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.     

Social Work and Child Mental Health: Psychosocial Principles in Community Practice

Correspondence to Steven Walker, Senior Lecturer, School of Community Health and Social Studies, Anglia Polytechnic University, 2nd Floor, Ashby House, Brook Street, Chelmsford, Essex CM1 1SQ, UK. E-mail: s.walker{at}apu.ac.uk Summary The increased prevalence, complexity and earlier onset of childand adolescent mental health difficulties, has prompted governmentinitiatives to reconfigure current provision for this clientgroup, their parents and the carers who try to support them.Social workers have an important part to play in respondingto the needs of these individual children and families. A residual,care management role is not adequate in these circumstances.This paper describes the development of social work in childand adolescent mental health, and suggests that a synthesisof psychosocial principles and community practice, offers theoptimum social work model of assessment and intervention. Sucha model embraces the most useful aspects of psychodynamic theoryin the context of practice consistent with anti-discriminatory,children's rights and partnership principles.     

The Need for a New Social Work Perspective in an African Setting: The Case of Social Casework in Zambia

Correspondence to Geoffrey W. Silavwe, Dean of Students Department, The Copperbelt University, P.O. Box 21692, Kitwe, Zambia. Summary This article discusses traditional social casework principlesand how some of these principles are irrelevant for social caseworkpractice in an African setting or culture. The principles onwhich social casework is based involve western concepts foreignto the cultures of most developing countries. They are thereforeinappropriate for social work practice in an African settingbecause they are based on values (especially self-determinationand confidentiality) which assume concepts of individualitynot applicable in an African society, particularly in Zambia.     

Tackling Inequalities in Physical Health: A New Objective for Social Work

Correspondence to Eileen McLeod, Department of Social Policy and Social Work, University of Warwick, Coventry, CV4 7AL, UK. Summary We argue that tackling the impact of social inequality on physicalhealth should become a central objective of social work andintrinsic to the development of anti-oppressive practice. Thisis on three grounds. First, the suffering embodied in inequalityin physical health should be a cause of concern to social workers,as a pervasive social problem. Secondly, awareness of socialwork's complicity in contributing to such a problem, throughits historical role in implementing state policies, needs toinform assessment of social work outcomes. Nevertheless, thirdly,social work—not confined to health care settings—whichredresses social disadvantage and tackles its consequences forphysical well-being can contribute to greater equity in health.Indicative examples of such practice are provided in relationto health maintenance, living with ill health and terminal illness.Finally, consideration is given to the current wider politicalcontext in which social work addressing health inequalitiesis embedded and to the need for complementary organizational,professional and political initiatives to buttress its development.     

A Comparative Study of the Management of Cases of Deliberate Self-Harm in a District General Hospital

Correspondence to Michael Bateson, Senior Psychiatric Social Worker, Lancaster Moor Hospital, Lancaster, Lanes. Summary A controlled study was undertaken of two services assessingand managing cases of deliberate self-harm admitted to a casualtydepartment. The first service featured psychiatrists only andthe second included psychiatric social workers as well as psychiatrists. A combination of standardized instruments, a structured questionnaire,a twelve month diary and medical and social work files wereused to collect information. Demographic factors, repetitionrates, types of help offered, client satisfaction, social circumstancesand general health were investigated. Few significant differences were found to have existed betweenthe client populations of the two services at initial assessment.Also, there were no apparent differences in factors interveningbetween initial assessment and follow-up. However, the analysisof outcome measures indicates that clients benefited substantiallyfrom the addition of a psychiatric social worker in the followingareas: help offered, client satisfaction, social circumstancesand general health. These results are discussed.     

Aspects of Social Work on a Cancer Research and Treatment Unit in a London Teaching Hospital

Summary With the rapid growth of technology and science in society today,an increasingly large number of people are becoming patientsin specialized research and treatment units. The reorganizationof social work support to the health service is upon us, andgreat care must be taken to ensure that this important groupof clients will receive the social work help it needs. The paper is based on work in a cancer unit in a London teachinghospital and seeks to illustrate ways in which the work is specialized     

Primary Health Care Workers' Views about Social Work

Summary SUMMARY A comparison of the views about social work held by 188 primaryhealth care workers—118 GPs, 31 health visitors and 39district nurses—working in the same teams is presentedhere.^* The study focussed particularly on their perceptionsof social workers, their role and performance. The data indicatea general acceptance of the social work role, but a lack ofknowledge of or extensive criticism about, social work performance.Significant differences of view emerged about social work training,role and clients, indicating occupation is a significant factorin perceptions held. In particular, the client group predominantlydealt with appears to have had an impact on perceptions. However,views about social work performance did not differ greatly,suggesting the influence of occupation on perceptions shouldnot be overstated.     

Social Workers Talking to Clients: A Comment

Summary I read Baldock and Prior's article with interest in view ofthe shortage of studies examining day-to-day practice in socialwork, but the authors' analysis leaves me reflecting uneasilyupon the state of uncertainty into which social work has fallen.The authors conclude by describing as ‘skilled’,practices which they say resulted in confusion for clients andwhich only apparently reflected social work principles. We arenot told whether the authors checked their analysis with workersor clients and it is possible that the clients were not as confusedas we are led to believe, given their long term contact withthe workers. If, however, the picture is an accurate one, shouldit really be described as representing skilled social work?Baldock and Prior do so but neglect to examine the ends towardswhich interviewing skill should be directed in social work.The result is a strangely ambiguous statement about practice,particularly in the light of research findings on effectivenessand client satisfaction, and one which offers little scope forcomplacency.     

Social Work in Accident and Emergency Departments: A Better Deal for Older Patients' Health?

Correspondence to Eileen McLeod, School of Health and Social Studies, University of Warwick, Coventry CV4 7AL, UK. Summary Well-established internationally, the current development ofsocial work in UK accident and emergency (A&E) departmentsis part of a conjoint health/social care policy drive to divertolder people from ‘unnecessary’ admission to acutehospital care on social grounds. However, from older serviceusers' standpoint, the prime criterion for assessing A&Esocial work is not its powers of diversion, but its contributionto optimum health and social care. Our account indicates thatA&E based social work can provide important benefits, includinghelp with negotiating the A&E environment and readier accessto social services. Nevertheless, continuing professional–serviceuser power imbalances, together with shortages in health andsocial care services, undermine its positive contribution bothwithin A&E and following discharge. Notably, under-resourcedcommunity based health and social care can lead to servicesimplemented through A&E, swiftly unravelling. This has seriousconsequences for older service users facing interlinked healthand social problems, and may be implicated in re-attendanceat A&E.     

Social Work at the Crossroads

Summary The contribution of social work to society has always been contested.Social workers work with some of the most psychologically damagedand socially disadvantaged people, and are susceptible to publicdevaluing of the services they provide. Indeed, social workhas been subjected to an ever-increasing volume of public debateand criticism, and its claims to professional status are underthreat. Recent years have seen a constant attack on its valuesand principles, which has taken place at political, organizationaland professional levels. Social work practice has been subjectedto increased managerial control and social workers' levels ofautonomy have been reduced. This has created a sense of crisis,which has been experienced particularly within social servicesdepartments (SSDs), the main source of employment for socialworkers. The paper will argue that its survival as a recognizableprofessional activity is dependent on the extent to which itcan redefine its role within society, and re-establish clarityabout its overall purpose and function.     

Government, Social Services Departments and the Health of Children and Young People: Which Way Forward?

Summary Despite the dearth of research into the health of children andyoung people in contact with or ‘looked after’ bylocal authorities, a series of official and quasi-official reportshave begun to raise awareness of this issue. There are goodreasons to believe that this group of children will be disadvantagedin terms of health as they are in other aspects of their lives.The evidence suggests that local authorities do not live upto the standards of ‘good parents’. Current notionsof good practice are critically appraised and the article concludesthat social work is unable to do more than mitigate the effectsof Government policies which affect health and social servicesand which have lead to widening social inequalities.     

On the Trail of a Radical Pedagogy for Social Work Education

Correspondence to Dr William De Maria, Department of Social Work and Social Policy, The University of Queensland, Brisbane 4072, Australia. Summary This article uses a general decade by decade approach to notethe emergence (1970s), decline (1980s), and re-emergence (1990s)of radical social work. An issue for this 1990s'-type radicalsocial work will become one of attending to its own teachingmission. A range of radical pedagogic principles is presented:cause-sensitive action, tailoring, contradiction-based learning,de-monopolized values, radical analysis, polemic storytelling,and centring marginality.     

Social Work Intervention on a New Housing Estate

Summary Families moving into a new housing estate were the subject ofa controlled experiment. Half received social work assistance,half did not. The two groups showed little difference in levelsof health or satisfaction with their environment. The problemsidentified tended to be communal problems of the estate, relatedto its design and management.     

A Political Critique of Kantian Ethics in Social Work

Correspondence to Stephen A. Webb, Department of Social Work, University of Dundee, DD1 4HN. Summary This paper addresses the Kantian theory of the subject whichis found in contemporary social work discourse on ethics andvalues. It is argued here that the Kantian idea of persons as(i) rational, (ii) autonomous, and (iii) ends-in-themselvesis wholly inadequate to the social work doctrine of ‘respectfor persons’. To show this, we counterpose a Foucauldianview of history, moral codes and theory of the person, and themeaning this can have in the social worker-client relation.This alternative reading claims that social work is essentiallya political practice which is constructed by various discursiveand institutional strategies of power. Therefore, it is suggestedthat social work needs a political reading of its own discourse.To this end we outline a Foucauldian micro-political analysisof the social work ‘subject’ or person as a pointwithin a field of discursive-knowledge based strategies.     

Non-Statutory Mental Health Social Work in Primary Care: A Chance for Renewal?

Correspondence to Malcolm T. Firth, Honorary Research Fellow & Senior Psychiatric Social Worker, 'DEAL', Department of Psychiatric Social Work, 12th Floor, Mathematics Building, University of Manchester, Oxford Road, Manchester M13 9PL, UK. E-mail: malcolm.firth{at}mhsc.manchester.nhs.uk Summary The current status of evidence-based practice in the field ofmental health has led some to question the potential for innovationif social work practice is organizationally proscribed or reducedto a dogged adherence to methodological orthodoxy. Conversely,social work's value base is esteemed disproportionately to itsevidence base. Changing service contexts in the UK, particularlythe emergence of Primary Care Trusts as gatekeepers and commissionersof health and social care services, are providing opportunitiesfor social work to develop a new presence and purpose. The authorsdescribe their work in a small-scale service based in primarycare that anticipated these opportunities, by a retrospectivestudy of 120 cases. A new evidence base that derives directlyfrom practice is suggested as a way forward for social workeducation and training, as well as for service and professionaldevelopment.     

Social Work as an Aspect of Primary Health Care: The Social Workers' View

Summary This study is based on an analysis of social workers' viewsof their work with 168 clients referred over a six month periodin 1977 in a health centre setting. A wide range of referralswas made and there was close collaboration with other primaryhealth care professionals as well as outside agencies. Far morepsycho-social problems were encountered by the social workersin the course of their intervention than were apparent on referral,although most of the work was short term. Social work with theindividual predominated and a variety of traditional socialwork skills were employed, although the elderly received relativelylittle help with emotional problems and were offered mainlypractical help. Social workers' perceptions of their clientsare discussed in relation to their choice of methods of interventionand feelings of efficacy. The attachment scheme emerges as generallyfruitful both in terms of social workers' job satisfaction andclients benefitting from a multi-disciplinary approach; howeverthe need for closer inter-professional collaboration in meetingthe needs of the elderly is highlighted.     

Tricks of the Trade: Questionable Theory and Practice in Family Therapy

Summary This paper looks at certain over-systematizing trends in familytherapy, and at a group of practices, connected with such systems-thinking,which espouse manipulation and deception. It is argued thatthese theories and methods, couched in a language of scientism,represent a questionable and cynical direction in therapeuticwork. This technocratic approach not only disfigures personaland social being, but erodes social work principles foundedmorally upon a respect for persons. An alternative view is advocatedin which the value of the person is considered as central toan adequate human science. This regards the nature of understandingas based upon the finitude of experience, and therefore offersan appreciation of the person not as an ‘object’fit for technocratic manipulation, but in terms of his subjectiveand historical being.     

Long Term Social Work in a Primary Health Care Setting

Summary This study was designed to explore which factors characteriselong term clients and to investigate the relationship betweenthe burden on medical and welfare resources in a general practicesetting. Two groups of clients were studied; 135 long term clientsreferred over a five year period, where contact was maintainfor a minimum of one year and 157 cases referred during a sixmonth period, in all of which the duration of social work interventionwas less than 12 months. Few differences were found betweenthe characteristics of the two groups, nor did any individualsocial worker emerge as being particularly predisposed to maintainlong term contact However, a significant change in the proportionof referrals which became long term was found over the fiveyear period under consideration, and policy regarding the handlingof cases was therefore felt to constitute a major influenceon the length of contact with any particular client Relationshipswith other members of the primary health care team were generallyfound to be good, especially in relation to the long term clients.Moreover, the OPs' workload with regard to these clients wasfound to be reduced following social work intervention. Theseclients' consultation rates dropped significantly after receivingsocial work help, and continued to drop when the case had beenclosed.     

1998 Human Rights Act: Social Work's New Benchmark

Summary The 1998 Human Rights Act makes the European Convention on HumanRights directly enforceable by the United Kingdom's courts andtribunals. This represents a major constitutional change andwill allow statute law and common law to be assessed, or reassessed,according to the rights laid down in the Convention. This hasmany implications for social work policy makers, managers andpractitioners. It will require the Convention rights to be atthe heart of social work practice. The ability of service usersto challenge decisions by social services departments will nolonger be dependent upon the traditional approach to judicialreview. Compliance with the Convention will now feature in legalchallenges. It is essential that the practice of social workembraces the principles outlined in the Convention. In manyrespects, they are rights that practitioners and others recognizeas being basic expectations of service users, and making themdirectly enforceable can only be for the good. However, we shouldnot underestimate the effect that the legislation will have.This article outlines the legal effects of the 1998 Human RightsAct and illustrates them by reference to examples from socialwork practice.     

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.