Introduction

In this concluding chapter, I will summarise the key themes of the book and then move on to consider different approaches to the role of social work and social workers in the mental health field. I began work on this project shortly before Theresa May made her speech that the treatment of mental health problems was one of the injustices that she would seek to rectify in her period of Prime Minister. Professor Sir Simon Wessely, formerly president of the RCP, was appointed to lead a review of the MHA. Whether the legislation is the key area that needs to be addressed to resolve the issues that mental health services face is a very debatable point. The fact that the past president of the RCP was appointed to lead the review is itself a source of concern for many – not because of Sir Simon's personal qualities or integrity – because of the symbolism of it being led by a psychiatrist.

Narratives of reform

In 1998, when he introduced Modernising mental health services (DH, 1998), Frank Dobson then Secretary of State for Health stated that ‘community care has failed’. Whether one agrees with that statement or not, the document provides an interesting and to my mind coherent analysis (with one huge exception) of the factors that need to be addressed to reform mental health services. The exception is the need for legal reform, which resulted in the introduction of the CTO. Reforms were needed to ensure that the legislation would remain compatible with the soon to be introduced Human Rights Act. Modernising mental health services (DH, 1998: 2) identified the causes of the failings of community care:

Failures of the past

Although with staff dedication and commitment, the policy of care in the community has benefited many, there have been too many failures. Failure has been caused by:

• • inadequate care, poor management of resources and underfunding;

• • the proper range of services not always being available to provide the care and support people need;

• • patients and service users not remaining in contact with services;

• • families who have willingly played a part in providing care have been overburdened;

• • problems in recruiting and retaining staff;

• • an outdated legal framework which failed to support effective treatment outside hospital.