Unweaving the web: Understanding the role and contribution of mental health social work to mental health services in England and Wales.

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Mental health services in England and Wales are pre-dominantly community based, with primary care services offering psychological interventions, and secondary care provided through specialist teams administered by 54 mental health trusts across the country. These services are in high demand, with mental health spend accounting for 11% of the NHS secondary care budget and over £2 billion in social care costs annually (Government, 2011). This demand is anticipated to increase, with both the upward trend in mental health diagnoses and population growth expected to contribute to an increasing necessity for mental health support (MHN, 2014).Acknowledging the requirement for mental health services to respond to the "totality and complexity of people's lives" (Coppock and Dunn, 2010, p. 144) the government mental health policy, No Health without Mental Health, calls for a multi-disciplinary approach to mental health care, focusing on holistic interpretations delivered by voluntary and statutory agencies (Department of Health, 2011). Mental health services have been structured along these lines, with multi-disciplinary input from professionals in medical, psychological and social fields representing the standard approach. However, efficiency savings within the NHS have equated to real terms budget cuts and reduction of resources available to mental health teams (MHN, 2014), while similar austerity measures affecting local authorities have seen the withdrawal of seconded social work staff from integrated teams as local authorities prioritise meeting their own statutory obligations (McNicholl, 2016). This resource reduction, combined with the increasing levels of expressed need, has resulted in service provision which is strained to the point of fracture.Understanding how mental health services can operate in the most efficient, but also effective way is therefore of paramount importance. Social work has, in various guises throughout its history, always played a central role in the delivery of mental health services (Webber, undated); however, both mental health practice (Kendell, 1996) and mental health research (McCrae, 2005) have remained biologically dominated, with an emphasis on disease models. Despite the acknowledged importance of social aspects in an individual's experience of mental health (Goemans, 2012), this dominance has ensured that social work's unique social perspective has been rendered subordinate in the medical hierarchy (Busfield, 1996).Given that existing research has worked exclusively in the small scale, whilst universally identifying context as significant to the MHSW role (Tucker, 2017; Bailey and Liyanage, 2012; Peck and Norman, 1999), it is essential to develop a broader understanding in order to identify those aspects of the role which appear universally regardless of context, as well as those which vary. This research aims to identify how context and role understanding interact and influence one another in order to inform the effective use of social work practitioners within a range of practice settings.To achieve these aims, the study will address two questions using a mixed methods approach:1. How do MHSWs understand their role within and contribution to the delivery of mental health services?2. How does employment status and setting impact on MHSWs perception of, undertaking of and satisfaction with their role?