Maintaining identity as a social worker in a multidisciplinary team

How do social workers recognise and maintain the core social work tasks in a multidisciplinary team? The Masked AMHP shares the advice he gave to one social work student
Row of feet in line
In a team where people bring different things, how do stand up for the roles which are your domain? Photograph: Martin Barraud/Getty Images

Our community mental health team currently has a first year social work student placed with us. The placement lasts for a year, and consists of three days a week in the CMHT, and two days a week course work at university. She's an able and enthusiastic student, but after a few weeks of the placement she came to me, as a social worker and practice educator, for advice and reassurance.

She was confused and perplexed. Working in a multi-disciplinary team, alongside nurses, psychiatrists and psychologists, as well as social workers, she was having difficulty identifying the core social work tasks in the team's work with people with mental health problems. What was the difference between a mental health social worker and a mental health nurse? What precisely did a social worker contribute to the overall functioning of the team?

I could understand her uncertainty. Having worked in a CMHT for over 20 years, there had been times when I had been close to going "native", when the majority of my work appeared to be using psychological therapies, making tentative clinical diagnoses, and arranging for medication reviews.

However, I had had the advantage of working for many years beforehand in a generic social work team, absorbing and internalising the social work perspective. I had also been an Approved Social Worker under the Mental Health Act 1983. This enabled me to cling to my core identity as a social worker, and to distinguish the important differences in my role from those of other members of the team.

The poor student, however, had not had those advantages. Although prior to her training, she had worked for several years in a social care setting with children, she had had no actual grounding in a social work team before her placement.

Added to this, she was receiving conflicting messages, according to whom she spoke in the team. The Mental Health Trust has specific pathways for referral to the team, and its own eligibility criteria for services. These, however, are different for the local authority.

The local authority has a set of criteria for provision of services that range from "critical", through "substantial" and "moderate", down to "low". In practice, only people assessed as having "critical" or "substantial" would be regarded as being eligible for services. The same does not apply to patients of a CMHT, who would also take on people with "moderate" need.

As I tried to explain to her what her core role was within the team, I realised how difficult it can be, especially for social workers working in the field of mental health, to hang on to their identity.

Many mental health teams within Mental Health NHS Trusts advertise explicitly for "mental health practitioners". Even the old role of Approved Social Worker has been replaced with that of Approved Mental Health Professional, who can be not just social workers, but nurses, occupational therapists or even clinical psychologists.

I used to attend meetings of ASW's secure in the knowledge that I would be with people who had all trained and practised as social workers; now the AMHP role is something distinct from the social work role, and the people attending AMHP meetings are from a range of different professional backgrounds.

According to a recent survey, as many as two fifths of local authorities are planning to withdraw their social workers from integrated community mental health teams. This may be in response to a crisis in social work identity and conflicts between health provision and social care provision, or it may be more to do with the financial cutbacks local authorities are enduring.

The steering group for the mental health faculty of the College of Social Work had its first meeting recently. It is currently establishing its terms of reference. Undoubtedly, one of the things the faculty needs to provide is support and definition for social workers working in multidisciplinary mental health settings. If mental health social work is to survive at all, social workers need to know what they're actually for.

The Masked AMHP is a social worker in a community mental health team in rural England and has been an approved mental health professional since 2007. They also blog on issues in mental health online here.
