Sherrill Evans

Urban regeneration and mental health

Abstract.Objective:The aim of this study was to assess the impact of an urban regeneration project on mental health.Method:A longitudinal study was made with 22-month follow-up in a Single Regeneration Budget area, and matched control area in South Manchester. A total of 1344 subjects responded to a postal questionnaire survey. The main outcome measures were GHQ12 (mental health) status, MANSA (Life satisfaction), and GP use.Results:Mental health outcome in the index and control areas showed no improvement over time. Health satisfaction declined slightly in the index compared to the control area. GP use was unchanged. Restricted opportunities, a variable closely related to mental health, were not removed by the urban regeneration initiative.Conclusions:The urban regeneration initiative may have had little impact because it failed to address the concerns of local residents and failed to remove restricted opportunities, which appeared to be the key factor. A longer follow-up period may be required to demonstrate an effect.

The Principles and Provisions of Relationships Findings from an Evaluation of Support, Time and Recovery Workers in Mental Health Services in England

• Summary: Health and social care services in the UK have been in the process of modernization since the New Labour government came to power in 1997. A central feature of modernization has been the scrutiny of existing work roles and the development and introduction of new work roles. The present article is concerned with the nature and content of work in one of these new roles, the Support, Time and Recovery worker which was introduced on the advice of service users, among others. • Findings: Qualitative data revealed that both workers and service users valued the relationship they developed. The nature of that relationship and its important component qualities are analysed using Biesteks Principles of the Casework relationship and Weisss categories of social relationship provision. • Applications : The results provide further support to a growing literature that emphasizes the value service users place on the nature and quality of the relationship with the worker in social care practice, and the importance of positive human qualities in workers.

More than jobs and houses: mental health, quality of life and the perceptions of locality in an area undergoing urban regeneration

BackgroundUrban regeneration initiatives are considered to be one means of making a contribution to improving people’s quality of life and mental health. This paper considers the relationship between lay perceptions of locality adversity, mental health and social capital in an area undergoing urban regeneration.MethodsUsing qualitative methods as part of a larger multi-method study, perceptions of material, and non-material aspects of the locality and the way in which people vulnerable to mental health problems coped with living in adversity were identified as being more highly valued than intended or actual changes to structural elements such as the provision of housing or employment.ResultsThemes derived from narrative accounts included concerns about the absence of social control in the locality, the reputation of the area, a lack of faith in local agencies to make changes considered important to local residents, a reliance on personal coping strategies to manage adversity and perceived threats to mental health which reinforced a sense of social isolation. We suggest these elements are implicated in restricting opportunities and enhancing feelings of ‘entrapment’ contributing to low levels of local collective efficacy. The gap between social capital capacity at an individual level and links with collective community resources may in part have accounted for the absence of improvements in mental health during the early life of the urban regeneration initiative.Implications/conclusionsIn order to enhance quality of life or mental health, agencies involved in urban initiatives need as a basic minimum to promote security, increase leisure opportunities, and improve the image of the locality.

The Principles and Provisions of Relationships

• Summary: Health and social care services in the UK have been in the process of modernization since the New Labour government came to power in 1997. A central feature of modernization has been the scrutiny of existing work roles and the development and introduction of new work roles. The present article is concerned with the nature and content of work in one of these new roles, the Support, Time and Recovery worker which was introduced on the advice of service users, among others. • Findings: Qualitative data revealed that both workers and service users valued the relationship they developed. The nature of that relationship and its important component qualities are analysed using Biesteks Principles of the Casework relationship and Weisss categories of social relationship provision. • Applications : The results provide further support to a growing literature that emphasizes the value service users place on the nature and quality of the relationship with the worker in social care practice, and the importance of positive human qualities in workers.

Developing wider workforce regulation in England: Lessons from education, social work and social care

This paper draws on the findings of a review of regulation of professionally qualified teachers, social workers and other staff in social care. It charts the process of developing and implementing both professional and wider workforce regulation in England, focusing on the implications for generic and integrated working and the development of cross-professional procedures for the protection of vulnerable adults and children from abuse. There are many uncertainties about how best to develop workforce regulation especially when integrated working is a policy goal. In light of the paucity of evidence of outcomes and benefits for improved practice and the protection of the public, there is a need for research to address this complex arena.

Prospects for mental health social work: A qualitative study of attitudes of service managers and academic staff

Background: Increasing overlap between professional roles in integrated mental health care raises questions about the future of social work as a distinct discipline. Aims: This study explored the prospects for mental health social work in the eyes of key stakeholders. Method: Qualitative interviews were held with senior mental health service managers, and academic staff from institutions providing social work training. Results: A typology of attitudes emerged from service managers, who were categorized as traditionalists, eclecticists and genericists. Traditionalists supported a unified social work discipline, which would remain distinct from the NHS professions. Eclecticists favoured merging of roles, whilst believing that professional diversity should be retained. Genericists saw little difference between the various disciplines, and were enthusiastic towards a generic mental health practitioner. There was widespread recognition of the challenges facing social work, particularly its lack of academic status and evidence to support its interventions. Conclusions: Mental health social work has an uncertain future. To gain influence on mental health policy and its own professional future, social work must boost its credibility by developing a stronger evidence base and asserting the value of its contribution. Declaration of interest: None.

State-event relations among indicators of susceptibility to mental distress in Wythenshawe in the UK

This paper explores the utility of concepts drawn from psychosocial theory as predictors of the proneness to mental distress among the residential population of a large suburban council estate (Wythenshawe, South Manchester). In this respect, items are selected and tested to form composite variables measuring individual ratings with regard to notions of structural risk, personal vulnerability, goal-setting behaviour, quality of life, and the frequency of life events and restricted opportunities. Mental distress is enumerated on the standard GHQ12-point scale. The design makes the distinction between composite variables that record persistent states and those which count events and aspirations immediate to the individuals present experience. To examine the consequences of this difference between indicators of prevalence and incidence, our analysis adopts a two-stage multiple regression format. The first examines these state-event interactions among the composite variables, while the second tests the separate significance of these types as predictors of GHQ12. The findings reveal significant proportions of the variation in GHQ12 are be explained either by associations with the ageing process or by those linked to subjective indicators of the quality of life. In contrast, structural deprivation correlates less significantly with the reporting of psychiatric distress in this socially homogeneous population. The discussion considers the methodological implications of these relationships for understanding common mental health problems together with their connotations for health policy.

The social care component of multidisciplinary mental health teams: a review and national survey.

Background The study reviewed the disciplinary composition of community mental health teams (CMHTs) and conducted a national survey of mental health providers in England and Wales to explore the determinants of the social care component of CMHTs. Methods A comprehensive literature review and a national survey of NHS mental health Trusts in England and Wales. Results The literature review showed that team composition was rarely well justified with regard to effectiveness, despite some evidence that greater professional diversity (i.e. inclusion of social workers) was associated with higher effectiveness. Forty-two mental health Trusts responded (53.2%) to the survey. There were no staffing differences between responding and non-responding Trusts. Social workers accounted for 19.3% of the staffing total. Nurses formed a third of the workforce and social support workers made up a further 10%. We found that there continues to be a shortage (compared to policy targets and previous research) of psychiatrists, psychologists and occupational therapists, whereas the numbers of nurses employed far exceeds their target numbers. Total staffing numbers appeared to be slightly higher in Trusts citing ‘financial resources’ as a determining factor of team composition. Despite being statistically non-significant, the ‘financial resource’ effect was of medium magnitude. Similarly, there was a non-significant but approaching medium-sized effect of higher numbers of social care support staff when guidance was cited as a rationale for CMHT composition. There was a non-significant (P = 0.076) medium magnitude (η2p 5 0.067) trend towards higher staff numbers in more integrated trusts that did not cite financial resources as a driver of team composition. Conclusions If service recipients are to gain equal access to appropriately staffed services, further attention needs to be paid to supporting an adequately skilled multidisciplinary workforce. The workforce needs to be organised in a way that best provides for local needs rather than a service based largely on the existing supply of different professionals and disjointed workforce planning.

INTERNATIONAL RECRUITMENT OF SOCIAL CARE WORKERS AND SOCIAL WORKERS: ILLUSTRATIONS FROM THE UK

This paper presents the results of a survey of international recruitment of social workers and social care workers into the United Kingdom. The literature on international recruitment, especially in relation to social care workers, is extremely sparse. Reviews conducted by the authors for the UK Department of Health did not find any definitive answer to the question of the numbers at present in the UK workforce, their movement between jobs, and their length of stay in the UK. The present study is based on qualitative interviews with three senior managers, four human resources managers, one employment agency manager, one senior social services inspector and three inspectors and three staff from the voluntary and private sectors. The interviews confirmed some of the major benefits associated with international recruitment: a reduction in vacancy rates; filling gaps in key shortage areas; improved sickness records; and once training has been provided the standards of care have improved. In addition, recruitment from overseas has the effect of creating a more diverse staff mix through the appointment of people with more varied experience and experiences. There may also be cost benefits associated with the reduction in costs of employing agency staff. The challenges involved are: having an ethical recruitment policy; the transferability of qualifications and skill sets, and cultural expectations and differences. Employers need to recognize that higher levels of induction are needed in order to meet the unique local knowledge requirements of an overseas candidate. Generally however, there are very few problems, and employers recruiting from overseas find that any problems that exist diminish with each round of recruitment, that is, as employers learn from their previous mistakes. Nevertheless, international recruitment is only a short term strategy, and, alone, does not solve the fundamental domestic problems that lead to the shortages in the first place.

Quality of life routine outcomes measurement: lessons from experience in the USA and the UK

This paper is concerned with issues in the routine measurement of quality of life in a mental health context. It is in three parts. In the first part the first author reviews briefly, lessons from a decade of experience in the use of data produced by routine measurement using the Colorado Client Assessment Record (CCAR) in the Mental Health Centre of Boulder County (MHCBC) in Colorado, USA. In the second part, the specific issues surrounding quality of life assessment as a routine outcome measure are considered. Evidence is presented to counter some of the commonly held beliefs about QoL measurement problems. Finally, general problems that affect QoL and all other routine measures are described and analysed using a framework devised by Peterson (1989).