Medicalization of Social Workers in Mental Health Services in Hong Kong

Correspondence to Dr Kam-shing Yip, Associate Professor, Department of Applied Social Studies, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong. E-mail: ssksyip{at}polyu.edu.hk Summary Medical dominance is a crucial problem in social work practicein mental health services. This paper is an examination of theresponse of social workers to medical dominance in mental healthservices in Hong Kong. To explore the process and the effectsof medicalization of social workers, sixty-three social workersin various areas of mental health service settings were interviewed.Their reaction and daily performance in facing medical dominancewere analysed and evaluated. The findings show that facing medicaldominance was a common occurrence for social workers in variousmental health services in Hong Kong. Conflict existed betweenthe rationalization of medical knowledge by medical professionals,and social work rationalization of social work knowledge bysocial workers. The process of medicalization consisted of fivestages: ignorance of medical dominance, confronting medicaldominance, compromise with medical dominance, acceptance ofmedical dominance and internalization of medical dominance.The findings also show that medicalization was influenced bythe organizational and team context.     

An exploratory study of different approaches between social work practice and correctional services in Hong Kong Special Administrative Region

This paper tries to explore the differences between social work and correctional services from the aspects of professional boundaries, concept, content, construct, context, approach, function, professional identity and relationship with service users. Through these, social workers will be informed what are the limitations of their service in a correctional environment, whilst for correctional officers, a better understanding of the philosophical stance of social services which may be helpful for them in discharging their dual role of law enforcer and social worker under the contemporary correctional policy stressing rehabilitation and reintegration of offenders.     

Shaping the Future of Mental Health Policy and Legislation in Northern Ireland: The Impact of Service User and Professional Social Work Discourses

This paper explores the complex interrelationship between serviceuser and professional social work discourses and provides acritical commentary on their respective contributions to therecent review of mental health policy and legislation in NorthernIreland. The analysis indicates that dominant trends in mentalhealth care, as mediated through service structures and institutionalidentities, have tended to prioritize the more coercive aspectsof the social work role and reinforce existing power inequalitieswith service users. It is argued that such developments underlinethe need for a ‘re-focusing’ debate in mental healthsocial work to consider how a more appropriate balance can beachieved between its participatory/empowering and regulatory/coercivefunctions. Whilst highlighting both congruence and dissonancebetween respective discourses, the paper concludes that opportunitiesexist within the current change process for service users andsocial workers to build closer alliances in working togetherto reconstruct practice, safeguard human rights and developinnovative alternatives to a traditional bio-medical model oftreatment.     

Countertransference Issues in Social Work With the Aged

Despite their growing number, their increased risk of mental disorders and social dysfunction, the elderly continue to be underserved by mental health workers. Two of the major obstacles to appropriate treatment and services for the elderly and their farnilies are countertransference and death anxiety. This article examines these issues through the use of case examples. It suggests that mental and social service agencies need to concern themselves with and provide opportunity for supervisors to review practitioners' work in order to identify countertransference issues and ageist stereotyping.     

Risk, Mental Disorder and Social Work Practice: A Gendered Landscape

Whilst the importance of gender for social work practice, riskand mental health has been recognized theoretically for sometime, few attempts have been made to explore this area empirically.This paper presents findings from a mixed-methods study of socialwork practice in relation to mental health service users perceivedto be ‘high-risk’. Findings suggest, first, thatthe concept ‘high-risk’ was gendered because theprimary focus in social work practice was on the risks posedby male service users to others. Second, female social workersin the present study were found to have more female serviceusers from their caseloads who had been defined as ‘high-risk’compared with their male counterparts. The paper goes on toexplore this apparent congruence between female social workersand female service users and highlights how the management ofrisk could be considered gendered because it reflects a worker’s(perceived) capacity in cultural terms to ‘decode’the nature of the risks that their clients face as genderedsubjects. The paper demonstrates how the intersections betweenrisk, mental disorder and social work practice can thereforebe understood as a gendered landscape. It concludes by highlightingthe implications of these findings for social work practiceand research.     

The nature and culture of social work with children and families in long‐term casework: Findings from a qualitative longitudinal study

Social work in the United Kingdom is preoccupied with what social workers cannot do due to having limited time to spend with service users. Yet remarkably little research has examined what social workers actually do, especially in long‐term relationships. This paper draws from an ethnographic study of two social work departments in England that spent 15 months observing practice and organizational life. Our findings show that social work some of the time has a significant amount of involvement with some service users and the dominant view that relationship‐based practice is rarely achieved is in need of some revision. However, families at one research site received a much more substantial, reliable overall service due to the additional input of family support workers and having a stable workforce who had their own desks and were co‐located with managers in small team offices. This generated a much more supportive, reflective culture for social workers and service users than at the second site, a large open plan “hot‐desking” office. Drawing on relational, systemic, and complexity theories, the paper shows how the nature of what social workers do and culture of practice are shaped by the interaction between available services, office designs, and practitioners', managers', and service users' experiences of relating together.     

Mental Health and the Asian Communities: A Local Survey

Correspondence to Barbara Hatfield, Lecturer in Psychiatric Social work, Department of Psychiatry, 12th Floor, Mathematics Building, Manchester University, Oxford Road, Manchester M13 9PL Summary The survey of people from the Asian communities in ‘Milltown’included people who used mental health services, family membersof service users, and members of the Asian general public. Personaland social stresses of the group were explored, as were theirperceptions of the ‘causes’ of mental ill-healthand appropriate responses. Although most people saw family andsocial stress as central, a religious dimension was also prominent,in terms both of causes and treatment of mental ill-health.There was no evidence of rejection of mainstream services becauseof a choice on the part of Asian families or communities tobe self-servicing. A range of issues identified by respondentssurrounded the cultural acceptability of services in ‘Milltown’to Asian people. A lack of knowledge of service availabilitywas also apparent, with a heavy reliance upon GP services formental health care in the community. The findings of the surveyare compared with similar studies, where available, which focuson indigenous white British service users. Some findings arecommon; other issues are specific to this Asian group.     

Service users' knowledges and social work theory: conflict or collaboration?

Summary So far, service users have not been systematically involvedin social work theorizing. However, disabled peoples's movements,mental health service users/survivors and other service usershave developed their own knowledges based on direct experienceand they have generated their own conceptual frameworks andbodies of theory. There are fundamental problems in social workseeking to interpret service user knowledges. Their developmentsand interpretation require the direct involvement of serviceusers and their organization in social work theorizing. Thereare strong practical, philosophical and political argumentsfor involving the knowledges and theories of service users andtheir organizations in the process of social work theory-building.This paper considers an inclusive approach to social work theorizing.While highlighting the importance of service users and theirorganizations being effectively included in social work theorizing,it also argues the need for them to have support and opportunitiesto develop their own prior and separate discussions about theory,including social work theory.     

Bilingual Social Workers in Mental Health Service Provision: Cultural Competence,Language, and Work Experience

Many agencies actively recruit bilingual social workers. This study presents the reactions of 10 Chinese bilingual social workers to the expectations and demands of their agencies. The study employed a qualitative design with a phenomenological approach. The participants’ responses provide insight into how they manage ethnic and cultural mental health issues in Chinese populations. This study aims to improve social service delivery for clients with limited English proficiency by identifying effective, culturally competent services. The findings suggest that when hiring bilingual social workers, it is just as important for them to be culturally competent as it is for them to be an ethnic or language match with the client base. Having all of these qualities will result in staff members who can provide more effective services by making accurate diagnoses and identifying appropriate treatment plans. In addition to employing bilingual social workers, it is important to maintain good supervision as this will allow supervisees to have a unique perspective on what is involved in providing effective delivery of services to clients with limited English proficiency. Implications for research, practice, and policy are discussed.     

Users as Citizens: Collective Action and the Local Governance of Welfare

Self-organization amongst users of community care services preceded the consumerist developments of the 1980s and early 1990s, but can be considered to have been "legitimized" by top-down objectives relating to "user involvement". Nevertheless, the objectives and value bases of disabled people's organizations and organizations of users (or survivors) of mental health services have not always been consistent with those of consumerism, and user groups have experienced tensions in determining the extent to which they should respond to official agendas. Drawing on theories of new social movements and of citizenship, this paper considers the developing place of user organizations within systems of local governance. It looks at the way in which groups have sought to assert the legitimacy both of experiential knowledge and of their position as citizens in the face of official responses which have constructed them as self-interested pressure groups. It draws on empirical research investigating local groups of disabled people and of mental health service users conducted in the first part of the 1990s. It discusses the significance of shared identity as a basis for collective action alongside more pragmatic motivations to influence the nature of health and social care services. In the context of appeals to "community" and "partnership" which are starting to replace the discourse of markets and contracts as the key metaphor for both policy-making and service delivery, the article considers likely future roles for groups comprising people often excluded from community.     

Putting the parity into service‐user participation: An integrated model of social justice

Models of service‐user participation have derived from citizenship or consumerist agendas, neither of which has achieved the structural reforms important for the most marginalised social work clients. This article proposes Fraser's model of ‘parity of participation’ as an appropriately multifaceted frame for capturing the social justice aspirations of service‐user participation. A qualitative case study compared the experiences and expectations of people who had used Australian mental health services with a sample who had used Australian homelessness services to examine their expectations of participation at individual and representative levels. The findings reinforce concerns from Fraser's research about the tendency for identity‐based consumerist notions of participation to reify group identity. This leads to tokenistic service‐user involvement strategies that have little impact on participation at a structural level. Fraser's parity of participation is shown to have untested potential to reshape service‐user participation to meet the social justice aspirations of social work clients. Key Practitioner Message: ● Innovative, service‐user driven strategies for collaboration will be those which challenge existing power structures; ● Service users want their contributions to decision making to generate identifiable change in the system of social services; ● The success of service‐user participation strategies might be the extent to which political, economic and cultural opportunities are enhanced.     

Commonality and Diversity in Feminist Social Work

Correspondence to Vicky White, Department of Applied Social Studies, University of Warwick, Coventry CV4 7AL. Summary The relationship between feminist social workers and women serviceusers is a central concern in the feminist social work literature.The literature's discussion of feminist social worker/womanservice user relationships, along the dimensions of commonalityand diversity, is compared with the experiences and understandingsof feminist social workers who participated in a small-scalequalitative study. Two main themes are considered: first, commonalityin feminist social worker/woman service user relationships;secondly, diversity amongst women service users. Issues forfuture work are drawn out of the discussion of these themes:the problematic nature of feminist social worker/woman serviceuser commonality; the impact of social divisions other thangender on women service users' lives; the importance of unpackinggeneralizations about both women service users and feministsocial workers; the need to explore the intersections of thestatutory context and feminist social work identities. It isargued that in addressing these issues future work would beenriched if greater prominence were given to feminist practitioners'perspectives, experiences and understandings.     

On the Inside: A Narrative Review of Mental Health Inpatient Services

This paper describes and discusses the results of a narrativereview of inpatient mental health services in the UK. Four mainthemes emerge from the review: the growing pressure on inpatienthospital services; the negative experience of inpatient servicesreported by many service users; the problematic nature of hospitaldischarge; and possible alternatives to hospital admission.This review also suggests that a failure to recognize and acton what appears to be happening in hospitals could result ininpatient care once again being subject to the scrutiny andcriticism that cast a shadow over psychiatric services in the1960s and 1970s. To stop this happening, current governmentpolicy is right to focus attention back onto acute care throughnew guidance and by commissioning research. However, changesalso need to take place at a practice level so that front lineworkers are familiar with conditions in local acute servicesand can challenge unacceptable behaviour/services in supportof their service users. With current changes in the make-upof local mental health services and a greater emphasis on partnershipworking between health and social care, it may be that socialcare practitioners can do this not only from the outside, butincreasingly ‘on the inside’ (from within integratedhealth and social care organizations).     

An Inclusive Approach to Knowledge for Mental Health Social Work Practice and Policy

As the integration of health and social care services progressesin the mental health sector, there is concern that mental healthsocial workers are disadvantaged, relative to health professionals,because they cannot identify the knowledge base for their practice.This paper argues that this concern is partly the product ofassuming that the knowledge base has to be premised upon randomizedcontrolled trials. Instead, it proposes a non-hierarchical frameworkbased on that developed in health research in Canada by Upshurand colleagues that generates a typology of knowledge whichis congruent with the main forms of inquiry that are relevantto mental health social work practice. The framework recognizesthe contribution of randomized controlled trials to the knowledgebase but also validates knowledge drawn from qualitative, epidemiological,practitioner and user knowledge. It is argued that the frameworkprofiles a wider knowledge base than that promoted by conventionalevidence-based practice, and also could be a basis for futuredevelopment of the research agenda in mental health social work.     

Change for children? The challenges and opportunities for the children’s social work workforce

Children’s services are currently undergoing their biggest changes in a generation. The government is seeking to create a more coherent, seamless configuration of services, with a view to securing improved outcomes for all children. However, there is a current crisis in the recruitment and retention of a range of child welfare professionals, including children’s social workers, which must be addressed in order for this ambitious agenda to be achieved. This paper discusses the findings of a series of focus group discussions with social workers undertaking the London Post Qualifying Child Care Award in response to the Children’s Workforce Strategyconsultation process. These findings are then analysed within the context of the wider literature on social work practice and workforce development. It is argued that central to the debate on how to sustain a competent and stable social work workforce should be consideration of the consequences of initiatives to audit and assess performance; the promotion of relationship‐based social work; and the wider role of social work in preventative and protective services for children.     

Unsettling the 'social' in social work: responses to asylum seeking children in Ireland

The ‘social’ context in which social work is located is becoming increasingly unsettled by emerging patterns of mobility. Mobility is constrained for many social work service users who are trapped within disadvantaged areas, while for others it has become a forced necessity to cross national boundaries and inhabit uncertain status in their nations of destination. This article explores the responses of the social work profession to children seeking asylum in the Republic of Ireland. These children's complex needs, produced by the conditions of mobility they have encountered and by the conditions of arrival/settlement in Ireland, force social work practice to be orientated beyond the boundaries of the national welfare state. In order to explore the varied responses of the social work profession in the Republic of Ireland to asylum seeking children, three different groups of children are considered: children seeking asylum who have been separated from their parents; children who are seeking asylum with their parent(s)/family; and young Irish citizens whose asylum seeking parents are in danger of being deported. It argues that the provision of appropriate services for these children requires the development of post‐national forms of social work practice.     

Reassessing a Theory of Professional Expertise: A Cross-National Investigation of Expert Mental Health Social Workers

This paper presents the findings from a cross-national studyof expert mental health social workers in Melbourne, Australiaand San Jose, California, USA. In this study, expert socialworkers were selected based on a peer-nomination process andthey were invited to participate in two-hour focus group interviewsin which they described memorable practice situations. Detailedaccounts of these practice situations were gathered from nineteenAustralian and American expert practitioners employed in community-basedmental health settings. The study findings corroborate manyof the dimensions that are explicated in a theory of professionalexpertise developed by Fook et al. (2000). Further, the findingsdescribe the skilful and ethical comportment of these socialworkers in the context of often complex and challenging practicesituations. Narrative accounts are used to demonstrate the distinguishingdimensions and features of expert practice described by Fookand her colleagues, especially when providing services to peoplewith chronic mental illness. In-depth articulation of practiceexpertise using cross-national data enhances social work researchand pedagogy by providing important exemplars that inform morefully the development of empirically based practice theories.     

A Collaboratively Designed Child Mental Health Service Model: Multiple Family Groups for Urban Children with Conduct Difficulties

This paper presents preliminary outcomes associated with an experimental, longitudinal study of a Multiple Family Group (MFG) service delivery approach set within thirteen urban outpatient clinics serving children and their families living in inner-city, primarily African American and Latino communities. Specifically, this paper focuses on parent reports of child oppositional behavior and parenting stress over time. MFG is a flexible, protocol-driven approach designed to address the most common reason for referral to outpatient child mental health clinics, childhood behavioral difficulties. The MFG also aims to enhance family-level engagement and retention in ongoing care. Further, the service delivery model was collaboratively developed with intensive input from parents rearing children with conduct difficulties, parent advocates, community-based child mental health providers and services research staff in order to ultimately expand the number of effective service models that can be situated within "real world," urban child mental health settings.     

Calling Social Work

New Labour has promoted the use of information and communicationtechnology. Call centres are a key development in this strategyand are now in use for accessing social services. In officialpolicy, the use of call centres is presented as an aspect ofattempts to change the relationship between service users andthe purchasers and providers of services. In contrast, we suggestthat the use of call centres in social care does little to shiftthe balance of power. Call centres bring together four dimensionsof New Labour discourse: learning from the private sector, cuttingcosts, technology and consumerism. Three issues emerge fromtheir development: the undermining of social work’s senseof place; the circumscribing of service user participation;the rationalization of social workers. The call centre servesas a signifier of what, it is claimed, the combination of NewLabour’s consumerism and technology can achieve. Thissignification disguises call centres’ properties of efficiency,calculability, predictability and control. Contrary to the rhetoricthat accompanies them, call centres may be curtailing serviceuser participation, as well as delimiting the social work role.Accordingly, their use has important, but as yet largely unresearched,implications for service users and social workers.