This essay critically explores the inherent tensions within social work (SW) law in relation to adults with mental ill health (MIH) and their carers in England and Wales. The discussion centres on key legislation, such as the Mental Capacity Act 2005 (MCA), the Mental Health Act 2007 (MHA), and the Care Act 2014 (CA) (Department of Health, 2014).
The International Federation of Social Work (2014) defines social work as a profession that fosters social change, development, cohesion, and the empowerment and liberation of individuals (Ifsw, 2019). Cree (2002, p. 28) elaborates on this by highlighting social work’s dedication to social justice and the reduction of inequalities in partnership with service users. This principle underlines the necessity of social workers (SWRs) for adults with MIH, who often face marginalisation, stigma, and the absence of a voice to advocate for themselves (CA2014). Likewise, carers for adults with MIH contend with numerous challenges, such as discrimination, breaches of human rights, and socio-political and economic pressures. Practitioners are thus urged to dismantle the “shackles of oppression” that distort the lives of these individuals (Dominelli, 1997, p. 248).
SWRs today operate as change agents within a profession increasingly shaped by regulation from bodies like the Health and Care Professions Council (HCPC) (HCPC: health and care professionals council, 2018). Although their mission involves tackling adversity and adhering to the ‘Code of Practice’ (Scie, 2010), significant tensions emerge in their implementation of social work law, particularly regarding partnership working, person-centred approaches, and the empowerment of adults.
Legislative Frameworks and Their Implications
Although legislative frameworks are designed to underpin SW practice, they can inadvertently obstruct MIH adults’ attainment of social justice and equality, particularly in areas like safeguarding and empowerment for those lacking mental capacity (Department of Health, 2015). For example, the MCA2005 seeks to empower individuals who ‘lack capacity’ (Department of Health, 2015), while the MHA2007 permits professionals to detain, assess, and treat those with mental health disorders. However, these laws can unintentionally reinforce power imbalances. Hasenfeld (1987) introduces the concept of normative social distance, whereby MIH adults may perceive a divide between themselves (‘us’) and social workers (‘them’), contributing to a sense of exclusion and vulnerability.
This power imbalance is exacerbated by a professional assumption of knowing best (Dalrymple, 2001), which can deepen the disempowerment of MIH adults. If SWRs fail to address the societal power structures that exclude minorities, they risk perpetuating this marginalisation (Hugman, 1991). This issue is particularly pronounced for Black and Minority Ethnic (BME) individuals with MIH, who may experience layered exclusion (Jupp, 2005). While the Code of Practice urges respect for individual rights (Scie, 2010), the use of compulsory measures can have adverse outcomes for MIH adults (Campbell, 2010).
Critique of Mental Health Legislation
Although mental health legislation aims to support MIH adults, it often justifies discrimination and reinforces negative stereotypes (Duffy, 2017), sometimes failing to align with HCPC standards (HCPC: health and care professionals council, 2018). The ‘medical model’ of mental health, which dominates much of this legislation, emphasises illness and difference, fostering stigma and social separation (Duffy, 2017). This model’s dependence on medical diagnosis can lead to stereotyping, exacerbating issues of social inclusion and human rights (Karban, 2016).
The social model of disability, which views disability as a societal construct rather than an inherent condition, provides a more inclusive framework. Nonetheless, legislative reforms aligned with this model have only recently emerged, aiming for a more patient-centred approach (Duffy, 2017). For example, India’s mental health laws are being revised to comply with the United Nations Convention on the Rights of Persons with Disabilities, signifying progress towards recognising the rights and equality of MIH adults (Kelly, 2016).
Social Work Practice and Discrimination
Despite early social work efforts to combat discrimination, economic and political influences have shaped its practice (Rapaport, 2008). While the CA2014 seeks to promote empowerment and protection, a Marxist critique argues that SWRs, acting on behalf of the state, may use their expertise to gain social influence, sidelining the needs of MIH adults (Hasenfeld, 1987). Nonetheless, the mental health workforce increasingly emphasises self-determination and minimising restrictive interventions, aligning with anti-discriminatory practices (Rapaport, 2008).
Reducing stigma and discrimination is central to policies such as ‘No Health without Mental Health’ (Department of Health, 2011), which seeks to promote mental health across government services while addressing social justice. However, while anti-oppressive practice challenges injustice (Baines, 2007), tensions between service-led and needs-led approaches persist, often silencing the voices of MIH adults.
Empowerment and Social Inclusion
Empowerment and social inclusion are vital for MIH adults, with advocacy groups in the UK championing ‘advanced directives’ to allow individuals to outline their treatment preferences (Mind, 2018). Such directives, endorsed by patient organisations in the Netherlands, can reduce stigma and foster empowerment (Knapp, 2006). However, challenges remain in their implementation, such as assumptions about their applicability (Emanuel et al., 1991).
In the UK, access to social care is means-tested and selective, while health care is universally available, creating practical and ideological challenges (Knapp, 2006). In Eastern Europe, resource shortages and government prioritisation further complicate the situation for MIH adults (Knapp, 2006). Policymakers must consider local customs and beliefs to ensure the acceptance of new programmes (WHO, 2002).
Carers of Adults with Mental Illness
An estimated 1.5 million people in the UK care for adults with MIH (Carers Trust, 2015), facing issues such as challenging behaviours, limited support options, and unmet cultural needs. Since the 1990s, UK policy has acknowledged carers’ contributions through legislation like the Carers (Recognition and Services) Act 1995 and the Carers Equal Opportunities Act 2004, which have enhanced carers’ rights (Seddon, 2015).
Despite these advancements, assessing carers’ needs remains complex. Tensions arise between personalisation for service users and formal recognition of carers’ needs (Repper et al., 2008). Assessment protocols often focus on problems, neglecting the nuanced realities of carers’ lives (Seddon, 2015). A narrative-based assessment approach could better support carers’ individual needs.
Funding and Resource Allocation
Economic constraints significantly affect MIH adults and their carers, limiting access to essential services (Wenzel et al., 2018). The CA2014 introduced substantial changes to social care, including greater recognition of carers’ rights and expanded responsibilities for local authorities (Meyer, 2018). Nonetheless, tensions persist between the needs of care recipients and carers, with the concept of choice in caregiving remaining underdeveloped (Rand, 2019).
Access to Services
Accessing services remains a significant challenge for carers, who often struggle to find relevant advice and information (Cavaye, 2006). Research suggests that such information is frequently presented in a generic format, failing to meet diverse carers’ needs (Meyer, 2018). Additionally, universal services often fall short of providing culturally appropriate support (Meyer, 2018).
Conclusion
In summary, social work law aimed at supporting adults with mental ill health and their carers faces significant tensions. While legislation like the MCA2005, MHA2007, and CA2014 is intended to uphold rights and provide support, issues of oppression, discrimination, and funding shortfalls complicate their implementation. SWRs must navigate these complexities while adhering to professional standards, striving to empower and advocate for MIH adults and their carers. Ongoing legislative and practical improvements are crucial to addressing these challenges and fostering social justice and equality.
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