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.     

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.     

Stress and Pressures in Mental Health Social Work: The Worker Speaks

Two-thirds of councils with social services responsibilities(CSSRs) took part in a UK survey of mental health social workers.A one in five sample of front line workers was drawn, and 237respondents completed a questionnaire and diary about theirwork context and content, and their attitudes to their work,their employer, mental health policy and the place of mentalhealth social work in modernized mental health services. Thequestions, that called for free-text responses, were completedin detail and at length. This paper reports the results of aqualitative analysis of these responses using NVIVO software.The paper is structured around the themes emerging from theanalysis: pressure of work; staffing matters; job satisfactionand well-being; recruitment and retention issues; and beingvalued. The conclusions are that the social workers value faceto face contact with service users, and that their commitmentto service users is an important factor in staff retention.The most unsatisfactory aspects of their work context arisefrom not feeling valued by their employers and wider society,and some of the most satisfactory from the support of colleaguesand supervisors. Without attention to these factors, recruitmentand retention problems will remain an unresolved issue.     

The Role of Religion and Spirituality in Social Work Practice: Views and Experiences of Social Workers and Students

Findings from surveys of qualified social work practitionersand students indicate a need for social work education and practiceto focus attention both on the importance of religious and spiritualbeliefs in the lives of many service users and on the potentialusefulness of religious and spiritual interventions. In thisBritish study, undertaken in 2003 and 2004, students were lesslikely than their qualified colleagues to consider religiousor spiritually sensitive interventions as appropriate. Attitudesvaried little between those students who held religious beliefsand those who did not, but Muslim students and qualified socialworkers were more likely to view these types of interventionsas appropriate. The authors conclude that there is a clear needfor all social work practitioners and educators to give greaterpriority to exploring the potential significance of religiousand spiritual beliefs in their training, in their professionalpractice and in the lives and perspectives of service usersand colleagues. Social workers need to be able to respond appropriatelyto the needs of all service users, including those for whomreligious and spiritual beliefs are crucial. ‘Culturallycompetent’ practice depends, amongst other things, onan understanding and appreciation of the impact of faith andbelief.     

Citizenship, Social Inclusion and Confidentiality

Correspondence to Tony Evans, Oxford Brookes University, Social Work Department, Heritage Gate, Sandy Lane, West Oxford OX4 6LB. E-mail: tevans{at}brookes.ac.uk Summary Confidentiality has tended to be disconnected from wider debatesabout citizenship and social inclusion. It has been hived offinto self-referential legal and professional discourses concerningthe principles that should inform social workers' conduct. Thelacuna concerning the significance of confidentiality in widerdebates is made more remarkable by the shift towards consumercitizenship, a shift that has ostensibly emphasized serviceusers' rights, including their capacity for active participationin service provision. The rights discourse, as a component ofactive consumer citizenship, is considered in relation to theperspectives of ‘interests’ and ‘will’.The arguments that support moving in the direction of a critical‘will’ perspective, through deliberative processesthat involve service users in developing and framing informationrights, are highlighted and linked to data from a small-scaleempirical study. This perspective is regarded as consistentwith a politically dynamic formulation of social citizenship.Such a formulation involves seeing citizenship as a practicethat requires on-going debates about claims to rights, movesin the direction of seeking to rectify imbalances in power andrecognizes the capacity of service users to act in their owninterests as citizens.     

Consistencies and Inconsistencies: Mental Health, Compulsory Treatment and Community Capacity Building in England, Wales and Australia

In relation to mental health, it is clear that medicalized underpinnings,the provision of a clinically orientated evidence base for practiceand the need to contain ‘risk’ continue to be prioritized,particularly when compulsory intervention is considered. Thisis despite the increasing influence of a citizenship and socialjustice agenda which is being promoted by psychiatrists involvedin the development of ‘postpsychiatry’, as wellas by service users/survivors. These drivers are not mutuallyexclusive, but in the context of compulsory treatment, thereare clear tensions. In this article, the policy surroundingmental health and compulsory intervention in Australia and inEngland and Wales is explored. In the context of this discussion,three ways in which current government policy can be interpretedare examined and links made between these interpretations anddifferent ways of viewing the relationship between mental healthand community capacity building. With regard to social workpractice, it is argued that a response to mental ill healthwhich concentrates on an individualized ‘diagnose andtreat’ approach, which particularly comes to the foreat times of compulsory intervention, has limited capacity tofacilitate community engagement, foster social inclusion andgenerate reciprocal dynamics between positive mental healthand community capacity building.     

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).     

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.     

Social Exclusion, Inequality and Social Work

This paper sets out the environment of inequality in which social work and the poor have recently operated. It explores pragmatic and idealist arguments concerning whether or not the poor need social work. Finally, policy solutions developed in consultation with social service users and carers are suggested in relation to poverty and social exclusion. Social exclusion can be linked to relative poverty as exclusion from economic and social norms. However, there is a wider brief in our own government’s publications and those of Europe, of examining how people are excluded from actions and policies of agencies who are there to support them. This paper will retain the concepts of poverty as lack of material income, and inequality as the gap between the rich and the poor, while being aware of the policy implications for social service users and carers of the more comprehensive process of being shut out partially or fully from social, economic, political and cultural systems. The debates around social work, social exclusion and inequality that follow establish: that some of the poor do need social work; that the poverty of social service users is related to policies that have restructured welfare in Britain; that the reason for individuals approaching or being referred to social services are complex but are likely to include financial deprivation as a key contributory factor; that if the poor do need social work, advocacy is essential rather than social work being seen as concerned only with social control—taking children into care, mentally ill people into hospitals, and advising the DSS on the suitability of claimants for benefits. Finally, the discussion turns to new policy agendas on social exclusion instigated by the Labour government. What positive difference can such policies make for social service users, their carers and social workers?.     

Constructivism in Social Work: Towards a Participative Practice Viability

Summary Social work has traditionally drawn upon an expansive rangeof social science research and theorizing as its claim upona ‘knowledge base’. Recent debates have exploredthe need for the profession to develop its own theory of socialwork knowledge arising from practice. This paper seeks to extendthe boundaries of these ideas through an operational and epistemologicalelaboration and critique of Sheppard's (1995a; 1998) notionof a practice paradigm. In an examination of the contributionof constructivism and the seminal work of George Kelly's (1955)Psychology of Personal Constructs, arguments are put forwardfor social work practice to focus upon the co-construction ofviable working relationships with service users as the basisfor an anti-oppressive and participative professionalism. Itargues that the sterile philosophical dichotomies between objectivism/realism-subjectivism/interpretivismand the equally unhelpful social work division between practice-theoryshould be integrated within a situated, participatory, constructivistapproach to knowledge creation in social work practice and continuingprofessional development.     

The Framework for the Assessment of Children in Need and their Families--A Basis for a 'Therapeutic' Encounter?

Does the Framework for the Assessment of Children in Need andtheir Families, implemented by local authorities in Englandin 2001, embody an ethos of bureaucratic regulation with stultifyingeffects on social work, or is there evidence, as was anticipatedin the official guidance accompanying the framework’sintroduction, that it has potential as a basis for therapeuticsocial work? These questions are considered in this paper, whichanalyses findings from a study of the use of the framework basedon interviews with service users and social workers. Some serviceusers found aspects of their assessment to be personally beneficial.This is discussed in detail, reaching the conclusion that usingthe framework can be therapeutic. Furthermore, it is arguedthat part of what some service users considered helpful wasrelated to the format of the new framework, and not only toits use in the hands of skilful and experienced practitioners.This point is pursued to suggest that carefully balanced analysisis particularly important in the discussion of developmentsin assessment practice that might seem too ‘bureaucratic’.     

学校社会工作与学校心理健康教育之比较研究

现今社会,心理健康问题凸显,人们对学生心理健康的重视程度也不断加深,学校心理健康教育在维持学生心理健康方面发挥着重要的作用,但其存在的问题也越来越明显。而此时,随着学校社会工作的兴起,越来越多的心理健康教育者开始重视学校社会工作在学生心理健康工作中作用。本文则以此为研究点,探讨学校社会工作与学校心理健康教育在目的、对象和方法上存在的异同,以便更好阐述学校社会工作和心理健康教育二者的地位和作用。     

Practitioner Research: Evidence or Critique?

In this paper, I revisit some of the origins and more recentdirections in practitioner research in social work, seeing itas a phenomenon that—rather than being special or narrowlyassociated with social work—manifests a pervasive clusterof concerns about good professional practice in contemporarysociety. Drawing on some general conclusions of a recent studyof practitioner inquiry, I indicate ways in which the widersystems of which it is a part frequently hamstring the potentialof such research to operate as more than a fringe operation—a‘street market’ version of mainstream research.I outline four ways in which social workers, service users,agency managers, academics, government departments and universitiesshould work to a transformative agenda for practitioner research—transformativefor both practice and research. This will involve refashioningthe interface between the methodology and methods of practiceand research; generating practitioner research capacity; recognizingthe subtlety and critical potential of a genuinely ‘practical’agenda in practitioner research; and rescuing practitioner researchfrom a simply technical information-providing function, thatby-passes the challenge to promoting critical practice.     

Beyond Power Discourse: Alienation and Social Work

Correspondence to Michael Lavalette, Department of Sociology, Social Policy and Social Work Studies, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool. E-mail: M.Lavalette{at}Liverpool.ac.uk Summary This paper argues for the relevance of the Marxist concept ofalienation to the development of an emancipatory social workpractice. As the concept has often been misinterpreted withinthe social work literature to refer primarily to a psychologicalstate, the first part of the paper seeks to establish the materialbasis of the theory as developed by Marx, and identifies fourkey aspects of alienation—from the product of labour,from the labour process, from our ‘human nature’and from our fellow human beings. Alienation theory is thenapplied to the experience of both social workers and serviceusers and it is argued that the notions of loss of control (inthe case of social workers) and powerlessness (in the case ofservice users) have greater explanatory power, and provide afirmer basis for a radical practice, than currently fashionablepower discourses, derived from postructuralism, which oftenmirror the individualism of the New Right approaches they seekto challenge. Finally, examples are given of the ways in whichthe concept of alienation might contribute towards the developmentof a new, emancipatory social work, central to which is likelyto be the development of more collective approaches.     

The Impact of Political Conflict on Social Work: Experiences from Northern Ireland, Israel and Palestine

This paper investigates the impact of violent political conflicton social workers and service users in three countries: NorthernIreland, Israel and Palestine. Despite its significance forsocial work (and other helping professions), there is a dearthof research on the subject. The authors construct a researchframework which encapsulates the complexity and ambiguity ofthe issues at stake and three parallel empirical studies, whichfollow this framework, are presented. The findings highlightthe burden of working and living in a violent political conflict,not just for service users but also for social workers. Emotionalstress, fear, competing national and religious identities, yetsome indication of resilience, are key findings from these studies.A number of moral and professional dilemmas emerged across allthree studies, often testing loyalty to universal social workvalues. Thus, some respondents at times found it difficult todeal with colleagues and service users who were perceived tobe ‘the enemy’. These studies highlight the needto raise the consciousness of social workers, agencies and policiesabout such issues in a world which is increasingly afflictedby violent political conflict. Support, education and trainingfor social workers which transcend national contexts and furtherinternational research in this important area are recommended.     

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.     

Emotional Intelligence, Emotion and Social Work: Context, Characteristics, Complications and Contribution

Emotional intelligence (EI) has become one of the new management‘buzz’ terms. It is suggested that this is the missingingredient that separates average from top management or performance.However, despite its potential relevance for social work practice,there has been little investigation and few reports about itsapplication in social work settings. This paper seeks to stimulatedebate about the role of EI in social work practice by consideringits development, definitions and problematics. Whilst the empiricalevidence supporting the existence of a separate and measurableEI is ambiguous and emergent, the role of emotion in the organizationof human behaviour is more firmly established. The paper examinesthe role of EI and emotion in relation to five core social worktasks: engagement of users; assessment and observation; decisionmaking; collaboration and co-operation; dealing with stress.The paper situates itself in the rapidly changing context ofsocial work: the merger of social services departments withlarger more powerful bureaucracies; the movement towards integratedservice delivery; and the new social work degree. It is arguedthat social work needs to identify its claims to professionalcompetence at a time of such change, one of which is the abilityto use relationships to address users’ needs. This requiresthe capacity to handle both one’s own and others’emotions effectively.     

Capacity Building and the Reconception of Political Participation: A Role for Social Care Workers?

This paper explores a citizen-based approach to social workwhich may counter modern negative managerialist pressures onpractice. It links the discourse concerning the growth of userinvolvement in public policy with the discourse about participationin political activity and suggests a role for social workersin supporting service users in initiatives such as self-help,campaigning and community action which offer a new interpretationof community-based social work. By engaging in this activity,health and social care professionals can support people to participatein emerging forms of active and inclusive citizenship. Whileparticipation in traditional political activity such as votingand political party membership is declining in the UK, peoplein marginalized groups are finding ways to have their voicesheard about issues which directly concern them. Increasingly,groups such as disabled people, older people and mental healthservice users/survivors are taking part in activity which marksa shift of focus to include both self-help and campaigning.In contrast to their disillusion with traditional politicalactivity, people across a range of groups have gained strengthand encouragement from campaigning achievements. The paper drawson a national research study which offers fresh insights onthese issues as a basis for exploring participative approachesto social work practice.     

Use of Critical Consciousness in Anti-Oppressive Social Work Practice: Disentangling Power Dynamics at Personal and Structural Levels

One of the limitations of anti-oppressive perspectives (AOPs)in social work is its lack of focus at a micro and individuallevel. AOPs should entail the social worker’s addressingthe needs and assets of service users, challenging the oppressivesocial structure and, most importantly, critically challengingthe power dynamics in the service-provider/service-user relationship.Critical consciousness challenges social workers to be cognizantof power differentials and how these differentials may inadvertentlymake social-work practice an oppressive experience. The authorscontend that critical consciousness fills in some of the gapsof AOPs, and argue for a fuller integration of critical consciousnessinto teaching and practice of AOPs. The methods to work towardcritical consciousness, such as inter-group dialogues, agent–targetdistinctions and empowerment, are detailed.