Malcolm T. Firth

Reducing the distance: mental health social work in general practice

Major changes in the organisation of health and social care provision in the UK are challenging traditional professional allegiances. This article reports on the development, infrastructure and distinctive features of a specialist social work service which was formerly based in secondary care, but which has relocated to general practice settings. The service has addressed a new clientele characterised by a high level of psychosocial adversity, without a significant increase in demand on secondary care. This has required flexibility and ingenuity on the part of the practitioners. The process of establishing the service is described and its implications discussed. An integrationist strategy aimed at professional complementarity and inter-agency collaboration is recommended to ensure that the needs of an otherwise under-serviced clientele can be addressed.

Developing a social perspective in mental health services in primary care.

The influence of Primary Care Trusts (PCTs) on the reorganisation of UK health and social care provision is already considerable. As well as challenging institutionalised processes of care, PCTs are encouraging innovation. This article reflects on a service pioneered by a small group of mental health social workers, which has been reconfigured within a new PCT, illuminated by examples of direct therapeutic work and service user feedback. In the new service, the practical application of a social perspective in mental health provision is demonstrated by eligibility criteria based on social context as well as psychological adversity. Possible developments arising from the prospective, multidisciplinary team membership and interface with secondary care are anticipated.

Men, sex and context in psychosexual therapy: finding a suitable frame

Abstract This descriptive study explores contextual factors and psychosexual therapy with the first 70 consecutive male clients seen by one therapist in a regional, hospital-based Psychosexual Healthcare clinic. Clinical, demographic and referral data were examined to provide a snapshot of client characteristics, specific sexual problems and more general life adversities. The data were ordered and categorised into biological, psychological, inter-personal and environmental factors to provide a generic taxonomy of (mostly inter-related) client problems across the four dimensions. Findings indicated that good outcome was linked to completion of therapy, individual counselling, and treatment via masturbatory control or sensate focus. Single men or those with non-cohabiting partners were significantly younger than men with live-in partners. Variance across the four biopsychosocial domains centred on alcohol/drug use and smoking, childhood (sexual) abuse and neglect, relationship discord, infidelity, dissatisfaction with previous therapy, and new employment or work re-location. The multiplicity and complexity of the mens adversities suggested that contextual factors, personal and material, figured as highly as the referred psychosexual problems. Practically, the need to harness both biomedical and psychosocial expertise was apparent from the amount of co-working and cross-referral, both in-house and externally. Clinically, the use of ‘non-specific’ factors in therapy risks stretching treatment beyond its specialist frame, but can enhance engagement and subsequent intervention.

Assessment in adult mental health: Present problems as past history

Summary This paper outlines a guide to professional assessment of mentally disordered adults and their relatives or care-givers. The format is based on the observed and reported experiences of practitioners at pre- and post-qualifying levels over six years whose use of, and comments on, the format have refined its development. Key texts supporting the assessment rationale, most of which remain readily available, are referred to; the purposes of assessment are discussed; and some guidance on aetiological factors is indicated. After a brief consideration of the assessment format itself, an example of a psychosocial assessment report is given. Overall, the emphasis is on the practicality and simplicity of the format, not only as a means to securing essential information, but as a guide to interviewing and, in many instances, to a working alliance with clients.

Quantifying creative encounters: The bumpy road to evaluating psychodynamic training

Abstract Four years of a one year, part-time, CCETSW-approved, post-qualifying course in psychodynamic approaches to practice were evaluated by the authors. Both course effectiveness and student learning were assessed, using a variety of measures, including (years 1 & 2) student diaries, multiple choice examinations, meetings with line managers and (years 3 & 4) repeated questionnaires on confidence (students) and skill (tutors), termly feed-back from students, and end-of-year tutor and self-reports. Dissertations were required from year 2 onwards. Objective tests of knowledge showed good evidence of new learning, although the later confidence/skill questionnaire was preferred, by students, to the multiple choice examinations used in the first two years. In the absence of actual practice-based measures of performance, the relative merit of each approach remains uncertain. The development of the course itself was enhanced by the use of external evaluators. Awkward or vague measures (diaries, meetings with ...

Childhood abuse and depressive vulnerability in clients with gender dysphoria

AbstractBackground: Childhood abuse in the early lives of gender variant people has been under-reported, although higher psychiatric morbidity, particularly depression and suicidality, than in the general population is more widely recognised. There are increasing numbers of people seeking advice and treatment for gender dysphoria (GD) some of whose experiences of depression and childhood abuse may be additional treatment considerations. Aim: To illuminate the issues relating to childhood abuse, depression and GD via case examples underpinned by a summary review of the relevant literature, for their combined relevance to therapeutic practice and service provision. Methods: A review of relevant online literature was conducted and two case examples were developed subsequently to capture the core review themes from a practice perspective. Results: Nine studies met the inclusion criteria. Gender variant children and adolescents may experience abuse by peers and teachers, as well as parents and caregivers. Emot...

Initial Assessment and Eligibility for Secondary Care Mental Health Services: Not a Simple Equation

This paper identifies the challenges of interpreting and implementing appropriate eligibility criteria and assessment processes in adult mental health services, with reference to an inner‐city Trusts own protocols. Central guidance, local interpretation and professional judgment are all legitimate contributions, but also confound both the concept and processes of entry to service.

Depression and practice learning in mental health social work

Abstract Training in mental health social work has to accommodate three main areas of learning: connecting past and present, being with and doing to, and psychiatric phenomenology. This learning emerges most actively through contact with those clients whose disorders and predicaments hold echoes for the student workers; most typically, these echoes are depressive. Practice teaching introduces another element of professional disillusionment, notably a shift from ideal to real practice. Current trends in community care are observed to add a further dimension of professional blight