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.     

Communal invalidation of young adults with co-occurring substance abuse and mental health issues

This study explores how young adults with co-occurring substance abuse and mental health issues experience the challenges of belonging to their local communities. The data were generated through qualitative in-depth interviews with seven young adult service users, six of whom were interviewed twice. The qualitative data analysis resulted in three overarching themes: the need to accept one’s own life and the structures surrounding it; being caught between conflicting social worlds; and moral fumbling in choices and actions. Using an empirical study, we suggest that a process of ‘communal invalidation’ operates through which young adults in the community are socially defined as inadequate. This invalidation serves as a formidable barrier to their recovery.     

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.     

Lay theories and criticisms of mental health news: elaborating the concept of biocommunicability

Abstract

This article examines how mental health service users/consumers, advocates, professionals and researchers interpret and theorise the impacts of mental health news. It focuses on the following themes: Creating fears about mental illness by focusing on criminal and violent acts; Reinforcing power imbalances by privileging biomedical issues and sources; and Sanitising mental health issues through the selective use of personal narratives. The study draws upon the concept of biocommunicability, which casts light on the performative power of health news in reinforcing ideas and expectations about the appropriate role for different actors to adopt in relation to health knowledge. Previous research on health news has identified biomedical authority, patient-consumer and public sphere as three predominant models of biocommunicability and this article examines how these are bound up with criticisms of mental health news. The findings are related to the ‘mediatisation of psychiatric culture’ as one of extremes and perspectives from Mad Studies.     

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.     

Using an action research approach to involving service users in the assessment of professional competence

This paper reports on a piece of action research that has involved people who use mental health services in systematically providing feedback from a user perspective on participants’ assessed work completed for one module of a masters’ training programme in mental health. In an attempt to improve professional practice and include people who were accessing mental health services in so doing, it outlines how users were trained to provide feedback and the training methods employed. The findings summarise the kind of issues users raised in their feedback to participants about the evidence professionals provided to demonstrate their learning from the training programme. A focus group interview with professionals provides a contrasting insight into the participants’ experience of having their work commented upon from a user perspective. The paper draws on the experience of a five-year external evaluation of an interdisciplinary programme in community mental health at Birmingham University in the UK which has highlighted the involvement of people who use mental health services as a particular innovation in the design, delivery and evaluation of the curriculum.     

Keeley's journey: From service user to service provider

Background: This paper presents the vocational journey of a young British woman, Keeley, who changed her career aspirations to become a mental health worker following an episode of significant mental health difficulties. Keeley's story illustrates the application of the locally developed WORKS framework in conceptualising and supporting Keeley's vocational recovery. Approach: A narrative approach highlights the partnerships that developed between Keeley, the Occupational Therapist, Sally, and the User Support and Employment Service. Findings: The WORKS framework supported Keeley and Sally to collaboratively develop a successful employment pathway. Strategies, including attention to Keeley's view of her capabilities and aspirations, volunteer placements, support of peers, employer engagement and planning for sustainable employment, assisted Keeley to establish her chosen career. Keeley's journey highlights the leadership role that mental health services can assume by providing paid work for people with experience of mental health difficulties.     

User‐oriented mental health reform in Sweden: featuring ‘professional friendship’

In developing new forms for society‐based support for mental health service users, authorities implemented a service in Sweden, called Personligt ombud (PO), with the assignment to support service users exercising their rights. The aim of this article is to describe what service users find to be significant features of their working relationships with their PO. Using a phenomenological approach, 23 users were interviewed sharing their experiences of their PO. The results show that service users describe their relationships with the PO as a ‘professional friendship’. The friendship‐like feature refers to reciprocity in sharing life experiences and forming a trustful relationship in which professional assistance can be offered, promoting well‐being and recovery. Conclusions are that the PO provides a service that calls for re‐interpretation of professional and user roles, where both give and receive.     

Direct What? The Untapped Potential of Direct Payments to Mental Health Service Users

This article describes research carried out for the Central Research Unit of the Scottish Executive about Direct Payments to mental health service users including people with dementia. Previous research had found that Direct Payments were not often, if at all, offered to mental health service users. Using focus groups, interviews and a telephone survey, Scottish Health Feedback explored the extent of implementation of Direct Payments across Scotland, and the views of mental health service users, carers and professionals about the idea of Direct Payments, the potential obstacles, and the support that would be needed. Awareness of Direct Payments was low, even among professionals. Many were hearing about this option for the first time through this research and a common reaction to the research questions was 'Direct what?' The study found that in order to make Direct Payments work for mental health service users, what was needed was 'person-centred' assessment, access to proper support, advice and training, and Direct Payment schemes that were flexible to allow for different arrangements and for transitions.     

Making Direct Payments a Choice: a report on the research findings

We describe research done in the London Borough of Tower Hamlets under the supervision of the local Coalition of Disabled People. It involved three different client groups-people with learning difficulties, mental health service users and those with physical disabilities. Few of these service users, their carers and staff had any experience or knowledge of people with disabilities receiving cash to purchase their own support. The study focused on several issues: how to provide effective information; what sorts of support could direct payments purchase; how could it be accessed; how could users handle the money; how could it all be evaluated? Most carers, staff and users considered this radical idea favourably, but were suspicious of their own local authority and would want independent systems of supervision and monitoring, accountable to other users, rather than professionals.     

The Give and Take of Volunteering: Motives,Benefits, and Personal Connections among Irish Volunteers

Volunteers are integral to the delivery of health and social services in many countries. Volunteer motivation is the key phenomenon around which research into the psychology of volunteering behaviour has been based in the recent past. This study comprised interviews with 26 volunteers working with eight health and social care organizations in Ireland. The study aimed to describe and interpret reasons for initial and continued volunteering involvement. Four key themes were proposed on the basis of a thematic analysis: volunteer motives; personal connections to organizations and causes; benefits; and challenges arising from volunteering. These themes are analysed in light of social psychological theory to better understand why people volunteer and maintain their involvement in the face of competing demands. The findings suggest that benefits and challenges merit a higher profile in research into the volunteer process, and that bonds of perceived obligation motivate many volunteers to begin and continue their involvement in health and social care.     

Carers of People with Mental Illness from Culturally and Linguistically Diverse Communities

Australia is a multicultural country and it is common for families from culturally and linguistically diverse (CALD) communities to care for their relatives with mental illness. However, there are limited Australian studies examining the experiences of informal carers of people with mental illness from CALD communities. A scoping review was conducted to search for peer-reviewed articles reporting the perception of carers regarding their caregiving experiences, wellbeing, and needs. Using cultural responsiveness as a conceptual framework, this study analysed the findings of the identified studies to generate themes. Findings show that carers experience severe caregiving challenges and face considerably poor culturally oriented services in mental health. Social work implications concerning the need to provide culturally responsive practice in mental health services are discussed.     

Research project on advocacy and autism

This article presents the findings of a qualitative research project about the difficulties in accessing advocacy faced by adults labelled as having autism and Asperger's Syndrome in the Northwest of England. It is also an example of partnership working between three organisations. The article examines both the process of team-led (emancipatory) research and the project findings. Seven main themes emerged throughout the research: late diagnosis and lack of service support; bad experiences with systems of care; feelings of 'not belonging' (identity issues); barriers around communication and sensitivity towards individuals; lack of awareness and access to advocacy and rights; difficulties of 'fitting into' what is already available; and interest in developing knowledge around advocacy. Examination of the main themes pointed to a disturbing link between poor service response, episodes of crisis and mental ill health. The Carlisle People First Research Team is made up of 6 researchers who are labelled as having 'learning difficulties' who work in partnership with one other researcher.     

Family interventions in early psychosis service delivery: A systematized review

The objective of this study was to explore the development of family intervention in an early psychosis context. The role played by family members and friends in the recovery of individuals with early psychosis is extremely important, and there is a growing body of literature that reflects this. However, how mental health services can best support and utilize family and friends as a core component in recovery from early psychosis is not yet established. The methodology entailed a systematic review of the international literature. Results from the current review highlight the principles of family engagement, its effectiveness to enhance service user outcomes, the need to differentiate early psychosis psycho-education from that provided in enduring illness, and challenges in implementation. The number of studies generally, and the number explicitly articulating and trialling family interventions being used in practice, are limited. This seems to highlight that—although practice guidelines acknowledge the importance of family support—there are challenges in implementation of evidence-based practice principles in this area. Changes in policy and service delivery are recommended for programs and services to better achieve family-sensitive and family-inclusive practice as core business in mental health service delivery.     

Supporting the emotional and psychological well being of sexual minority youth: Youth ideas for action

Gay, lesbian, bisexual and transgender (GLBT) populations are susceptible to stress-related mental health disorders because of daily imposed stigma and prejudice. Yet minimal information exists from the perspective of sexual minority youth about how to support them in managing a challenging social environment during critical stages of development. Through the lens of youth from two geographic communities this study examined what is needed to support GLBT adolescent mental health. The study employed inductive secondary analysis of qualitative and quantitative data gathered through Concept Mapping needs assessments. Findings include 61 unduplicated ideas for support across the two groups of youth; 14 primary themes emerged with 22 stated needs common among both groups. Areas of need in multiple service systems are identified. The importance of the supports for meeting youths' emotional needs varied between the two communities. Ideas generated represent youth ideas for improving conditions which contribute to disparate community supports needed to develop positive emotional and psychological well being. The findings are conceptualized with regard to psychological and physical safety; community impact on emotional well being; schools and psychosocial supports; and access to relevant mental health and health care. Discussion includes implications for practice and policy.     

Mental health social work in Northern Ireland and the Republic of Ireland: challenges and opportunities for developing practice

Drawing on their experience of mental health social work in Northern Ireland and the Republic of Ireland, the authors examine the impact of current legislative and policy change in both jurisdictions. The paper applies Lorenz's theoretical framework to develop a comparative analysis of how global and country specific variables have interacted in shaping mental health social work. The analysis identifies linkages between factors and indicates similarities and differences in mental health social work practice. The paper highlights emerging discourses in this field and explores the impact on practice of developments such as de-institutionalisation, community care, and ‘user rights’ versus ‘public protection’. The article concludes with a review of key challenges facing social workers in both jurisdictions and identifies opportunities for developing mental health social work in ways that can positively respond to change and effectively address the needs of mental health service users and their carers. The analysis provides an opportunity to evaluate Lorenz's theoretical framework and the paper includes a brief critical commentary on its utility as a conceptual tool in comparative social work.     

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.     

Questioning the professionalization of recovery: a collaborative exploration of a recovery process

While the recovery concept strongly resonates in clinical mental health care today, it first arose in service user-led contexts. A major risk of this professionalization shift is that recovery primarily becomes defined by treatment providers. This study aims to keep the debate on recovery alive through a collaborative exploration of Pete’s recovery process by means of a bricolage approach. This resulted in an idiographic portrait of Pete’s experiences of recovery and treatment, clustered around four themes: life rebuilding, identity, continuity of care and the role of drugs. His experiences illustrate a number of contradictions in the operationalization of the recovery ethos in today’s mental health care; whilst recovery appears as a hopeful vision of empowerment, it also risks being reduced to a tokenistic model that fails to address the social realities of people in recovery and in which the assumption that mental illness is chronic is still latently present.     

Barriers to Utilization of Mental Health Services amongst Male Child Sexual Abuse Survivors: Service Providers’ Perspective

ABSTRACT

Most research on child sexual abuse has been on survivors to the exclusion of service providers. This paper focuses on one group of findings from a larger qualitative study. The aim of the paper is to identify existing services and highlight the gaps in the current programs available for male CSA survivors from the perspective of service providers. Semi-structured interviews were conducted with 11 mental health service providers, recruited from two Southern and Central Ontario cities. Findings presented here report service providers’ perspective of gaps in services for male CSA survivors. “Limited Male CSA Programs”, “Institutional Barriers”, “Attitudinal Barriers”, and “Systemic Gaps” emerged as four major themes from the data analysis. Findings demonstrate the need to re-evaluate currently available service and highlights gaps in mental health service available for male CSA survivors. Implications for policy, practice, and research are discussed.