Max Bell

Street triage practitioners, consisting of mental health social workers and nurses, act as a conduit between service users and emergency services and have a significant amount of discretion in determining the care and treatment pathways for individuals experiencing mental health crises. However, this is set on a backdrop of neoliberal reforms which have resulted in an increased focus on risk management, accountability, responsibilisation, and managing scarce resources. Based on ethnographic research undertaken in a street triage setting in England, this paper examines the role of street triage practitioners as ‘street level bureaucrats’ and explores the impact of neoliberal mental health reforms on street level practice and how these shape and constrain the use of discretion in a street triage context. Revisiting the relevance of Lipsky through a neoliberal lens, the research paper identifies how street triage practitioners use their discretion to navigate practice dilemmas in a contemporary mental health landscape.

Within this article we highlight that social work is both a political as well as a professional practice. Despite years of technical specialisation and a policy context that has focused social work on risk management and resource allocation, there remains a deep commitment to care, compassion, and solidarity within contemporary social work practice. The article and its analysis make the case for a more politically informed social work practice, one that is based on solidarity; in opposition to a system that isolates individuals and internalises complex social problems. We posit that the application of solidarity within social work delivers a practice that promotes social inclusion and is based on the provision of practical social support. It is from this perspective that we will present evidence from ethnographic research, drawn from community social work practice, to highlight the importance of social solidarity and provide an insight into different ways of working.