Reform into Renewal: how social care and community services can seize the opportunity for change
By Rob Manchester
Cast your mind back to 2016 when Theresa May made her inaugural prime ministerial speech outside Downing Street about the ‘burning injustices’ of our age…do you vaguely remember? To be fair, since then, a LOT of other stuff has gone on in and around that most famous of UK addresses - but it was quite something that a prime minister chose to include the ever-increasing use of compulsory Mental Health Act powers as one of her priority issues for government during that all important opening period in office. Eight years, a costly Independent Review, and considerable expert-by-experience, professional and political debate later, will the stricter detention criteria and some of the other reforms in the Mental Health Bill contribute to a reduction in compulsory admissions and address the disproportionate use of compulsion amongst some racialised communities, as it was intended to do?
If so, then community services, including mental health social care, will become more relevant than ever in supporting people in crisis, managing risk and preventing admission. This certainly links in with the Government’s overall mission in its Ten-Year Plan for the NHS to create three clear shifts in healthcare: “treatment to prevention; hospital to community; and analogue to digital”.
When it comes to reducing psychiatric admissions, I have always been more interested and invested in how mental health services are designed and delivered to enable much more localised, social, relational, co-produced models of care and support – rather than legal reform per se. Don’t get me wrong, the Act is over forty years old and parts of it are certainly beginning to show their age (a bit like me :)), so modernisation is welcome. Yet perhaps the law is kind of analogous with the foundations of a building – yes, it sets the parameters, the scope, the tone for what is to come above the surface; yes, it has to be strongly grounded in the right principles and values. But what we now build together on top of it is what really counts. We definitely don’t want to put back what was already there. Now is the time to be bold, innovative and collaborative, ensuring that Local Authorities and their statutory mental health social work services (AMHPs included but not exclusively) are at the forefront of the new offer. In this changing landscape, social and relational models of care such as Peer-Supported Open Dialogue are gaining traction with research evidence increasingly confirming what we have for a long time intuitively known. I am very hopeful that the much-awaited and imminent ODDESSI results don’t disappoint in this regard - word on the ground is that they won’t (See https://www.ucl.ac.uk/brain-sciences/pals/research/clinical-educational-and-health-psychology/research-groups/oddessi/oddessi-trial for more info on ODDESSI).
Another exciting example of this innovation towards more social model care is in the new 24/7 neighbourhood mental health centres, which are being piloted in six areas of the country. As I understand it, these are “one-stop shops” located in the heart of communities (not on hospital sites – and that is important) where people experiencing mental health problems of any description (they are intended to have no exclusionary criteria) can access immediate help and support – of a clinical nature if they want it, but crucially also peer workers, housing and benefits advice, and social support. As these centres get rolled out across the country, mental health social care will need to be agile in how it positions itself and its vibrant social and rights-based offer and skillset in these new spaces. We need to learn to meet people where they are and when they need help (to prevent rather than wait for crises), without falling back into tired old silos defined more by referral forms and criteria, rising thresholds, waiting lists, inaccessible phone lines, and assessment after assessment.
As a manager of a mental health social care team, often one of my biggest gripes with the psychiatric system is the disconnect between community and inpatient services, with a faltering lack of continuity of care in a person’s journey into and back out of hospital. Even for those with s117 aftercare rights, social care frequently gets called to the table at the last minute or even once a person has already been discharged. Therefore, it is encouraging that every person admitted to hospital will have a statutory care and treatment plan to cover their entire journey. These plans will need to include comprehensive discharge arrangements and social care as a crucial part of these. Yet parliamentary scrutiny has expressed concern that these proposed statutory care and treatment plans risk sidelining social care professionals, as care planning remains medically-driven and medically-focused. Is there anything more or different we can do to shift these traditional professional power dynamics?
In addition, some among you will point to the fact that s117 aftercare plans already cover this ground, have a statutory footing and yet are not consistently produced, let alone properly co-produced (between health and social care, the person and carer) and given to the person they are about (a legal requirement). There are not just practical or logistical challenges to overcome when developing good ‘joined up’ s117 aftercare plans with input from healthcare and social care professionals who increasingly have different employers and different electronic care record systems– there is also a fundamental conceptual clash between the relapse prevention and risk averse emphasis of s117, as opposed to the much more strengths-based and independence-focused framework of The Care Act, within which social care staff are accustomed to operating (and which, let’s face it, is closer aligned to core social work values).
It’s also true that the existing legislation or accompanying guidance provides only partial clarity on how s117 assessments should be undertaken (or even whether formal assessments are required) although the statutory guidance on ‘Discharge from mental health inpatient settings’ from last year (Discharge from mental health inpatient settings - GOV.UK) does outline some strong principles which stress the importance of systemic working with the person of concern and their social and professional networks. This additional guidance is welcome (although underused in my experience), as is the news that ADASS and the Local Government Association are currently putting together more of a ‘how to’ guidance to LAs on this. The government's response does indicate an intent to bolster guidance—committing to clarify the purpose and content of section 117 aftercare in the new Code of Practice and to develop national guidance on financing and responsibility sharing.
Bringing the way in which we determine ordinary residence for aftercare in line with the Care Act deeming provisions and The Children Act for children and young people makes some sense, as it can be difficult to smoothly transition a person’s aftercare to a different responsible local authority if/when they get detained whilst living in specified accommodation in another area. Continuity of care can suffer when Local Authority responsibility changes hands – reducing the frequency of such changes could, therefore, be a good thing. However, reviewing and providing consistent and reliable care across county lines and long distances, and with a high turnover in the workforce also has its challenges. How will we match this long-distance social care provision with the principle of community based mental health care?
With fewer people on Community Treatment Orders and for shorter periods of time, services will have to rely much more on pro-active relational approaches to engage harder to reach people in care and support, rather than on coercive methods. The fact that mental health social workers can make a big difference in the areas of life that tend to matter most to people – access to decent, stable housing; welfare rights; meaningful occupation; and social connection – provides an existing platform to reach people and build trust.
The Dynamic Support Registers, which subject to parliamentary approval, will place a duty on Integrated Care Boards (ICBs) to improve monitoring of the needs of, and support for, people who may be at risk of going into crisis and being detained under Part II. The Bill places a duty on ICBs and local authorities to have regard to information on the register when exercising their commissioning and market shaping functions. This shows that there is recognition that the reforms will only work if there is a diverse community and preventative mental health offer, one which is tailored to the specific needs of specific localities. Likewise, the changes to the detention criteria for people with autism and/or learning disability will apparently only come into effect once the community services for these cohorts are strengthened. It’s heartening to see that legal reform is being accompanied by proposals for strong, targeted investment in the right areas. You cannot have one without the other. Understandable though that after such a long period of austerity in public service spending there is still plenty of scepticism that sufficient money will actually follow through.
In summary then, the renewed focus on community-based and preventative care is extremely welcome. Community mental health teams and mental health social care have seemed like Cinderella services in recent times, rather than the heartbeat of the mental health system. I have never been one to believe that more acute beds were the answer. Is this not like building more lanes on the motorway, you just get more traffic? Divert the money from urgent and inpatient care and into community provision – it is not just sound investment in the health and wellbeing of people, it makes much more financial sense too. As with any policy and practice shift, it will be about bringing all the stakeholders together behind an inspiring shared vision – a shared vision for what 21st century mental health services can look like, and what they can feel like to receive and to work in. This is why the stress on better multi-agency and multidisciplinary co-operation is encouraging (we have to make the ‘system’ less confusing to navigate with fewer pillars and posts), as is the strong engagement of users/survivors, families and carers in shaping care. It would appear that we now have a very good opportunity to ensure the ideas, values and skills of social work and social care are less like an adjunct or an afterthought in the mainstream mental health system, and much more like central components.
The Casey Commission will further shine a light on social care reform as one of the key policy areas of our times for national government, and the potential of a National Care Service to improve and create more consistency in both the access to, and quality of, social care is a very interesting development. The landscape is really opening up and evolving, and I like a lot of what I am seeing. But now isn’t the time for complacency – as mental health social work professionals and leaders we have to continue providing the systems leadership to ensure social work and social care are firmly in these spaces, shaping the new offer. MHA reform and the broader policy direction have created opportunities which we must now seize to help improve and modernise the mental health system along much more social, relational and local community-based lines.
Acknowledgements
As ever, I am thankful to count upon a number of brilliant minds within my professional network who have indirectly or directly contributed to the development of this piece.
A big thank you to Robert Lewis, Mental Health Social Work Lead at the Department of Health and Social Care, for bringing me up to speed on the Mental Health Bill and the broader policy direction.
And a big shout out to Tom Woodd, Forensic Social Work Lead in Devon Partnership NHS Trust, a great advocate and ally in all things mental health social care, and who contributed some excellent ideas as well as a rigourous edit :)
I am also grateful to Christina Cheney who also provided inspirtation for this piece through her excellent recent blog entitled ‘Local Authorities: Leaders in Community Mental Health’ - https://socialworkwithadults.blog.gov.uk/2025/10/10/local-authorities-leaders-in-community-mental-health/