July 1946
History
The first Psychiatric Social Worker was appointed in 1912 in U.S.A. where public interest had been stirred by Freud’s theories and a growing concern for the proper handling of delinquents and defectives. Dr. Meyer’s biographical approach to child problems made a new opening for social work as did the demonstration clinics started by the Commonwealth Fund to deal with problem children especially delinquents where the necessity of cooperating with local welfare agencies for children was quickly recognised. In Britain the 1907 investigation of delinquency and the new probation system showed a parallel development here. The Central Association for Mental Welfare’s concern for the supervision of MDs and provision of facilities for them in all areas, and the Maudsley Hospital’s experiment with voluntary patients and its stress on suitable education and environments for the cure of mental patients, also provided opportunities for a new type of social worker.
1927 the Commonwealth Fund’s invitation for British workers to visit their clinics led to our first Psychiatric Social Workers being trained in the U.S.A. and subsequently starting child guidance clinics here, first under voluntary bodies and later under Hospitals and Education committees, After-care of adult mental patients extended also as the proper placement of discharged patients was found to result in fewer readmissions. The Mental Health Course started by the L.S.E. now trains Psychiatric Social Workers, matrons of children’s homes, workers among MDs and delinquents, almoners and administrators etc., and the year’s course which included adult and child psychiatry, criminology, psychology, physiology, procedure of juvenile courts, certification of the defective and insane etc., has now achieved an international reputation.
Functions
Usually the Psychiatric Social Worker works in a team with a psychiatrist and/or a psychologist. She may interview at out-patient clinics, on visiting days, in the patient’s home or in the Mental Hospital wards. Her task is to prepare a “Social History” (this exploration of the family background and childhood of the patient also records his health, interests, employment, education etc., and is a skilled job often taking as long as an hour or more). After the psychiatric interview the Psychiatric Social Worker will be consulted about practical plans for the patient’s future (if training hostel placement, boarding school) and will contact outside agencies and relatives on the patient’s behalf, being their liaison officer with the psychiatrist. After discharge she will be responsible for follow up rehabilitation and after care eg. convalescence, supervision of adults out on trial or children in foster homes, Not only will her work involve home visits to reassure relatives or secure their cooperation, but she will make personal contact with employers, schools, case work agencies, the Ministry of Labour etc. In Child Guidance Clinics the task of modifying the mother’s attitude may involve touching on her own psychological difficulties or matrimonial problems at a psychiatric level and contact with discharged adult patients may also involve work of a similar nature.
The Future
As the Psychiatric Social Worker is an experienced social worker plus the Mental Health Course certificate she may be considered a specialist and should be available for consultation by other workers over psychological problems. Most mental hospitals and Child guidance clinics of any size need two Psychiatric Social Workers and for satisfactory service a car, an interviewing room, a clerk and telephone are essential. Easy access to records and the psychiatrists go without saying, and opportunities for regular conferences with GPs and other social workers might well be supplied at the Health Centres where advice on procedure for admission might be given on cooperation over patients involving different departments, eg a TB decertified man or an epileptic unmarried mother,
Wherever neurotics, psychotics and problem children are treated a Psychiatric Social Worker will be needed in the team of workers. Though at present many areas have no psychological clinics, under the National Health Service equal facilities will be available in all areas and extension of the work during the staff shortage may well involve touring teams using health centres, especially in rural areas where a separate building is uneconomical. Working from a health centre would have an advantage over an Education Authority Child Guidance Clinic in including all age groups, and would supply opportunities for consultation with other workers and education of parents in handling children’s difficulties.
The extended use of a regional Psychiatric Social Worker might also ease the interim period of development. Working from a regional hospital she could advise the social workers at Health Centres on adoptions placement, referral, certification and employment for their psychological patients etc. while keeping current a directory of foster homes, schools and treatment centres in the area. Many of the present Ministry of Health Regional Officers with PSW training could combine these functions with their responsibility for training students and staffing hostels etc. The planning of treatment facilities, interpreting legislation and mental health and education for the public would also be their sphere. The present regional PSWs employed by the Provisional National Council for Mental Health on the after care of service patients are also fitted for this wide general task in scattered areas, and could usefully combine case work, administration and propaganda.
The PSW’s scope could usefully be extended to advising Homes, schools, parents, employers etc. in minor psychological problems, for only too often only grosser anomalies of conduct are referred for treatment when prognosis is poor – some contact with the earlier stages and preventative work could be undertaken if her help was more readily available and this may well arise through cooperation with Health Centres.