Mental health practice in primary care: Some perspectives concerning the future of social work in organized delivery systems

Abstract

The rise of managed care as the dominant form of healthcare delivery in the U.S. clearly has dramatic implications for the profession of social work. Thus far and for good reasons, the professional dialog about managed care has largely focused on . the threats posed to the professional agenda of social work by managed care in its various forms. This article considers some of the more positive aspects of the transformation from fee‐based to population‐based healthcare systems, in particular the vigorous trend toward multidisciplinary primary care and collaborative mental health practice in primary care settings. It is argued that the market forces behind this trend also promote the emergence of models of social work practice that better integrate historically dichotomized aspects of health and mental health practice. Also considered are implications for social work education and the division of labor among the healthcare professions.     

Death-qualified jurors and the assumption of innocence: A cognitive dissonance perspective on conviction-prone verdicts

The conviction-prone behavior of death-qualified juries is a phenomenon that has been widely observed, but is not fully understood. This work presents a cognitive dissonance perspective as a possible mechanism that may be contributing to the high rate of conviction in death-qualified juries. This review contends that the selection procedures for death qualification may create juries with attitudes that are contrary to the fundamental assumption of innocence presupposed by the court. As a result of this conflict between juror attitudes and the assumption of innocence, dissonance will occur. One path to dissonance resolution may be the act of conviction. The empirical findings from juror studies support this dissonance interpretation of the conviction-prone status of death-qualified juries. This work also reviews the legal history of the death qualification process in Witherspoon v. Illinois (1968) and Hovey v. Superior Court (1980) and summarizes the social psychological criticism that process has received.     

Experiencing breast cancer in the context of mental illness in New Zealand

ABSTRACT

This study aimed to explore the experiences of women with mental illness who had also experienced breast cancer diagnosis and treatment, in particular, to identify barriers and facilitators to cancer treatment. Semi-structured interviews were conducted with ten breast cancer survivors who had had contact with secondary mental health services prior to their cancer diagnosis. Thematic analysis was used to identify key themes. Participants described positive experiences of cancer treatment, expressing surprise at both how well they coped with diagnosis and treatment and how well they were treated by services. Many contrasted this with their less positive experience of mental illness and mental health services. The women interviewed were active participants in their cancer treatment and did not report feeling stigmatised because of their mental health experiences. A lack of connection between cancer and mental health services was described, but this was not regarded as necessarily a bad thing. This study begins to counter the stereotypes of the difficult patient or the person unable to understand and cooperate in their own care which are prevalent in the literature. Further work is needed to understand the reasons for disparities in cancer outcomes.     

Differences by Race in Social Work Students’ Social Distancing,Treatment Options,and Perceptions of Causes of Mental Illness

ABSTRACT

Research has shown that racial and cultural differences are related to the degree of social distancing associated with mental illness, beliefs about what causes mental illness, and what treatment options are best; however, there is little information on how this may manifest in social workers’ perceptions of these issues. This cross-sectional survey analyzed the differences in perceptions by race of 835 students enrolled in social work classes in the United States. Results indicated that individuals who self-identify as African American/Black expressed the greatest social distance concerning mental illness. Whites were most likely to endorse the use of medication and were least likely to normalize mental illness. The most frequently endorsed mental health provider varied according to racial/ethnic groups. Our findings show that future research may be needed to further investigate the conceptualization of the role of social work among different groups. The need for self-reflection and keeping biases in check are discussed as implications for social work practice and education. Suggestions for working with diverse clients, including religious diversity, are offered as well.     

I. Patients of the treatment division of the judge baker guidance center 1

Abstract

There is a growing emphasis in the social work literature that social work's overall mission should be that of social justice and that mental health be relegated as outside of social work's realm. This paper draws upon a constructionist and narrative perspective in developing a general formulation of clinical social work to bridge the gap between social justice and mental health.     

Survivor of Suicide Loss Support Group Facilitators: Do Peers and Professionals Differ?

ABSTRACT

Suicide is a major public health issue affecting countless people each year worldwide. Support groups are one of the few resources available to survivors of suicide loss to aid the healing journey. This study examined differences among support group facilitators based on status as a peer, professional, or peer/professional. Differences emerged among the facilitator types, particularly on attitudes of group effectiveness, the role of sharing stories in the group, when loss survivors should attend, and who should facilitate groups. The results provide important insights about group facilitation differences, though further research is necessary to understand effective approaches. A degree in social work was the most common educational background for facilitators who identified as professionals. As social workers often facilitate groups or work alongside peers in the provision of support groups across a variety of areas, the findings provide insights regarding facilitation differences to which social workers may need to attend.     

Stress and Pressures in Mental Health Social Work: The Worker Speaks

Two-thirds of councils with social services responsibilities(CSSRs) took part in a UK survey of mental health social workers.A one in five sample of front line workers was drawn, and 237respondents completed a questionnaire and diary about theirwork context and content, and their attitudes to their work,their employer, mental health policy and the place of mentalhealth social work in modernized mental health services. Thequestions, that called for free-text responses, were completedin detail and at length. This paper reports the results of aqualitative analysis of these responses using NVIVO software.The paper is structured around the themes emerging from theanalysis: pressure of work; staffing matters; job satisfactionand well-being; recruitment and retention issues; and beingvalued. The conclusions are that the social workers value faceto face contact with service users, and that their commitmentto service users is an important factor in staff retention.The most unsatisfactory aspects of their work context arisefrom not feeling valued by their employers and wider society,and some of the most satisfactory from the support of colleaguesand supervisors. Without attention to these factors, recruitmentand retention problems will remain an unresolved issue.     

Conversations at the End of Life

Abstract

Oregon's Death with Dignity Act (ODWDA) has been in effect for eight years. The United States Supreme Court recently decided that Oregon's law did not violate the Controlled Substances Act. Other states may consider a law similar to Oregon's through legislative process or ballot measures. Although social work is not mentioned in the law, our profession interfaces with the terminally ill, particularly in hospice. Eighty-seven percent of those who have used the law were enrolled in a hospice program. As a pilot project, this article explores conversations that the authors have had with patients, families, team members and health systems in hospices and oncology settings under Oregon's unique environment. The following four themes emerged from these conversations: (1) mental health, education, choice; (2) team concerns; (3) family issues; and (4) values, ethics, restricted conversations and professional struggles.     

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Abstract

Social work practice in a psychiatric emergency department presents a unique set of professional and personal challenges for the clinician. This article presents an individual account of practice within this setting and within a larger system of mental health care which is overwhelmed by individual and societal needs and limited provider options. The personal and professional challenges which arise in response to crisis work with chronic populations is discussed.     

The Role of Family in Career Choices among Social Workers in China

Abstract

High turnover rate affects social work workforce development in China. Few empirical studies have been conducted to explore the factors that have influences on turnover intention among Chinese social workers. This study used data from China General Survey on Professional Social Workers to examine the influence of job satisfaction and family attitude on social workers’ career choices. The findings reveal that both job satisfaction and family’ attitude toward the profession have significant effects on social workers’ turnover intention. Family’s support or disapproval of the social work profession has moderate effect on the negative correlation between job satisfaction and turnover intention. The findings could be explained by the familyism culture of Chinese society and unique challenges of professional development experienced by social workers in China. Future studies should consider the influence of family to develop a more comprehensive research framework. Management in social service agencies should help family of social workers to learn and embrace the profession to gain their support of choosing social work as career.     

Politics of interprofessional collaboration: challenge to advocacy

Both interprofessional collaboration and advocacy for clients are highly valued social work activities; yet, when pursued jointly, they pose political dilemmas. An exploration of these activities reveals the potential for ethical dissonance and highlights the need for clear guides to professional behavior.     

On the Value and Meaning of Trauma-Informed Practice: Honoring Safety,Complexity, and Relationship

ABSTRACT

In social work, as in other mental health fields, there has been a surge of literature regarding trauma-informed practice. Even so, the value and meaning of being a trauma-informed practitioner still call for further explication and analysis, especially in the realm of clinical social work practice. Approaching and engaging traumatized clients with a trauma-informed lens carry profound implications in the assessment, diagnostic, and intervention stages of treatment, and these implications warrant further unpacking. Additionally, it is critical to explore, through real-world case examples, the significance of working with a trauma-informed lens. This article develops a stage-based, relational definition of trauma-informed practice and argues that trauma-informed practice prioritizes client complexity, social context, and the therapeutic relationship throughout the assessment, diagnostic, and treatment process. In addition, it prioritizes the nuanced experiences and needs of the client, in particular the need for safety, above specific treatment modalities. In this way, it has vital importance to the field of social work. The significance of being trauma informed is considered at all stages of treatment and will be illuminated through practice examples and a longer clinical vignette.     

Health and distress in social workers: Results of a national survey

Abstract

This study investigated the physical and emotional health status of professional social workers as well as their levels of distress. The results of this national survey of 668 randomly selected NASW‐member social workers indicated that while most were healthy and satisfied with work and relationships, 17% experienced distress, defined as substance abuse, emotional problems, and/or physical illness. The distressed social workers were more likely to experience difficulties in many areas of their lives, including dissatisfaction with work and low self‐esteem. Some of the social workers reported seeking help for personal/ emotional problems, but very few sought help for alcohol/other drug problems.     

Psychiatric nursing in the Netherlands and Great Britain: class,status and gender in the making of a profession

ABSTRACT

In most Western countries psychiatric nursing, from the late nineteenth century onwards, developed as a specialization under medical supervision and within one general training scheme for all nurses. In the Netherlands as well as in the United Kingdom (UK), this occupation, initiated by psychiatrists, more or less distanced itself from somatic nursing. A comparison of the twentieth-century development of psychiatric nursing in these two countries shows similarities in its basic conditions and some of the problems it faced, but also some remarkable differences, which are largely of a social nature. We argue that Dutch mental health nurses, in cooperation with asylum doctors rather than in opposition to them, succeeded in establishing a stronger professional identity than their British colleagues: earlier in time and to a greater extent they had opportunities to voice their views on their work and to define the social and didactic nature of their vocation. Our explanation of these national contrasts focuses on gender, class and social status, which had dissimilar effects in the two countries because of some fundamental differences in the hierarchies and religious affiliations of institutional psychiatry as well as in the more general class structure of the Netherlands and the UK.     

Enhancing Psychosocial Competence Among Black Women: A Psycho-Educational Group Model Approach

ABSTRACT

The lack of social work intervention models targeted toward the specific mental health needs of Black women has been recognized as a major gap in our knowledge concerning effective treatment. More recently, group work has been recognized as a useful and effective method of treatment for this population. This paper discusses the utility of a culturally specific, group intervention with Black women aimed at enhancing psychosocial competence as an effective mechanism to assist Black women in coping with the tasks of life and contributes to their ability to master life events. The model incorporates the use of literary works, authored by Black women as an innovative tool for enhancing the group process. Case vignettes are offered.     

Social Workers’ Perceptions of Job Satisfaction,Interdisciplinary Collaboration,and Organizational Leadership

ABSTRACT

To address job satisfaction, and therefore employment retention, of hospice social workers, this study examined how relationships with other members of the interdisciplinary hospice team and perceptions of hospice leadership may be associated with job satisfaction of hospice social workers. The sample of 203 hospice social workers was recruited by e-mailing invitations to hospice social workers identified by hospice directors in three states, use of online social media sites accessed by hospice social workers, and snowball sampling. Study measures included professional experience, hospice characteristics, interdisciplinary collaboration, perception of servant leadership, and intrinsic and extrinsic job satisfaction. Variables significant in the model for intrinsic satisfaction were perception of servant leadership, interdisciplinary collaboration, and feeling valued by the hospice physician. Variables significant in the model for extrinsic satisfaction were perception of servant leadership, interdisciplinary collaboration, feeling valued by the hospice physician, and number of social workers at the hospice. Interdisciplinary collaboration was more important for intrinsic job satisfaction and leadership style was more important for extrinsic job satisfaction. Profit status of the hospice, experience of the social worker, caseload size, and other variables were not significant in either model. These results support previous findings that leadership style of the hospice director and relationships with hospice colleagues are important for hospice social workers’ job satisfaction. Such low-cost modifications to the hospice work environment, albeit not simple, may improve job satisfaction of hospice social workers.     

Risk, Mental Disorder and Social Work Practice: A Gendered Landscape

Whilst the importance of gender for social work practice, riskand mental health has been recognized theoretically for sometime, few attempts have been made to explore this area empirically.This paper presents findings from a mixed-methods study of socialwork practice in relation to mental health service users perceivedto be ‘high-risk’. Findings suggest, first, thatthe concept ‘high-risk’ was gendered because theprimary focus in social work practice was on the risks posedby male service users to others. Second, female social workersin the present study were found to have more female serviceusers from their caseloads who had been defined as ‘high-risk’compared with their male counterparts. The paper goes on toexplore this apparent congruence between female social workersand female service users and highlights how the management ofrisk could be considered gendered because it reflects a worker’s(perceived) capacity in cultural terms to ‘decode’the nature of the risks that their clients face as genderedsubjects. The paper demonstrates how the intersections betweenrisk, mental disorder and social work practice can thereforebe understood as a gendered landscape. It concludes by highlightingthe implications of these findings for social work practiceand research.     

Exploring Social Justice for Clinical Social Work Practice

This article explores social work practitioners' understanding of social justice and how understanding facilitates or impedes the pursuit of social justice within the practice field of mental health. Existing confusion and ambiguity regarding what social justice is poses a barrier to social justice pursuits. Analysis of qualitative interview data from practitioners resulted in a multidimensional conceptualization of social justice as social systems, resources, and transformative respect. Clinical social workers in the field of mental health with an enhanced understanding of social justice may be better prepared to meet the profession's social justice aims.     

Social Workers' Personal Death Attitudes,Experiences, and Advance Directive Communication Behavior

Abstract

This research surveyed 29 social workers to examine their personal death attitudes and experiences in relation to their advance directives communication practice behavior. The study measured death attitudes on 5 dimensions: fear, avoidance, neutral, approach, or escape acceptance of death. Participants' personal experiences with terminal illness and death were also assessed. Advance directive communication practices were operationalized as 7 phases: initiation of the topic, disclosure of information, identification of a surrogate decision-maker, discussion of treatment options, elicitation of patient values, interaction with family members, and collaboration with other health care professionals. Findings suggest that social workers' advance directive communication behavior differs by practitioners' death attitudes and experiences. Implications for social work education and professional development are discussed.