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What makes an outstanding mental health trust?

Posted by: , Posted on: - Categories: Knowledge and skills, Mental health, Recognition

Regular readers of my blog will know that I am keen to highlight the significant contribution that social work can make in different settings and contexts. Working with other professions to support and assist people with mental ill health is one of those areas, and includes the development of resources such as Social Work for Better Mental Health, the celebration of the AMHP role and the establishment  of the Think Ahead programme bringing graduates into social work.

Social workers are respected and valued by health and other colleagues and, most importantly, by people who benefit from social work involvement. It is important that we are able to play a confident role in improving mental health services and become more vocal in telling the story about the value and expertise social work approaches can make in this area.

I’m pleased to say this view is shared by our colleagues in the Care Quality Commission (CQC), including their Head of Inspection, Natasha Sloman, a social worker herself, whose professional background and values have contributed to her leadership in this role. Here she pays tribute to the 20th Century architects of social psychiatry and urges today’s social workers to celebrate and share their vital contribution to better mental health support for those who need our help.


Natasha: 'Mental health social work... has... quietly [taken] its rightful place alongside mental health professionals.'
Thanks to years of occasionally well intentioned, but sometimes misinformed reporting, the public are much more aware of the input of mental health professionals than they were even 10 or 20 years ago. Psychotherapists, psychiatrists and counsellors are all now strongly associated with mental health, though not always in ways that accurately reflect their roles and contributions.

More to the point, there’s another vital group of professionals missing from this list - social workers!


If the first half of the twentieth century cemented psychotherapy in public consciousness and psychiatry/psychology took its place in the second half, the pendulum of mental health validity has swung from declaring itself a medical science - psychiatrists are not neurologists - to recognising the importance of psycho-social triggers.


With this in mind, we should credit the doctors who supported the rise of social psychiatry after the war and their part in raising awareness of the effects of institutionalism, which in turn led to the subsequent closure of asylums.


Ironically, in the landscape of evidence based practice for psychiatry and psychology and the growing awareness of the validity of the Human Rights, Mental Capacity, and Social Care Acts, it is mental health social work that has quietly, unobtrusively sidled in to take its rightful place alongside mental health professionals. As social workers we should be smiling in this realisation – as should our fellow health and care colleagues and those who commission all of us.


Why? Decades of refining mental health practice have verified what we already knew - you can’t do it right without incorporating social work’s core values and methodologies.  Any half decent psychiatrist will tell you this. Mental ill health cannot and should not be treated in isolation; this is the road to poor outcomes, as it denies the impact - and mitigation - of deprivation, poverty, loneliness, social injustice, alienation and stigma.


I have worked as a front-line social worker, primarily in the NHS, with people who have mental health problems. For the past three years I have been a head of inspection for hospitals at the Care Quality Commission (CQC). In that time, our organisation has been working hard to inspect and rate every provider of health and social care.


That campaign has now come to an end and represents a massive achievement. We now have a baseline of safety and quality in every single organisation providing services across the whole country. I believe this is the first time any country in the world has managed to do this.


Working in the mental health part of the hospitals directorate, we have rated two of our 56 mental health trusts as outstanding. These two trusts share a number of common approaches, many of which seem to be firmly rooted in social constructs of care and treatment.


At their heart, outstanding trusts have of non-hierarchical structures, where the people who use services and the staff who care for them are the absolute priority. These trusts are conscious of the imbalance of power that exists in mental health services. They make efforts to shift power back to people at the frontline and involve patients and people who use their services in decision making.


There is a focus on close partnerships with local communities and meeting local need. They focus on employment opportunities and recovery orientated practice. These organisations both share a commitment to addressing inequality and have strong strategies in place based on human rights approaches, such as reducing restrictive practices. These trusts have a strong commitment to carers and families and seek to understand not just the needs of the patient but of the people who support them.


Both Northumberland Tyne and Wear and East London Foundation Trust actively manage risk in a dynamic way and they understand the importance of good risk management, making sure there is a good balance between positive risk taking and people’s safety.


Sound remotely familiar?


The adoption of underlying principles that led to these FTs becoming outstanding was about more than paying lip service to their ideals but a genuine attempt to embrace them. As a social worker now leading a CQC inspection, I know when patient involvement resonates meaningfully, when gender and cultural diversity don’t have to be put in invisible quotes but slip off the tongue as easily as the word ‘medication’.


This is social work’s moment as a discipline - we must seize it now, celebrate the scale of our contribution and grab the headlines.  We know how good we are – it’s time to tell the world!


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  1. Comment by Christine Dunkley posted on

    What makes an outstanding mental health trust is the response of the organisation to the population it is seeking to treat. A good clue is the ratio of clinical staff to administrators, followed by the ratio of treatments delivered to containment processes. Lastly the correlation between length of contact time with a patient and the qualifications of the staff member they are seeing. Poor trusts are top heavy in administration, rely on 'time passing' as a treatment, and allocate the lowest paid and lowest qualified staff to do the bulk of face-to-face contact time with the patient.

  2. Comment by Terrence Phillips posted on

    This is the 21st.CENTURY not the dark ages although it seems like it she. Trying to help a aged teacher who gave so much to her charges and contributed to almost every charity you can think of .paid for her funeral twenty years ago ,now when needing care because of her Altzhimers gets treated in a (care home) as a nuisance,
    So much for looking after our elderly in the 21st century.


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