Guardianship for people with mental illness: Social workers' perspectives and decisions.

This research examines how social workers view the use of guardianship to meet the needs of clients with mental illness. It is the first empirical study of social work perspectives on guardianship and of social workers' decisions to select particular clients as appropriately placed on guardianship. An historical review confirms current relevance of 'tutor' and 'curator', forms of guardianship for this care group since Roman times, in contrast with the commonly held view that guardianship was introduced by the Mental Health Act, 1959. The nature of 'committee', as English equivalent to the Scottish tutors, is given particular attention. The survey part of the research employed a standard questionnaire which explored key guardianship concepts, sought to compare the role of social worker with that of guardian, and looked to future possibilities for the development of guardianship. The fieldwork took place in two adjacent London local authority social services departments. The profile of guardianship clients indicated that guardianship was used mainly for clients living alone in socially isolated circumstances, particularly women. It was used to help to gain access to the client to provide care and services, or to enable the person to move into residential care, often direct from hospital. For the most part, the present research confirms previously available data on clients. However it contests the view that guardianship is mainly used for people suffering from dementia, as clients with schizophrenia were in the majority in the survey sample. Different models of guardianship were used to assist in the analysis of data: the 'legal/substituted judgement' or 'advocacy' model; the 'parent/child' or 'social casework' model; and the 'therapeutic welfare' or 'case management' model. There was clear support for these and for core guardianship concepts, including authority, continuity, personalised care and surrogacy - irrespective of the model considered. Arguably, the idea of trust (as in trusteeship) was endorsed as being at the heart of guardianship. The position of social services departments as 'host' agencies for providing guardianship was seen as equivocal in that directors of social services have few incentives (and a number of disincentives) for taking on the responsibility. If social workers themselves have to shoulder the responsibility in the new community care climate, the absence of management back-up could seriously undermine the care given to clients and limit possibilities for effective adaptation of the guardianship concept. Social workers' verdict' on guardianship was that it has potential which so far has not been realised. There was general agreement that guardianship needs to change so as to be more adaptable and enforceable to meet clients' individual needs. It is anticipated that a revised guardianship formulation on this basis would be widely supported