Mental Health Workers Negotiating Risk on the Frontline

Abstract

Following deinstitutionalisation and the shift to models of community care, mental health practice has become increasingly focused on managing the risks posed by service users. However, the effects of risk management on workers’ professional identities have not been investigated empirically in Australia. Drawing on in-depth interviews with mental health workers from Victoria, Australia, this paper explores the diverse ways in which these workers adapted the formal technologies of risk management (e.g., the completion of risk assessment screens) to their professional identities. Some workers experienced risk management technologies as constraining their interventions with clients, while others saw these technologies as providing opportunities to strengthen and enhance their professional skills. Pondering these differences, the author speculates on the emergence of a new form of professional identity in the broader context of contemporary community mental health care.     

An Adult Protective Services' View of Collaboration With Mental Health Services

Mental Health Services (MHS) meet mental health needs of older adults through active, outpatient, community-based care. Adult Protective Services (APS) are involved with needs of older adults who have mental disability and mental illness. Adult Protective Services and MHS staff may to work together when they respond to the needs of victims and adults at risk for abuse, neglect, self-neglect, and exploitation. The purpose of this study was to understand effective APS–MHS collaborations (e.g., leadership, organizational culture, administration, and resources in predicting success). A survey that was sent to members of the National Adult Protective Services Association (NAPSA) revealed that both APS and MHS have strong commitments to protecting clients' rights and autonomy, but there appear to be differences between the two with regard to implementation, apparent in cases involving clients with diminished mental capacity who are at imminent risk, but who refuse help. Strengths of APS–MHS collaborations included improved communication and better service for at-risk clients.     

Risk,Recovery and Capacity: Competing or Complementary Approaches to Mental Health Social Work

Mental health social workers have a central role in providing support to people with mental health problems and in the use of coercion aimed at dealing with risk. Mental health services have traditionally focused on monitoring symptoms and ascertaining the risks people may present to themselves or others. This well-intentioned but negative focus on deficits has contributed to stigma, discrimination, and exclusion experienced by service users. Emerging understandings of risk also suggest that our inability to accurately predict the future makes risk a problematic foundation for compulsory intervention. Therefore it is argued that alternative approaches are needed to make issues of power and inequality transparent. This article focuses on two areas of practice: the use of recovery-based approaches, which promote supported decision-making and inclusion; and the assessment of a person's ability to make decisions, their mental capacity, as a less discriminatory gateway criterion than risk for compulsory intervention.     

Service User/Survivor Involvement in Mental Health Training and Education: Overcoming the Barriers

This article discusses 10 barriers to the involvement of service users/survivors in learning and teaching about mental health in higher education, suggesting ways of overcoming each. The paper is addressed to mental health trainers and educators, some of whom will be mental health service users/survivors. We have not looked at the involvement of carers/relatives in learning and teaching here. They also clearly have an important role to play and some of what we have written will have relevance to their involvement.     

Risk and new exclusions in community mental health practice

Abstract

Over the past two decades, mental health practice has become increasingly focused on assessing and managing the risks posed by service users. British researchers have made significant advances in studying the consequences of risk management for community-based health and welfare services, but in Australia this field remains largely undeveloped. Drawing on my experiences as a social worker in a Melbourne-based Crisis Assessment and Treatment Team from 1991 to 2008, the present paper offers a reflective analysis of the shift in practice orientation that has emerged through the growing prominence of risk as a foundation for intervention. Specifically, I argue that this shift has led to a narrowing of service provision and that “low-risk” clients are newly disadvantaged, often excluded from service.     

Repositioning Risk and Resilience: Improving the Lives of Children and Adults with Mental Health Problems in Eastern Europe and Central Asia

The repositioning of risk and resilience within the social work and mental health agenda is examined in this paper through a consideration of the social exclusion of vulnerable children and adults living in Eastern Europe and Central Asia (EECA). There is a pressing need in this region for the development of better conceptions and cultural adaptations of risk and resilience models. An important task is spelling out the implications for effective prevention and intervention programs, and for practitioners and service users in terms of an inclusive, person-centred, and emancipatory practice. The societies of the EECA region may be understood as comprising a distinctive form of risk society, distinguished from Western counterparts by their adverse risk levels, and by their emancipatory potential. Strategies based on user inclusion and participatory action require to be fashioned, along with the development of the social work profession, to facilitate the empowerment of users in the EECA region.     

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.     

Working in Complexity: Ethics and Boundaries in Community Work and Mental Health

While codes of ethical conduct are important, they do not always fit neatly in the organic community settings in which some workers engage. Professional standards from accrediting bodies are easy to sign up to, yet much more difficult to put into practice. Drawing upon community connection practice in recovery-oriented mental health work, this article names the professional boundary tensions peculiar to less structured fields of engagement. We suggest that for workers in these fields, there has been a disconnection between the theory, the experience, and the public discourse of professional boundaries. We argue that such disconnection can create uncertainty, anxiety, and secrecy, creating exactly those cultures we wish to avoid. Ultimately this leads to greater harm for vulnerable individuals, as well as the workers and organisations that serve them. The alternative is to engage in what we name a “risky conversation,” to expose this disconnect and engender a new type of professionalism.     

Forging an Identity as a Newly Qualified Worker in the Non-government Community Services Sector

Forging a professional identity is commonly assumed to be a key objective for new graduates transitioning to work. However, the extant literature on professional identity development gives minimal consideration to the role of contemporary work conditions such as increased contract-based employment and occupational instability in carving out a work identity. These workforce trends are particularly pronounced in the non-government community services sector, where worker mobility is high and workers often occupy roles that are not profession-specific. In light of these trends, this article seeks to broaden existing understandings of professional identity development. Focus groups were conducted with 24 newly qualified workers with degree-level qualifications in social work and the human services employed in the community services sector in Queensland. The findings suggest that these workers held a variety of allegiances, which were not necessarily aligned with a profession but instead shaped by the interplay of personal, professional, and organisational factors.     

Access to Mental Health Services: The Struggle of Poverty Affected Urban Children of Color

It is estimated that, in the United States, one in ten children and adolescents suffer from illness severe enough to cause some level of psychosocial dysfunction. Urban children, and in particular low-income children of color, are at greater risk of developing mental health problems, and are less likely to receive effective child mental health services. Prompt and effective access to mental health services by urban children of color is a critical direct practice and social policy concern. This article provides an overview of significant barriers to mental health care experienced by poverty affected urban children of color and their families. It also addresses a broad range of practice and policy issues that need to be raised in order to ensure competent delivery of mental health services for children living in urban environments. The role of social work in assisting poor urban children of color to access and benefit from mental health services is stressed. Manny John González, D.S.W., is an Assistant Professor of Social Work at Fordham University Graduate School of Social Service.     

Asian Americans and Mental Health Services

Abstract

Research in the 1970s and 1980s revealed that Asian Americans, compared with other ethnic groups, tended to under-utilize mental health services. This article is aimed at adding new information to the literature by examining data from the 1990s. The raw data comprised 97,212 total admissions representing 45,774 total individuals utilizing mental health services during a four-year period in San Diego County, California. By comparing our findings with previous research cases on utilization patterns of mental health services, new evidence is found about Asian Americans in terms of their (1) underrepresentation in mental health services, (2) presentation of more severe symptoms than those of other racial/ethnic groups when first seen at clinics, (3) lower dropout rates and higher average lengths of stay than other racial/ethnic groups, and (4) higher percentages of using day treatment and outpatient programs but lower percentage of using inpatient programs.     

Chapter 4. Older Latinos and Mental Health Services

SUMMARY

This article discusses the biopsychosocial and spiritual aspects related to older Latinos' use of mental health care. It also addresses the environment that older Latinos have to navigate to access mental health services. Structural barriers to mental health services are emphasized as critical to a holistic assessment of the client's situation.     

Community Mental Health and the Educational Dilemmas of the Mental Health Professions

Liberation theory from a Third World adult educator is seen as consistent with social work ideals and an avenue for social work education to travel in developing better learning and more motivated, knowledgeable, critical, responsible, and autonomous learners. Conscious choice can free professional education from its pedagogical overtones, recast it in an androgogical perspective, and help it produce learners who are creative subjects rather than receiving objects.     

Engaging with a Mental Health Service: Perspectives of At-Risk Youth

Studies suggest that only a small number of young people with diagnosable mental health difficulties are referred for treatment. Of these a significant proportion fail to engage in treatment or terminate prematurely. This situation is exacerbated when the young people are homeless or at risk of homelessness, and considered to be at-risk. With this at-risk population the process of engagement is likely to be a critical aspect of successful interventions. Using qualitative methodology, at-risk clients of a mental health service (n = sixteen) were interviewed, and four primary themes crucial to the engagement process were identified. The data indicated the importance of considering the young person and their multifarious life-experiences; the attractiveness and accessibility of the service; and the follow-up offered by the service provider. The implications for mental health services that provide counseling for young people are discussed.     

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.     

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.

     

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’.     

Homelessness and Children's Use of Mental Health Services: A Population-Based Study

This study examined whether children who become homeless differ from other low-income children in their mental health service use before and after their first homeless episode, and to what extent homelessness is associated with an increased likelihood of mental health service use. Differences between children with and without new onset of sheltered homelessness in the use of mental health services emerged following homelessness and widened over time. Sheltered homelessness and foster care placement history were associated with increased odds of receiving inpatient and ambulatory mental health services. Findings underscore the importance of collaborations between homeless assistance, foster care, and mental healthcare in efforts to mitigate family homelessness and collateral needs among homeless children.