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Introduction Beginnings Making sense of the information Deciding what to do Reviewing the plan
 
     
     

Stage 4 - Reviewing the plan

Case Information

  • The Crisis Resolution Team visited Edna, who was now physically recovered and discharged from hospital. Their assessment was that Edna was not in sufficient crisis to warrant their intervention. They offered the social worker and other team members views about what they perceived as the 'long slow crisis' of Edna's life and how to enable her to respond to it.
  • The implementation of the plan is evaluated.
  • Bernie is still given support. He attends college the following year and completes the A levels. He still has a further 'psychotic' episode. The CMHT bring in the Crisis Resolution Team to help with this. Their short-term work with Bernie proves productive. He copes with the episode with no further incidents. He is in the process of applying to take a degree course.
  • Edna still oscillates in and out of depression. She is less dependent on drugs to control it.
  • Jim is motivated to start engaging with using the smallholding to grow their own vegetables. He doesn't keep up his good intentions with the smallholding. He finds it physically too demanding. He admits he feels better about having off-loaded to a counsellor. He's talked about sadnesses in his past he hasn't shared with anyone, including his family. The counsellor persuades him to talk with Edna, which he does.
  • Bernie's aunt leaves Harrow Hall. For a few days nobody knows where she is. Then she appears. She has moved in with her half-sister.


Key Questions

Values-based Questions

  • It may be said of family group and organisational situations, that one person's empowerment is another person's disempowerment. What kinds of ethical and practical dilemmas arise in judging the outcomes of the work, in terms of gains and losses for each member of the family?

Practice-driven Questions

  • How should Bernie's situation and the work done be reviewed?
  • How can the review feed into evaluation of the practice?
  • How can the practice be improved in the light of the evaluation?
  • How does crisis work relate to the mental health interventions in this case?

Research Focused Questions

Knowledge Questions

  • Can the evaluation itself be evaluated and the outcomes be used to review practice critically and perhaps alter future practice?
  • Do crisis work and emergencies have a legal and evidence basis in mental health work?

Skills-related Questions

  • How should the work which has been done be evaluated?
  • How should the evaluation be used?

Relevant Knowledge

National Standards of Practice

The Mental Health National Service Framework standards, referred to above, are particularly relevant at the stage of monitoring and reviewing work done with a person with mental health problems. These are found in DoH (1999).

Critical practice

Ann Brechin (Brechin, 2000, pp. 25-47) puts forward the view that the critical practitioner

  • is constructively not negatively critical
  • can cope with uncertainty and change
  • uses knowledge with awareness of personal biases
  • adopts no moral direction, apart from the fundamental professional commitment to social justice for others and empowering, anti-oppressive work (p. 26-9).

Critical practice involves three interlocking and overlapping domains:

  • critical analysis, involving evaluating knowledge and practice
  • critical reflexivity involving engaging one's own assumptions and values
  • critical action involving using skills to challenge injustice and empower people (p. 30-41).

Brechin, Ann (2000) 'Introducing Critical Practice' in Brechin, Ann, Brown, Hilary and Eby, Maureen A. (eds) Critical Practice in Health and Social Care London, Sage in assoc. with Open University, pp. 25-47

Work in rural areas

The particular issues arising in work in rural areas include:

  • Overcoming problems of dispersed families, isolated clients;
  • Clients living long distances from appropriate services in agencies and groups;
  • Managing intensive work where practitioners have to travel long distances;
  • Time management.

Crisis and emergency work

The National Service Framework for mental health (DoH, 1999a) specifies that in crises and emergencies, early intervention is required for the safety of the patient and the general public. This implies people should have 24 hour access to Community Mental Health teams. In practice, Bernie would go to this team for his mental health to be monitored. All staff in the team should be trained in techniques of psycho-social intervention.
The NSF makes specific requirements in its ten-year plan. All areas must have:
  • Crisis teams
  • Twenty-four hour access to them by client
  • Assertive outreach services
  • Early Intervention in Psychosis teams.
  • Other relevant sources of further knowledge

    On the policy context:

    DoH (1999b) Reform of the Mental Health Act 1983: Proposals for Consultation, Cm 4480 London SO
    Department of Health (1999c) Modernising Mental Health Services, London, Stationery Office
    Provides a rich and diverse collection of material on mental health perspectives, debates, policies, user viewpoints and practice.
    Ulas, Marion and Connor, Anne (1999) (eds) Mental Health and Social Work, London, Jessica Kingsley
    Sainsbury Centre for Mental Health (2000) On Your Doorstep: Community Organisations and Mental Health, London, Sainsbury Centre for Mental Health

    On mental health practice:

    Bailey, Di (2000) At the Core of Mental Health, Brighton, Pavilion
    Onyett, S. (1992) Case Management in Mental Health, London, Chapman and Hall

    On managing risk:

    Davis, A. (1996) 'Risk Work and Mental Health' in Kemshall, H. and Pritchard, J. (1996) Good Practice in Risk Assessment Vol. 2 London, Routledge

    On mental health issues:

    Heller, Tom, Reynolds, Jill, Gomm, Roger, Muston, Rosemary and Pattison, Stephen (1996) Mental Health Matters: A Reader Basingstoke, Macmillan

    On employment prospects for people with mental health problems:

    Research by Secker, Grove and Seebohm (2001) has studied the Care Programme to Work project in Sheffield. It demonstrates how an integrated approach to vocational guidance is necessary, with strong links to educational and employment agencies and organisations. It also shows how important it is for mental health practitioners to take the lead in promoting employment opportunities for people with mental health problems.

    Secker, Jenny, Grove, Bob and Seebohm, Patience (2001) 'Challenging Barriers to Employment, Training and Education for Mental Health Users: The Service User's Perspective' Journal of Mental Health 10, 4, pp. 395-404

    Summary

    The key features of this case have been:

    • Developing a self-critical, evidence-based practice,
    • engaging with Jim, Edna and Bernie in an empowering person-centred way,
    • working with them to assess their needs,
    • working with Jim and Edna as carers and Edna and Bernie as clients, to empower them to manage their difficulties
    • reviewing with Jim, Edna and Bernie the work done,
    • recognising the need for further work with family members as the situation develops,
    • self-critically evaluating the practice.
    Bibliography

    Barnes, Marian (2001) Taking over the Asylum: Empowerment and Mental Health, Basingstoke, Palgrave
    Barnes, M. and Maple, N. (1992) Women and Mental Health: Challenging the Stereotypes, Birmingham, Venture Press
    Bean, Philip (2001) Mental Disorder and Community Safety, Basingstoke, Palgrave
    Bowlby, J. (1969) Attachment and Loss Vol. 1: Attachment, Harmondsworth, Penguin
    Bowlby, J. (1973) Attachment and Loss Vol. 2: Separation, Anxiety and Anger, Harmondsworth, Penguin
    Brandon, David (1995) Advocacy: Power to People with Disabilities, Birmingham, Venture Press
    Brown, G.W. and Harris, H. (1978) Social Origins of Depression: A Study of Psychiatric Disorder in Women, London, Tavistock
    Currer, Caroline (2001) Responding to Grief: Dying, Bereavement and Social Care, Basingstoke, Palgrave
    Davies, N., Lingham, R., Prior, C. and Sims, A. (1995) Report of the Inquiry into the Circumstances Leading to the Death of Jonathan Newby on 9th October 1993 in Oxford, Oxfordshire Health Authority, Oxford
    DoH (1999c) Modernising Mental Health Services, London, Stationery Office
    DoH (1993) The Health of the Nation: Key Area Handbook, Mental Health, 3/930/N 14914A London HMSO
    DoH (1995) Building Bridges A Guide To Arrangements for Inter-Agency Working for the Care and Protection of Severely Mentally Ill People, London DoH
    DoH (1997) Developing Partnerships in Mental Health Green Paper, Cm 3555 London SO
    DoH (1998) Our Healthier Nation: A Contract for Health Cm 3852 London SO
    DoH (1999a) National Service Framework for Mental Health: Modern Standards and Service Models 1999/0572 London SO
    DoH (1999b) Reform of the Mental Health Act 1983: Proposals for Consultation, Cm 4480 London SO
    DoH (2002) Women's Mental Health: Into the Mainstream, London, SO
    Durham, Robert C., Swan, John S., and Fisher, Peter L. (2000) 'Complexity and Collaboration in Routine Practice of CBT: What Doesn't Work with Whom and How Might It Work Better?' Journal of Mental Health, 9, 4, pp. 429-44
    Heller, Tom, Reynolds, Jill, Gomm, Roger, Muston, Rosemary and Pattison, Stephen (1996) Mental Health Matters: A Reader Basingstoke, Macmillan
    Howe, D. (1995) Attachment Theory for Social Work Practice, Basingstoke, Macmillan
    Kohen, Dora (2000) (ed) Women and Mental Health, London, Routledge
    Morgan, Steve (1994) Community Mental Health: Practical Approaches to Long Term Problems, London, Chapman and Hall
    O'Sullivan, T. (1999) Decision Making in Social Work, Basingstoke, Macmillan
    Parton, Nigel (1998) 'Risk, Advanced Liberalism and Child Welfare: The Need to Rediscover Uncertainty and Ambiguity' British Journal of Social Work 28 pp. 5-27
    Parton, Nigel (2001) 'Risk and Professional Judgement' in Cull, L. and Roche, (eds) T. Law and Social Work: Contemporary Issues for Practice, London OUP
    Paterson, C.H. (1986) Theories of Counselling and Psychotherapy, New York, Harper and Row
    Prior, Pauline (1999) Gender and Mental Health, Basingstoke, Macmillan
    Read, Jim and Reynolds (1996) (eds) Speaking our Minds: An Anthology, Basingstoke, Macmillan
    Ritchie, J.H., Dick, D. and Lingham, R. (1994) The Report of the Inquiry into the Care and Treatment of Christopher Clunis, London, HMSO
    Rogers, Anne, May, Carl and Oliver, Dianne (2001) 'Experiencing Depression, Experiencing the Depressed: The Separate Worlds of Patients and Doctors', Journal of Mental Health 10, 3, pp. 317-33
    Rogers, Anne, Pilgrim, David and Lacey, Ron (1993) Experiencing Psychiatry: Users' Views of Services, Basingstoke, Macmillan with MIND
    Rogers, Anne and Pilgrim, David (2001) Mental Health Policy in Britain (Basingstoke, Palgrave)
    Rogers, Carl (1961) On Becoming a Person: a Therapist's View of Psychotherapy, London, Constable
    Rogers, Carl (1961) On Becoming a Person: a Therapist's View of Psychotherapy, London, Constable
    Rogers, Carl 1965 Client-Centred Therapy: Its Current Practice Implications and Theory, London, Constable
    Rose, Diana (2001) Users' Voices: The Perspectives of Mental Health Service Users on Community and Hospital Care, London, Sainsbury Centre for Mental Health
    Sainsbury Centre for Mental Health (2000) On Your Doorstep: Community Organisations and Mental Health, London, Sainsbury Centre for Mental Health
    Sayce, Liz (2000) From Psychiatric Patient to Citizen: Overcoming Discrimination and Social Exclusion, Basingstoke, Macmillan
    Secker, Jenny, Grove, Bob and Seebohm, Patience (2001) 'Challenging Barriers to Employment, Training and Education for Mental Health Users: The Service User's Perspective' Journal of Mental Health 10, 4, pp. 395-404
    Ulas, Marion and Connor, Anne (1999) (eds) Mental Health and Social Work, London, Jessica Kingsley

    Robert Adams
    Professor of Social Work
    University of Teesside

    My thanks to Lindy Conway and Craig Wilson, Staff Development and Training Unit, Northumberland NHS Care Trust, for critically reviewing and commenting in detail on an earlier draft of this case study. I am grateful also to Professor Ann Davis for her extremely helpful review, corrections and suggestions for improvements. Responsibility for any remaining mistakes remains mine.

         
           
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