figures and their acceptance of
mental problems. In this sense, women are considered to encounter unique barriers to accepting
their mental health problems (Mizock & Russinova, 2015). However, more women than men are
diagnosedwithmental illness. Gender-related discrimination is among the main factors that cause
the differencesindiagnosisratesaswell asthe symptomsof mental illnessinwomen(Hallett,2015).
The acceptance of mental illness relies on the availability of the relevant tools and resources for
dealing with stigma and discrimination. Women experiencing mental problems are likely to go
through high stigma and intersectional oppression levels, therefore, affecting their acceptance
(Mizock& Russinova,2015). This problemthatislinkedtogenderdiversity results in higher rates of
victimization of women who have been diagnosed with mental health problems. They, therefore,
end up dealing with poverty, unemployment, and homelessness compared to the rest of the
population.
The literature on mental health is also paying more attention to the need to use
intersectionality in conceptualising difference in the delivery of mental health care (Mizock &
Russinova,2015). The advocatesof intersectionalitycontendthatdisadvantagedgroups,inthiscase,
the female gender tend to feel powerless and will struggle to break the silence regarding their
experiences with the seriousness of the intersections. It would, therefore, be important for
professionals to focus on the strengthening and empowerment of such groups. Such an initiative
would help women experiencing mental health problems to accept their realities and resist
internalizingnegative attitudes (Hallett, 2015). It is also suggested that intersectionality should be
incorporatedintoperson-centredtreatmentinitiativesasaway of addressingthe inequalities in the
experiences of clients’ gender abuse or preferred sex of counsellor.
Collaboration
Mental healthproblemsare onthe one hand consideredtobe the resultof reactingtosocial
circumstances,whose experience ismanifestedthroughpain,contradiction,exclusionoroppression
(Lawn, et al., 2015). Not surprisingly, comparisons have always been made between this social
orientation of mental health disorders and medical orientation. On the other hand, archetypal
medical orientationportraysmental healthdisordersasbeingsimilar to any other medical illnesses
whose originisfrombiological,chemical orphysical sources(Lawn,etal.,2015).The inference inthe
medical orientationisthatpsychological problems can be broken down into psycho and logic about
meaning and rationality. Beyond the two, the proponents of the medical orientation contend that
there isa needto abandonotherintentionalexplanationandfocusonbiological level causes. In this
sense,the medical orientationislessinterestedinmeaningful explanationsthatare notaligned with
natural sciences.Thiscontradictsthe social orientationwhose objective is to determine observable
causal relations with the physical world.
The conflict between social and medical orientations of mental health also manifests in
clinical governance.Thisisparticularly evident in the mandates of the National Institute of Clinical

5. Excellence (NICE) andSocial Care Institute of Excellence (SCIE)(Dawson,etal.,2016).It is interesting
to note that bothorganisationsare taskedwithpromotingevidence-based practice. However, they
tendto have varyingperspectivesof whatamountsto"evidence". On the one hand, SCIE advocates
for the application of qualitative evidence common in social sciences. On the other hand, NICE
encourages the use of quantitative evidence common with natural sciences. In this regard, SCIE
maintainsasocial orientation,where the focusof mental healthservices is on the individuals while
promotingempowerment, change and independence. This contradicts NICE’s agenda of producing
guidelines to guide professionals on the right treatment interventions for particular conditions.
The Mental HealthActof 2007 embedsthe significance of the recoveryorientationinmental
healthservices(Dawson, et al., 2016). In this regard, services that are geared towards the recovery
of an individual require the professionals to acknowledge the individual’s capacity for agency. This
includes enabling the individual to capitalise on the positive sense of self (Weich, et al., 2018).
Community treatment orders were therefore included in the Mental Health Act (2007) to create
room forpatientsthatwere formallyunderdetentioninhospitalstoprogresswithtreatment within
the communitysettingevenafterbeingdischarged (Dawson, et al., 2016). The eligibility criteria for
CTO is that the individual must have been under detention in hospital as prescribed in the MHA
(2007). The introduction of CTOs in MHA was driven by two factors (Weich, et al., 2018). First was
the need to minimise readmissions that were caused by the failure of individuals to adhere with
care, and second was the need to create room for treatment within less restrictive environments,
concerning the Human Rights Act. However, planning of mental health care delivery under CTOs
tends to be affected by service delivery models and the availability of resources.
Safeguarding
The initiative to safeguard adults experiencing mental health problems involves various
protective measurestargetedatvulnerable patientsinvulnerable circumstances (Carr, et al., 2019).
The vulnerabilitymaybe causedbya mental illnessoran impaired mental capacity due to ageing or
various circumstances. Safeguarding is considered as being critical to the achievement of quality
mental health care outcomes in two domains (Carr, et al., 2019). The first involves the need to
ensure thatindividualshave apositive care experienceandthe secondisto treatand care for people
within a safe environment free from harm. Also, safeguarding guarantees individuals of their
fundamental rightsas required in the Human Rights Act 1998 (Skills for Care, 2018). It is, therefore,
the role of mental health professionals to uphold these rights, especially when the patients are
incapacitatedtodo sofor themselves.Interventionsare meant to make life easier through acts like
the treatmentof physical andmental illnesstothe extent that the person gains independence. The
outcome of the interventions should also be a reduction in barriers to patients’ autonomy and
reliance on others. The Care Act 2014, therefore, outlines the legal framework that guides the
mental health care system on how to protect adults at risk.
The lack of coordination and information sharing between practitioners and agencies
involvedinsafeguardingadultmental health patients is likely to affect the safety of these patients
(Mannion,etal.,2018). It is,therefore,necessaryforpractitionerstoshare the relevant information
regarding their concerns, but without compromising the individual's confidentiality rights. NICE
guidelines prohibit doctors from making best interest decisions on behalf of individuals retaining
capacity indicated in the Mental Capacity Act (Skills for Care, 2018). In this regard, there is likely to
emerge adilemmaof balancing respect for the individuals’ decision and the desire to enhance the
wellbeing of the individuals. Practitioners must also be keen to address the potential that is not
obvious and may fail to be noticed over time in the individuals’ wider context of life. During the
assessment of abuse, the circumstances behind any concerns raised by the individual must be
established (Skills for Care, 2018).

6. All partiesdealingwithindividualswithmental health disorders should know the necessary
actions to take when they suspect a case of abuse or neglect. This should include instances where
theythinkthatthe personentrustedwithtakingcare of individuals with mental disorders does not
appearto do so (SkillsforCare,2018). Thisact is what is referred to as whistleblowing and involves
safeguardingagainstthe poorpractice.In this regard, whistleblowing exposes unethical behaviour
within organisations. Safeguarding commissioners should guide whistleblowers to make honest
accounts of safeguarding incidents, which should then be investigated and presented as a report.
However,casesinvolvingamemberof staff as the abusive or neglectful party are likely to diminish
theircareerprospectsconsideringthatactionswill be takeninlinewiththe available organisational
policies(Mannion,etal.,2018). On the otherhand,whistleblowers who may be regarded as heroes
by the public may find it difficult securing employment. In the long run, individuals will shy away
from reporting unethical behaviour.
References
Allen,R.,Car,S.,Linde,K.& Sewell,H.,2016. Socialworkfor better mentalhealth. [Online]
Available at:
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file
/495500/Strategic_statement_-_social_work_adult_mental_health_A.pdf
[Accessed23 January2020].
Barnes,D., Boland,B.,Linhart,K.& Wilson,K.,2017. Personalisationandsocial care assessment–the
Care Act 2014. BJPsych bulletin, 41(3), pp.176-180.
Carbon,M. & Correll,C.U., 2014. Clinical predictorsof therapeuticresponse toantipsychoticsin
schizophrenia. Dialoguesin clinical neuroscience, 16(4),p. 505.
Carr, S. etal.,2019. “KeepingControl”:A user‐ledexploratorystudyof mental health individual
experiencesof targetedviolence andabuse inthe contextof adultsafeguardinginEngland. Health&
social care in the community, 27(5),pp.e781-e792.
Dawson,S.,Lawn, S.& Simpson,A.,2016. Care planningforconsumersoncommunitytreatment
orders:an integrative literaturereview. BMCPsychiatry, 16(394).
Franklin,C.,2015. Anupdate on strengths-based,solution-focusedbrief therapy. Health &social
work, 40(2), pp.73-76.
George,S.,2019. Abuse of patientsinmental healthcare inEngland:historyrepeatingitself. British
Journalof MentalHealth Nursing, 8(3),pp.110-113.
Gerard, N.M., 2010. A diagnosisof conflict:theoreticalbarrierstointegrationinmentalhealth
services&theirphilosophical undercurrents. Philosophy,Ethics,and Humanitiesin Medicine, 5(1), p.
4.
Hallett,K.,2015. Intersectionalityandseriousmental illness—A case studyandrecommendations
for practice. Women & Therapy, 38(1-2),pp. 156-174.
Jacob,K. S.,2015. Recoverymodel of mental illness:A complementaryapproachtopsychiatriccare.
Indian journalof psychologicalmedicine, 37(2),p. 117.
Jennings,M.,2019. Social Workersand a new Mental Health Act. [Online]
Available at:https://www.basw.co.uk/system/files/resources/Inquiry%20Report%20-
%20APPG%20on%20Social%20Work%20-
%20Social%20Workers%20and%20A%20New%20Mental%20Health%20Act..pdf
[Accessed24 January2020].

7. Keown,P.,Murphy,H.,McKenna,D. & McKinnon,I.,2018. Changesinthe use of the Mental Health
Act 1983 inEngland1984/85 to 2015/16. The British Journalof Psychiatry, 213(4), pp.595-599.
Khoury,E. & Rodriguez,L.,2015. Recovery-orientedmentalhealthpractice:A social work
perspective. British Journalof SocialWork, 45(1), pp.i27-i44.
Lawn,S. et al.,2015. A qualitative studyexaminingthe presence andconsequencesof moral
framingsinpatients’andmental healthworkers’experiencesof communitytreatmentorders. BMC
psychiatry, 15(1),p. 274.
Mannion,R. etal.,2018. Understandingthe knowledge gapsinwhistleblowingandspeakingupin
healthcare:narrative reviewsof the researchliterature andformal inquiries,alegal analysisand
stakeholderinterviews. HealthServicesand Delivery Research, 6(30).
Michailakis,D.& Schirmer,W.,2014. Social workandsocial problems:A contributionfromsystems
theoryand constructionism. Internationaljournalof socialwelfare, 23(4), pp.431-442.
Mizock,L. & Russinova,Z.,2015. Intersectional stigmaandthe acceptance processof womenwith
mental illness. Women &Therapy, 38(1-2),pp.14-30.
Penhale,B.etal.,2017. The Care Act 2014: a new legal frameworkforsafeguardingadultsincivil
society. TheJournalof AdultProtection, 4(169-174), p. 19.
Singh,S.P. etal.,2017. A prospective,quantitative studyof mental healthactassessmentsin
Englandfollowingthe 2007 amendmentstothe 1983 act: didthe changesfulfilltheirpromise?. BMC
psychiatry, 17(1),p. 246.
SkillsforCare,2018. A guideto adultsafeguarding foradultsocialcare employers. [Online]
Available at:https://www.skillsforcare.org.uk/Documents/Topics/Safeguarding/A-guide-to-adult-
safeguarding-for-social-care-providers.pdf
[Accessed25 January2020].
Slade,M. & Longden,E.,2015. Empirical evidence aboutrecoveryandmental health. BMC
psychiatry, 15(1),p. 285.
Weich,S.et al.,2018. Evaluatingthe effectsof communitytreatmentorders(CTOs) inEnglandusing
the Mental HealthServicesDataset(MHSDS):protocol fora national,population-basedstudy. BMJ
open, 8(10), p. e024193.