“I love my job and the amazing team I work with. It can be frustrating at times, but just as I think I’m getting fed up something fantastic happens,” says Abigail, a practice consultant in the forensic social work team within Norfolk.

Abigail works with patients who have been convicted of a crime but have also been diagnosed with a mental health problem, such as personality disorder, bipolar disorder or schizophrenia. The latter is the most commonly diagnosed mental health condition for those under forensic care in Norfolk, which is consistent with the rest of the country.

Abigail has worked in the forensic team for eight years, and works with patients in psychiatric hospitals, prisons, residential homes and community settings.

Abigail, practice consultant forensic team

But what is the “something fantastic” that Abigail describes? She gives the example of a young person, Charlie*, who Abigail has been working with for some years.

When Abigail started working with them, Charlie was a resident in a psychiatric hospital, but was unsettled there, ready to move on and wanted to live in the community.

“We approached a large number of providers seeking accommodation. However, due to serious but historical risks, they were unable to offer accommodation. This felt like a massive rejection and triggered past traumas, so hit them very hard.

“We work very closely with people which means we are able to support providers well and act quickly if there are difficulties.”

“They’ve now just moved into supported housing and they’re so happy and it’s absolutely lovely. Those little bits make [the job] brilliant,” adds Abigail.

Serious offenders

The forensic social work team works with patients who have committed serious offences – such as murder, attempted murder, violent sexual offences or robbery – while being seriously unwell.

Another person the team has worked to support is Keith*, a man in his 40s who was diagnosed with paranoid schizophrenia. Keith was convicted of the manslaughter with diminished responsibility of two of his family members. After his conviction, he was placed in a secure hospital, progressing after some time to a residential home and is now working towards living independently.

His recovery was made possible by medication and him fully engaging with many different healthcare professionals such as a psychologist, occupational therapist and the forensic team. Keith went through many rounds of therapy acknowledging his mental health problems and what he had done.

Only when he has a full understanding of the impact of his crime, the risks, relapse indicators and importance of engagement with the team, would he be able to move on to live in the community.

Abigail says working in the forensic team will make practitioners confront their own biases.

On one day, Abigail shook hands with four people who between them had committed nine murders.

“That was a bit of a shock,” she adds.

“You get a Christmas card from somebody who’s killed their parents, which does make you think about things. ‘Do I want to put it up in my house or at work? Is it something I want to accept?’ There’s a lot to think about and always a wider picture.

“It does make you think, ‘Am I doing the right thing?’. But if you can change one person’s life for the better then that’s a good thing.”

Residential reviewing team

The mental health accommodation-based review team (residential reviewing team for short) is another specialist team in Norfolk’s adult social care service that works with people with mental health problems.

The team was created in September 2022 as a pilot for one year, but has been extended for another two due to the success it has had with service users.

The main role of the team is to review the needs of adults who have a mental health diagnosis and are living in residential care or supported living.

Most of the people the team supports have a history of complex mental health problems or conditions, such as schizophrenia, severe autism or dementia.

Many have had periods of being detained in hospital and are receiving aftercare – the right under section 117 of the Mental Health Act to receive support after discharge.

The team helps people to move on to more independent forms of living, if appropriate, depending on how and where the person wishes to live and the progress they have made.

Hopeful work

Team manager Anna describes it as “hopeful work”.

“Because we’re not a frontline team, we’re mostly focused on reviews and 117 aftercare. We’re able to work quite closely with people and build up quite a strong working relationship with them, which is quite satisfying for practitioners,” she says.

Anna, team manager of the residential reviewing team

“Even if a potential move to more independent forms of living is not imminent, we can work with people on small goals. We work closely with providers to look at small goals such as increasing someone’s independence with meal preparation or going out into the community if they lack confidence with that.”

Anna shares a story of a woman in her 50s who had a history of rough sleeping. She had been through several evictions due to being unable to pay her rent and also experienced challenges with hoarding. She had a hospital admission and then was helped to move into a residential care home. After a stay at this particular home, she moved into supported accommodation and, says Anna, is flourishing.

“[The residential home] aspire to move people through their care home rather than have them stay there. I guess it’s the skill of the social worker and team as well that they’ve managed to engage with her.

“She’s quite difficult to engage with for various reasons. She has issues with trust, so I think forming those relationships with people [in the team] over time has helped get her to where she is now – to achieve some stability with support around her to maintain her tenancy, which has been the stumbling block.

“She is loving it, has much more independence, has her own flat, [and is] going into the community, to the library, to her church.”

The forensic social work and residential reviewing team both have a mix of practitioners with different expertise. Approved mental health professional (AMHP) training is necessary to work in the forensic team. Having past experience of working in mental health is ideal for both teams as cases can be extremely complex.

Norfolk provides in-house training specifically for those specialising in mental health, as well as offering on-the-job training, with shadowing and observation opportunities available across the department.

Are you interested in a career in adult social services with Norfolk? Visit the local authority’s employer profile to find out more.

*names changed for anonymity