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.     

What mental health professionals in Israel know and think about adolescent problem gambling

Mental health professionals are well versed in addressing multiple adolescent risky behaviours and play a primary role in the identification of and referral process and service provision for young people who engage in such behaviours. Given their ‘person-in-environment’ approach, training in multi-sectoral collaboration, and awareness of social policies, social workers are especially equipped to provide needed mental health services to young people. The aim of the current study was to examine Israeli mental health professionals’ awareness of and attitudes towards adolescent high-risk behaviours, including gambling. Child psychologists, social workers and school counsellors (N = 273) completed an online survey addressing concerns related to high-risk behaviours. Findings revealed that social workers perceived gambling as being among one of the least concerning adolescent mental health issues and reported feeling the least confident in their abilities to provide services to young people with gambling problems. The results suggest the importance of youth gambling addictions being incorporated into social work training curricula.     

The Caring Experience: Learning about Community Care through Spending 24 Hours with People Who Use Services and Family Carers

This paper describes a teaching and learning initiative developed in a UK social work programme that has involved carers, service users, academic social work staff and practitioners. Post‐graduate student social workers spend 24 hours in agreed periods with family carers or people who use social work services. The paper explains the origins of this initiative, rooted in a model of service user and carer involvement established over a number of years within the social work programme at the University of Dundee, Scotland. The development of this teaching and learning method is outlined and an account is given by a family carer describing their experience of being involved in the programme. Findings from the evaluation of this first year of operation are reported.     

Allies in Learning: Critical-Reflective Practice On-line with Allied Mental Health Practitioners

This paper is a reflection in action using personal examples of student feedback to guide teaching. In 2003, a post-graduate course was developed at Victoria University in New Zealand for occupational therapists and social workers employed in the mental health services. The aim of the programme is to provide opportunities for on-the-job learning while recruiting and retaining a skilled allied mental health workforce. The programme is publicly funded for students as part of a national workforce development strategy for mental health professionals. In this article, I reflect upon my first year as co-ordinator of the programme in 2007–2008. Due to my background as a social worker and my familiarity with social work theories of practice, I focus on my theories of teaching from a social work perspective while returning to reflect on themes for the student cohort as a whole. The programme is delivered using distance methods supported by nine days of on-site learning throughout the academic year. A problem-based learning (PBL) approach delivered on the Internet platform, ‘Blackboard’, enables students to study from their workplaces. The conceptual model of teaching evolved is a process of ‘creative attunement’ to the learner's world. I conclude by providing examples of the key elements of my teaching/learning model as a ‘work in progress’.     

Survival and Abuse: What We Can Learn From It

This article is about a journey involving survival, abuse and learning. It is written by two people who have considerable experience of being involved with mental health services; both are currently making an active contribution to social work education. It describes the way in which, in situations of survival and abuse, service users can use their experience and knowledge to learn how to support and advocate for each other. It suggests that the relationships that are built between service users as a result of these experiences can be used to address some of the gaps in service provision. At the same time these relationships can provide mutual learning which can be used to improve the education and training of social workers and other professionals.     

The Coalition,austerity and mental health

In the United Kingdom, the Coalition government’s recent commitment to improving mental health provision masks the extent that their policies of austerity have already brought harm to those same services. Government-driven policies have led to significantly reduced funding within mental health, increasing pressure on a system that was already chronically under-resourced. Further, people who are experiencing mental distress, and mental health service users, have been especially vulnerable to the harms of the current austerity programme, including being at the sharp end of the assault on public services and welfare spending. This piece discusses the impact of austerity, exploring the effects of government policies and with a critical perspective of the dominant discourses around mental health. It argues that by exacerbating social inequality, government policies are also directly leading to worsening mental health in the United Kingdom.     

The school-to-work transition of people with mental handicap in Hong Kong

The purpose of this study was to examine the school-to-work experience of people with mental handicap in Hong Kong. Fourteen young adults with mild mental handicap participated in in-depth interviews. An interview guide was utilized which included topics related to the participants' vocational preferences, work motivation and post-school placements. Data were analyzed according to a constant comparative method and content analysis. Three-quarters of the participants expressed job preferences. Three-quarters of the participants had taken a vocational training program unrelated to their job preferences. Half of the participants who had taken up open employment had not obtained their preferred jobs. None of the participants who had completed vocational training obtained job placements that matched their vocational training programs. All of the participants except five were not involved in making independent decisions regarding employment. The need to improve the quality of vocational services and empower people with mental handicap to take up self-determining roles are discussed.     

Differences in Experiences of Discrimination in Accessing Social Services Among Transgender/Gender Nonconforming Individuals by (Dis)Ability

Transgender and gender nonconforming (GNC) individuals frequently experience discrimination and potentially a lack of respect from service providers, suggesting they have decreased access to professionals with cultural competency. Similarly, people with disabilities experience higher levels of discrimination in social services than their nondisabled counterparts. From an intersectional perspective, this study examines rates of discrimination in accessing social services faced by transgender and GNC people, comparing across ability. Data indicate that although transgender and GNC individuals of all abilities experience gender-based discrimination when accessing social services, those with disabilities experience higher levels of antitransgender discrimination in mental health centers, rape crisis centers, and domestic violence shelters.     

e-Social work in practice: a case study

ABSTRACT

This paper presents a theoretical reflection on e-social work by considering a case study: an intervention programme with vulnerable people, included in the services catalogue of a non-governmental organization (NGO), Zaragoza Red Cross Assembly. This programme cares for older people with a home assistance system mediated by information and communication technologies (ICTs). The digital convergence of the Spanish Red Cross and the digitalization of internal processes were accelerated by the use of ICTs as a tool in the aftermath of the 2008 crisis: first, to manage bureaucratic matters; second, to coordinate professionals and third, to interact with users. The text is divided into five sections including an introduction and final remarks. The first section describes the intervention programme and its evolution from a traditional social work vision to an e-social work perspective. The second section describes and analyses the intervention programme and the incorporation of ICTs in this NGO, over more than two decades. The third section describes professional contributions to the implementation and adaptation of social work to new social and technological circumstances and users’ requirements based on these intervention experiences.     

Making it ‘APP’en: service user feedback: developing and implementing a service user APP: reflections from Northern Ireland,England and Scotland

Despite the advent of social media and increasing use of smart phone technology amongst global and UK populations, APP’s for social work remain in their infancy. Several have been developed which focus on the education of social workers and practitioners providing information on specific social work issues, and one we are aware of that explores ethics and values using a games-based approach. In this paper, we discuss the importance of service user perspective in social work practice and how this informed the development of the feedback App. We reflect on developing this instrument using digital technologies which social workers can use to gather anonymous feedback from service users about their experiences of social work interventions. This project, developed in response to demands placed on social work agencies to evidence the effectiveness of service interventions, provide robust data from service users for inspection regimes and sustain service user involvement in improving services. The evaluation model is designed to document the implementation process, exploring what works and what barriers, challenges and lessons were learned by the project team together with how some of the tensions in the process were addressed and resolved.     

A bit more understanding: Young adults' views of mental health services in care in Ireland

Children and young people in the care system typically experience very high levels of mental health difficulties, yet their views of these difficulties and of mental health services have rarely been explored. For this qualitative study we spoke with eight young adults aged 18 to 27 years with experience of the care system in Ireland about mental health challenges, service experiences, and how they felt mental health services needed to improve. Themes from the interviews illuminated young adults' views of their emotional well-being while in care, and the double stigma of being in care and mental health difficulties. In terms of services, young adults wanted these to be flexible and sensitive to level of need; to offer choice and more congenial environments; to provide more creative routes to engaging young people; and to offer honest, reciprocal, caring communication — treating children in care as one would any child. Recommendations highlight three key needs: an ethic of care in services as well as an ethic of justice; mental health training for all professionals in contact with children in care; and the need to listen, hear and act on what children and young people say.     

‘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.     

Role-played interviews with service users in preparation for social work practice: exploring students’ and service users’ experience of co-produced workshops

Abstract

Within a Theory and Practice of Social Work module, prior to embarking on practice placements, social work students practised professional communication skills with people who had used social work services. They undertook role-played interviews with service users about real issues, which had led individuals to seek assistance in the past. Using principles of co-production, the workshop was developed in partnership with members of the University’s social work service users and carers’ group. Care was taken to safeguard service users’ well-being, as well as developing an effective learning opportunity. Drawing on evaluations by students and feedback from service users, this paper discusses the process of planning and delivering the workshops, as well as perceived outcomes for both groups. Findings indicate that students valued the opportunity to engage with service users, gaining key learning about their own practice skills. Service users described a boost to self-esteem through contributing to students’ learning. The workshop provides an example of how service user involvement in social work education has evolved from a primary focus on sharing personal testimonies to active participation in student skill development. It underlines the importance of investment in service user involvement to achieve an appropriate context for such projects to develop.     

Marketing ‘madness’: conceptualising service user/survivor biographies in a period of deinstitutionalisation (1975–2014)

This article aims to present the lived experiences of psychiatric service users/survivors who have experienced the transition from institutional care in the 1970s and 1980s to community care services in the 1990s and post-2000s. By using a biographical narrative approach the study compares service users’ historical experiences with their contemporary experiences of community and residential care. Sixteen biographical narratives were analysed to explore how mental health services have changed over time, from the perspective of service users/survivors, their families and mental health practitioners. The study examines how the closure of NHS mental hospitals in the 1980s, which were replaced in the 1990s with new types of community and residential care services, has changed the lives of service users/survivors. Thus, the article presents these lived biographical experiences which, for the majority of service users/survivors, were defined by the process of trans-institutionalisation rather than de-institutionalisation, within a neoliberal context.     

Process evaluation of a diversity training program: the value of a mixed method strategy

Patients’ health and health needs are influenced by categories of difference like sex, gender, ethnic origin and socioeconomic status (SES). To enhance awareness of this diversity among patients and to provide holistic care for them, health professionals should first be aware of the relation between dimensions of diversity and patients’ health and health demands. This paper presents a formative process evaluation of a diversity sensitivity training programme for healthcare professionals. The training was implemented in three healthcare settings (mental healthcare, nursing home and hospital care). Mixed methods were used to monitor the implementation of the training and its effects after three years. Findings demonstrate that the training stimulated participants’ awareness, knowledge and critical attitudes towards diversity. Their motivation and willingness to take action regarding diversity was also enhanced. Yet these developments were less apparent among nursing home participants who felt less satisfied and did not develop a critical perspective on this issue. Qualitative data were helpful to explain differences between the settings. By means of the combination of quantitative and qualitative data, we can conclude that individual learning was not enough to guarantee a sensitive approach to diversity at the organizational level.     

Variations in provider capacity to offer accessible health care for people with disabilities

Since social workers are likely to practice in a range of health care settings, their training focusing on human behavior in the social environment could help providers develop strategies to improve access to care for people with disabilities. In this article, results from a comprehensive survey of providers about access to health care for people with a broad range of disabilities are reported. Results suggest that a minority of providers report difficulty serving people with disabilities. However, dentists and mental health/substance abuse providers are significantly less likely than other providers to report that they provide accessible services to individuals with disabilities. These providers are less likely to report having had training related to mobility impairments, providing mirrors at their facility, having an accessible door, or providing assistance with personal care needs, and are more likely to report that their building poses a barrier for people with disabilities. Social workers are well positioned to take a leadership role in working with providers and patients to improve access to health care for people with disabilities. A social work framework of understanding the individual in a social environment may be the most appropriate perspective for creating innovative strategies for addressing the complex, multidimensional needs of people with disabilities who experience limited access to care.     

Associative stigma among mental health professionals: implications for professional and service user well-being

In contrast with growing attention given to the stigma experiences of mental health service users, the stigma literature has paid almost no attention to mental health professionals. This study focuses on experiences of associative stigma among these professionals. We investigate the link between associative stigma and three dimensions of burnout as well as job satisfaction among mental health professionals, and the link of associative stigma with self-stigma and client satisfaction among service users. Survey data from 543 professionals and 707 service users from diverse mental health services are analyzed using multilevel techniques. The results reveal that among mental health professionals associative stigma is related to more depersonalization, more emotional exhaustion, and less job satisfaction. In addition, in units in which professionals report more associative stigma, service users experience more self-stigma and less client satisfaction. The results reveal that associative stigma is related to more depersonalization, more emotional exhaustion, and less job satisfaction among mental health professionals.     

Variations in Provider Capacity to Offer Accessible Health Care for People with Disabilities

Abstract

Since social workers are likely to practice in a range of health care settings, their training focusing on human behavior in the social environment could help providers develop strategies to improve access to care for people with disabilities. In this article, results from a comprehensive survey of providers about access to health care for people with a broad range of disabilities are reported. Results suggest that a minority of providers report difficulty serving people with disabilities. However, dentists and mental health/substance abuse providers are significantly less likely than other providers to report that they provide accessible services to individuals with disabilities. These providers are less likely to report having had training related to mobility impairments, providing mirrors at their facility, having an accessible door, or providing assistance with personal care needs, and are more likely to report that their building poses a barrier for people with disabilities. Social workers are well positioned to take a leadership role in working with providers and patients to improve access to health care for people with disabilities. A social work framework of understanding the individual in a social environment may be the most appropriate perspective for creating innovative strategies for addressing the complex, multidimensional needs of people with disabilities who experience limited access to care.     

Experiences of volunteering: A partnership between service users and a mental health service in the UK

The aim of the study was to investigate how people with serious mental illness perceived the experience of volunteering for the health care organisation in which they had received a service. The study took a qualitative approach and in phase one, eleven service user volunteers were purposefully sampled and interviewed. In depth interviews were analysed using grounded theory. This paper describes the findings from phase one, and highlights the following themes to represent the volunteering experience: 1) rehearsing for a new direction; 2) treading carefully at first; 3) discovering my new self; and, 4) using my experience and extending relationships. These themes further support a tentative theoretical framework that considers supported volunteering to enhance recovery because it fosters positive risk taking and gives individuals a valued identity that integrates their mental health experience. In phase two, this framework will be tested with service users in more diverse volunteer positions. The findings of my study suggest that mental health services are in a unique position to build partnerships with service users to support their recovery and journeys toward employment by providing opportunities for volunteering.     

An equality of condition framework for user involvement in mental health policy and planning: evidence from participatory action research

Discussions about user involvement in the mental health services tend to throw up four major areas of concern: the capacity of service users to participate, their lack of participation skills, the need for a positive organisational culture and the need for arenas of participation. This article presents evidence from participatory action research with Irish mental health service users which explored how they could more equally participate in advisory committees. Participants identified barriers to their equal participation due to unequal cultural, physical, mental and economic resources, time, power, ‘stigma’(prejudice) and lack of respect for their experiential knowledge and emotional expression. These barriers fall within the ‘equality of condition framework’ developed by Baker and colleagues. Enabling equal user involvement in strategic decision‐making requires more than arenas of participation – it requires comprehensively addressing service users’ structural disadvantages throughout the process of involvement.