Walking the tightrope of a mental health act assessment

This article is an attempt to capture something of the atmosphere of a Mental Health Act assessment, and was inspired by a recent article by Professor Harry Ferguson on child protection (2010). Here, the focus is on adult mental health practice and, in particular, on Mental Health Act assessments which may take place in any location including police stations, hospital wards or care homes. The following article mainly concentrates on assessments that take place in the service user's home. The Mental Health Act 2007 replaced Approved Social Workers with Approved Mental Health Professionals (AMHPs) in England and Wales; prior to this change the role was, as the name stated, entirely performed by social workers and they remain the predominant profession within the ranks of AMHPs.     

Devils and deep blue seas: the social worker in-between

This paper examines the role of the approved social worker, as defined by s.114 of the Mental Health Act 1983, with particular regard to ethical dilemmas in crisis intervention. Issues of management accountability, health and safety are set against the approved social worker's statutory responsibility to assess people experiencing mental health problems and, where necessary, admit to psychiatric hospital under compulsion. Consideration is given to the impact of this work upon the worker, on whom extreme and sometimes conflicting demands are made. An attempt is made to integrate these viewpoints within a fundamentally psychodynamic perspective.     

Can Health Care Reform End Stigma Toward Mental Illness?

This article addresses the destigmatization of mental health through health care reform by incorporating antistigma efforts—a destaining of mental illness—through prevention and early intervention in community-based programs that would be mandated and funded through the auspices of Patient Protection and the Affordable Care Act (ACA). Mental health care policies under the ACA and the Mental Health Parity Act are briefly described, following a definition of mental health stigma and its impacts. Recommendations for statutory mandates in stigma reduction at the community and federal levels and guidelines for mental health/behavioral health providers form the article’s conclusion.     

'In the real world we're all put on the spot at some time or other,so you need to be prepared for it': An exploratory study of an oral method of assessing knowledge of mental health law

The education and training of Approved Social Workers (ASWs) involves at least 60 days of college and practice-based learning. A major component of the college-based curriculum is the teaching and assessment of knowledge of mental health law. One programme in England assesses student knowledge of law by an oral examination that includes a case discussion and questions about the Mental Health Act 1983. Oral assessment of knowledge of law is commonplace for those entering legal professions. Oral assessment of clinical knowledge in professions such as medicine and psychiatry is similarly frequent. However, examination by oral assessment is not usual in social work education. An exploratory study by postal questionnaire of all past students of the programme and their line managers was undertaken to establish their views of this means of assessing knowledge of law. This paper considers the results of the research and outlines student perceptions of the law oral assessment as preparation for practice as an ASW. The paper focuses on three distinct but interlinked areas--education, assessment and practice--and suggests some implications for educators and practitioners, which are especially relevant in the light of the current review of mental health legislation.     

Mental Health Workforce Change Through Social Work Education: A California Case Study

The 2004 CaliforniaMental Health Services Act requires large-scale system change in the public mental health system through a shift to recovery-oriented services for diverse populations. This article describes an innovative strategy for workforce recruitment and retention to create and sustain these systemic changes. The California Social Work Education Center Mental Health Program provides stipends to master's of social work students at 17 California universities. In return, students must work for 1 year postgraduation in community mental health practice. Results of a 5-year study show that stipend recipients closely mirror the diverse demographics of the state, and 94% have remained in community mental health practice. The article also discusses lessons learned and implications for social work education in California and other states.     

The care manager’s dilemma: balancing human rights with risk management under the Intellectual Disability (Compulsory Care and Rehabilitation) Act 2003

In New Zealand, the Intellectual Disability (Compulsory Care and Rehabilitation) Act 2003 provides diversion for persons with an intellectual disability who have been charged with, or convicted of, a criminal offence. This unique Act moves the responsibility for such ‘care recipients’ from the criminal justice system to a disability sector that values a social model of disability and philosophies of autonomy, choice and normalisation. This research identified dilemmas faced by care managers legally responsible for care recipients. Care managers experienced: tension between imperatives of risk management, rehabilitation and human rights; role ambiguity between ‘custodian’ or ‘therapist’; philosophical incongruity within their services; and ethical dilemmas over decisions to lengthen care orders. The changing care recipient population has intensified these dilemmas: services must now adapt to the needs of young, street-wise people with alcohol and drug problems and histories of criminal behaviour. The article makes recommendations about how these dilemmas can be addressed.     

From here to Recovery: One Service User’s Journey through a Mental Health Crisis: Some Reflections on Experience,Policy and Practice

This article documents the experiences of a service user through a mental health crisis, the experience of detention under Section 136 of the Mental Health Act, admission to hospital and eventual recovery. It gives a unique first person account of the experience of a psychotic episode together with a reflective commentary based upon the service user's auto-ethnographic analysis of both the event itself and her medical records, which were obtained post-recovery, as well as interviews with professional practitioners. The reflective commentary considers the practice of various professionals encountered during the service user's illness, treatment and recovery. The service user, whilst critical of some of the treatment she received, has engaged in a positive way with her local police force, involving herself in training sessions for officers about good practice under the Mental Health Act.     

Protection and Advocacy for Individuals with Mental Illness Act

Abstract

This study explored the perceptions of one state's policy stakeholders toward the implementation of the Protection and Advocacy for Individuals with Mental Illness Act (PAIMI Act). This congressional act established state programs authorized to investigate abuse, neglect, and civil rights violations against individuals with mental illness in residential facilities. A qualitative case study approach was selected to study the perceptions of the impact of this law. Participants were chosen using a maximum variation sampling of four diverse stakeholder groups. In-depth interview responses were developed into a series of proposed assertions regarding the impact of the PAIMI Act.     

The impact of P.L. 93-641, the National Health Planning and Resources Development Act, upon health and mental health programming

Federal legislation regarding health care in the U.S. has increased rapidly in the past few years. A major law with potential far-reaching effects was enacted as a result of increasing legislation and rising health care costs. This law,The National Health Planning and Resources Development Act,has created a network of over 200 local, mostly nongovernment units, called health systems agencies. These agencies are responsible for areawide health planning, plan implementation, review and approval of federal health care expenditures for local programs, and facilities review. They will affect health and mental health programs at the local level. The article is directed to local health and mental health care providers who will, of necessity, deal directly with the local HSA's.     

Minimising Coerciveness in Coercion: A Case Study of Social Work Powers under the Victorian Mental Health Act

The balance between care and control in mental health social work is one of constant tension. In the State of Victoria, Australia, the Mental Health Act 2014 gives coercive powers to social workers employed by public mental health services. These include the power to decide if a person needs to be assessed by a psychiatrist, to “take” a person using bodily restraint, to enter premises, and to search and seize a person’s belongings. This paper applies a doctrinal analysis to examine the law, then argues that the use of these powers by social workers, where safe, may be less restrictive than when they are used by police or paramedics. The exercise of these powers may be less traumatic and stigmatising to the people who are subject to them, and social workers may be both legally and ethically obligated to use coercion when appropriate.

IMPLICATIONS

• More social work literature on the coercive powers under mental health legislation is needed as well as more guidance on using these powers for social workers in practice.

• In some circumstances, these coercive powers may be better exercised by social workers than by other professionals.

• Social workers should carefully consider their legal and ethical obligations to use these powers in some circumstances.

     

Alcohol reinforces both positively and negatively,complicating treatment

The Mental Health Parity and Addiction Equity Act (MHPAEA) and the Affordable Care Act of 2010 require insurance companies to provide parity for mental health and substance use disorders, but these laws, on the books for a decade, aren't being enforced. And insurance companies are taking advantage of this, leaving treatment centers one choice, according to attorney Matthew Lavin: to appeal until they win, and if they don't win, to sue.     

Social Inclusion as an Agenda for Mental Health Social Work

Summary

Following New Labour's election to office in the UK in 1997, policy initiatives have proliferated relating to mental health. Much of this policy innovation emphasises the social dimensions of mental health and distress, with an emphasis on employment and social inclusion. Paradoxically, this modernization of the mental health agenda comes at a time when mental health social work is struggling to establish its role and contribution within recently integrated health and social services. The paper considers whether New Labour's flagship programme, Mental Health and Social Exclusion, constitutes a “New Deal” for mental health, and whether it provides a perspective that will help mental health social work to define its distinctive contribution to integrated services.     

Ethnic Minority Social Work Mental Helath Training Programs:

This article reports on the critical mental health issues and concerns of ethnic minority groups of color. Accomplishments are summarized from National Institute of Mental Health ethnic minority social work clinical training programs. Goals and proposals are suggested for addressing ethnic minority mental health needs. Personnel and curriculum recommendations are offered to enhance the effectiveness of social work mental health interventions.     

Evaluating a community based mental health programme in West Bengal,India: Description of the methodology and lessons learned

Mental disorders impose an enormous burden on society. In developing countries like India, there is a lack of adequate number of trained mental health professionals to provide specialized care and 75–85 % of affected individuals do not have access to appropriate mental health services. The National Mental Health Programme (NMHP) is being implemented by the Government of India to support state governments in providing mental health services in the country. The Urban Mental Health Programme (UMHP) is a pilot initiative that has attempted the integration of mental health services in primary health care settings in two municipal wards in Kolkata, West Bengal, India. The overarching aim of this paper is to describe the methodology used for the evaluation of the community based mental health programme and to understand the processes of the programme in terms of barriers and facilitators. The current evaluation is based on a concurrent nested design, where qualitative and quantitative data are both collected at the same time but analysed separately and priority was given to qualitative data. This experience will contribute in helping other researchers to make some evaluations more effective, useful and manageable. Ethics approval was obtained from an institutional ethics committee of an organization (Ekjut) based in Ranchi, Jharkhand, India. The evaluation was undertaken by the George Institute for Global Health, New Delhi from February- June 2016.     

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.

     

Promoting rights or avoiding litigation? The introduction of the human rights act 1998 into adult social care in England

Rights to social care in England have traditionally been highly restricted. By placing positive obligations on social care agencies and practitioners to make provision for vulnerable adults, the incorporation of the European Convention on Human Rights into UK law through the Human Rights Act 1998 promised to extend their reach. Yet transforming a set of largely procedural rights into something more substantive requires the active intervention of social care practitioners. This article firstly examines the fit between human rights and the policy and operational contexts of social care before exploring the views of social workers included in a recent interview study. Whilst the findings point to a willingness on the part of some to advocate on behalf of vulnerable adults, they also highlight the extent to which individualistic beliefs about dependency and responsibility reinforce the dominant construction of citizenship rights under the current government as contingent upon the fulfilment of responsibilities. Treating the Human Rights Act as a weapon of litigation, the article concludes, simply reinforces defensive practice. Progressive change is best supported by fostering a human rights culture in social care which, in turn, depends upon challenging social workers’ assumptions about the nature of dependency, responsibility and rights.     

Navigating stormy waters: Challenges and opportunities for social work in mental health

The reforms driven by the National Mental Health Strategy have created both opportunities and challenges for social work as a profession. This paper examines the rapidly changing context for practice in mental health, including policy change, and developments in the education and training of the mental health workforce. Key practice issues identified for social work include: (i) the need to establish a viable paradigm for practice; (ii) a more positive response to the challenge of evidence-based practice models; (iii) a national agenda for education and training; and (iv) the importance of working collaboratively with consumers and families in a way that values their human rights and the lived experience of mental illness.     

Changing social responsibilities: the role of advocacy organisations in the construction of the Social Support Act in the Netherlands

This paper describes a study on civic participation in legislative processes. In January 2007 a new law on health and social care in the Netherlands was implemented: the Social Support Act (SSA). This law specifically aims at greater civic participation in the implementation of the law, in the provision of health and social care and in the social policy making process. This study focuses on civic participation in policy making, more specifically on civic participation in the legislative process of the Social Support Act. It examines whether national advocacy organisations were successful in their efforts to influence the legislative process and the final construction of the Social Support Act. The main conclusion is that the client and patient organisations were indeed successful in obtaining important changes in the law both through a well informed and professional individual lobby as well as by means of collective action. Yet questions concerning the justification of high expectations for successful local civic participation in the local policy-making process remain.     

Mens Sana: The Growth of Mental Health in the American College Health Association

Abstract

In 1910, the first college mental health service sought to help college students with personality development and building a healthy mind. In 1920, the meeting that founded the American College Health Association (ACHA) identified “mental hygiene” as important, although a separate Mental Health Section was not established in ACHA until 1957. Between 1920 and 1960, a series of national meetings helped define the role and functioning of college mental health and counseling services. Most colleges employed a multidisciplinary staff of psychologists, psychiatric social workers, and psychiatrists to provide clinical services for students and consultation and education for faculty and staff. Mental health services on college campuses grew rapidly in the 1960s and 1970s, leading to discussions in the late 20th century of the use of brief psychotherapies, prevention and treatment of drug and alcohol abuse, prevention of suicide and homicide, the use of psychotropic medications, and effective campus interventions.