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 groupa
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
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.