“I’m depraved on account I’m deprived”

The interface between health and social care

Jan Cubison

Sheffield Perinatal Mental Health Service

0114 2716069

jan.cubison@shsc.nhs.uk

A romp through 4 decades

• 1970s Nature v. nurture

• 1980s C/conservatism

• 1990s Integration of health & social care

• 2000 on…

1960sChild care officer

• 1968 Seebohm Committee

• Recommended that the specialist areas of local authority social work should be fused

• Single community based response to the range of needs that individuals, families and communities presented

• Probation still separate

1970sGeneric social work

• 1969 Children and Young Persons Act

• 1970 Chronically Sick and Disabled Person Act

• 1970 Local Authority and Social Services Act

Health

Health was another country

Mental Welfare Officer• The 1959 Mental Health Act

encouraged the development of community care

• End of moral defect, lunacy and mental deficiency

• psychopathic disorder had to be “susceptible to medical treatment”

Debate “mad or bad – or sad?”• 60s R.D. Laing “The

Divided self”

• T.Szasz “The myth of mental illness” 1960

• Strong debates between role of social worker as radical activist for social change or social police

• Autonomy of the medical profession

Cycle of deprivation

• 1970s dissertation

• Explanation of structural factors leading to cycle of poverty and poor mental health

• Politicised to blame behaviour of parents for passing on poverty and deprivation to their children

1980s

• Individualism

• Making money

• High unemployment

• 1983 Mental Health Act

• Approved social workers

1990sBack to specialisation

• 1989 Children Act emphasised need for partnerships with

• 1990 National Health Service and

Community Care Act introduced internal market

• 1994 Diploma in SW replaces CQSW

• Social workers - Adult or Children

2000

• 2000 new post working with pregnant and new mothers with mental health problems

• Employed by NHS Trust

• Across mental health and child care

2000 and on…

• Set up and manage small perinatal mental health service

• Little health treatment for personality disorders

• Social workers offer support and behaviour modification

• Training in therapies

• 2003 Development of treatment services for personality disorder

• Multiagency teams

• Psychological therapies available across primary and secondary care

• NICE guidance

National Institute forMental Health in England

Personality disorder:No longer a diagnosis of

exclusionPolicy implementation guidance for the

development ofservices for people with personality disorder

Issue date: January 2009

Borderline personality

disorder

Borderline personality disorder:

treatment and management

NICE clinical guideline 78Developed by the National Collaborating Centre for Mental Health

Issue date: January 2009

NICE clinical guideline 77Developed by the National Collaborating Centre for Mental health

Antisocial

personality

disorder

Treatment, management

and prevention

What works well between health and social care?

What does not work well between health and social care?

How can the interface between health and social care be

improved?

Joint work in perinatal mental health

• All cases discussed jointly – psychiatrist & social worker

• Joint care antenatal clinic• Joint training• Multiagency meetings • Joint CPA / CIN meetings• Involve service users,

volunteers• Postcode, ethnicity audit

NICE guideline:Pregnancy and complex social factors due Sept 2010

• Rigorous methodology

• Dearth of evidence

• SCIE involved

• Not joint guidance

• Health employs specialist midwives in domestic abuse, safeguarding children, asylum seekers, teenage pregnancy, substance misuse

Integration of research and practice

• Research traditionally led by health

• RCTs – ‘gold standard’

• Social care research often qualitative

National Institute for Health and Clinical Excellence (NICE)

• NICE is an independent organisation

• Their work is underpinned by the need for:– transparency – collaboration – involvement of stakeholders

• NICE provides national guidance, sets quality standards and manages a national database to improve people’s health and prevent and treat ill health.

Social Care Institute for Excellence (SCIE)

• Registered charity

• On line database

• Joint NICE and SCIE guideline – Parent-training/education programmes in the

management of children with conduct disorders July 2006 (TA guidance)

– Dementia Supporting people with dementia and their carers in health and social care Nov 2006

– Looked after Children September 2010

The White Paper, Equity and excellence: Liberating the NHS

July 2010 • "no decisions about me without me“

• NICE to develop quality standards for social care

• NICE on a firmer statutory footing, securing its independence and core functions

• Extend NICE remit to social care

• care services minister Paul Burstow has made clear “SCIE ... continue to have a role but it won’t be the same role they played directly alongside NICE in the past