Psychiatric morbidity in the clients of social workers: clinical outcome

Out of 141 new referrals to a Social Services Department 101 were assessed at inception and twelve-month follow-up using the Present State Examination (PSE), the Social Maladjustment Schedule (SMS) and the Case Review Form (CRF). Mental illness, financial and housing problems were the three problems most frequently identified by the social workers. At inception 72 (51%) of the subjects were PSE cases (ID greater than 5) and 25% at follow-up. The type of social work help offered to cases and non-cases did not differ. Social and clinical data collected at inception and follow-up were used to classify (using discriminant function analysis) caseness at inception and follow-up and clinical change. Caseness at inception (82% of subjects were correctly classified) was associated with depression, subjective social problems and poverty. Caseness at follow-up (74% correctly classified) was associated with poor coping abilities at inception and clinical features of depression. Clinical change (worsening) (71% correctly classified) was associated with seeing a Community Psychiatric Nurse and poor coping abilities at inception. The ability to classify correctly cases and change was enhanced when additional data from follow-up interviews were used. In the PSE cases, only clinical worsening was correctly classified by a high GHQ score at inception, age and poor coping abilities. The last result is similar to that obtained in general practice by Mann et al. (1981).