Introduction

ABSTRACT

Conceptualizations of mental health and mental illness continue to be an important influence in shaping social work practice and education. By critically analyzing the emergence of the current concepts of “brain disease” and “behavioral health,” we are able to better understand the stakeholders in this renaming process. The inherent assumptions and the sociopolitical aspects of these two concepts are analyzed. Recommendations for social work practitioners and educators in preparing for a future in which they will participate more fully in the professional dialog about changes in the vocabulary of mental illness and thus more meaningfully shape the service delivery system in general, and the social work domain, in particular, are offered.     

Social Work Education and the Neo-Liberal Challenge: The US Response to Increasing Global Inequality

During the past several decades, a ‘perfect storm’, resulting from the political–economic changes accompanying globalization, dramatic demographic and cultural transformations in US society and rapid technological advances, has created unprecedented challenges for the social work profession and social work education. These challenges include the widening gap in income and wealth both within the US and between the Global North and South; growing racial and class disparities in health and mental health care, education, employment and housing; a shift within policymaking circles towards fiscal austerity and policies that emphasize market-oriented and individually-focused solutions; and the changing nature of universities, student populations and the educational process itself. Although the formal documents of major social work organizations continue to emphasize social justice themes, the actual practice of social work and the preparation of students for practice, teaching and research have diverged considerably from this rhetorical mission. This is reflected in a variety of ways including, but not limited to, the uncritical adoption of ‘evidence-based practice’ as a cornerstone of social work education and research; the growing stratification of social work faculty; the increased reliance on untested online methods of education; and the emphasis on quantitative ‘outcomes’ as indicators of educational success. At the same time, social work education in the US has been unable to respond effectively to the implications of demographic and cultural diversity, despite the demands of its accrediting body, the Council on Social Work Education. This article will provide an overview of the changing environment of social work and social work education during the past several decades. This will be followed by a discussion of the impact of these changes on social work education and a critique of the response—to date—of social work educators. Finally, it will suggest some potential educational responses to these challenges.     

Going social: Championing a holistic model of mental distress within professional education

Within the context of current debates as to how to raise the profile of social perspectives within mental health social work education, this paper seeks to assemble various elements that might belong within a social (or psychosocial) model of mental health practice. A clarification of what may actually be meant by a social model would be helpful in starting to set the parameters of future social work curricula, both at qualification and post-qualification levels, in terms of an appropriate value base and theoretical orientation. This may be seen to be important if social workers are to be properly prepared for taking on some form of leadership around the promotion of social approaches within the practice of multi-disciplinary teams.     

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.     

Developing a framework for anti-discriminatory practice teaching on social work courses

This article suggests that recognition of mental health issues in social work is a generic requirement. It considers the parameters of a mental health perspective in social work, examines the obstacles to its integration into practice, and outlines the contribution that social work training can make to the competence of individual workers. It recognises, however, the tension between individual and structural solutions, and locates mental health awareness within its organisational context.     

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.     

Personal reflection and experience of a Fulbright Scholar: teaching a mental health course in Vietnam’s changing culture

This paper documents the experience of developing and teaching a course on mental health for undergraduate social worker students during a semester in Vietnam. Social work is a profession at the early stages of development in Vietnam, requiring much curriculum development. There are over 40 universities with undergraduate social work education programs, but few of the faculty have had training or experience in practicing social work. The paper will summarize the main reasons for developing such a course given the current state of mental health need and services in a changing culture, as well as the current state of professional social work education and the newly established profession of social work. The author describes the contexts underlying the course—the status of social work and social work education in Vietnam, the context of mental health and mental illness in Vietnam, and curriculum adaptation to the cultural context. From this experience, the lessons learned about the role of cross-cultural critical thinking, cultural knowledge, and other strategies will be discussed about teaching a subject like mental health internationally.     

Educating for mental health practice: Results of a survey of mental health content in Bachelor of Social Work curricula in Australian schools of social work

Health problems are amongst the most pressing encountered by social workers in practice. Health policy, largely through deinstitutionalisation, has placed mental health problems in the mainstream of health practice. One in 25 Australians will require professional assistance with mental health problems. Moreover, other professions are increasingly claiming that mental health is their area of expertise. Social work needs to reclaim this area as their own and hence it is incumbent on social work education to prepare students to practise in this area. As the second of a two-part survey of health and mental health curricula in Australian schools of social work, the findings of the survey on mental health curricula conducted in 1997 are presented in this article. Based on responses from 95% of the schools, nine of the 20 respondent schools were found to offer a separate mental health unit. The remaining 11 schools' coverage ranged from no coverage at all through to considerable integration in other subjects. Overall it was concluded that the majority of students received a significant amount of input on mental health. A number of recommendations are made to improve mental health input including more skill development, greater local contextualisation, more attention to an anti-oppressive agenda, and more explicit links to field education.     

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.     

Teaching Note—Integrating Prevention Content Into Clinical Social Work Practice Courses

Rapid changes in health care services and delivery suggest an upcoming paradigm shift in the field of mental health. Recent national reports, health care policy changes, and growing evidence support a shift toward prevention-focused mental health care. The social work profession is uniquely positioned to act as leaders in this shift as the profession’s values, goals, and hallmark practice approach are consistent with preventive care. Most social work students, however, do not receive training in prevention practice. The author’s development, implementation, and evaluation of a prevention-focused master of social work elective in the area of mental health is presented as an example of integrating prevention content into clinical social work practice courses. Implications for social work education are discussed.     

Mental Health Difficulties and the Support Needs of Social Work Students: Dilemmas,Tensions and Contradictions

There are a growing number of students in higher education who experience mental health difficulties and have support needs. The behaviour of small numbers of students on social work programmes indicates also a need to examine the mental health difficulties and needs of social work students. There is only limited factual information on this topic. It is rarely discussed or written about. There is a danger of discriminating against those experiencing such difficulties, especially black or female students. Yet, at the same time, undertaking a social work programme is a demanding experience, as is doing social work itself. Furthermore, on courses leading to a professional qualification, such as social work, there is an obligation to protect the rights of, and assess possible risks to users, as well as to support students. Programmes should give particular attention both to the mental health difficulties and support needs of social work students at selection, during the programme itself and upon conclusion of the programme at a wide range of levels, both within the higher education system and outside that system.     

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.     

Learning from Mental Health Lived Experience and the Influence on Students’ Practice

This study explored how learning from mental health lived experience influenced Australian social work students’ practice during their first fieldwork placement. Involvement of mental health consumers in social work education is gaining momentum, yet little is known about how this type of learning informs students’ practice. Ten social work students participated in semistructured interviews and one focus group. Findings suggest that learning from lived experience promoted social work practice that honoured the expertise of mental health consumers and privileged personal recovery. Factors such as organisational culture and supervisor attitudes were found to mediate the students’ attempts to privilege lived experience.     

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.     

Promoting sexual well-being in social work education and practice

This paper explores the importance of including sexual well-being within social work practice and education. Social workers often work with individuals for whom opportunities for sexual expression are limited and who face discriminatory attitudes. Sexual well-being is a global concern, and is particularly relevant considering international interest in the influence of notions of well-being on mental and physical health. Implementation of new social care policy in England, underpinned by the well-being principle, provides practitioners with the opportunity to explore what is meaningful to individual’s well-being through person-centred approaches to practice. There is currently little coverage of sexual well-being within social work education, this means students and practitioners lack the knowledge and skills to challenge barriers. Promotion of the concept of sexual citizenship, with its associated rights and responsibilities, enables social workers to engage in rights focused practice. Sexual well-being is a sensitive subject and the social and personal barriers practitioners may experience in addressing this topic are explored.     

Advocating the Clinical Social Work Professional Identity: A Biographical Study

Aiming to portray the clinical social work (CSW) professional identity, the present biographical study examines the CSW knowledge and practice domain boundaries as they appear from the perspectives of three Greek mental health social workers who have advocated for the professionalization of CSW. The practitioners' perspectives are studied in relation to their demographic characteristics, education and training, and multidisciplinary relationships. A thematic analysis of the in-depth interviews revealed that these practitioners retained their nuclear social work identity and felt their skills and interests to be different from those endorsed by the present generic social work education and practice system. The study also revealed differences in the educational qualifications and routes that each of the three practitioners followed in order to be able to identify themselves as ‘clinical social workers’. Although the common denominator in the practitioners' perspectives was their training in psychotherapy, the type of psychotherapy training pursued and the experience of personal psychotherapy differentiated each practitioner's ability to theorize on the CSW practice identity. The research data were filtered through a psychodynamic lens to reveal the dynamics of the unconscious processes within the relationships formed between individuals and organizations.     

The meaning of mental illness within the Victorian Mental Health Act: the problem of definition

This study will critically examine the Mental Health Act 1986 (Vic), including the significant changes introduced through the Mental Health (Amendments) Act 1995 (Vic). It will be argued that the Victorian legislation presents some practical difficulties in application as it adopts too broad a definition of mental illness to be used reliably in assessing a person's need for treatment and/or criminal responsibility within a court of law. This lack of precision is potentially problematic for social workers and lawyers alike with respect to key decisions regarding assessment for mental health services and assigning criminal responsibility before the law. Implications for social work practice will be briefly discussed.     

The fusion of culture and science: Challenges and controversies of cultural competency and evidence-based practice with an African American family advocacy network

This paper identifies interrelationships between evidence-based practice (EBP), radical structuralism, and culture, arguing that culturally-specific beliefs and norms should be integrated into evidence-based, cross-cultural partnerships within child and family service systems. A single case study of family advocate training in evidence-based practice is provided as an illustration of, and impetus for, the development of a format for use with community-based and ethnically-diverse parent/family advocates. The lessons learned from teaching evidence-based practice to a parent advocate in a particular child welfare service system are highlighted. The use of enhanced roles for social workers and indigenous social capital and resources, such as family advocates as allies, is recommended to help achieve a greater degree of accountability, cooperation, and core understanding in the use of EBP. By training racially-diverse foster parents as mental health advocates to work collaboratively with policymakers, community groups, and family participants, proponents of EBP will reach and benefit more diverse populations.     

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.