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About this book

This best-selling book explores the crucial role of social workers in securing a better future for vulnerable and disadvantaged adult service users. Tacking the problems most common to this branch of social work it focuses on four major themes: personalization; mental health; substance use; and old age. Edited by the highly respected Martin Davies, and with contributions from some of the leading names in the field, Social Work with Adults provides a clear map and guidance to help navigate between the different elements of social work knowledge and practice.

Whether a student on an undergraduate degree taking a module on working with adults or a qualified professional wanting to ensure they are proving the very best service they can, this is essential reading. The breadth and depth of coverage makes this text a perfect handbook for students of adult social work.

Table of Contents



Social workers have, for more than a century, been a significant and increasingly substantial occupational group in the UK and other parts of the world. From their beginnings within the framework of voluntary societies, they have moved steadily, as public employees, towards the hard centre of our democratic welfare economy. They grow accustomed to the fact that members of society who have no need of their services may view them and their profession with some ambivalence. Thirty years ago, in The Essential Social Worker, I argued that they play a crucial part in the maintenance of our complex community in a state of approximate equilibrium. This remains true.
Martin Davies

Social Work and the Personalization Agenda


1. The emergence and development of the personalization agenda

The notion of personalization is a relatively recent one in social care. It is generally taken to mean ensuring that people who receive support remain central to and in control of the process by which they receive it; the aim is to enable them to live their lives as they choose. Fundamental to the idea of personalization is the use of individual or personal budgets and direct payments. The terms ‘individual budget’ and ‘personal budget’ are frequently used interchangeably, although there is a difference between them. Initially, it was intended by government that individual budgets would combine money from different funding streams such as Supporting People and the independent living fund, but in practice this encountered difficulties (Glendinning et al., 2008). A personal budget contains only money from local authorities’ community care funding. People who are eligible for a personal or individual budget can choose whether to take it as cash (direct payment), as services brokered by an adviser or as services commissioned by a local authority.
Janet Leece

2. Law on personalization

As yet, there is no statute law on personalization. It has emerged within a context of policy development relating to older people, disabled people and those with health or mental health-related needs. While it can be seen as a response to the pressure to find a way of delivering adult social care that is value driven, accountable and recognizes dignity, it is arguable that individualization, responsibilization and the privatization of risk also are discernible drivers (Ferguson, 2007). Clements (2011, p. 47) notes that ‘in contrast to the many statutory duties and the fanfare of regulations that underpin community care law, personalization is based on no law whatsoever’. Nevertheless, legal rules from a range of sources, including statute, guidance and case law, are highly relevant to personalized practice. Sometimes, they provide mandates (duties and powers, principles and procedures) on aspects of practice that help achieve the goals of personalization. Sometimes, they provide guidance on the balance to be struck when dilemmas arise. Occasionally, they place constraints on what can be done to personalize services. Equally, there are core legal principles and concepts that underpin the whole notion of personalization and are influential in shaping our approach to the wellbeing of those who require support to achieve their goals and ambitions.
Suzy Braye, Alison Brammer

3. Conceptual foundations and theory-building in personalization

In this chapter, we discuss what we consider to be the principal theoretical approaches that have influenced and informed the concept of ‘personalization’. In addition to reviewing the main conceptual foundations, we lend critical attention to the challenge of building a robust ‘theory’ to support the development of this notion by emphasizing selected theoretical elements, which we feel have particular potential for this task.
Susan Hunter, Mike Titterton

4. Personalization: what the research tells us

This chapter will identify the key messages emerging from research with respect to the personalization agenda within social work and across the UK.
Gillian MacIntyre

5. Personalization in practice

There has been a venerable tradition in social work of ‘starting where the client is’ as a counterbalance to the temptation for professionals to superimpose their own preconceptions on the service user’s situation; the personalization agenda is a logical and imaginative progression from that principle. It pays respect to the idea that every individual is an expert in their own life. Although the social worker bears responsibility for the appropriate use of public resources, the service user may often be the best judge of how those resources may most efficiently be employed.
Michael Bamber, Jenni Brooks, Shirley Cusack, Jane Edwards, Mary Gardner, Kate Gridley, Liz Howard, Niki Marshall, Liz Salmon, Judith Wood

Social Work and Mental Health


6. Social policy and mental health social work

Contemporary mental health social work practice is a fusion of statutory functions, therapeutic interventions and care management. In multidisciplinary mental health services, social workers play an important role in promoting social perspectives as a counterbalance to the dominant psychiatric paradigm.
Martin Webber, Jack Nathan

7. Mental health law and social work

It might be surprising to many people in the UK that mental health is the area of practice in which social workers have the most direct power in relation to the restriction of liberties of citizens. This is despite the raised public profile of child protection work and the prominence of statutory social work in that arena. Since the Mental Health Act 1959 (MHA), social workers have carried the primary responsibility for applying for admission to hospital of people with a mental disorder, although, as we shall see, the Mental Health Act 1983, as amended by the 2007 Act (hereafter referred to as the MHA 1983) has broadened the role to incorporate other professionals. This chapter will consider:
  • the social and institutional factors that have shaped the law in relation to people living with mental health problems
  • how in modern times the legal context has influenced the social work role
  • the part played by social workers in relation to people detained in mental hospitals or treated compulsorily in the community
  • the role of social workers in the deprivation of liberty of individuals by virtue of mental incapacity
  • the social work contribution to safeguarding, with particular regard to the tribunal system
  • some potential trends for the future.
Nick Gould, Debbie Martin

8. Theory in mental health social work

Perhaps more than in any other field of social work practice, theory within mental health remains a contested area, with medical, psychological and social theories providing radically different accounts of how we should approach the range of strange and unusual experiences that constitute mental distress. Particularly in the 1990s, the biomedical paradigm became increasingly dominant in framing understanding and we were invited to see complex human experiences as if they were just ‘symptoms’ of supposed underlying disease processes. Although still dominant, this paradigm has become increasingly challenged, not least by service users and survivors themselves.
Jerry Tew

9. What research findings tell social workers about their work in mental health

Mental health research and practice cover a wide spectrum of disorders and a wide range of social influences affecting the causation, course and outcome of episodes of illness. It is impossible in a single chapter to do justice to this wealth of information and practice wisdom, and we have chosen to focus on adults of working age. A major reason for concentrating on adults of working age is that the incidence and prevalence of common mental disorders (depression/anxiety and so on) is considerable and the economic costs to society are huge. Also, as demonstrated some years ago (Huxley et al., 1989a, 1989b), in the average social workers caseload, whether made up of childcare cases or older people or a mixture of all types, one can confidently expect about two-thirds of the people being helped to have some form of common mental disorder. Similarly, Isaac et al. (1986) showed that a huge proportion of the parents of the children being helped have a psychiatric history themselves.
Sherrill Evans, Peter Huxley

10. Social work practice in mental health

Contemporary mental health practice in a field of changing policy and legal requirements presents many challenges to the inexperienced and experienced social worker. In recent years, the rapid rate of changes to policy and practice has served to exacerbate the complexity of social work practice in an increasingly uncertain world. What then for the morale of the social worker and the service user? How can the competing ideological concepts of recovery and risk be reconciled in a world of dwindling resources? These are some of the challenges that frontline practitioners face.
Caroline Leah

Social Work and Substance Use


11. Social policy and substance use

What we call people, the labels we assign them or their behaviours, give powerful messages about our value base. In the alcohol and drug field, there are a plethora of terms, many of which are stigmatizing and negatively labelling. People with alcohol and other drug problems should not be defined by their problem. Social work principles have always rejected pejorative terms and the homogenization of individuals. Where alcohol and drugs are concerned, these include terms such as ‘alcoholics’, ‘winos’, ‘addicts’ and ‘junkies’. Such terms do little to help motivate or support someone to change, nor do they accurately reflect the fact that people with alcohol and drug problems have a range of identities, including being professionals, partners, parents, family members or members of a local community. They are, first and foremost, people.
Sarah Galvani, Angela Thurnham

12. The legal foundations of social work in the field of drug and alcohol abuse

Working with children and adults who misuse drugs and/or alcohol, or who are affected by their use by those around them, although challenging in itself, brings into sharp relief several tensions that surround or pervade social work more generally. To begin with, there is nothing inevitable about the shape or content of the legal rules that are enacted.1 Rather, they reflect the nature of society and its social divisions, which is demonstrated in how diverse European countries have legislated differently with respect to misuse of drugs (EMCDDA, 2005). Consequently, debate and contestation are characteristic of law-making, and the outcome is frequently one that exhibits elements of compromise, moral judgement, lack of clarity and/or political ideology. It can be instructive, therefore, to discern the push-pull dynamics surrounding legislative developments.
Michael Preston-Shoot

13. A theoretical perspective on social work and substance use

At the heart of this chapter are two beliefs. The first is that social work and social workers need to know how to work with substance misuse issues. The second is that the substance misuse field would benefit from social work involvement because social work brings a distinctively critical and characteristically psychosocial approach to alcohol and other drug problems. As a result, a strong engagement by practitioners and researchers from social work with theories in relation to substance use and misuse is likely to be beneficial for social work and the substance misuse field. It is worth exploring these beliefs further before outlining the content of the chapter.
Donald Forrester, Aisha Hutchinson

14. Social work research and substance misuse

Chapter 13 argued that social work would benefit from better knowledge of what works with drug and alcohol problems. It also suggested that the substance misuse field could learn from the theoretical insights and practice approaches typical of social work. These arguments were outlined by illustrating the contribution that key approaches in the substance misuse field (specifically motivational interviewing and social behaviour and network therapy) might make to improving social work practice and the ways in which social work’s critical and sociopsychological approach might strengthen these interventions. It was also suggested that this might be a good fit with a general move towards a focus on ‘recovery’ in substance misuse work. This chapter develops these ideas further by considering some research studies that look at social work contributions to substance use and misuse intervention; in essence, it illustrates the arguments outlined in the theory chapter.
Donald Forrester, Georgia Glynn, Michelle McCann

15. Working with people who use substances

Social workers from all areas of practice work with people affected by their own or someone else’s alcohol or other drug problems. Problematic substance use (alcohol and other drugs) is common within child and family social work practice, adolescent work and in mental health settings. Social workers working with older adults and people with learning difficulties also report increased substance use among their service user groups. It is important therefore that whichever group of people you are working with, you are prepared to identify and assess their substance use. Set within the wider context of a range of social work assessment processes, this requires few additional skills but it does require an understanding of what to ask, how to ask it and what to do with the responses you receive.
Sarah Galvani, Sarah Wadd

Social Work and Old Age


16. The place that social policy plays in shaping the social context of older people

Old age is not, of itself, a ‘problem’, a pathology or a statement of need. ‘Older people’ are not a homogeneous group and categorization as a distinct service user group is, arguably, contentious (Phillipson, 1998). Furthermore, since the advent of personalization, conceptualizing support by user groups is considered by many as obsolete (Poll and Duffy, 2008). People do not receive social services by virtue of being ‘older’; rather, they are in need of a service because of, for example, ill health, physical impairment, mental health difficulties, addiction or offending.
Tony Gilbert, Jason L. Powell

17. The legal foundations and requirements for social work with older people

Within the legal system of England and Wales, there is no body of law separately identifiable as relating exclusively to older people. Old age, unlike childhood, has no separate legal status; although age thresholds may act as a gateway to welfare benefits, or as a barrier to remaining in employment, older people generally have no greater call on public services or public protection than other adults. This has both an advantage and a disadvantage. The advantage is that older people have the freedom to reject paternalistic involvement from concerned others, relying on their status as capacitated adults. The disadvantage is that legal powers and duties in relation to older people are often ill-defined, and securing rights for older people may be a contentious issue.
Ann McDonald

18. Landscapes and portraits: using multiple lenses to inform social work theories of old age

The application of social work theories, methods, frameworks and models often presents great challenges to practitioners in many fields of practice. Sometimes, the explicit use of theories is avoided, ostrich-like, with social workers protesting that they do not see their relevance. Some social workers espouse an anti-intellectualism, which fails to understand that all practice is based on an understanding of the world, whether that be local, at a personal level, an agency-adopted and tacit approach, or a procedural or legislatively prescribed model, rather than a more formal, recognized method of practising social work (Coulshed and Orme, 2006; Parker and Bradley, 2010). Sometimes, it may be the structure of the workforce and social policy that leads to the eschewal of theory. Social work with older people has not been the priority of policymakers, workforce planners or academics for many years. As such, the workforce has not been able to develop its theoretical base as fully as other areas of practice.
Jonathan Parker

19. What research tells social workers about their work with older people

Introductory texts often establish two broad themes in relation to older people in society. First, societies are ageing and this poses a problem for policy-makers in terms of finance and long-term care systems. Second, the growth in the numbers of older people will necessarily be accompanied by a rise in illnesses, vulnerabilities and social difficulties of old age that will put untold pressure on statutory and other services. These considerations lie largely outside the personal experiences of social workers, but they do set a context for practice. Societies are undoubtedly ageing (the first point) but research offers evidence to temper the enthusiasm with which the second point has been articulated. Research evidence also leads us to pause slightly and examine just who it is that the social worker, working with older people, might routinely offer help to.
Paul Clarkson

20. Social work with older people

Contrary to commonly held perceptions, older age is not a period of inevitable decline, and most older people never need social work intervention, with only 15% of people over the age of 65 receiving social care support (Audit Commission, 2008). As people grow even older, however, their take-up of social work and social care support increases (Forder, 2008). It can be surmised that a person over the age of 85 is more likely to be in receipt of social care support than at any other time in their life. It is important, however, to put this statement into perspective, by noting that over 50% of people over the age of 85 are not in receipt of social care services (Phillips et al., 2006), with only 18% of people over 80 years of age living in residential care, a figure that rises to 28% for people over 90 years of age (Audit Commission, 2008).
Rhiannon Jones
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