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

英格兰和威尔士的精神健康服务主要是以社区为基础的，初级保健服务提供心理干预，二级护理服务通过由全国54个精神健康信托管理的专家团队提供。这些服务的需求量很大，精神卫生支出占NHS二级保健预算的11%，每年的社会保健费用超过20亿GB(政府，2011年)。这一需求预计还会增加，精神健康诊断的上升趋势和人口增长预计都有助于增加对精神健康支持的需求(MHN，2014)。认识到对精神健康服务的需求，以应对“人们生活的全局性和复杂性”(Coppock和Dunn，2010，第144页)。政府的精神健康政策--没有心理健康就没有健康--呼吁对精神健康保健采取多学科方法，重点放在自愿和法定机构提供的整体解释上(卫生部，2011)。心理健康服务是按照这些思路构建的，来自医学、心理和社会领域的专业人员的多学科意见代表了标准方法。然而，NHS内部的效率节约相当于实际预算削减和精神健康团队可用资源的减少(MHN，2014)，而影响地方当局的类似紧缩措施导致借调的社会工作人员从综合团队中撤出，因为地方当局优先履行自己的法定义务(McNicholl，2016)。这种资源的减少，加上所表达的需求的增加，导致提供的服务紧张到了分崩离析的地步。因此，了解精神健康服务如何能够以最有效率但也是最有效的方式运作是至关重要的。在其整个历史中，社会工作一直以各种形式在精神健康服务的提供中发挥核心作用(韦伯，未注明日期)；然而，精神健康实践(Kendell，1996)和精神健康研究(McCrae，2005)仍然是生物学上的主导，重点放在疾病模型上。尽管社会方面在个人心理健康体验中的重要性得到了公认(Goemans，2012)，但这种主导地位确保了社会工作的独特社会视角在医疗等级中处于从属地位(Busfield，1996)。鉴于现有研究仅在小范围内工作，同时普遍认为背景对MHSW的角色很重要(Tucker，2017；Bailey和Liyanage，2012；Peck和Norman，1999)，为了确定角色中普遍出现的那些与背景无关的方面，以及那些不同的方面，至关重要的是发展更广泛的理解。本研究旨在找出背景与角色理解如何相互影响，以帮助社会工作从业者在不同的实践环境中有效地使用。为达到这些目标，本研究将采用混合方法解决两个问题：1.医务工作者如何理解他们在提供心理健康服务中的角色和贡献？2.就业状况和环境如何影响医务工作者对其角色的认知、承诺和满意度？

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?