The aim of this work is to provide a critical analysis of what, I argue is, an ongoing crisis in mental health services. It argues that the roots of this crisis can be traced back to the failings of community care in the late 1980s and early 1990s. From the Spokes inquiry (DHSS, 1988) onwards, the response of successive governments was to focus on procedural approaches, risk and risk management. I argue that the original progressive ideas that were part of the underpinning of community care policies need to be rediscovered, updated and reinvigorated. This process can provide the basis for mental health social work that is based on fundamental notions of dignity, respect and mutuality.

This work seeks to contribute to the debate about the role of social work in mental health services. It is based on the fundamental premise that mental health social work has lost its way. Core social work values have been marginalised. The original aims and values of community care – properly resourced community based resources to support citizens in acute distress – have been lost in a world of managerialist doublespeak and risk assessment. Risk assessment has replaced the ethic of care as the main focus of service user contact. I feel that there is a danger of a kind of therapeutic pessimism dominating debates. There is a need to take a critical but also realistic and ultimately optimistic and positive approach to tackling the challenges that mental health social work faces in a climate of austerity. There have always been practitioners who are very skilled at carving out a creative space in which to work alongside service users and their families. Social workers have traditionally placed tremendous value and importance on this as a way of maintaining professional integrity and identity. This book will argue that the current crisis in mental health services requires a fundamental reshaping of service provision. The focus needs to shift from risk and risk assessment to models of service provision that are securely based on notions of dignity, inclusion and citizenship. These are at the core of social work values but also were at the heart of the original challenges to institutionalised psychiatry. The book will argue that the social work role has been marginalised within mental health service provision.