Medicalization of Social Workers in Mental Health Services in Hong Kong

Correspondence to Dr Kam-shing Yip, Associate Professor, Department of Applied Social Studies, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong. E-mail: ssksyip{at}polyu.edu.hk Summary Medical dominance is a crucial problem in social work practicein mental health services. This paper is an examination of theresponse of social workers to medical dominance in mental healthservices in Hong Kong. To explore the process and the effectsof medicalization of social workers, sixty-three social workersin various areas of mental health service settings were interviewed.Their reaction and daily performance in facing medical dominancewere analysed and evaluated. The findings show that facing medicaldominance was a common occurrence for social workers in variousmental health services in Hong Kong. Conflict existed betweenthe rationalization of medical knowledge by medical professionals,and social work rationalization of social work knowledge bysocial workers. The process of medicalization consisted of fivestages: ignorance of medical dominance, confronting medicaldominance, compromise with medical dominance, acceptance ofmedical dominance and internalization of medical dominance.The findings also show that medicalization was influenced bythe organizational and team context.     

Differential Impacts of Stressful Life Events and Social Support on the Mental Health of Mainland Chinese Immigrant and Local Youth in Hong Kong: A Resilience Perspective

Based on a resilience perspective, this study attempted to explorethe risk and protective factors influencing the mental healthof immigrant and local youths in Hong Kong. A structured questionnairewhich consisted of The Chinese Adolescents Life Events Checklist,The Perceived Satisfaction of Social Support Scale and The BriefSymptoms Inventory was used. Two hundred and ten local and immigrantyouths between the age of 15 and 20 were individually interviewedby the trained interviewers. Contrary to our hypotheses, thefindings revealed that immigrant youth had better mental healthand similar levels of stress than local youth. Moreover, peersupport was found to exert a strong impact on the mental healthof immigrant youth. While ‘Interpersonal relationshipdifficulties’ was identified as a common risk factor facedby local and immigrant youths, immigrant youth faced additionalrisk factors in relation to a change to a new school and parentalconflicts. On the other hand, endurance of hardship, socialcompetence and peer support were considered as the protectivefactors that might be associated with better mental health inimmigrant youth. The implications of this study included: toadopt a resilience perspective to understand the protectivemechanisms that enhance the mental health of immigrant youth;to develop a national strategy to build up the interpersonalrelationship skills of youth in a society; and to organize specificprogrammes to strengthen the peer system and tackle parentalconflicts in immigrant youths.     

Assessing the Impact of Social Factors on the Mental Health of Chinese at Risk Adolescents in Hong Kong

Correspondence to Dr Cindy Davis, University of Tennessee, College of Social Work, Nashville Campus, 193E Polk Avenue, Nashville, TN., 37210, USA. E-mail: cdavis3eutk.edu Summary The purpose of this study was to explore the relationship offamily, peer and school factors on the mental health of Chinesemale and female at risk adolescents and secondary school studentsin Hong Kong. Questionnaire surveys based on various standardizedassessment scales were conducted with 398 (183 female and 215male) Chinese at risk adolescents and 320 (160 female and 160male) Chinese secondary school students between 12 and 18 yearsof age in Hong Kong. Compared to secondary school students,at risk adolescents had poorer relations with parents, morenegative family and peer influence, a more negative school environment,and poorer social functioning. Findings also revealed that femaleparticipants had more somatic symptoms, anxiety, and depressioncompared to males. The importance of environmental factors onthe mental health of Chinese adolescents supports previous researchin Western countries. Implications for intervention and preventionwere discussed from a cross-cultural perspective.     

Working in Multidisciplinary Community Mental Health Teams: The Impact on Social Workers and Health Professionals of Integrated Mental Health Care

Correspondence to Professor John Carpenter, Centre for Applied Social Studies, University of Durham, Elvet Riverside II, Durham DH1 3JT, UK. E-mail: J.S.W.Carpenter{at}dur.ac.uk Summary This study investigated the relationships between the organizationof community mental health services and professional and teamidentification, team functioning and the psychological well-beingand job satisfaction of staff working in multidisciplinary communitymental health teams (CMHTs). Staff in four districts in theNorth of England completed anonymous questionnaires on two occasions,twelve months apart. There were systematic differences in teamfunctioning, favouring teams in districts where mental healthand social care services were integrated. However, service organizationhad no evident impact on professional or team identificationor on outcomes for staff in terms of stress or job satisfaction.There were differences between social workers (n = 31) and healthservice professionals (n = 82) indicating that social workershad poorer perceptions of team functioning and experienced higherlevels of role conflict. Controlling for other factors includingthe study districts, role conflict was a significant predictorof stress and of job dissatisfaction, while role clarity promotedjob satisfaction. We conclude that support and supervision aimedat ensuring a social work contribution to multidisciplinaryworking should be provided in the course of establishing CMHTsand integrated health and social care services.     

A systematic review of studies on ethnic minority youth development in Hong Kong: an application of the ecological framework

Abstract

Ethnic minority young people play a significant role in the socio-economic growth of an ageing society with a decreasing fertility rate. The successful social integration of individuals with diverse cultural backgrounds within a society is a core value of the social work profession. This study examines the understanding of ethnic minority youth development in Hong Kong using a systematic review methodology. Risk prevention and positive promotion factors were identified using Bronfenbrenner’s ecological framework. Articles were searched through multiple databases in English, and 36 academic articles were reviewed. These studies mainly examined the risks of academic failure of these students in Hong Kong while few focused on the positive directions of multidimensional youth development. Future social work research and practice should examine positive youth development for ethnic minorities which can inform social work practice in Hong Kong and within other East Asian traditionally ethnically homogeneous societies undergoing significant changes in ethnic diversity.     

A Natural Locally-Based Networking Approach for Singleton Disabled Elderly: Implementation and Case Illustration

Correspondence to Dr. Yip Kam-shing, Associate Professor, Department of Applied Social Studies, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong. E-mail: SSKSYIP{at}POLYU.EDU.HK Summary Hong Kong is a high industralized and commercialized city-sizedregion. Within such a business-orientated and competitive lifestyle,the elderly usually are the ones who have poor social supportand social networks. Many singleton elderly lead lonely liveswithin the community. The Good Neighbour Centre of the UnitedChristian Nethersole Community Health Service in Hong Kong hasimplemented a natural locality-based supportive networking approachfor disabled singleton elderly in a public estate (1991-2000).As part of this approach, various psycho-social interventionswere developed over nine years to strengthen mutual supportamong neighbours, able-bodied elderly, outpatients sufferingfrom mental illness and volunteers who were matched and integratedwith the disabled singleton elderly person to form a locality-basednaturally supporting community. Different stages of developinga natural, supportive community by networking were identifiedin this project: network assessment, network matching, networkformation and network strengthening. The concepts of stableand constant mutual support, mutual development and mutual concernwere stressed. Feedback from stakeholders was encouraging andthe demonstrated improvement in the functional and psycho-socialwell-being of disabled singleton elderly and mental health outpatientswas impressive and clear. Also, according to the principlesof the strengths perspective, the approach was strength oriented,that is it cultivated the potential strengths within a locally-basedcommunity: challenging the care and concern of members withinthe community through the loneliness of singleton elderly; developingthe mutual support and nurturing new supportive resources withina locally-based community. Further research may help to consolidatethe effectiveness of this approach through new strategies.     

Mental health of parents with young children in Hong Kong: the roles of parenting stress and parenting self-efficacy

This study aimed to explore the sources of parenting stress and the mental health of parents with kindergarten and primary school children in Hong Kong. It also examined the intervening effects of parenting self-efficacy on mental health of parents. Results indicated that parents who perceived their children as more demanding, less acceptable and less reinforcing had more parenting stress. Those who found their parental roles to be more restrictive also had more parenting stress. Lastly, parenting self-efficacy moderated the effects of parenting stress on the mental health of parents. Cultural and social factors were put forward to explain these findings and suggestions were made towards reducing the parenting stress experienced by parents with younger children in Hong Kong.     

Responding to Youth Crime in Scotland

Correspondence to Bill Whyte, Director, Criminal Justice Social Work Development Centre for Scotland, School of Social and Political Studies, University of Edinburgh, Flat 1FR, 31 Buccleuch Place, Edinburgh EH8 9LJ. E-mail: B.Whyte{at}ed.ac.uk Summary Scotland’s Children’s Hearings deal with young peoplewho offend within an integrated system dealing also with youngpeople in need of care and protection, on the assumption thatthe difficulties of both groups have similar roots in multiplesocial disadvantage and social adversity (Whyte, 1998a). A government-fundedstudy, one of the first since the system’s inception in1971, was commissioned to examine the social characteristicsof over 1,000 children and young people referred for offenceand nonoffence reasons. This paper describes the characteristicsof 465 of the young people who were referred specifically foroffending. It provides the first ‘official’ datain twenty-five years on young people in the system. The studyfound that most of those referred for offending had characteristicsstrikingly similar to those referred for nonoffence reasons,as predicted when the system was first established, and similarto those present in the general literature on young offendersfrom other jurisdictions. The study poses fundamental questionstaken up by the Scottish Executive’s review of youth crimeon how best to design systems and develop social interventionsthat can address offending and social disadvantage in an integratedway.     

Internationalizing Women's Struggle against Discrimination: The UN Women's Convention and the Optional Protocol

Correspondence to Dr Kwong-leung Tang, Department of Social Work, The Chinese University of Hong Kong, Shatin, Hong Kong. E-mail: kltang{at}cuhk.edu.hk Summary In the face of rampant violations of women’s human rights,women’s activism for change has extended beyond the nationalboundary. This paper discusses the importance of the UnitedNations Convention on the Elimination of All Forms of Discriminationagainst Women (Women’s Convention) in the promotion ofwomen’s rights. Adopted by the UN General Assembly in1979, this Convention has been ratified by over 170 nations.As an anti-discrimination treaty, it has both strengths andweaknesses. Recently, it has been strengthened through the introductionof an individual complaint mechanism (the Optional Protocol).It also provides for the conduct of special inquiry into violationsof women’s rights. To draw benefits from the Convention,women across the world must understand and act upon its keyprovisions. Social workers should support and facilitate itsimplementation by educating women about its main provisions,assisting them in the complaint procedure and overseeing states’full compliance with the Convention.     

The Approved Social Worker -- Reflections on Origins

Correspondence to Pauline M. Prior, Department of Social Policy and Social Work, University of York, Heslington, York YO1 5DD. Summary The aim of this paper is to examine the role of social workersunder current mental health law, in order to see if the adventof the Approved Social Worker (ASW) represents any more thanthe re-appearance of old concepts in a new guise. It is arguedthat it is impossible for the ASW to be anything more than anupdated version of the Relieving Officer of the last century,in view of the fact that the Mental Health Act 1983 does notprovide a clear mandate for an effective professional advocateon behalf of mentally ill people.     

An Unacceptable Role for Social Work: Implementing Immigration Policy

Correspondence to Dr Beth Humphries, Department of Applied Social Science, Lancaster University, Cartmel College, Lancaster, LA1 4YL. E-mail: b.humphries{at}lancaster.ac.uk Summary Social work has always had a role in policing the boundariesof welfare, and under New Labour there has been a decisive shiftto an increasingly narrow and negative practice. This articletakes social work’s involvement in internal immigrationcontrols as an example of the profession’s complicityin implementing social policies that are degrading and inhuman.It argues that social work has adopted a reactionary and uncriticalview of policy, and asks whether there might be a more progressivefuture for the profession.     

Beyond Retroduction? -- Hermeneutics, Reflexivity and Social Work Practice

Correspondence to Susan White, University of Manchester, Department of Social Policy and Social Work, Williamson Building, Oxford Road, Manchester Summary Over the last three decades qualitative research methodologieshave been in the ascent within social science. Yet social workevaluation studies have tended to be quantitative in nature,conventially relying upon the generation of criteria againstwhich interventions are retrospectively judged. The generationof such criteria inevitably depends upon pre-suppositions, whichin themselves go unresearched. As a consequence the .sense makingactivities on which social work interventions depend are renderedimmune from critical analysis. This reflects a broader tendencyfor social work to cling to naive realist epistemologies, whichare arguably obsolete within the interpretive paradigm in whichits activity is properly located. By examining the debates withininterpretive social science, this paper argues for an approachto social work assessment which avoids the pitfalls of naiveobjectivism and the nihilism of anarchic relativism, whilstretaining creativity, imagination and hope.     

Non-Statutory Mental Health Social Work in Primary Care: A Chance for Renewal?

Correspondence to Malcolm T. Firth, Honorary Research Fellow & Senior Psychiatric Social Worker, 'DEAL', Department of Psychiatric Social Work, 12th Floor, Mathematics Building, University of Manchester, Oxford Road, Manchester M13 9PL, UK. E-mail: malcolm.firth{at}mhsc.manchester.nhs.uk Summary The current status of evidence-based practice in the field ofmental health has led some to question the potential for innovationif social work practice is organizationally proscribed or reducedto a dogged adherence to methodological orthodoxy. Conversely,social work's value base is esteemed disproportionately to itsevidence base. Changing service contexts in the UK, particularlythe emergence of Primary Care Trusts as gatekeepers and commissionersof health and social care services, are providing opportunitiesfor social work to develop a new presence and purpose. The authorsdescribe their work in a small-scale service based in primarycare that anticipated these opportunities, by a retrospectivestudy of 120 cases. A new evidence base that derives directlyfrom practice is suggested as a way forward for social workeducation and training, as well as for service and professionaldevelopment.     

Working in the Social Services: Job Satisfaction, Stress and Violence

Correspondence to Professor Jan Pahl, Department of Social and Public Policy and Social Work, Darwin College, University of Kent at Canterbury, Canterbury CT2 7NY. Summary A major survey of the social services workforce (Balloch etal., forthcoming), carried out in the Research Unit at the NationalInstitute for Social Work, has produced new data about sourcesof job satisfaction and about the incidence of stress and violence.The survey took place in five different local authorities inEngland, and interviews were carried out with 1276 individuals,selected from four groups of staff: managers, social work staff,home care workers and residential staff. The results suggestedthat those who work in the statutory, social services do experiencemore stress and violence than workers in other parts of thehealth and welfare services. However, different jobs presenteddifferent hazards. In general, home care workers were the mostsatisfied with their jobs, and were also the group least likelyto be stressed or to experience violence in the course of theirwork. By contrast, residential workers, especially those withmanagement responsibilities, were most at risk of both violenceand stress. Men were more likely than women to experience violence,while other groups with a higher than average risk of stressincluded younger members of staff, and managers and social workstaff responsible for elderly people.     

Integration and Targeting of Community Care for People with Severe and Enduring Mental Health Problems: Users' Experiences of the Care Programme Approach and Care Management

Correspondence to Professor John Carpenter, Director, Centre for Applied Social Studies, University of Durham, Elvet Riverside II, Durham DH1 3JT, UK. E-mail: J.S.W.Carpenter{at}dur.ac.ukJ.S.W.Carpenter@dur.ac.uk Summary We report the experiences of different models of community careof random samples of 262 people with severe and enduring mentalhealth problems living in four districts in the north of England.The districts were characterized in terms of the extent of (1)integration between the health service-led Care Programme Approach(CPA) and social services Care Management, and (2) targetingof services on people with severe mental health problems. Themajority of service users felt involved in planning their owncare and considered that they had choice in their care and treatmentwhen in the community, but not in hospital. Although all theseusers were formally subject to the CPA, the proportions of usersin the districts believing they had a written care programmeranged between 37 per cent and 60 per cent. Of these, the greatmajority were very positive about their care programmes andfelt that they were being helped to become independent. Theseresults were replicated when 87 per cent of the original samplewas re-interviewed six months later. There were significantdifferences between the four districts and evidence that userspreferred an integrated health and social care service. In addition,a higher proportion of users in inclusive districts were satisfiedcompared to those in targeted districts. Notwithstanding thesepositive findings, there is still considerable room for improvementin relation to the involvement of family carers and the provisionof adequate information about prescribed medication and makingformal complaints.     

The Vulnerabilities of Children whose Parents have been Sexually Abused in Childhood: Towards a New Framework

Correspondence to Carol-Ann Hooper, Department of Social Policy and Social Work, University of York, Heslington, York YO10 5DD, UK. E-mail: cah13{at}york.ac.uk Summary Concerns about the parenting capacity of adults with a historyof childhood sexual abuse have often been framed in individualizingand pathologizing ways. This paper draws on qualitative researchwith twenty-four women survivors of childhood sexual abuse todevelop a new framework for understanding the possible vulnerabilitiesof their children that may help inform anti-oppressive practice.The framework places the mother-child relationship in its broadercontext, taking account of the role of the immediate family,the extended family, the community and the state. Within eachlevel of context we identify the range of issues that couldcontribute to children’s vulnerability, elaborating theprocesses involved. Some issues recur within different contexts,for example the impacts of survivors’ issues around attachment,and others connect across contexts, such as the impact on childrenof deterioration in their mothers' mental health when appropriateservices are not available. All of these issues may affect survivors’well-being and access to social support and hence their abilityto care effectively for their children. Ways of supporting bothsurvivors and their children involving greater collective responsibilityfor children, effective collaboration between mental healthservices and child-care services, and professional responseswhich take account of contextual issues are identified.     

Sleepwalking through an Epidemic--Why Social Work should Wake up to the Threat of Hepatitis C

Correspondence to Dr Ian Paylor, Department of Applied Social Science, Cartmel College, Lancaster University LA1 3HY, UK. E-mail: i.paylor1{at}lancaster.ac.uk Summary One of the many consequences of injecting drug use is the potentialrisk to infectious blood-borne viruses. There is evidence thatthe risk of contracting Hepatitis C (HCV) is greater than thatof HIV. Despite repeated warnings from a variety of sourcesand thousands of new infections among drug users each year andrising incidents of ‘'crack’ injecting, successivegovernments have failed to address a public health emergencyof immense proportions - the HCV epidemic. This article exploresthis issue and the implications it has for social work.     

The New American Social Work Gospel: Case Management of the Chronically Mentally III

Correspondence to Dr R. A. Cnaan, School of Social Work, University of Pennsylvania, 3701 Locust Walk, Philadelphia, PA 19104, USA. Summary Case management is currently the most popular mode of servicedelivery in the United States, especially in community programsfor chronically mentally ill people. Proponents of case managementclaim that it is cost-effective and that it assures provisionof necessary services to clients. In this paper I do not challengeits effectiveness but argue that case management neither empowersclients nor is it free of drawbacks. Given that many countriestend to model the United States, foreign social workers andother human service professionals should first examine the usefulnessof case management vis-à-vis their own cultural and economiccontexts, especially in the light of its many drawbacks.     

‘Not a good person’: family stigma of mental illness from the perspectives of young siblings

The purpose of this paper is to critically examine family stigma as one form of the stigma of mental illness in child and youth mental health. Presented are the outcomes of a thematic content analysis of in‐depth, semi‐structured interviews conducted with seven (n = 7) young siblings, ages 13 to 21 years old, with a brother or sister identified as having a mental‐health issue. The focus of the interviews was on the ways the siblings experienced their other sibling's mental health and how those experiences shaped their sense of self and family. From the analysis, young siblings had predominately negative experiences, struggled with making sense of their brother or sister and the family as ‘flawed’ against the mental illness as ‘bad’ and experienced considerable family stress and overt family stigma. Current practice theories fail to consider the complexity of these factors and, in doing so, fail to adequately explain the nature and extent to which stigmatization occurs for immediate family members. The importance of peer support and understanding stigma in social work practice with children and their families is discussed.