The Social Work/Mental Health Boundary: A Qualitative Exploration

This study qualitatively investigates the conceptual border between social work practice and mental health practice. It explores how social workers experience, interpret and navigate mental health issues that are shaped by power imbalances, managerialism and fragmented inter-professional relationships. Drawing on the theoretical lenses of boundary spanning and the social/medical model debate, the research examines where social work is perceived to end, where mental health care begins, and how social workers operate within this contested space.

Social work and mental health services in the United Kingdom are historically organised within distinct professional, legislative and philosophical silos. Mental health provision is largely situated within the National Health Service and grounded in medicalised models of diagnosis and treatment, while social work practice is embedded within Local Authorities and informed by social, environmental and relational frameworks. Despite these formal boundaries, contemporary social workers increasingly encounter complex and severe mental health issues in routine practice. Global socio-economic pressures, including the 2008 financial crisis and the COVID-19 pandemic have contributed to rising levels of psychological distress. Consequently, social workers are frequently required to respond to poor mental health despite limited training, authority and access to mental health resources. This creates significant professional tension, uncertainty and emotional strain.

An interpretivist research design was adopted to capture the subjective meanings social workers attach to their experiences. Serial, in-depth interviews were conducted with 11 qualified social workers practising in the United Kingdom. Following an initial meeting, participants were interviewed on two occasions. A total of 22 interviews were undertaken. This approach enabled the exploration of participants’ reflections, allowing for deeper insight into how experiences of mental health are understood, rationalised and emotionally processed. Interview transcripts were analysed using Reflexive Thematic Analysis (RTA), resulting in a four-part thematic framework providing an intuitive and theoretically grounded explanation of social workers’ experiences.

Findings reveal that social workers routinely engage with severe mental distress while operating without the recognition, resources or legitimacy afforded to medical professionals. Participants described tensions arising from medical dominance, role ambiguity, and limited collaboration with mental health services, alongside feelings of responsibility, frustration and powerlessness. These conditions frequently generated moral distress, contributing to emotional exhaustion. At the same time, social workers demonstrated adaptive strategies consistent with boundary-spanning practice, including negotiation, translation between professions and problem-solving to meet service users’ needs.

This thesis makes original contributions to knowledge throughout. In its entirety, it articulates how social workers conceptualise mental health, professional identity and inter-professional boundaries within contemporary UK practice. The literature review concludes by offering a new way of thinking about an existing conceptual construct providing social workers with language to capture possible erroneous assumptions. The recommendations offer a re-conceptualisation of an existing model used to explain complexity in social work and offer suggestions to improve social work education to include mental health knowledge. Lastly, it provides an evidence-based argument for a new socio-therapeutic model of advanced social work practice to better address the overlap between the social and mental health domains, building upon, but conceptually distinct from, existing Advanced Practitioner roles in the UK.