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卫生服务主要以社区为基础，初级保健服务提供心理干预，二级保健服务由全国54个精神卫生信托机构管理的专家小组提供。这些服务需求量很大，精神卫生支出占国民保健制度二级保健预算的11%，每年的社会保健费用超过20亿英镑（政府，2011年）。这一需求预计会增加，心理健康诊断的上升趋势和人口增长预计将有助于增加心理健康支持的必要性（MHN， 2014年）。政府的心理健康政策“没有心理健康就没有健康”认识到心理健康服务需要满足“人们生活的整体性和复杂性”（Coppock和Dunn， 2010年，第144页），呼吁对心理健康护理采取多学科方法，重点是由自愿和法定机构提供整体解释（卫生部，2011年）。心理健康服务是按照这些思路构建的，医疗、心理和社会领域的专业人员的多学科投入是标准做法。然而，NHS内部的效率节约等同于实际预算削减和精神卫生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已经看到从综合团队中撤出借调的社会工作人员，因为地方当局优先履行自己的法定义务（McNicholl, 2016）。资源的减少，加上需求的增加，导致服务供应紧张到崩溃的地步。因此，了解精神卫生服务如何以最有效的方式运作是至关重要的。社会工作在其历史上以各种形式一直在提供精神卫生服务方面发挥核心作用（Webber，未注明日期）；然而，心理健康实践（Kendell, 1996）和心理健康研究（McCrae, 2005）仍然以生物学为主导，强调疾病模型。尽管社会方面在个人心理健康体验中具有公认的重要性（Goemans, 2012），但这种主导地位确保了社会工作独特的社会视角在医学层次中处于从属地位（Busfield, 1996）。鉴于现有的研究只在小范围内进行，同时普遍认为情境对MHSW角色很重要（Tucker, 2017; Bailey and Liyanage, 2012; Peck and Norman, 1999），因此有必要发展更广泛的理解，以确定角色中那些无论情境如何都普遍出现的方面，以及那些变化的方面。本研究旨在确定背景和角色理解是如何相互作用和相互影响的，以便为社会工作从业者在一系列实践环境中有效使用提供信息。为了实现这些目标，本研究将使用混合方法解决两个问题：1。mhsw如何理解他们在提供精神卫生服务中的作用和贡献？就业状况和环境如何影响医务工作者对其角色的认知、承担和满意度？

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?