Select Committee on Health Appendices to the Minutes of Evidence


Memorandum by Mr Guy Soulsby (H38)

  1.  Introduction; I am a social worker. I qualified in 1990. I became an approved social worker in 1992. I have always worked with adults. Prior to qualifying I worked in residential work in a variety of settings with people with physical handicap, learning disabilities, mental health problems and addictions. Since January 1995 I have worked exclusively at the Brain Injury Rehabilitation Centre (BIRC) at Rathbone Hospital in Liverpool, an NHS unit covering the boroughs of Knowsley, Liverpool, St. Helens and Sefton. I am employed by Liverpool Social Services. The BIRC is in a psychiatric rehabilitation hospital and the nursing staff are RMNs. I am part of Social Services' Mental Health Directorate. I am also secretary of the brain injury social work group—a loosely and informally constituted interest group of nearly 200 social workers drawn from across the country working either exclusively with this client group or having a particular interest in it. I am, however, writing in a personal capacity and not as a representative of either of these bodies. As far as I am aware representatives of BIRC will be writing to you about that service. I intend to write about the social work contribution to head/brain injury rehabilitation.

  2.  The biggest problem with the social work response is deciding where head injury fits within their services. The Social Services Inspectorate report on Traumatic Brain Injury Services in 1995 noted, in paragraph 3.4, that most social work departments routed their brain injury referrals through physical disability services. In my experience as secretary of the brain injury social work group this is either the ad hoc case by case response or sometimes the pre-defined route. The SSI report stated that this was not appropriate in the majority of cases although they did not go on to say which directorates within social services should respond. The two main alternatives would, in most areas, be mental health or learning disability.

  3.  It is commonly accepted that only 1 in 10 people have physical disability after a head/brain injury. The commonest problem is usually felt to be with memory followed by problems with other cognitive skills such as planning, problem solving, organising themselves. This can bring people under the Mental Health Act (1983).

  4.  This does, in my view, have an impact on what responses service users get. The first problem is that if there is no pre-defined route or pathway for referrals there can often be delays in having referrals allocated. If people are not physically disabled then the physical disability services will not be keen to take the case on. However, the mental health services will argue that it does not constitute a severe and enduring mental illness. Once allocated, and I have found that the vast majority of members of the brain injury social work group are based in physical disability terms, then there can be differences in what services people get. In a recent survey I did of the type of services members of the brain injury social work group can offer I found that those from physical disability teams were more likely to be limited to providing practical help within the home whereas those from mental health teams were more likely to be able to offer support to help people do a wider range of things in and outside the home. It is this type of enabling support which is, in my view, more appropriate for most people with a head injury. It should be noted that some members of the brain injury social work group felt that there might be some reluctance for people to engage with services located in the mental health services because of the stigma that can be attached to people felt to have a psychiatric problem.

  5.  When attempting to refer people to services in the community there can be problems with voluntary, private and public sector domiciliary, day and residential services which are often either funded or registered for a particular client group being reluctant to accept referrals.

  6.  This does not mean to say we need to have completely separate services for people with head/brain injury to have a seamless service. It is unlikely that completely separate services will happen quickly even if it were decided that that is the preferred route. I feel the basic skills are there within the existing services and can be easily transferred and applied to people with head injury given some guidance by those who are aware of the problems. What is needed is some recognition of head/brain injury in planning and funding services and a clear route for them be defined.

February 2001

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