Medicare Funded Mental Health Social Work: Better Access to What?

ABSTRACT

Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Scheme initiative (Better Access), is an Australian Federal Government scheme aiming to improve access to mental health services. Accredited mental health social workers have been involved in the delivery of services under Better Access for more than a decade. In this time, there have been significant changes in the field of mental health services, with consequent increases in size and costs for Better Access. Better Access now represents public spending of more than one billion dollars per annum, yet there is no ongoing account of its impact. In this paper we consider the policy chronology and evaluation of the program, using current available data to question the impact of Better Access on both the service system and the nature of mental health social work practice. This case highlights the importance of a clear articulation of the scope of mental health social work, and ongoing monitoring of the impact of policy in a policy environment increasingly characterised by individualised funding and service delivery structured according to the principles of New Public Management.

IMPLICATIONS

• Social workers' increasing involvement with Better Access has reshaped the scope of mental health social work practice.

• The impact of Better Access on outcomes for service users and mental health social work is not currently a focus of research attention.

• Better Access is a case study illustrating the potential of the policy context to directly shape social work practice, therefore critical engagement with the impact of Better Access is an essential professional imperative.

     

Developing Advanced Practitioners in Mental Health Social Work: Pedagogical Considerations

Advanced social work practitioners in mental health services daily face the challenges of working alongside the more powerful professions of psychiatry and psychology. Advanced post-qualifying programmes in mental health social work equip practitioners with the knowledge, skills and expertise to confidently work alongside both psychiatrists and clinical psychologists in multi-disciplinary teams. This includes training in empirical research methods, which are used to develop the evidence base for psychiatry and psychology, although social work practitioners find this particularly challenging. This paper explores the importance of research methods teaching in the development of advanced practitioners in mental health social work. Using learning theory to explore possible reasons why practitioners find it so difficult, it offers some solutions which may enhance the learning and teaching of research methodology to experienced social workers.     

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.

     

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.

     

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.     

Social Work Research in the Field of Disability in Australia: A Scoping Review*

Although in Australia disability is receiving unprecedented attention with the rollout of major reforms, the body of research on disability to inform policy and practice has been found “not fit for purpose”. This scoping review of empirical research papers published by Australian social work authors between 2007 and 2015 investigated the quantity, nature, and scope of social work research on disability in Australia. We found a steady growth, an annual average of 13.8 papers, and a total of 124. Social work disability research makes a distinctive contribution; it is contextualised in service systems or policy, has a greater focus on community and civic participation and social relationships, and concentrates on adults, with either intellectual disability or traumatic brain injury. These research strengths provide foundations for building the profession’s research capacity and informing its practice and contribution to the multidisciplinary field of disability.

IMPLICATIONS

• Service system reform is increasing engagement of social workers with people with disabilities, yet disability has a low profile in the profession.

• Social work disability research has strengths in understanding service systems, social relationships, and strategies for social and civic participation, particularly with adults with cognitive disabilities.

• Increased attention to disability in qualifying and higher degree programs will better prepare students for complex practice and develop the distinctive contribution of social work research in this interdisciplinary field.

     

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.     

Project Discovery: Social Work Research @ Southern Health

Abstract

The health sector uses a “person-in-environment” perspective reflected in multidisciplinary teamwork to understand and influence human lives. This standpoint accords closely with social work's knowledge and theory base, recognising that material, economic, political, organisational, and social structures interact, creating a complex array of factors impacting on individuals and families. Practice research activities are an effective way of exploring social work's particular contribution to health service provision. We describe and critique various models of practice research reported in the literature. A unique model of practice research that we are developing is discussed. Called Project Discovery: Social Work Research @ Southern Health 18 June 2011, this model demonstrates ways in which practice research may exemplify theoretically-driven and service-based research and in so doing advance social work's knowledgebase.     

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.     

When Work and Family are in Conflict: Impact on Psychological Strain Experienced by Social Workers in Australia

Abstract

The impact of workplace stress and the need for work-life balance are increasingly recognised within social work. Recent theorising on work–family interface suggests that work-related stress cannot be contained within the workplace without it impacting on other life domains such as the family. Similarly, it is claimed that family-related issues also affect what happens at work. The present study examined the impact of different forms of work-to-family conflict (WFC) and family-to-work conflict (FWC) on social workers' psychological strain. An online survey of Australian Association of Social Workers members yielded a final sample of 439 responses. Hierarchical multiple regression analyses examining the direct effects of work–family conflict on psychological strain showed that respondents experienced all three forms of WFC (time, behaviour, and strain) and two forms of FWC (strain and behaviour), and these were significantly associated with psychological strain. These findings may be useful in developing strategies that aim to reduce conflict, thereby enabling social workers to make meaningful contributions in their work and family lives.     

Narcissism and the Social Work Response

Abstract

This paper reflects on and discusses the relationship between social work knowledge and practice in the context of work with narcissistically-oriented clients. Two subtypes of narcissism postulated in the literature are discussed in relation to the pattern of narcissistic internal claims about self and associated relational expectations. Key messages for social workers are that greater knowledge of the dynamics of narcissism may lead to: accepting and adapting practice based on the idea that narcissistic dynamics have a certain intentionality; applying empowerment models more carefully with this group; better understanding of how to effectively engage clients without reinforcing strong narcissistic tendencies or “results”; and protection of social workers' wellbeing by being able to identify and understand how narcissistic dynamics impact in practice situations. Social workers are urged to critically reflect on and to develop deeper, social work-specific, understandings of personality psychology in the interests of greater practice effectiveness.     

Grappling with Realities: Policy and Practice in HIV Social Work

In 2012 the NSW HIV Strategy 2012–2015: A New Era was released, with a goal of eradicating Human Immunodeficiency Virus (HIV) by 2020. This new policy, prioritising biomedical treatment, has raised challenges for social work practitioners working in the HIV field. We undertook a research project exploring the implications of the Strategy on social work clients and practice. A questionnaire was sent to 57 HIV social workers and 32 (56.1%) responses were received. Thematic analysis identified five main themes affecting social workers and their clients. These were a new stigma, treatment benefits, the complexity of people's lives, the psychosocial voice, and ethical and professional tensions. We propose that a more holistic HIV strategy including the psychosocial realities that inform HIV transmission, testing and treatment options, and adherence be adopted.     

The Expansion of the Peer Adviser Workforce: Opportunities and Challenges for Social Work

ABSTRACT

Peer adviser roles are becoming an increasingly common—and celebrated—aspect of agencies where social workers are located. This article reports on a qualitative research study exploring the experiences of staff within a homelessness outreach service in which three peer advisers (people with a lived experience of homelessness) commenced employment. Drawing on action research principles, the study explored the experiences of the peer advisers and the broader team following the introduction of the peer adviser roles. Themes identified include, realising the skills of peer advisers, defining the role, taking a “whole of team” approach, and reflecting on power. This study demonstrates that the introduction of peer adviser roles into human service organisations is a promising strategy for creating services that are more likely to respond effectively to the needs of service users. However, social workers need to be aware of the pitfalls of tokenism and the devaluing of experiential knowledge.

IMPLICATIONS

• Peer advisers in health and welfare agencies add significant benefits to an agency’s capacity to respond to the needs of service users.

• The introduction of the peer workforce is aligned to social work values of service user empowerment and the valuing of experiential knowledge.

• In order to avoid tokenism, the introduction of peer adviser roles should be supported by both the attitudes and actions of other staff members, as well as organisational support structures.

     

Back to the Future of Social Work: Child and Adolescent Mental Health and the Post Qualifying Curriculum in England and Wales

The first social work course to focus on children's mental health in the UK began in 1929 at the London School of Economics and Political Science. The subsequent child guidance movement spawned the genesis of child and adolescent mental health services (CAMHS) where social workers held a pivotal and much-respected role among multi-disciplinary teams. This role has been undermined in recent years. Post qualifying social work education and training needs to recognise and reflect the potential social work contribution to modern CAMH services to enable social workers in England and Wales to engage and contribute to supporting the increasing numbers of troubled young people. This paper sets out a rationale, knowledge base and outline content for ways in which the post qualifying social work curriculum can be developed to equip social workers with the necessary skills to engage purposively in this area.     

Programs to Improve the Social and Emotional Wellbeing of Aboriginal and Torres Strait Islander Communities

Attending to the social and emotional wellbeing of those from Aboriginal and Torres Strait Islander cultural backgrounds is widely recognised to play a key role in effective social work practice. However, relatively little is currently known about what effective practice comprises, and significant challenges exist in any effort to demonstrate that programs do achieve significant change both for individual participants and the communities in which they live. This paper considers one program, Seasons for Healing, to illustrate the type of intervention that holds promise when working with adults and discusses the difficulties that arise in both defining and assessing program outcomes.     

A Framework for Enabling Evidence-based Practice in Allied Health

Evidence-based practice (EBP) is upheld as best practice in health and human services but there is a need for more research on how this approach can be enabled in day-to-day practice. This qualitative study examined EBP with allied health managers and practitioners in a health service network (n = 17). The findings highlight the systemic nature of EBP and the extent to which it involves both individual and environmental attributes. Individual attributes include clear understanding of EBP, relevant knowledge and skills, and motivation and passion. Environmental attributes are the presence of an organisational culture that values and prioritises EBP and an integrated mix of research support services, professional development activities, supervision and mentorship, and university partnerships. Theoretical frameworks can be useful for making sense of complex processes, planning, and evaluating change. Therefore, the findings are presented as a framework incorporating reflective questions relating to the elements identified as enabling EBP.     

Families and Mental Illness: Contested Perspectives and Implications for Practice and Policy

Abstract

Mental health research, policy, and service provision over the last 50 years have constructed families and their connections with mental illness in various and contradictory ways. Three distinct but intersecting perspectives derive from the clinical mental illness literature, the family advocacy movement, and mental health policy. Within the clinical literature, the perspective of families is largely one of blame and pathology. By contrast, the family advocacy movement has generated the perspective of the burdened family, whereas mental health policy has created the perspective of the obligated caregiver. The result is an ambiguous understanding of the role of the family in both contributing and responding to mental illness. Implications for policy and practice include the need for a commitment to the principles of partnership with families, a recognition of diversity within families, recognising the difference between carer and family positions, and a need for policy to reflect the position of family as both intimately concerned, but not necessarily responsible, for patient care.     

Social Work Practice in Mental Health: An Introduction

The results of empirical research suggest that the ability to assess, regulate, and utilize emotions is important to the performance of health professionals. Nevertheless, few professional programs adequately address this matter in their curricula. The main objective of the present research was to examine whether emotional intelligence and empathy could be improved in the traditional classroom, employing experiential teaching modes. Pre- and post-questionnaires were used to assess the emotional competencies of 165 social work undergraduate students. The results indicated an increase in emotional intelligence at the end of a course for advanced-year students. Overall empathy had not increased for both first- and advanced-year students. Further findings indicated significant correlation between empathy and emotional intelligence at the end of a course for advanced-year students compared with an insignificant correlation at the beginning of the course, whereas for first-year students, findings were in the opposite direction. Future research should focus on strategies for the teaching and professional training of social workers that promote emotional competencies.     

Borderline Personality Disorder and Access to Services: A Crucial Social Justice Issue

A diagnosis of Borderline Personality Disorder (BPD) can significantly affect access to services. Two Australian approaches to addressing this crucial social justice issue are compared: Project AIR (Affect Integration and Recovery), exemplifying changes within the existing psychiatric paradigm; and Adults Surviving Child Abuse's Practice Guidelines for Treatment of Complex Trauma and Trauma Informed Care and Service Delivery. Changes within the existing paradigm do not address stigma and fragmented services that create barriers to service. By comparison, the Guidelines represent a trauma informed perspective that recognises underlying complex trauma for most with the BPD diagnosis. Implications for services are discussed.     

Readings in Evidence-Based Social Work

Abstract

This article describes the development, validity, and reliability of the Parent Empowerment and Efficacy Measure (PEEM). Development was guided by theory and by challenges faced by Pathways to Prevention family support staff who required a short, practical, and reliable measure of parent empowerment. The measure's psychometric properties were tested using data from 866 parents of children aged 5 to 12, living in high to low socioeconomic status areas. Principal factor analysis revealed a strong general dimension with high internal consistency (α = 0.92) that correlated at 0.60 or more with three validation measures, as well as the existence of two hypothesised subfactors (correlated at 0.78): efficacy to parent and efficacy to connect, each with internal consistencies of 0.85+. Test–retest reliability (n = 200) was 0.84. PEEM exhibits excellent convergent and concurrent validity and is a reliable tool for use in planning services, monitoring participant progress, and evaluating program effectiveness.