- Email: [email protected]
The role of the social worker
Old age psychiatric services
The role of the social worker
What’s new?
Sandra Dwyer
• The Mental Capacity Act 2005 is major new legislation • The reform of the Mental Health Act 1983 (Mental Health Bill, 2006) • There has been new legislation affecting carers
Care management
Abstract
In the UK, a major element of the social work role in older people’s mental health relates to duties under the National Health Service and Community Care Act (NHS&CCA) 1990.1 Section 47(1) of the Act states that: where it appears to a local authority that any person for whom they may arrange community care services may be in need of such services the authority – (a) shall carry out an assessment for his needs for such services, and (b) having regard to the results of that assessment, shall then decide whether his needs call for the provision by them of any such services. Care management is the functional process for assessment, care planning, monitoring and review that derives from this. Assessments are proportionate to the presenting problem. Those undertaken within community mental health teams (CMHTs) for older people are nearly always comprehensive because of the nature and complexity of the work. Broadly speaking, comprehensive assessment is an analysis of the person in relation to their environment, both material and interpersonal. Care management should not descend into a bureaucratic exercise. Older people are often anxious about professionals ‘taking over’ their lives; social workers use their knowledge, values and skills to keep them at the centre of the process.
A concern with social justice and countering inequality are fundamental to the value base of social work. Ageism and the stigma of mental illness are issues to the fore of social work practice in older people’s mental health. Social workers operate within the parameters of several prominent pieces of legislation, which have been detailed in this brief article. There is a degree of overlap with the work of other professionals and collaborative working is crucial. Particular social work preoccupations are the preservation of service-user networks so that family and friends maintain contact, the underpinning of service users’ rights to take risks when they have the ability to decide, and assisting people to remain living in the community by the provision of practical services like home care. Relating to people holistically implies garnering practical help to wider psychosocial issues, and professionals in community mental health teams aim for supportive working relationships with service users and carers. Entry to permanent care, where it occurs, needs to be the result of rigorous, measured, multidisciplinary assessment. Salient matters during the process of care home admission are – the practicalities of the move, contact with the service user and the home in the initial post-admission period, and the encouragement of ongoing involvement of significant people in the service user’s life. In general terms, judgement and discretion are required to cope constructively and optimally with practice dilemmas to the benefit of service users.
Keywords Capacity; collaborative working; countering discrimination; professional judgment; self-determination
Eligibility criteria Eligibility for services is assessed according to the Fair Access to Care Services2 2002 Policy Guidance, whereby the conclusion of each assessment has to be categorized on the basis of risk of harm to the service user and others, and risks to independence. The relevant categories are: low, moderate, substantial and critical. Clements (2004)3 quotes paragraph 40 of the guidance as follows: This evaluation should take full account of how needs and risks might change over time and the likely outcome if help were not to be provided (p. 89). Individual local authorities can determine the level on the scale at which services will be provided.
The roots of social work lie in 19th-century charitable societies, and a concern with inequality and social justice is inherent in its value base. Social workers focus on the social genesis of mental illness and mitigation via the social context. Salient themes in older people’s mental health are: • the impact of ageism together with the stigma of mental illness • preservation of self-determination (encompassing the right to take risks) • the maintenance of social networks.
Services commissioned Services commissioned under the NHS&CCA include: • domiciliary care • day care • transport • respite care in residential homes • permanent care in residential and nursing homes.
Sandra Dwyer BA MSc is a Lecturer in Social Work at the University of Leicester, Leicester, UK, and an experienced social worker. She qualified from the London School of Economics and has worked for several local authorities. Her special interest is social work with older people, particularly those with mental health problems.
PSYCHIATRY 7:2
76
© 2007 Elsevier Ltd. All rights reserved.
Old age psychiatric services
Unlike NHS services, these are not all free at the point of delivery, and some charges are mandatory (e.g. the social care content of residential and nursing home provision). Direct payments (Department of Health 2000)4 may be made in lieu of services. In deprived areas, homelessness, inadequate housing and income maintenance are important issues.
wishes of carers and service users; and, in a minority of cases, abuse. Such complexities benefit from constructive and flexible working at team level. Carers who provide a substantial amount of care on a regular basis may be provided with services by local authorities to meet their own needs (Carers and Disabled Children Act 2000),8 and under the Carers (Equal Opportunities) Act 20049 consideration must be taken of whether the carer wishes to work, or undertake any educational, training or leisure activity.
Stages of care management There are seven stages of care management (Table 1). This is a cyclical process whereby the review stage feeds into a re adjustment of the original assessment and care plan. This accords logically with complex cases in CMHTs for older people because of the continually changing care needs of people with mental health problems being supported to live at home. A person with dementia who is living alone may need an increase in home care if their cognitive state deteriorates, or if their main carer goes into hospital; care plans therefore need to be flexible. Many of these principles exist in the Care Programme Approach (CPA). Social workers may be care coordinators under the CPA, which is particularly apposite for those service users with major social care needs.
The approved social worker It is not known at national level how many people aged 65 and over are detained each year under the Mental Health Act 1983, because Department of Health aggregate figures do not include age. Likewise, there are no national figures on the number of detained older adults who apply to Mental Health Review Tribunals. Approved social workers’ (ASWs) knowledge of mental health law and the responsibilities of the ASW role under the Act are of general use at team level. Social workers are also responsible for preparing social reports for tribunals. Under the Mental Health Act 2007 the legal powers and duties of ASWs will be extended to other professionals.10
Work with carers
Permanent care in care homes
Work with carers is pivotal for all professionals in the multi disciplinary team. The recent report Dementia UK5 highlights the stress, resulting, in particular, from behavioural and psychological factors associated with dementia. The alleviatiation of strain and burden on carers and service users is a focus of CMHT work. Carers are supported by the provision of practical services to service users, and within working relationships between the carer, service user and team members, enabling discussion of chan ging difficulties. Empathy and support are important, and social workers have particular skills in relationship-based practice.6 Sustained input is neither necessary nor possible in all cases, given the unmet need for mental health services within the population – untreated depression being one example.7 Practice dilemmas include the added strain engendered by the mental illness of one person in problematic relationships; carers whose health is negatively affected by their role; conflict between the needs and
Policy on the promotion of independence and rehabilitation of older people (Audit Commission 2000;11 Department of Health 200112) contains a robust acknowledgement that unnecessary admissions to permanent care occur. Given a 62% prevalence of dementia in older people in institutional care settings,13 issues relating to whether or not a person enters permanent care are a key component of social work in older people’s mental health work. These issues include risk assessment of people with dementia living in the community where continual risk appraisal and reduction may be required. People’s right to live at home despite risks often needs defending. The practical work with regard to admissions is considerable, encompassing the mixed economy of care in private, voluntary or local authority homes, questions of choice and availability, financial assessments, costs and contracts. The Mental Capacity Act 2005 Because mental health work with older people covers the full spectrum of mental illness, there are no capacity issues for many service users, but this legislation will have relevance for some. All professionals must have regard to the Act’s Code of Practice.14 The Act aims to empower and recognize the uniqueness of each individual. Time and attention must be spent on ensuring that individuals make their own decisions if they have the capacity, and there are special protective measures for major decisions like entry to permanent care for those who are unable to make their own decision. The Act is underpinned by five statutory principles (Table 2). A two-stage test of capacity is set out in the Code: Stage 1: does the person have an impairment of, or disturbance in the functioning of, their mind or brain? Stage 2: does the impairment or disturbance mean that he person is unable to make a specific decision when they need to?14 p (44–45). Where a person lacks capacity to make a decision, specific and detailed guidelines must be followed to determine the person’s best interests, which include past and present wishes and
The seven stages of care management • Publishing information on services available
Local authority responsibility
• Determining the level of assessment
Management task
• Assessment • Care planning • Implementing the care plan • Monitoring • Review
The practitioner role
Source: Social Services Inspectorate/Department of Health, 1991.
Table 1
PSYCHIATRY 7:2
77
© 2007 Elsevier Ltd. All rights reserved.
Old age psychiatric services
The five statutory principles of the Mental Capacity Act 2005
Social work roles • Care management • Care coordination under the Care Programme Approach • Approved social work under the Mental Health Act 1983 • Work with carers • Admissions to care homes • Work with vulnerable adults under No Secrets
Mental Capacity Act 2005 Persons who lack capacity. The principles: • A person must be assumed to have capacity unless it is established that he lacks capacity • A person is not to be treated as unable to make a decision unless all practicable steps to help him to do so have been taken without success • A person is not to be treated as unable to make a decision merely because he makes an unwise decision • An act done, or decision made, under this Act for or on behalf of a person who lacks capacity must be done, or made, in his best interests • Before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person’s rights and freedom of action.
Table 3
Child protection Local authorities have a duty under Section 47 of the Children Act 1989 to investigate if a child in their area is suffering or is likely to suffer significant harm. Consequently, any child protection issues that arise in the course of work with any group of service users must be communicated immediately to the relevant section of the social services department.
Source: Section 1 Mental Capacity Act 2005.
Conclusion Social workers who specialize in working with older people with mental health problems have some defined roles (Table 3), and several that overlap with other professionals. Social workers are taught to use theory and to engage in reflective, thoughtful practice. In the multidisciplinary setting there are many areas of concurrence in everyday work and any differences of opinion should be constructively harnessed as there is not always an unambiguously clear way to proceed. A sense of realistic optimism is pivotal: people recover, and for those with chronic conditions much can be done to maintain their quality of life. ◆
Table 2
feelings, and beliefs and values likely to affect his decision if he had capacity (paragraph 4).15 Significant others: the Act involves new players who have a say in decision-making for those people who lack capacity to make important decisions on serious matters and who have no appropriate person in their lives who can be consulted. An Independent Mental Capacity Service has been created for this purpose. Where individuals have capacity they may bestow a lasting power of attorney on one or more donees, and these powers may be for either or both financial matters or personal welfare decisions. In rarer cases professionals will work with deputies appointed by the Court of Protection.
References 1 Department of Health. The National Health Service and Community Care Act. London: Stationery Office, 1990. 2 Department of Health. Fair access to care services: guidance on eligibility criteria for adult social care, 2003. http//www.dh.gov.uk (accessed 15 November 2007). 3 Clements L. Community Care and the Law, 3rd edn. London: Legal Action Group, 2004. 4 Department of Health, Community Care (Direct Payments) Amendment Regulations, (LAC (2000) 1). London: Department of Health. 5 King’s College London/London School of Economics. Dementia UK. London: Alzheimer’s Society, 2007. 6 Morrison T. Emotional intelligence, emotion and social work: context, characteristics, complications and contributions. Br J Soc Work 2007; 37: 245–63. 7 London School of Economics. The depression report: a new deal for depression and anxiety disorders. London: the Centre for Economic Performance’s Mental Health Policy Group, 2006. 8 Department of Health. Carers and Disabled Children Act. London: Stationery Office, 2000. 9 Department of Health. Carers (Equal Opportunities) Act. London: Stationery Office, 2004. 10 Department of Health. Mental Health Act. London: Stationery Office, 2007.
Vulnerable adults The legal basis for the protection of vulnerable adults, No Secrets (Department of Health 2000)16 is under Section 7 of the Local Authority Social Services Act 1970. It is a multi-agency policy and social services are the lead agency. Social workers have a key role in the assessment and management of abuse cases within the partnership working required by all relevant agencies. In cases of suspected or proven abuse within domestic settings, the social worker would usually be expected to: • undertake a comprehensive assessment • present a social report and an informed professional opinion to a multi-agency case conference • participate in the construction of a care plan. There is usually more than one team member directly involved in abuse cases. The abuse may not be clear-cut and the situation may be ambiguous and dilemma-ridden. Alleged abusers may be hostile and condemnatory towards investigating practitioners, and constructive partnership working between professionals is crucial.
PSYCHIATRY 7:2
78
© 2007 Elsevier Ltd. All rights reserved.
Old age psychiatric services
11 Audit Commission. The way to go home: rehabilitation and remedial services for older people. London: Stationery Office, 2000. 12 Department of Health. National Service Framework for Older People. London: Department of Health, 2001. 13 Matthews F, Dening T. UK Medical Research Council cognitive function and ageing study, prevalence of dementia in institutional care. Lancet 2002; 360: 225–6. 14 Department for Constitutional Affairs. Mental Capacity Act Code of Practice. London: Stationery Office, 2007. 15 Department for Constitutional Affairs. Mental Capacity Act. London: Stationery Office, 2005. 16 Department of Health. No Secrets: guidance of delivering and implementing multi-agency policies and procedures to protect vulnerable adults from abuse. London: Stationery Office, 2000.
PSYCHIATRY 7:2
Practice points • Social workers focus on the resolution of mental illness via the social context • Care management under the National Health Service and Community Care Act 1990 is a major role • Social workers may be care coordinators under the Care Programme Approach • Risk assessment and management to support people to remain at home is a central feature • Collaborative working with other professionals is vital
79
© 2007 Elsevier Ltd. All rights reserved.
The role of the social worker
What’s new?
Sandra Dwyer
• The Mental Capacity Act 2005 is major new legislation • The reform of the Mental Health Act 1983 (Mental Health Bill, 2006) • There has been new legislation affecting carers
Care management
Abstract
In the UK, a major element of the social work role in older people’s mental health relates to duties under the National Health Service and Community Care Act (NHS&CCA) 1990.1 Section 47(1) of the Act states that: where it appears to a local authority that any person for whom they may arrange community care services may be in need of such services the authority – (a) shall carry out an assessment for his needs for such services, and (b) having regard to the results of that assessment, shall then decide whether his needs call for the provision by them of any such services. Care management is the functional process for assessment, care planning, monitoring and review that derives from this. Assessments are proportionate to the presenting problem. Those undertaken within community mental health teams (CMHTs) for older people are nearly always comprehensive because of the nature and complexity of the work. Broadly speaking, comprehensive assessment is an analysis of the person in relation to their environment, both material and interpersonal. Care management should not descend into a bureaucratic exercise. Older people are often anxious about professionals ‘taking over’ their lives; social workers use their knowledge, values and skills to keep them at the centre of the process.
A concern with social justice and countering inequality are fundamental to the value base of social work. Ageism and the stigma of mental illness are issues to the fore of social work practice in older people’s mental health. Social workers operate within the parameters of several prominent pieces of legislation, which have been detailed in this brief article. There is a degree of overlap with the work of other professionals and collaborative working is crucial. Particular social work preoccupations are the preservation of service-user networks so that family and friends maintain contact, the underpinning of service users’ rights to take risks when they have the ability to decide, and assisting people to remain living in the community by the provision of practical services like home care. Relating to people holistically implies garnering practical help to wider psychosocial issues, and professionals in community mental health teams aim for supportive working relationships with service users and carers. Entry to permanent care, where it occurs, needs to be the result of rigorous, measured, multidisciplinary assessment. Salient matters during the process of care home admission are – the practicalities of the move, contact with the service user and the home in the initial post-admission period, and the encouragement of ongoing involvement of significant people in the service user’s life. In general terms, judgement and discretion are required to cope constructively and optimally with practice dilemmas to the benefit of service users.
Keywords Capacity; collaborative working; countering discrimination; professional judgment; self-determination
Eligibility criteria Eligibility for services is assessed according to the Fair Access to Care Services2 2002 Policy Guidance, whereby the conclusion of each assessment has to be categorized on the basis of risk of harm to the service user and others, and risks to independence. The relevant categories are: low, moderate, substantial and critical. Clements (2004)3 quotes paragraph 40 of the guidance as follows: This evaluation should take full account of how needs and risks might change over time and the likely outcome if help were not to be provided (p. 89). Individual local authorities can determine the level on the scale at which services will be provided.
The roots of social work lie in 19th-century charitable societies, and a concern with inequality and social justice is inherent in its value base. Social workers focus on the social genesis of mental illness and mitigation via the social context. Salient themes in older people’s mental health are: • the impact of ageism together with the stigma of mental illness • preservation of self-determination (encompassing the right to take risks) • the maintenance of social networks.
Services commissioned Services commissioned under the NHS&CCA include: • domiciliary care • day care • transport • respite care in residential homes • permanent care in residential and nursing homes.
Sandra Dwyer BA MSc is a Lecturer in Social Work at the University of Leicester, Leicester, UK, and an experienced social worker. She qualified from the London School of Economics and has worked for several local authorities. Her special interest is social work with older people, particularly those with mental health problems.
PSYCHIATRY 7:2
76
© 2007 Elsevier Ltd. All rights reserved.
Old age psychiatric services
Unlike NHS services, these are not all free at the point of delivery, and some charges are mandatory (e.g. the social care content of residential and nursing home provision). Direct payments (Department of Health 2000)4 may be made in lieu of services. In deprived areas, homelessness, inadequate housing and income maintenance are important issues.
wishes of carers and service users; and, in a minority of cases, abuse. Such complexities benefit from constructive and flexible working at team level. Carers who provide a substantial amount of care on a regular basis may be provided with services by local authorities to meet their own needs (Carers and Disabled Children Act 2000),8 and under the Carers (Equal Opportunities) Act 20049 consideration must be taken of whether the carer wishes to work, or undertake any educational, training or leisure activity.
Stages of care management There are seven stages of care management (Table 1). This is a cyclical process whereby the review stage feeds into a re adjustment of the original assessment and care plan. This accords logically with complex cases in CMHTs for older people because of the continually changing care needs of people with mental health problems being supported to live at home. A person with dementia who is living alone may need an increase in home care if their cognitive state deteriorates, or if their main carer goes into hospital; care plans therefore need to be flexible. Many of these principles exist in the Care Programme Approach (CPA). Social workers may be care coordinators under the CPA, which is particularly apposite for those service users with major social care needs.
The approved social worker It is not known at national level how many people aged 65 and over are detained each year under the Mental Health Act 1983, because Department of Health aggregate figures do not include age. Likewise, there are no national figures on the number of detained older adults who apply to Mental Health Review Tribunals. Approved social workers’ (ASWs) knowledge of mental health law and the responsibilities of the ASW role under the Act are of general use at team level. Social workers are also responsible for preparing social reports for tribunals. Under the Mental Health Act 2007 the legal powers and duties of ASWs will be extended to other professionals.10
Work with carers
Permanent care in care homes
Work with carers is pivotal for all professionals in the multi disciplinary team. The recent report Dementia UK5 highlights the stress, resulting, in particular, from behavioural and psychological factors associated with dementia. The alleviatiation of strain and burden on carers and service users is a focus of CMHT work. Carers are supported by the provision of practical services to service users, and within working relationships between the carer, service user and team members, enabling discussion of chan ging difficulties. Empathy and support are important, and social workers have particular skills in relationship-based practice.6 Sustained input is neither necessary nor possible in all cases, given the unmet need for mental health services within the population – untreated depression being one example.7 Practice dilemmas include the added strain engendered by the mental illness of one person in problematic relationships; carers whose health is negatively affected by their role; conflict between the needs and
Policy on the promotion of independence and rehabilitation of older people (Audit Commission 2000;11 Department of Health 200112) contains a robust acknowledgement that unnecessary admissions to permanent care occur. Given a 62% prevalence of dementia in older people in institutional care settings,13 issues relating to whether or not a person enters permanent care are a key component of social work in older people’s mental health work. These issues include risk assessment of people with dementia living in the community where continual risk appraisal and reduction may be required. People’s right to live at home despite risks often needs defending. The practical work with regard to admissions is considerable, encompassing the mixed economy of care in private, voluntary or local authority homes, questions of choice and availability, financial assessments, costs and contracts. The Mental Capacity Act 2005 Because mental health work with older people covers the full spectrum of mental illness, there are no capacity issues for many service users, but this legislation will have relevance for some. All professionals must have regard to the Act’s Code of Practice.14 The Act aims to empower and recognize the uniqueness of each individual. Time and attention must be spent on ensuring that individuals make their own decisions if they have the capacity, and there are special protective measures for major decisions like entry to permanent care for those who are unable to make their own decision. The Act is underpinned by five statutory principles (Table 2). A two-stage test of capacity is set out in the Code: Stage 1: does the person have an impairment of, or disturbance in the functioning of, their mind or brain? Stage 2: does the impairment or disturbance mean that he person is unable to make a specific decision when they need to?14 p (44–45). Where a person lacks capacity to make a decision, specific and detailed guidelines must be followed to determine the person’s best interests, which include past and present wishes and
The seven stages of care management • Publishing information on services available
Local authority responsibility
• Determining the level of assessment
Management task
• Assessment • Care planning • Implementing the care plan • Monitoring • Review
The practitioner role
Source: Social Services Inspectorate/Department of Health, 1991.
Table 1
PSYCHIATRY 7:2
77
© 2007 Elsevier Ltd. All rights reserved.
Old age psychiatric services
The five statutory principles of the Mental Capacity Act 2005
Social work roles • Care management • Care coordination under the Care Programme Approach • Approved social work under the Mental Health Act 1983 • Work with carers • Admissions to care homes • Work with vulnerable adults under No Secrets
Mental Capacity Act 2005 Persons who lack capacity. The principles: • A person must be assumed to have capacity unless it is established that he lacks capacity • A person is not to be treated as unable to make a decision unless all practicable steps to help him to do so have been taken without success • A person is not to be treated as unable to make a decision merely because he makes an unwise decision • An act done, or decision made, under this Act for or on behalf of a person who lacks capacity must be done, or made, in his best interests • Before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person’s rights and freedom of action.
Table 3
Child protection Local authorities have a duty under Section 47 of the Children Act 1989 to investigate if a child in their area is suffering or is likely to suffer significant harm. Consequently, any child protection issues that arise in the course of work with any group of service users must be communicated immediately to the relevant section of the social services department.
Source: Section 1 Mental Capacity Act 2005.
Conclusion Social workers who specialize in working with older people with mental health problems have some defined roles (Table 3), and several that overlap with other professionals. Social workers are taught to use theory and to engage in reflective, thoughtful practice. In the multidisciplinary setting there are many areas of concurrence in everyday work and any differences of opinion should be constructively harnessed as there is not always an unambiguously clear way to proceed. A sense of realistic optimism is pivotal: people recover, and for those with chronic conditions much can be done to maintain their quality of life. ◆
Table 2
feelings, and beliefs and values likely to affect his decision if he had capacity (paragraph 4).15 Significant others: the Act involves new players who have a say in decision-making for those people who lack capacity to make important decisions on serious matters and who have no appropriate person in their lives who can be consulted. An Independent Mental Capacity Service has been created for this purpose. Where individuals have capacity they may bestow a lasting power of attorney on one or more donees, and these powers may be for either or both financial matters or personal welfare decisions. In rarer cases professionals will work with deputies appointed by the Court of Protection.
References 1 Department of Health. The National Health Service and Community Care Act. London: Stationery Office, 1990. 2 Department of Health. Fair access to care services: guidance on eligibility criteria for adult social care, 2003. http//www.dh.gov.uk (accessed 15 November 2007). 3 Clements L. Community Care and the Law, 3rd edn. London: Legal Action Group, 2004. 4 Department of Health, Community Care (Direct Payments) Amendment Regulations, (LAC (2000) 1). London: Department of Health. 5 King’s College London/London School of Economics. Dementia UK. London: Alzheimer’s Society, 2007. 6 Morrison T. Emotional intelligence, emotion and social work: context, characteristics, complications and contributions. Br J Soc Work 2007; 37: 245–63. 7 London School of Economics. The depression report: a new deal for depression and anxiety disorders. London: the Centre for Economic Performance’s Mental Health Policy Group, 2006. 8 Department of Health. Carers and Disabled Children Act. London: Stationery Office, 2000. 9 Department of Health. Carers (Equal Opportunities) Act. London: Stationery Office, 2004. 10 Department of Health. Mental Health Act. London: Stationery Office, 2007.
Vulnerable adults The legal basis for the protection of vulnerable adults, No Secrets (Department of Health 2000)16 is under Section 7 of the Local Authority Social Services Act 1970. It is a multi-agency policy and social services are the lead agency. Social workers have a key role in the assessment and management of abuse cases within the partnership working required by all relevant agencies. In cases of suspected or proven abuse within domestic settings, the social worker would usually be expected to: • undertake a comprehensive assessment • present a social report and an informed professional opinion to a multi-agency case conference • participate in the construction of a care plan. There is usually more than one team member directly involved in abuse cases. The abuse may not be clear-cut and the situation may be ambiguous and dilemma-ridden. Alleged abusers may be hostile and condemnatory towards investigating practitioners, and constructive partnership working between professionals is crucial.
PSYCHIATRY 7:2
78
© 2007 Elsevier Ltd. All rights reserved.
Old age psychiatric services
11 Audit Commission. The way to go home: rehabilitation and remedial services for older people. London: Stationery Office, 2000. 12 Department of Health. National Service Framework for Older People. London: Department of Health, 2001. 13 Matthews F, Dening T. UK Medical Research Council cognitive function and ageing study, prevalence of dementia in institutional care. Lancet 2002; 360: 225–6. 14 Department for Constitutional Affairs. Mental Capacity Act Code of Practice. London: Stationery Office, 2007. 15 Department for Constitutional Affairs. Mental Capacity Act. London: Stationery Office, 2005. 16 Department of Health. No Secrets: guidance of delivering and implementing multi-agency policies and procedures to protect vulnerable adults from abuse. London: Stationery Office, 2000.
PSYCHIATRY 7:2
Practice points • Social workers focus on the resolution of mental illness via the social context • Care management under the National Health Service and Community Care Act 1990 is a major role • Social workers may be care coordinators under the Care Programme Approach • Risk assessment and management to support people to remain at home is a central feature • Collaborative working with other professionals is vital
79
© 2007 Elsevier Ltd. All rights reserved.