The United Nations Convention on the Rights of Persons with Disabilities (hereafter CRPD) has provided a radical imperative for the reform of mental health and capacity legislation around the world. The interpretation of the CRPD has been controversial, ranging from the complete abolition of detention, forcible treatment, and substitute decision-making to accepting that elements of these measures need to be retained based on non-discriminatory criteria, additional safeguards, and a comprehensive shift towards supported decision-making. While the potential effects of the CRPD on mental health social work and social work generally are considerable given their shared commitment towards social justice, to date there has been no review of research evidence exploring their relationship. In addressing this knowledge gap, this study held a preliminary discussion with practitioners and academics at the European Association of Social Work Mental Health Special Interest Group in Amsterdam 2022, followed by a scoping literature review on the question: What impact, if any, has the CRPD had on social work practice? The review produced four main findings: impact on legislation; positive impact on practice; limited impact on practice; and impact on social work education and research. In sum, while there were some positive indications of social work and mental health social work practice being influenced by the CRPD, these were scant. Barriers to change included tendencies among some social workers to practise substitute decision-making, in part related to resourcing and policy contexts, and understandings of disability aligned to individualised/medical rather than social perspectives. The results indicate that legal reform on its own is insufficient to impact social work practice, and that realising the potential of the CRPD will necessitate good quality training, as well as improving social workers’ knowledge of the human rights of people with mental impairment.

Introduction: We sought to evaluate the Robotic Anastomosis Competency Evaluation (RACE) — a validated tool that objectively quantifies surgical skills specifically for urethrovesical anastomosis (UVA) — as a means to track progress of trainees, as well as to determine its predictive value. Methods: UVAs performed by trainees at our institution were evaluated using RACE over a period of two years. Trainees were supervised by an experienced robotic surgeon. Outcomes included traineerelated variables (RACE score, proportion of UVA performed by trainee, and suturing speed), and clinical outcomes (total UVA duration, postoperative urinary continence, and UVA-related complications). Significance was determined using linear regression analysis. Results: A total of 51 UVAs performed by six trainees were evaluated. Trainee RACE scores (19.8 to 22.3; p=0.01) and trainee proportion of UVA (67% to 80%; p=0.003) improved significantly over time. Trainee suture speed was significantly associated with RACE score (mean speed range 0.54–0.74 sutures/minute; p=0.03). Neither urinary continence at six weeks nor at six months was significantly associated with RACE score (p=0.17 and p=0.15, respectively), and only one UVA-related postoperative complication was reported. Conclusions: Trainee RACE scores improved and the proportion of UVA performed by trainees increased over time. RACE can be used as an objective measure of surgical performance during training. Strict mentor supervision allowed safe training without compromising patient outcomes.

This article reports on an exploratory study comparing mental health social work (MHSW) in Europe. There has been very limited previous research comparing approaches to MHSW in Europe and so the aim of the study was to develop a better understanding of the similarities and differences between and, where relevant, within countries (referred to as jurisdictions). An online survey was distributed mainly through existing European networks and social media to seek information on the role, nature, extent and context of MHSW in a range of European jurisdictions. Conducted during the COVID-19 pandemic, there were 158 responses from 10 jurisdictions. Data were analyzed using thematic analysis. From this analysis, four main themes were identified, relating to: role; law, policy and education; the distinctive contribution made by MHSW; and the key challenges for MHSW. The study demonstrates that MHSW, although it is described and provided in different ways and is confined by a range of factors, plays an important role in mental health services across jurisdictions. There are also interesting differences between contexts, especially in the balance of therapeutic, legal and specialist/generic approaches, some of which reflect the World Health Organisation’s vision and objectives for mental health. Lastly, the study illustrates a need and provides a valuable basis for further comparative and collaborative work to define MHSW and enhance the contributions it makes.

Research shows that tensions between family carers and professionals become acute where the issue of compulsory admission to hospital is at stake. In England and Wales, a specific family member is appointed to safeguard the interests of a person assessed under the Mental Health Act 1983. This currently occurs through the Nearest Relative (NR) role. The Government is proposing to replace this with a Nominated Person role, chosen by the service user. Drawing on the concept of carer burden, this study reports on the views of nineteen NRs in England to discover their experiences of being involved in a Mental Health Act assessment. Participants identified that they undertook the role due to a sense of duty. Their experiences were mixed with participants highlighting both feelings of distress during the assessment and feelings of relief once their relative had been detained. Participants reported feeling conflicted when their relative was detained and feelings of frustration towards mental health services. The findings have implications for proposals to reform the Mental Health Act 1983. They show that education and support programmes should be created for NRs/Nominated Persons and that research is needed to assess whether such support is effective at reducing carer burden.

The enactment of the Mental Health Act (MHA) 2007 introduced the role of the multidisciplinary Approved Mental Health Professional (AMHP) in England and Wales by amending The MHA 1983. The role can now be performed by a range of professionals including a psychologist, an occupational-therapist, a social worker or a mental-health/learning difficulties nurse. This amendment amongst other legal provisions replaced the earlier Approved Social Worker role. This is an exploratory qualitative research that aimed to identify if the decision-making relating to management and assessment of risk varied according to the professional background of the AMHP. The decision-making of 10 social work and 10 nursing AMHPs were examined through the use of an experimental vignette containing audio-visual and written materials in order for participants to reach a decision about whether or not to detain. Proposed detention rates between social work and nurse AMHPs were identical although variation was found across the whole sample in terms of the risks that were identified in the vignette. The paper concludes by arguing that these results suggest that differences in the way AMHPs reach decisions may well relate to a variety of individual differences rather than reflecting initial professional identity and training as so often argued in the literature.

Seeking ethical approval and conducting research in an ethical manner are necessary components of research with human participants. Using the experiences of four individual studies undertaken separately into the same role, that of the Approved Mental Health Professional (AMHP), this article critically examines the challenges for multi-site research in health and social care settings. Issues arising are discussed: these are systemic and procedural, or barriers encountered using the integrated approach of the National Research Ethics Service. We discuss the lessons learned and argue that seeking ethical approval in multi-site research is currently a static construct involving the satisfying of what are in effect closed systemic and procedural requirements. We suggest that being a virtuous social work researcher, which we explore in the context of contemporary debates in social sciences, should instead afford open-ended integrity whereby the ‘permission’ granted is constantly revisited by the researcher or, in other words, that the integrated approach should allow being a virtuous researcher. We suggest that this cyclical activity has particular resonance for those researchers who are, simultaneously, health and social care practitioners. The article adds to the literature on ethics, conduct and integrity in health and social care.