Implementing mental health law: a comparison of social work practice across three jurisdictions

Abstract

Purpose – Over the last 12 years there have been substantial developments in UK law and policy relevant to mental health social work practice. The previous legal frameworks across the jurisdictions were very similar but the new laws have developed in different ways and provide greater opportunities for comparison. Across all the jurisdictions policy developments, especially in the areas of recovery and risk assessment, have influenced the way that mental health social workers practice. Design/methodology/approach – This exploratory study used case study vignettes with 28 respondents to examine how these major legal and policy developments impact on social work practice. Findings – There were variations in how levels of risk are defined and often a lack of clarity about how this informs decisions. There was a consensus that recovery is important but difficulties in understanding how this might apply in crises. Predictably, differences in legal and policy contexts meant that there were a variety of perspectives on how mental health social workers applied the laws in their jurisdictions. Research limitations/implications – The limited focus on research informed practice and the lack of transparency in decision making across areas of risk assessment and intervention, use of recovery approaches and the use of mental health laws suggest the need for a more evidence-based approach to training, education and practice. Originality/value – There is very limited previous research on practitioner experiences of the complexities involved in implementing mental health law. This paper provides some insights into the issues involved and for the need for more detailed examination of the decision-making processes involved.

Decision Making by Practitioners in the Social Professions Involved in Compulsory Admission to Mental Health Hospital: A Scoping Review

“…AMHPs, ASWs and MHOs all work under a legal mandate to bring a social perspective to the decision, as an important counterbalance to the perspective of medical professionals involved. This is the defining feature of the social professional role and so unsurprisingly the extent to which this social focus in fact informs their decisions in practice has been a key preoccupation of researchers (Barnes et al, 1990;Buckland, 2016;Sheppard, 1990;Morgan et al, 1999;Peay, 2003;Campbell et al, 2006;O'Hare et al, 2013;Hall, 2017;Karban et al, 2020;Leah 2020). Differing findings can be found in the included studies.…”

“…Some researchers found that participating social professionals did indeed clearly articulate a social model of mental disorder in their decision-making (Peay 2003;Morgan et al 1999;Hall 2017;Karban et al 2020) and performed a valuable independent role alongside medical professionals (Manteklow et al, 2002;Campbell et al, 2001;Karban et al, 2020). However, this is in contrast with research suggesting that the perspective of the social professional can become dominated by medicalised perspectives (O'Hare, 2013;Campbell et al, 2006;Barnes et al, 1990). So while Hall (2017), for example, found ASWs to frame the experience of the citizen in terms of a 'social crisis' (p. 451) in counterpoint to the Home Treatment Professionals with whom they interacted, O' Hare et al (2013) were concerned to find that social professionals in their vignette study tended to focus on relapse of psychiatric symptoms and non-compliance with medication.…”

“…Quirk et al (2003) assert that this occurs when professionals have insufficient time to put alternatives in place and are not supported by colleagues in doing so. However, O'Hare et al (2013), who attempted to delve into how social professionals weighed up the feasibility of alternative treatment provision, report that their participants, from all three UK jurisdictions, seemed to make limited use of research evidence in reaching their judgements on feasibility and struggled to apply recovery approaches to the crisis context of MHA assessment. They call for more explicit attention and discussion of what constitutes a feasible alternative to detention and how it might be provided at a crisis point.…”

A Structured Narrative Literature Review of Approved Mental Health Professional Detention Decisions: An Infusion of Morality

“…The implication from Sheppard (1990), O'Hare at al. (2013 and Buckland (2016) is that a medical orientation is more likely to lead to detention than a social orientation, however Abbott found this was equally true of a social orientation (Abbott 2018, 5).…”

Does Training Enhance Professional Practice in Infant Mental Health?

“…The limited focus on research informed practice with regard to the application of recovery approaches suggest the need for a more evidenced based approach to training, education and practice. More concerted discussion is needed about how the principles of recovery can be translated into the realities of everyday policy and practice (O'Hare et al, 2013).…”