Medicare Funded Mental Health Social Work: Better Access to What?

ABSTRACT

Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Scheme initiative (Better Access), is an Australian Federal Government scheme aiming to improve access to mental health services. Accredited mental health social workers have been involved in the delivery of services under Better Access for more than a decade. In this time, there have been significant changes in the field of mental health services, with consequent increases in size and costs for Better Access. Better Access now represents public spending of more than one billion dollars per annum, yet there is no ongoing account of its impact. In this paper we consider the policy chronology and evaluation of the program, using current available data to question the impact of Better Access on both the service system and the nature of mental health social work practice. This case highlights the importance of a clear articulation of the scope of mental health social work, and ongoing monitoring of the impact of policy in a policy environment increasingly characterised by individualised funding and service delivery structured according to the principles of New Public Management.

IMPLICATIONS

• Social workers' increasing involvement with Better Access has reshaped the scope of mental health social work practice.

• The impact of Better Access on outcomes for service users and mental health social work is not currently a focus of research attention.

• Better Access is a case study illustrating the potential of the policy context to directly shape social work practice, therefore critical engagement with the impact of Better Access is an essential professional imperative.

     

Policy-Practice in Social Work: Models and Issues

Abstract

The emergence of policy—practice is a recent development in social work. In this article, policy—practice is defined as a direct social work practice mode with the potential to strengthen the social work profession's abilities to meet its century-long commitments of providing policy-informed services to those in need of them. At the same time, policy—practice advocates for and participates in policy implementation and change. This article examines policy—practice and places it within the context of the profession's historic cause—function debate and identifies several barriers that have complicated development. Most important, the article reviews five policy-practice models found in the literature: (1) social worker as policy expert, (2) social worker as change agent in external work environments, (3) social worker as change agent in internal work environments, (4) social worker as policy conduit, and (5) social worker as policy itself.     

The Evolution of Mental Health Care Policy and the Implications for Social Work

Abstract

The focus of this article is on the evolution of mental health care policy in the United States from the eighteenth century to the present. To the extent that social work practice enacts policy, this article focuses particularly on the ways 20th century social workers have reflected, interpreted, and forged mental health care initiatives and reforms. The article includes a discussion of how the cycles of mental health reform (moral treatment, mental hygiene, and community mental health) have influenced not only the roles but also the actual practices of social workers. The article concludes with a consideration of the impact of managed care on mental health policy and the implications for social work.     

Social work and pastoral counseling: Empowering each other

ABSTRACT

This article addresses the divergent outcomes which can result from counseling services offered pastorally versus clinically. As faith leaders often have greater direct access than social workers to supporting religious populations, it is important to explore the intersection between religious pastoral support and clinical social work. Presenting six scenarios from the author’s own experiences as both a rabbi and social worker, this article processes each scenario first through the pastoral lens of an Orthodox rabbi, followed by the clinical lens of a social worker or other mental health professional. The client outcomes which are produced from each modality are radically different. This contrast demonstrates the distinction between the goals, values, and training of each profession, and highlights importance for future work to be done in linking religious and pastoral training to mental health services, as well as broadening the scope of cultural competence for social workers and therapists who may engage with tight-knit religious populations.     

Independent Mental Health Advocacy: A Model of Social Work Advocacy?

ABSTRACT

Advocacy has received less attention in social work research than other aspects of social work practice. This paper draws attention to two tensions in social work advocacy; between worker-led advocacy and person-led advocacy, and between individual advocacy and system level advocacy. We argue that human-rights-based social workers must choose a person-led approach over a worker-led approach while advocating with both systems and individuals. This argument is made by drawing on findings of an evaluation of Independent Mental Health Advocacy (IMHA) in Victoria, Australia. It is shown that social work training had not prepared social workers for rights-based, person-led advocacy and that social workers in public mental health services were struggling to maintain the rights of people in their services even with assistance from IMHA.

IMPLICATIONS

• Independent Mental Health Advocacy (IMHA) is a model of advocacy influenced by social work theory and delivered in part by social-work-trained advocates.

• Social work training is not preparing social workers for person-led, human-rights-based advocacy.

• Public mental health social workers are struggling to maintain the rights of people in mental health services even with the support of external advocacy services.

     

Legal capacity and the mental health social worker role: an international comparison

ABSTRACT

New capacity laws have been introduced to many jurisdictions over the last decade. These laws have substantially changed the way in which mental health social workers and other professionals approach decisions about, and for, clients. Most notably, there is now an expectation that mental health social workers engage more in supported decision-making to prevent the need for substitute decision-making. This article describes the legal and policy drivers that have led to these changes in practice, with a particular emphasis on the significance of the United Nations Convention on the Rights of Persons with Disabilities (the UNCRPD) and the importance of recovery approaches in mental health services. It then uses selected literature to explore the efficacy of the laws and decision-making in this area. The second part of the article identifies the role that mental health social workers can play in supporting legal capacity, drawing from the authors’ experience and knowledge of mental health social work and law in four jurisdictions: Victoria, Australia; Ontario, Canada; England and Wales; and Northern Ireland. It is concluded that mental health and other social workers need to refine skills, knowledge and values to accommodate this paradigm shift in law, policy and practice.     

Peer Support Among Consumers of Professional Mental Health Services

ABSTRACT

Peer-support services have become increasingly prevalent in mental health; consumers now deliver many services once provided by professional mental health providers. Recognizing this key asset in mental health consumers' service environment is critical for social workers. This exploratory study examines differences among 311 consumers of professional mental health services, half of whom also used peer-support services. The two groups (peer support compared with non-peer-support) were compared on a number of dimensions related to their utilization of and satisfaction with professional mental health services. Users of peer-support services perceived greater availability of professional services and used more professional services, but found professional services to be less useful than those not participating in peer support. No differences between the two groups were found for overall satisfaction with professional services. Findings related to policy, practice, and research are discussed.     

Educating Social Workers for Practice in Integrated Health Care: A Model Implemented in a Graduate Social Work Program

ABSTRACT

This article introduces a curricular innovation, the Integrated Health Scholars Program (IHSP), developed to prepare master's-level social work students for practice in integrated health care settings, and presents preliminary findings related to students’ self-reported program competencies and perceptions. IHSP, implemented in a research-intensive school of social work in a large midwestern public university, includes specialized course work, interprofessional education across health science disciplines, and field practicum in integrated health care settings. Curricular components support stepwise learning and follows the British Columbia model of interprofessional education learning tiers: exposure, immersion, and skill mastery. Despite IHSPs successful development in a well-resourced, supportive environment, challenges facing our profession's ability to develop and sustain training of MSW students in integrated health care are discussed.     

Back to the Future of Social Work: Child and Adolescent Mental Health and the Post Qualifying Curriculum in England and Wales

The first social work course to focus on children's mental health in the UK began in 1929 at the London School of Economics and Political Science. The subsequent child guidance movement spawned the genesis of child and adolescent mental health services (CAMHS) where social workers held a pivotal and much-respected role among multi-disciplinary teams. This role has been undermined in recent years. Post qualifying social work education and training needs to recognise and reflect the potential social work contribution to modern CAMH services to enable social workers in England and Wales to engage and contribute to supporting the increasing numbers of troubled young people. This paper sets out a rationale, knowledge base and outline content for ways in which the post qualifying social work curriculum can be developed to equip social workers with the necessary skills to engage purposively in this area.     

Mental Illness,Social Construction,and Managed Care

Abstract

Managed care is creating a social reality that affects the lives of millions. Mental health coverage under health care plans is a function of how mental illness and its proper treatment are defined. These definitions are shaped by social actors competitively seeking to satisfy their particular interests. This paper examines the influence of privatized managed behavioral health care on these evolving social definitions, as evidenced in published works, written reports, and legal actions. It is written from the perspective of social workers as providers of services and advocates for social justice. Options for social work responses to managed behavioral health care are explored.     

A Joint Legal/Social Work Services Program Helps Working Women Through the Divorce Process

Abstract

This study examined the effect of divorce on working class women and the effects of social work services of these women's experiences. The study was based on women who were members of a New York City Labor Union.     

Social Exclusion and Psychosis

SUMMARY

This article considers aspects of the possible impact of social exclusion upon psychosis and the implications of this for mental health social work practice. Against a background of calls for evidence based practice, and increasing recognition of the significance of theories and understandings as the foundations of practice, the article will first explore current and historical ways of viewing and intervening with the relationship between social adversity and mental health. Then, alternative understandings of this relationship, supported by recent research regarding the impact of trauma and extreme social adversity upon physiological and physical processes implicated in mental ill-health, will be discussed. These approaches have major implications for social work practice with psychosis, suggesting that experiences of trauma and disadvantage, and interventions seeking to alleviate the inner and outer effects of these experiences-tasks central to the social work remit-can make a significant difference to mental health outcomes. However, this is not to advocate a simple (albeit under-resourced) 'social solution'! On the contrary, the understandings underpinning these approaches recognise biological processes play a role in mental and physical ill-health: importantly, however, they can be shown to question the stigma traditionally attached to the concept of biological disorder in mental health, thus pointing to the value of a truly biopsychosocial approach with psychosis, involving fully holistic interventions that differ from those currently dominant, and which carry implications for more egalitarian worker-user relationships.     

An Innovative Behavioral Health Workforce Initiative: Keeping Pace with an Emerging Model of Care

ABSTRACT

Recent policy shifts in health care have created opportunities for social workers to provide services in integrated primary care and behavioral health settings. However, traditionally prepared social workers may not have the skill set necessary to meet practice demands. This article describes a behavioral health workforce initiative that trains master’s of social work students for work in integrated primary care settings with children, adolescents, and transition-age youths. The training model includes field placements in integrated care settings, co-curricular seminars, and advanced clinical electives. This article identifies challenges of creating new field placements and developing new curricula to support students’ acquisition of knowledge and skills required in integrated care settings. Additionally, it presents data on changes in students’ knowledge and confidence.     

Theoretical and Practical Imperatives for Reflective Social Work Organizations in Health and Mental Health

Summary

This article describes the common challenges to health and mental health organizations that require these agencies to become more “reflective” in their culture and structures. This necessitates integrating practice and research at all organizational levels. Schon's concept of reflective practice to health and mental health organizations is extended to develop the construct of a reflective organization, in which direct practitioners are integral to organizational learning through ongoing service evaluation and redesign. The theoretical and practical reasons why social work administrators and clinicians alike are obliged to integrate practice and research are discussed. University-based models of practice-research integration impede this process; Epstein's Practice-Based Research approach facilitates it.     

Window on the world. Social policy and social work in New Zealand

In recent years, New Zealand has attracted some international attention for its relatively rigorous application of monetarist, neo-liberal social and economic policies. This has led to its transformation from being one of the most socialized and protected economies in the western alliance to being relatively deregulated and open to global trade. The implications for New Zealand society and its publicly funded services have been profound. This article gives a summary of the outcomes of the neo-liberal era for New Zealand, including some of the major changes specific to social policy and social work. Areas of interest include: the growing recognition of the bi-cultural foundation of New Zealand society; the changes in welfare, labour, housing, and social security policies; and especially New Zealand's unique approach to the welfare of children and young persons. The implications of New Zealand's strong emphasis on contracting-out of social services are considered, alongside a broader assessment of the benefits of the 'reforms' for New Zealanders collectively. Some indications of future changes in direction, subsequent to the recent change in government, are also given.     

Recreating Social Capital

ABSTRACT

This paper describes the establishment of a pilot neighbourhood-based intergenerational programme and its evaluation in one town in England. It sets this in both the context of English inter-generational programmes involving schools and of English social policy. The latter is currently influenced by Putnam's concept of social capital. It argues that intergenerational programmes of all kinds are likely to be useful contributions to the development of social capital. The paper reports how the evaluation of the pilot has lead to the refinement of the original model. The pilot highlighted the need for more systematic measures of the process and outcomes, including the project's contribution to development of social capital. The revised model is being implemented in a number of contrasting neighbourhoods and will be evaluated in both outcome and process terms. These developments will be reported in further articles.     

Social Enterprise in Mental Health: An Overview

ABSTRACT

This article provides an overview of the models and concepts of social enterprise utilized for and by people with serious mental illness histories. Although social enterprise in mental health is not new, the naming of it as social enterprise and the attention these efforts have garnered is new. This article will provide a brief history of social enterprise in formal social services; review some conceptual issues and differences between social enterprise in Europe and North America—the two major current centers of its activity; and conclude with some observations of the ways in which mental health social enterprises are developing.     

Neuroscience in Social Work Practice and Education

Abstract

In the past two decades, advances in neuroscience research have revolutionized the scientific community's understanding of branehavior connections. Social work is now taking note of this trend. Specialists in substance abuse, addiction, and co-occurring diagnoses are beginning to relinquish long-held beliefs in mind-body dualism in favor of a truly integrated biopsychosocial understanding. This article identifies challenges related to social work and argues that neurobiological knowledge is essential for a biopsychosocial understanding of substance abuse and addiction, other mental disorders, co-occurring conditions, and human behavior. It gives examples of drawing on neurobiological knowledge for practice applications. These include educating users, families, and providers about neurobiological aspects of substance abuse (psychoeducation); using neuroscience research on mental illness and addiction to develop integrated approaches for dually diagnosed persons; and considering a range of medication options to alleviate cravings and reduce relapse.     

Addiction Problems,Addiction Services,and Social Work in the Republic of Ireland

SUMMARY

The aim of this paper is to review policy and practice in relation to the management of alcohol and drug problems in Ireland, with a specific focus on the role of professional social work. There is a high prevalence of alcohol and drug problems in the caseloads of social workers that work within the statutory childcare and criminal justice services. Professional social work in Ireland is of comparatively recent origin and there are few social workers employed in specialist addiction posts or settings in Ireland. The profession as a whole, moreover, has not actively lobbied for a greater role in specialist services. While formal social policy on addictions has shifted in recent decades towards broad public health strategies, which reflect a pragmatic European perspective, the disease model from the United States of America continues to have popular appeal.     

Social Comparisons of Psychological Distress by Boarding House Residents: Self-Evaluations of Mental Health and Healthcare Need

Abstract

Boarding house residents (BHRs), like the wider homeless population, are multiply disadvantaged and have disproportionately high levels of mental ill-health. Social comparison processes that involve comparing one's mental health to others, may lead BHRs to minimize their mental health problems and needs. This cross-sectional study examined BHRs' evaluations of their psychological distress compared to three social reference groups and the significance of these to their felt need for help with distress. Fifty-seven, mostly male, BHRs in New South Wales participated in structured face-to-face interviews that included an objective measure of distress (K10). There was no evidence that psychological distress was underestimated due to social comparison processes. Objective distress produced the strongest prediction of participants' desire for help. Participants reported substantially higher distress than the Australian normative sample and 58% had clinically significant distress. Of these BHRs, 42% indicated that they did not want any help for their distress, which highlights the need for strategies to better engage this group.