Commonalities between Social Care and Psychiatric Nursing
In looking at the social, political and historical backdrop to social care in Ireland, it struck us that there are a number of commonalities between psychiatric nursing and social care and it is worth alluding to these briefly here.
• Major shift from institutional
residential care to foster care in social care.
• Major shift from hospital setting to community care in psychiatric nursing.
• More problematic clients coming into social care and psychiatric care.
• Range and depth of problems with 'clients' and patients has widened.
• Severity of problems with 'clients' and patients has worsened (this is, of course, debated in the literature
in psychiatric nursing and social care).
• ''Clients' and patients in touch with a range of statutory and voluntary services.
• More violence and aggression is apparent amongst clients and patients (another area that is debated
in psychiatric nursing and social care).
• Staff in social care and psychiatric nursing becoming proceduralistic and legalistic in
their work practices (see for example, Wells, 1998 and Wells, 1999).
• Public more aware and interested in social care and psychiatric provision.
• Definitional issues in social care and psychiatric nursing.
• Scandals driving social care and mental health policy responses.
• Issues of (further) training have become paramount in both social care and mental health (Wells, 1999a).
• Research being commissioned on a more regular basis in both disciplines. (McElwee, C. N., 1999, b).
Psychiatric nurses and social care workers appear to have a great deal in common as noted above. Both groups work with service users in either the health or social services environment who tend to be either marginalised or manifest difficulties in coping in social settings. Both are interactive disciplines with high degrees of interpersonal contact with clients. In addition, both groups are striving for professional status and recognition and it would appear that both groups are 'minority' sections of their particular broader fields. For example, within nursing, the numbers of general nurses are far greater than those in psychiatric nursing; while in the social service arena, social workers, for example, are better established than social care workers. Internally, the differences in focus and expertise may be apparent to both respective groups, but it may not be as clear to outsiders. Both groups are involved in environments that have been transforming their service orientation and philosophies, with major shifts in both cases from institutional to community based services (McElwee & Wells, 1999).
Both general nursing and social care appear to have no difficulty in attracting applicants with four applicants for each place in general nursing in 1998 (Commission on Nursing, 1998, p. 87) and similar figures given anecdotally for social care. Two new courses in social care, one in the Institute of Technology in Tralee and one in St. Patrick's College, Carlow have recently commenced and a number of post Leaving Certificate courses are run in various locations around the country.
A major difference between the two disciplines is that, historically, nursing has been regulated by a statutory authority whereas social care has attempted self-regulation (albeit, unsuccessfully). Minister Fahey met with representation from the Irish Association of Care Workers in April 1999 and 'reported that statutory registration for social care workers would not be a realistic option for at least another three years as there was ongoing research into the matter' (LA.C.W., p. 2, 1999). He has advised the Irish Association of Care Workers to embark on registration on an administration as opposed to a legalistic basis for the interim period.
Social care is an emergent profession in Ireland and has much work to do to acquire similar professional status to colleagues in social work and related professions. Nonetheless, social care is currently over-subscribed in the training Institutes and has developed very quickly from an unwieldy base with little training or accreditation. Social care workers now enjoy some of the benefits of an established profession and the work of social care is increasingly in the realm of the public. Several government departments have established various working and study groups to assess aspects of social care practice and training and the future for the discipline is, in some areas at least, more positive than it was at the time of the Kennedy Report in 1970 and the Task Force Report in 1980. More change has occurred since the beginnings of the 1990s in social care than in the previous one hundred years. Nonetheless, there is a considerable distance to be traveled and many barriers to overcome. In this there are further comparisons with psychiatric nursing. Perhaps one path to consider is the development of a generic worker who has a training background in social care, social work, mental health and psychiatric nursing. This mental health worker could work in specific areas of nursing and/or social care.
JOHN WELLS et al
Wells, J.S.G.,, Ryan. D., McElwee, C.N., Boyce, M.
and Forkan, C. (2000). Worthy, Not Worthwhile?
Choosing a Career in Caring Occupations. Waterford Institute of Technology.
McElwee, C. N. (1999, b). 'Mental Health, Social Care and Adolescence: Two Disciplines Divided by a Common Language', In D. Ryan, A. Jacob & M. Kirwin (eds.). Reflection and Rejuvenation: Issues for Irish Psychiatric Nursing into the Millennium. Kilkenny. APNM Ch. 5,pp. 95-140.
McElwee, C. N., Wells, J.S.G. (1999) 'Registration of Social Care Workers. An Irish Solution to an Irish Problem'. Irish Youth Work Scene. A Journal for Irish Youth Workers. 26,3-4.
Wells, J.S.G (1998) Severe mental illness, statutory supervision and mental health nursing in the United Kingdom: meeting the challenge Journal of Advanced Nursing 27, 698-706
Wells, J.S.G (1999) "How sharper than a serpent's tooth it is to have a thankless child" - A comparative analysis of mental health policy and practice with children and adolescents Irish Journal of Applied Social Studies 1(2), 2-26
Wells, J.S.G. (1999a) A Rose by Any Other Name In Ryan, D; Jacob, A; Kirwan, M (eds.) Reflection and Rejuvenation Issues for Irish Psychiatric Nursing into the Millennium Kilkenny Association of Psychiatric Nurse Managers Ch.4, pp.67-93