PRACTICAL SOCIAL WORK Series Editor: Jo Campling /BASW/ Editorial Advisory Board: Robert Adams, Terry Bamford, Charles Barker, Lena Dominelli, Malcolm Payne, Michael Preston-Shoot, Daphne Statham and Jane Tunstill Social work is at an important stage in its development. All professions must be responsive to changing social and economic conditions if they are to meet the needs of those they serve. This series focuses on sound practice and the specific con tribution which social workers can make to the well-being of our society. The British Association of Social Workers has always been con scious of its role in setting guidelines for practice and in seeking to raise professional standards. The conception of the Practical Social Work series arose from a survey of BASW members to discover where they, the practitioners in social work, felt there was the most need for new literature. The response was over whelming and enthusiastic, and the result is a carefully planned, coherent series of books. The emphasis is firmly on practice set in a theoretical framework. The books will inform, stimulate and promote discussion, thus adding to the further development of skills and high professional standards. All the authors are practi tioners and teachers of social work representing a wide variety of experience. JO CAMPLING A list of published titles in this series follows overleaf PRACTICAL SOCIAL WORK Self-Help, Social Work and Empowerment Computers in Social Work Robert Adams Bryan Glastonbury Social Work and Mental Handicap Working with Families David Anderson Gill Gorell Barnes Beyond Casework Women, Management and Care James G. Barber Cordelia Grimwood and Ruth Popplestone Practising Social Work Law Women and Social Work Suzy Braye and Michael Preston-Shoot Jalna Hanmer and Daphne Statham Citizen Involvement Youth Work Peter Beresford and Suzy Croft Tony Jeffs and Mark Smith (eds) Social Workers at Risk Problems of Childhood and Adolescence Robert Brown, Stanley Bute and Peter Ford Michael Kerfoot and Alan Butler Social Work with Old People Social Work and Mental Illness Mary Marshall Alan Butler and Colin Pritchard Applied Psychology for Social Workers Social Work and Europe Paula Nicolson and Rowan Bayne Crescy Cannan, Lynne Berry and Karen Lyons Crisis Intervention in Social Services Residential Work Kieran O'Hagan Roger Clough Social Work with Disabled People Social Work and Child Abuse Michael Oliver David M. Cooper and David Ball Care Management Management in Social Work Joan Orme and Bryan Glastonbury Veronica Coulshed Separation, Divorce and Families Social Work Practice: An Introduction Lisa Parkinson Veronica Coulshed Social Care in the Community Social Work and Local Politics Malcolm Payne Paul Daniel and John Wheeler Working in Teams Sociology in Social Work Practice Malcolm Payne PeterR. Day Working with Young Offenders Anti-Racist Social Work John Pitts Lena Dominelli Effective Groupwork Working with Abused Children Michael Preston-Shoot Celia Doyle Adoption and Fostering Applied Research for Better Practice Carole R. Smith Angela Everitt, Pauline Hardiker, Jane Social Work with the Dying and Bereaved Littlewood and Audrey Mullender Carole R. Smith Welfare Rights Work in Social Services Child Care and the Courts Geoff Fimister Carole R. Smith, Mary T. Lane and Terry Walsh Student Supervision in Social Work Social Work and Housing Kathy Ford and Alan Jones Gill Stewart and John Stewart Working with Rural Communities Working with Mental Illness David Francis and Paul Henderson Derek Tilbury Children, their Families and the Law Anti-Discriminatory Practice Michael D. A. Freeman Neil Thompson Family Work with Elderly People Community Work Alison Froggatt Alan Twelvetrees Child Sexual Abuse Working with Offenders Danya Glaser and Stephen Frosh Hilary Walker and Bill Beaumont (eds) Working with Mental Illness A Community-based Approach Derek Tilbury !50th YEAR M MACMILLAN ©British Association of Social Workers 1993 All rights reserved. No reproduction, copy or transmission of this publication may be made without written permission. No paragraph of this publication may be reproduced, copied or transmitted save with written permission or in accordance with the provisions of the Copyright, Designs and Patents Act 1988, or under the terms of any licence permitting limited copying issued by the Copyright Licensing Agency, 90 Tottenham Court Road, London WlP 9HE. Any person who does any unauthorised act in relation to this publication may be liable to criminal prosecution and civil claims for damages. First published 1993 by THE MACMILLAN PRESS LTD Houndmills, Basingstoke, Hampshire RG21 2XS and London Companies and representatives throughout the world ISBN 978-0-333-58536-8 ISBN 978-1-349-22717-4 (eBook) DOI 10.1007/978-1-349-22717-4 A catalogue record for this book is available from the British Library. Series Standing Order (Practical Social Work) If you would like to receive future titles in this series as they are published, you can make use of our standing order facility. To place a standing order please contact your bookseller or, in case of difficulty, write to us at the address below with your name and address and the name of the series. Please state with which title you wish to begin your standing order. (If you live outside the UK we may not have the rights for your area, in which case we will forward your order to the publisher concerned.) Standing Order Services, Macmillan Distribution Ltd, Houndmills, Basingstoke, Hampshire, RG21 2XS, England. Contents Preface viii 1 Introductory Parameters 1 2 Determinants of Practice I: Defining Mental Health and Mental Illness 4 What constitutes mental health 4 Criticisms and reservations 6 Influence on practice 8 What constitutes mental illness 10 Approaches to defining mental illness 12 Influence on practice 16 3 Determinants of Practice II: Attitudes to Psychiatry 19 Expectations of psychiatrists 19 False expectations 20 Appropriate expectations 21 Social attitudes to psychiatric practice 24 Anti-psychiatry 25 Anti-institutionalism 25 Civil liberties 26 Influence on practice 26 Disagreements within psychiatry about the origins of psychosis 27 Views and outcomes 28 Choice of view 30 4 Practice Issues: Reflections from Experience 33 The genericism of mental health social work 33 Psychosis or not: the dynamics of deciding 34 Psychosis or not: the outcomes of deciding 37 v vi Contents The impact on dynamics 37 The consequences of the decision 40 The implications for teamworking 41 5 Working with the Sufferer 43 Axiom 1: Empathise with the sufferer's reality and the responses it generates 43 Exploring the sufferer's reality 43 The functions of empathy 45 Axiom II: Help the sufferer to keep in touch with reality 48 A voiding further confusion 48 Developing strategies for controlling symptoms 49 Axiom Ill: Relate to the person, not the symptoms 50 Axiom IV: Promote the sufferer's skills to manage themselves and their lives 51 Handling unconscious material 52 Strengthening conscious processes 53 Implementing skills programmes 55 Expectation levels 56 The social work skills 57 6 Working for the Sufferer 1: The Team 59 Axiom 1: See the sufferer stays alive 59 Self-determination: issues of ethics 59 Protecting life: the practicalities 62 The quality of life 65 Axiom II: Contribute to the diagnosis and treatment plan 68 Contributing to the diagnosis 69 Knowing what the treatment programme is 71 Seeing the treatment programme is implemented 74 7 Working for the Sufferer II: The Environment 77 Axiom 1: Secure an appropriate environment 77 Special factors 78 Assessing the current environment 79 Modifying the existing environment 80 Alternative environments 83 Contents vii Planning moves to alternative environments 86 Complicating factors in planning moves 88 Axiom II: Secure a routine 91 The importance of routines 91 Routines and mental illness 92 Working for people: conclusion 97 8 The Family: Responding to Needs 99 The pressures on families 99 Axiom 1: Shape intervention to the stage of adaptation reached 101 Stages of the process 101 Stages and responses 104 Axiom II: Help individual members of the family with their feelings 106 Responding to feelings 108 Children 109 Axiom III: Help families with their management strategies 110 Reactions to symptomatology 111 Management consistency 112 Helping families to live their own lives 114 Axiom IV: Help resolve maladaptive patterns 117 Patterns of response 118 Functionality or dysfunctionality of patterns 120 Addressing dysfunctional elements 121 Conclusion 127 Bibliography 129 Index 135 Preface This book, like many others, is a synthesis, emerging from my training and practice as a psychiatric social worker, my involve ment with voluntary organisations (mainly MIND) and my teach ing of social work theory and mental health to social work students over the years, together with all the associated reading. In addition to other authors, then, I am indebted to my mentors, to my colleagues from a wide variety of professional and academic background~, to fellow voluntary workers, to my students, their practice teachers and agencies, but, above all, to my former clients and their families. I hope they feel that, in the end, they managed to teach me something. DEREK TILBURY Vlll 1 Introductory Parameters For the purposes of this book it is assumed that readers will be familiar with the principal features of the mental illnesses and have an acquaintance with social work. For those who do not have these prerequisites, perhaps they should break off here and read Naomi Smith's Menta/Illness: what you should know. For social work a beginning might be Martin Davies' The Essential Social Worker (not that the present author shares all of his views) fol lowed by the Barclay Report, Social Workers: their role and tasks - especially the appendices by Brown, Hadley and White and Pinker. The present volume has been written with social workers in mind but social work has continuously absorbed knowledge and skills originally developed by others, while others have made use of what was first practised by social workers. The boundaries of many professions have been extended in this mutual exchange and their areas of overlap have grown. I try to keep this diffusion in mind in the hope that some of what I write will also be of interest to others. The book has little to say about practice methods, concentrating on what should underlie whatever particular technique is adopted. Little is said about emergency work and the associated legal aspects. The focus is on on-going work, which is crucially import ant but which seems to have been pushed aside. Priorities have gone elsewhere, reflecting the mandatory responsibilities and public pressures on agencies which are, in their tum, reflections of social values. The National Health Service and Community Care Act 1990 and the shift of policy it represents has renewed the debate about provision for people with a mental illness, coupled with a growing recognition that the lack of facilities in the community is 1