Consensus or contention: an exploration of multidisciplinary team functioning in an Irish mental health context

Multidisciplinary teams (MDTs) are conventionally recommended in mental health care literature as an important way to offer holistic treatment provision to patients. This study aims to explore multidisciplinary teamwork in contemporary mental health settings, particularly what aids and hinders the process of multidisciplinary teamworking, and the social work contribution in such teams. In order to attain an in-depth exploration of these phenomena, a single case study design was employed. Within this design, data were generated through semi-structured interviews and structured observation of a mental health MDT in Ireland. These data were analysed using interpretative phenomenological analysis. The research highlights how the concept of mental illness is contested within this MDT, with the medical model dominant within an environment of fluid working arrangements. Professional role blurring and stereotyping were found to impact the division of labour on this team, with role negotiation found to be an integral part of retaining a professional's practice identity. This research raises concerns for social work's capacity to function within mental health MDTs in Ireland, and highlights ways in which social work educators might respond in order to empower Irish social workers to meet the challenges of mental health multidisciplinary teamworking.     

‘I'M NOT A PERFORMING MONKEY’: REFLECTIONS ON THE EMOTIONAL EXPERIENCE OF DEVELOPING A COLLABORATIVE TRAINING INITIATIVE BETWEEN SERVICE USERS AND LECTURER

In recent years there has been much interest in exploring how to meaningfully involve service users in social work education and training but there has been little attention paid to the emotional experience of such work. Working together involves emotional labour on the part of both the lecturer and the service user which is often overlooked in both the planning and evaluation of such work. Drawing on a collaborative training initiative undertaken by the authors on the subject of mental illness, this paper seeks to unpick some of the unconscious dynamics that can be at play. Using psychodynamic concepts such as transference, projection, reverie and containment, this paper aims to explore the emotional experience of service user and lecturer, as well as students, when working collaboratively. Assumptions and expectations underpinning service users' involvement in social work education will be unpicked with a view to facilitating an alternative understanding of experiences in the classroom and lecture theatre.     

Thinking from experience in psychosocial practice: reclaiming and teaching ‘use of self’

A course based on psychosocial theory and students' experiences in practice has been taught in the UK, Norway and Quebec. It departs from the classical social work concept ‘use of self’ and aims to help novices in health and social work to understand how the social world is internalised and re-produced and the value of thinking from experience. International developments such as, competency-based education, New Public Management and evidence-based practice reduce opportunities for experiential learning. This trend has been exacerbated by a focus on anti-oppressive practice without a corresponding understanding of how oppressive relations are internalized and enacted by defended and conflicted subjects. Attempts to rectify a relational deficit through traditions of reflective practice and critical reflection are important developments, but could be further strengthened by psychosocial and psychodynamic perspectives. The course combines critical, contextual and relational thinking for students in caring professions.     

Resilience,mental health and Assertive Community Treatment

Clinicians try to promote resilience by building an effective therapeutic relationship with their clients. Assertive Community Treatment (ACT) is an established approach for providing services to individuals with severe mental illness who have not fared well in the regular mental health system. This work underscores the importance of a resilient therapeutic relationship in preventing relapse and assuring adherence to therapeutic outcomes. Persistent psychiatric illness takes a toll on the resilience of the client, while the relationship work takes a toll on the resilience of the clinician. This article explores the concept of relational resilience between clinician and client as a dynamic process of shared success and failure, progress and regression through cycles of crisis, stabilization, relapse, and partial recovery. This is a qualitative study exploring how ACT clinicians promote and sustain resilience and is based on interviews with social workers, nurses, occupational and recreational therapists, coordinators, and psychiatrists.     

Navigating the ‘shadow of loss’ in mental health social work

ABSTRACT

The human experience of loss has been at the centre of psychoanalytic understandings of the human condition since Freud’s first writings on ‘melancholia’. This essay draws on psychodynamic theory to show how workers who are attuned to the experience of loss in service users can shape their interventions accordingly. By reflecting on how a diagnosis of ‘depression’ might better be understood as the rippling wave of past grief, professionals can utilise the dynamics of projection, transference and containment to help understand the emotional pain of individuals they support. But this essay also suggests that the use of psychodynamic practice works best when it is bolstered by other frameworks – in this case an understanding of systems theory. When the two traditions are utilised together, they provide an understanding of psychic phenomena which can enable social workers to build a basis for effective interventions with service users experiencing mental distress.     

‘It's People's Whole Lives’: Gender,Class and the Emotion Work of User Involvement in Mental Health Services

The concept of emotion work has been widely applied to the study of service work. Yet its use in understanding the social dynamics of user involvement in public services remains under explored. Drawing on a study of user involvement in mental health service development, I show its utility for understanding this social and political realm. The article discusses findings from a critical discursive and contextual emotional labour perspective, taking into account organizational and institutional factors as well as social structural dimensions of gender and social class. It shows how discourses on emotion, constructed through articulation of personal experiences of service usage both reflected and constructed the ideological and structural positionings of women service users, while emotional discourse — displays of anger in user involvement forums — worked to constitute traditionally male and ideologically masculine elements of the field, as well as the working‐class identities of some participants. These forms of emotion work, and the ways in which they elicited further emotion management from service users and workers alike, are located in relation to the rules of engagement of user involvement and the bureaucratic institutional forms within which this took place. The article concludes that the emotion work of user involvement ultimately helped to reproduce the dominant institutional and social order, including its gender and class dimensions. Implications for policies and practices of user involvement in mental health services are provided.     

RELEASING POTENTIAL — THE FUTURE OF SOCIAL WORK AND CAMHS

Several recent UK government initiatives are set to have an impact on child and adolescent mental health services. As a result new primary mental health worker and similar posts are being established. These jobs are proving attractive to social workers seeking to develop their special interest in child and adolescent mental health. This article sets out some of the problems and prospects for social workers undertaking them seeking to develop a modern psycho‐social practice using psychodynamic skills.     

The Impact of Family of Origin on Social Workers from Alcoholic Families

This study draws on the experience of six social workers who are adult children of alcoholics, to demonstrate that childhood learned responsibility and the capacity for attachment are translated into later professional acuity. The place of resilience in developing an understanding of the linkages between the experiences of adult children of alcoholics and social workers is examined and the consequences for social work practice and the education of social workers is outlined. Undeniably, prior life experience impacts on practice. Less well understood is the positive impact of negative experience. In the case of social workers who are adult children of alcoholics we argue that being part of an alcoholic family may significantly contribute to, rather than detract from, later practice competence.     

Educating Resilient Practitioners

Many social workers face challenges maintaining professional optimism and personal well-being in their chosen career. The retention of capable practitioners is important to employers and the wider profession. This paper reports on elements of an ongoing study into practitioner resilience in social work in health and non-statutory practice settings. The project aims to explore experienced social workers' understanding of their resilience in the face of workplace demands and stressors. Findings from a small, qualitative study of experienced practitioners in New Zealand suggest that social work education contributes in multi-faceted ways to preparing resilient practitioners. The authors recommend the strengthening of these elements in pre-service education.     

Psychological distress among mental health social workers

This study employs the General Health Questionnaire (GHQ-12) in order to examine psychological distress among Greek mental health social workers. The findings are examined in the light of the respondents' demographics, professional characteristics (educational background and work experience), work perspectives (job satisfaction and perceived work efficiency) and perceived financial strain. The study took place two years after austerity measures were imposed in the country. A self-addressed questionnaire employing 4-point Likert-type scale items was posted to 154 mental health social workers residing in an urban area in Greece. A statistical analysis of the 65 returned questionnaires identified frequencies and correlations in the corpus of the data. According to the findings, 15% of the practitioners were within the psychological distress range. When compared to their non-psychologically distressed counterparts, the psychologically distressed respondents were clearly differentiated according to their professional characteristics, work perspectives and perceived financial strain.     

A case for psychodynamic social work

Abstract

Psychodynamic casework is not as popular in social work theory and practice as it once was. It is considered by some to be impractical, unscientific, and not suitable for those customarily receiving a social work service. Task-centred casework, behavioural approaches, the newer psychotherapies, and family therapy have all taken over as major paradigms of social work method. This is especially so, I think, for the social worker working in a psychiatric setting, where many clients stay only for a short time and where emphasis is placed on assessment and short-term intervention.

In this paper I shall argue that a psychodynamic approach in social work is still relevant; that it is important for its humanizing qualities, for understanding and working with people with severe problems and for, perhaps, helping us to locate the position of social work vis-a-vis other mental health professions. I shall do this by focusing on a particular case I had as a social work student on placement in a psychiatric day hospital.     

City of One: A Qualitative Study Examining the Participation of Young People in Care in a Theatre and Music Initiative

Young people's engagement with the arts can facilitate skills development, improve mental health and strengthen resilience. This article reports on a qualitative study exploring the experiences and involvement of ten young people in care in the development of a musical play exploring life in the care system. The project was viewed as successful in a number of ways: involving young people who had not previously taken part in drama; developing skills, confidence and resilience, and improving feelings of social connectedness. Extending work on participatory arts approaches, this study identifies factors that influence young people's ability to maintain involvement and the implications for carers and professionals supporting them.     

Intersections of Stigma,Mental Health,and Sex Work: How Canadian Men Engaged in Sex Work Navigate and Resist Stigma to Protect Their Mental Health

Men engaged in sex work experience significant stigma that can have devastating effects for their mental health. Little is known about how male sex workers experience stigma and its effects on mental health or their strategies to prevent its effects in the Canadian context. This study examined the interrelationships between stigma and mental health among 33 Canadian indoor, male sex workers with a specific goal of understanding how stigma affected men’s mental health and their protective strategies to mitigate against its effects. Men experienced significant enacted stigma that negatively affected their social supports and ability to develop and maintain noncommercial, romantic relationships. Men navigated stigma by avoidance and resisting internalization. Strategy effectiveness to promote mental health varied based on men’s perspectives of sex work as a career versus a forced source of income. Programming to promote men’s mental health must take into consideration men’s diverse strategies and serve to build social supports.     

Resilience in the Face of Disasters: Bridging Micro- and Macro-Perspectives

This paper discusses the use of risk and resilience theory to understand how individuals and communities respond to natural disasters that present ongoing developmental challenges to personal and collective well-being. In the past two to three decades, mental health workers have developed numerous disaster relief strategies; while economists have become expert at estimating risk. These develops are explored.     

Potential and Possibility: Psychodynamic Psychotherapy and Social Change with Incarcerated Patients

In the present paper, Pierre Bourdieu’s theory of symbolic power is used to illustrate how the practice of psychodynamic psychotherapy in a prison-based mental health treatment program constitutes both a psychological and sociological intervention, congruent with clinical needs of this particular population. The author draws from psychodynamic theory, Bourdieu’s framework and her experience as a clinical social worker with the California Department of Corrections and Rehabilitation.     

The psychosocial benefits of work for people with severe and enduring mental health problems

Perceptions of the value of work for people with severe and enduring mental health problems have changed frequently over the last two decades. With the new social inclusion agenda manifest in the Disability Discrimination Act and in the NHS modernization agenda, work is once again in vogue. There is a need for a way of evaluating work which draws on its potential contribution to psychological well-being as well as its provision of a valued social role and which is less susceptible to fluctuations in health and social policy. Jahoda's work on the psychosocial functions of work provides such a framework and this study sets out to explore its utility among workers who are severely disabled by mental health problems. Twelve of the psychosocial functions of work were rated by 50 people attending two sheltered work placements according to how important they were perceived to be and the extent to which the functions were fulfilled through their attendance. Satisfaction of the psychosocial functions through work was compared with their satisfaction through other aspects of the respondents’ lives. All functions were perceived as important, but self-confidence/self-esteem was rated as more important than most of the others. Structure to the day, self-confidence and social contact were better satisfied through work than were decision making, practising old skills and having goals to aim for. In general, the results showed that the functions were fulfilled better by work than by other aspects of the respondents’ lives. The study supports the notion that work is of value in the rehabilitation of people with severe and enduring mental health problems and offers a possible framework for the further exploration of this theme, both within mental health services and the community at large.     

Being a service user and a social work academic: balancing expert identities

Abstract

I am a service user and academic working in a university social work department. My hybrid identity allows me to draw on different types of knowledge in all aspects of my work, including: academic, practice and experiential wisdom. Service user involvement is mandated across social work education but the scope and breadth of different kinds of participation is developed in diverse ways across university contexts. This article affirms the value of service user involvement in health and social care education, exploring its positive impact on students. When lecturers share personal experience of using services alongside practice and academic wisdom in the course of teaching, sometimes the value of experiential knowledge is doubted and its influence dismissed. I examine the importance of experiential wisdom in social work education, specifically when it is embedded in an academic role in a university social work department, and consider how it can be respected and valued. The parallel experiences of involving peer support workers in mental health services, who use their knowledge of recovery to mentor other service users, are then briefly examined, together with reflection of the concerns across mental health with professionals sharing their experiential wisdom with the people that they support.     

Teaching and Providing Recovery-oriented Care Through Problem-posing Dialogue

As the recovery paradigm proliferates throughout systems of mental health care, social workers are being required to provide recovery-oriented services. Yet there has been little discussion about what changes need to be made in social work education to produce recovery-oriented social workers. This article uses Paulo Freire's theory of pedagogy to help social work educators understand how they can develop problem-posing relationships with their students in order to teach students about the relationships that social workers ought to have with people in recovery.