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Abstract
Psychiatry in the UK is seemingly moving inexorably towards bureau-medicalisation, a potent combination of the medical model and organisational imperative. This paper looks at the causes of these developments and one consequent trajectory toward a generic mental health practitioner. This paper provides a rationale for mental health social work (MHSW), arguing against the temptation to modernise mental health care by seeing the demise of MHSW and creating a generic mental health practitioner. A case is made for the unique role of the mental health social worker, requiring a redefinition of MHSW. Because of the profound changes in the National Health Service, we propose that, far from moving to a world of the generic mental health practitioner, MHSW has a key role to play in providing a challenge to this monolithic structure, through having a double identification with both the institution it represents and representing the service users' relationship to that institution. No other professional body carries this unique role.