This bureau study will concentrate upon the intent and maps of a Community Mental Health Team ( Older People ) ( CMHT ( OP ) ) . It will research the responsibilities and duties of the squad, trying to analyze the CMHT ( OP ) part to run intoing the demands of their service users.
Outline of the Agency.
Based in the north-east of England, this CMHT ( OP ) is one of five vicinity squads, who are portion of a model lending to the proviso of specialist mental wellness services for older people, within this distinguishable geographical country. Basically, a multidisciplinary squad supplying intervention and support for older people with complex and/or long term mental wellness jobs and their carers within the community, directed through an appraisal of demands upon referral. The squad consists of three community psychiatric nurses ( CPNs ) , two societal workers and societal work helper, who carryout such appraisals of demands under the way of the Care Programme Approach ( CPA ) and Single Assessment Process ( SAP ) . Whilst, an occupational healer ( OT ) and an occupational therapy helper ( OTA ) utilise the appraisal procedure to back up in the proviso of specialist equipment to ease rehabilitation. The support worker helps the service user with practical demands in order to back up their recovery.
A Principal Social Worker is straight responsible for the direction of the societal work staff and they are in bend accountable to the Local Authority ‘s ( LA ) Community Partnership Manager. The CPNs and back up worker are managed by a Team Manager, who is accountable to a Clinical Services Manager from the NHS Foundation Trust. Both the OT and OTA are managed by a Principal Occupational Therapist whom is accountable to an Assistant Commissioning Services Manager from the NHS Foundation Trust.
For the intent of this study, it is of import to clear up that the relationship that appears to be between the LA and NHS Foundation Trust is based chiefly upon the joint commissioning of services. The operation of the CMHT ( OP ) is such that the wellness and societal attention professionals who compose the squad operate from the same base, nevertheless, the services they deliver run aboard one another but are non genuinely ‘integrated ‘ , as in the entirety depicted by Lingard and Milne ( 2004 ) .
Agency Provision within the Policy and Legislative Context.
In recent old ages, the demands of older people with mental wellness jobs have been comparatively neglected with support and resources afforded to the spheres of Mental Health and Older Peoples, insufficiently achieving to the alone demands of this group ( Audit Commission, 2002 ; Marshall and Tibbs, 2006 ) . A permissive legislative model nowadayss in run intoing the demands of older people, so, merely those with the most advanced demands appear to profit, with no specific support towards the demands of older people with mental wellness jobs. Yet, the hopes of righting this balance have been set against a background of current policy that strives towards raising criterions, equity, authorization, societal inclusion, bar and partnership ( Department of Health 1998 ; HM Government, 2007 ) . While such rhetoric agreements with the intrinsic beliefs that permeate the value base of societal work ( BASW, 2002 ) , the world of the clime in which they intersect nowadayss an wholly contradictory discourse in mundane societal work pattern, as will be farther discussed in this study.
Notably, the huge array of policy tendencies and statute law which guides the CMHT ( OP ) is founded upon the rule of ‘seamless attention ‘ . Basically, supported through wellness and societal attention professionals working together to enable people to populate independently within the community, as outlined within the NHS and Community Care Act ( NHSCCA ) ( 1990 ) . Indeed, the policy jussive mood of integrating between wellness and societal attention was furthermore established with the debut of the National Service Frameworks for Older Peoples ( NSFOP ) ( Department of Health, 2001 ) . Standard 7 of the NSFOP kind to guarantee that older people with mental wellness jobs could entree integrated services for mental wellness which were efficient and effectual in their bringing. Supplemented further through the debut of the SAP, whereby, older people ‘s wellness and societal attention demands were to be responded to in a well reasoned, efficient mode avoiding unneeded duplicate of appraisals from other professionals ( LAC ( 2002 ) 1 ) . At roundabout the same clip as SAP was being introduced, the modernization of the CPA was besides happening with precise mention to the effectual attention co-ordination of the demands of older people with mental wellness jobs ( Department of Health, 1999 ) .
Agency policies and processs are a direct reading of such counsel and are farther underpinned by the rules of the Human Rights Act ( 1998 ) and Data Protection Act ( 1998 ) . Further still, the squad must guarantee that older people with mental wellness jobs receive the attention and intervention they need for their ain wellness or safety and for the protection of other people ( Mental Health Act, 1983 ) . Conversely, it is necessary to follow with the Mental Capacity Act ( 2005 ) , determining that the individual has mental capacity ; nevertheless, it should be presumed that the individual does so unless otherwise called into inquiry.
Upon referral the squad is duty edge to supply and an appraisal of the service user ‘s demands under the NHSCCA ( 1990 ) . The point of referral, service user ‘s demands and history, find whether or non the appraisal is based upon the SAP or CPA ( Department of Health, 2004 ) . Even though, policy counsel is in topographic point to turn to the troubles of the interface between these two appraisals procedures ( Department of Health, 1999 ; Department of Health, 2004 ) , research suggests that it has proved vastly debatable with much duplicate across their boundaries ( Hughes et al, 2001 ) . Intelligibly, a deficiency of comprehension around the application of these tools has lead to uncertainness of professional functions and duties doing defeat and confusion to service users and their carers likewise, as they can be left experiencing that their positions are non readily being listened to ( Care Services Improvement Partnership, 2005 ) .
Assessed service users ‘ demands must run into with certain ‘eligibility ‘ standards, prior to being allocated a service. This is based upon clinical eligibility for wellness co-workers and societal attention co-workers are bound by the Fair Access to Care Services counsel ( FACS ) ( LAC ( 2002 ) 13 ) . FACS counsel sought to develop a more just distribution of services by spliting eligibility into four sets. An single whose demands fall in moderate or low stria will be re-directed through signposting to other services. Upon run intoing the significant or critical sets, a service user will undergo a fiscal appraisal to find their part to service proviso and a attention bundle will be devised to run into their identified demands.
The efficaciousness of FACS can be seen as a combative issue, peculiarly in the field of mental wellness service proviso. Recent research by Huxley et Al ( 2008 ) suggests that the incompatibility and confusion around the application of FACS by professionals has resulted in reenforcing a turning separation between the subjects of wellness and societal attention within CMHTs.
Soon, the LA steering the operation of the societal attention staff within the CMHT ( OP ) is undergoing a immense restructuring of its services. The Personalisation Agenda and greater integrating between wellness and societal attention is the driving force behind this. It will see personal budgets to be the pillar of service proviso, how successful they will be in run intoing the demands of older people with mental wellness jobs will stay to be seen. I predict that unless there are extra resources targeted towards handiness for this group, uptake will be slow, as in that displayed by Direct Payments ( Department of Health, 2005 ) .
Service Users and Their Needs.
Service users inhabit what can be categorised as a preponderantly rural country made up of little towns. It is of import to observe this CMHT ( OP ) is runing within the boundaries of a LA identified as one of the most economically deprived in England ( Index of Deprivation, 2007 cited in LA and NHS Trusts, 2009 ) . Appreciably, this service user group is likely to be more exposed to the impact of poorness and societal exclusion which correlates straight with increasing mental wellness jobs. Recognition of such factors coupled with a service user ‘s alone history, should let the context of the service user to be more accurately understood and their demands met. Hence, the CMHT ( OP ) presenting on the ‘person-centred ‘ attention so aspired to by the NSFOP ( Department of Health, 2001 ) , and back uping the societal worker value to esteem human self-respect and worth, in peculiar with respect to guaranting that service users and carers participate in decision-making procedures ( British Association of Social Workers, 2002 ) .
This CMHT ( OP ) works with people over the age of 65 with a important mental wellness job and those under 65 with a cognitive damage ( early onset dementedness ) life within their boundaries, who appear to be in demand of community attention and/or wellness service proviso. As this is a specialist service for older people, the squad does know apart on the footing of age, though non on gender, ethnicity or faith. However, the construct of category is unfastened to challenge ; if we refer to an person ‘s ability to pay for services, demoing how indirect favoritism may inadvertently happen.
Frequently, referrals come straight from GP patterns that are aligned to the CMHT ( OP ) ; internal referrals made from other LA societal services squads or as a consequence of an single petition. The squad besides receives referrals from community infirmaries, whereby, it is perceived that patients will necessitate community attention services upon discharge as laid out by the Community Care ( Delayed Discharges ) Act 2003 ( s2 ) . Similarly, in instances where the patient is due for discharge after being detained under Section 4 of the Mental Health Act ( 1983 ) ( MHA 1983 ) , whilst support duties are located with the NHS, a referral will be made to the squad to run into their responsibility of supplying such services under Section 117 ( MHA 1983 ) .
Whilst, funding agreements for service proviso under Section 117 ( MHA 1983 ) mean that services are provided free at the point of bringing to such service users, so, this is non the instance for most societal attention proviso. Obviously, funding agreements for such societal attention services are a important concern for service users and their carers, as they are normally capable to a agencies tested fiscal appraisal. Upon finding a service user ‘s part it may do some people to worsen services, particularly those on the borders of eligibility, even when an evident demand exists ( Marshall and Tibbs, 2006 ) . At this point as a societal worker, confined to the worlds of the structural restraints of the bureau, we should oppugn out ability to keep the values of anti-discriminatory pattern ( Thompson, 2006 ) . We would necessitate to see whether we would merely accept the restraints that we were working within, rationalizing that we would be run intoing some demands and keeping some degree of effectivity. Otherwise, should we dispute the system and advocator for services on behalf of the service user, concomitantly seeking resoluteness of their demands through any gettable step. Obviously, the latter affords more congruity with our societal work values but it does non truly history for the capacity of an single societal worker to contradict wider affairs of resource allotment and handiness, frequently, beyond their control ( Trevithick, 2005 ) .
Integration of wellness and societal services was made possible through the flexiblenesss of the Health Act ( 1999 ) ( s31 ) , subsequently replaced by the NHS Act ( 2006 ) ( s75 ) , through the undermentioned steps:
These possibilities enabled the formation of the CMHT ( OP ) . Although, joint commissioning has been the preferable endeavor of these spouses and their degree of incorporate proviso is besides questionable.
It is of import to place the collaborative relationships which exist with the CMHT ( OP ) and other services ( see Appendix 1 ) . Services and their employees may convey their ain dockets or values which can do clash within and around the interactions between such services. Ultimately, they should be working to run into the demands of their service users to the best of their capablenesss ; unluckily this is non ever the instance.
Partnership with service users and their carers is profoundly embedded within the operation of the CMHT ( OP ) . The CMHT ( OP ) collates service user feedback through the usage of questionnaires, studies, meetings and ailments processs that they have in topographic point. However, the success of these tools in regulating alteration in the bringing of services is dependent upon service user and carer consciousness of their possible impact. Frontline employees, who are the chief point of contact for most service users, need to be to the full committed and endeavour towards the publicity of constructive feedback. This is an of import portion of the societal work function given their value base and the duties they have towards service users ( BASW, 2002 ) .
Agency Activity: Theories and Methods
Within the bureau assorted elements of theories and methods are employed, tailored towards a better apprehension of the service user ‘s state of affairs, the troubles encountered and the context in which they occur. One theoretical position used by the CMHT ( OP ) is based upon the work of Carl Rogers. Roger ‘s relationship-based position ( 1961 ) sought to set up that behind the labels created by society people have their ain strengths and capablenesss ; nevertheless, this can merely be amplified through reliable contact, communicating and relationships. Kitwood ( 1997 ) concurred with such thought and proposed a person-centred attack to the attention of people with dementedness ( Kitwood, 1997 as cited in Jacoby et Al, 2008 ) , enabling the curative relationship to be used as a tool to emancipate the service user ‘s capableness. Kitwood suggested that through person-centred attention people with dementedness were non reduced to the restrictions of dementedness but did in fact enjoy a better quality of life from acknowledgment of their alone ‘personhood ‘ ( Kitwood, 1997 cited in Jacoby et Al, 2008 ) . Within the CMHT ( OP ) , societal workers use the relationship to follow an individualized attack to measuring and run intoing the demands of the individual with dementedness, the empowering nature of such an attack agreements with the societal work values of human self-respect and worth ( BASW, 2002 ) . Within the attention program, they support the individual to stay every bit independent as possible but with respect given to run intoing the demands of the individual ‘s disablement as required.
The CMHT ( OP ) may set about a task-centred attack to actuate alteration within a relationship-based position. The benefits are such that it is short-run, time-limited, seeking further to heighten the capablenesss of the service user through job resolution in partnership with the practician ( Trevithick, 2005 ) . Research suggests that there are benefits to following this attack with older people, whereby, ends directed at resources that enable the individual to stay within their ain place improve their quality of life ( Challis and Davies, 1989 in Coulshed and Orme, 1998 ) .
Crisis theory is employed within the CMHT ( OP ) , when a service user is faced with the trouble imposed by such an event. Distress in otherwise stable fortunes is the definition given to crisis, being that a individual may experience unable to get by because of such alteration ( Chui and Ford, 2000 in Stepney and Ford, 2000 ) . Within this, it is believed that the individual meeting the crisis has the competency for problem-solving but at this precise clip they do non hold the capacity for call uping such operation, at this point the societal worker intervenes. Crisis intercession, ab initio, struggles with our societal work value base as it can be seen to be intrusive and oppressive through application ( Lishman, 2007 ) . Payne ( 2005 ) criticises this intercession for being excessively brief, avoiding the venue of long-run jobs and social unfairnesss. This is important given the multiple subjugations that older people with mental wellness jobs are obviously still sing within society ( Brooker, 2008 in Jacoby et Al, 2008 ) .
Appropriately, the CMHT ( OP ) appreciates this point and is able to understand the service user ‘s place through an ecological position. By working in partnership with service users, societal workers seek to analyze the structural disadvantage faced by older people with mental wellness jobs and see the wider societal support webs that could be harnessed for their benefit ( Jack and Jack, 2000 in Stepney and Ford, 2000 ) . This meets with the societal work value of advancing societal justness ( BASW, 2002 ) .
Measuring the Agency.
The squad may transport the rubric CMHT ( OP ) and be runing under a multi-disciplinary, interagency formation but the degree of operation and integrating is badly compromised by the clear divisions bing at both a managerial and operational degree. Evidence suggests that such weaknesss are common amongst such squads ( Audit Commission, 2002 ; Lingard & A ; Milne, 2004 ) . A recent survey undertaken by Tucker et Al ( 2009 ) further emphasised that, frequently, societal work staff were non managed by a individual lead for the CMHT ( OP ) , nor did they use the same certification for appraisals as their wellness co-workers. Opportunities to advance joint working were progressively exacerbated by the mutual exclusiveness of IT systems within the squad for sharing information and the absence of an in agreement operational policy for the squad, such incongruousness resonates within this CMHT ( OP ) . Staff within the squad effort to countervail such troubles by furthering good working dealingss with their fellow co-workers and informally sharing information where IT system restrict entree, whilst still adhering to policies around consent for sharing information.
Given the structural lacks of the CMHT ( OP ) , so, we should non undervalue the important degree of support and committedness provided by the professionals within the squad. Neither should we disregard the value this service holds for service users and their carers. One service user commented that “ we ‘d be lost without [ the societal worker and service ] ” and “ we did n’t cognize if there was any aid out at that place but [ mentioning to the societal worker ] pointed us in the right way ” . The CMHT ( OP ) undertakes a batch of valuable preventive work with respects to early sensing and attach toing support for service users and their carers, which proves good in footings of consistence of attention, as an person ‘s illness develops. Unfortunately, the model pattern and benefits of the service are lost in the LA ‘s unequal appraisal of the societal work part. Given that public presentation information associating to work undertaken for “ older people with mental wellness jobs is non available individually ” as it is included in the information “ for all older people aged 65 old ages and over ” ( LA and NHS Trusts, 2009 ) .
Presently, the proposals of a joint scheme for the commissioning of services for older people with mental wellness is doing major service reconfiguration with the purpose of better functioning the demands of the country. This program is seeing the move of this CMHT ( OP ) from its current site to another some 11 stat mis off, at the terminal of this fiscal twelvemonth, 2009/10. Whilst, I can appreciate the demand for reconstituting I can non understand how the demands of this vicinity will be better met by professionals who have to pass more clip going to make them. Surely, it would be better to aim resources at a managerial and operational degree, seeking better communicating between the directors of the squad, so to cut down the sum of duplicate taking topographic point and the cost deduction from this. Futile as this may be, if the issues around the appraisal procedure remain unsolved, but it may be deserving trusting that the recent audience around the possibilities of a Common Assessment Framework for Adults ( Department of Health, 2009 ) , will travel some manner towards rectifying such jobs.