The meaning of mental illness within the Victorian Mental Health Act: the problem of definition

This study will critically examine the Mental Health Act 1986 (Vic), including the significant changes introduced through the Mental Health (Amendments) Act 1995 (Vic). It will be argued that the Victorian legislation presents some practical difficulties in application as it adopts too broad a definition of mental illness to be used reliably in assessing a person's need for treatment and/or criminal responsibility within a court of law. This lack of precision is potentially problematic for social workers and lawyers alike with respect to key decisions regarding assessment for mental health services and assigning criminal responsibility before the law. Implications for social work practice will be briefly discussed.     

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.     

Using Social Work Theory and Values to Investigate the Implementation of Community Treatment Orders

Abstract

This paper establishes the value of a social work investigation of good practice with people on Community Treatment Orders in the context of social work's longstanding interest in the ethical challenges of working with involuntary clients. The emancipatory values of social work were used to guide this research, thereby ensuring the participation of consumers and their families or carers. Critical social work theory provided an important theoretical base. A mixed methods approach was undertaken, including a cluster analysis and case studies. Five principles of good social work practice emerged from the qualitative data: (a) use and develop direct practice skills; (b) take a human rights perspective; (c) focus on goals and desired outcomes; (d) aim for quality of service delivery; and, (e) enhance and enable the role of key stakeholders. These principles are briefly presented along with recommendations for practice and service development.     

Accredited Mental Health Social Work in Australia: A Reality Check

Abstract

Accredited mental health social workers (AMHSWs) have a great deal to offer the clients they see in their private practices, many of whom have complex needs. However, they are constrained by the inflated expectations Government has about evidence-based psychological interventions. The restrictions placed on the professional private practice of AMHSWs by Federal Government Medicare funding of a narrow set of psychological interventions ultimately limits the services received by clients. In this article, the findings of a survey of AMHSWs are presented, highlighting the tensions between individualised responses promoted by Medicare payments, and those premised on principles of social justice and social inclusion.     

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.     

Supervising Social Workers in Involuntary Contexts: Some Considerations

ABSTRACT

This article outlines areas for reflection for those providing supervision to social workers working in involuntary and semivoluntary contexts. This includes clinical implications, impacts on social work identity, and potential impacts on the supervisory relationship itself. It suggests that there are some areas that could be considered for discussion and exploration that may be different in focus to other types of supervisory practice, encouraging supervisors to consider their own approach in response to the issues raised.

IMPLICATIONS

• Working in involuntary contexts raises specific challenges in relation to power and authority in practice, as well as a range of ethical dilemmas.

• Supervisors might wish to consider the issues raised with a view to exploring with their supervisees how working with involuntary clients changes their framework or approach.

     

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.

     

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.     

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.     

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.

     

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.     

Student to Practitioner: A Study of Preparedness for Social Work Practice

Abstract

Australian social work graduates face an increasingly complex work environment where the role of the social worker is often overlooked or misunderstood. In order to examine the anticipated and concrete practice reality for social workers, this qualitative study examined the expectations of social work students preparing to enter the workforce (n=29) and the experiences of new social work graduates in the workplace (n=9). Findings suggest that undergraduates have a realistic understanding of the challenges they would encounter in practice, including anticipated value and ethical conflicts, and allied professions' conceptions of the social work role. They did not anticipate the busyness of the workplace or the level of supervision offered.     

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.     

Raising the Titanic: Rescuing Social Work Documentation from the Sea of Ethical Risk

Abstract

One of the most contentious issues in social work practice concerns what should be written about people who access social work services, how comprehensively, and in what format social work assessments, interventions, and outcomes should be documented. The present paper describes a structured approach linked to an action research project that was undertaken by hospital-based social workers to identify and minimise problems associated with documentation in the medical record. The Social Work Ethics Audit provided social work staff with a risk-management tool that highlighted documentation as a key area of ethical risk. Through a process of evaluating existing recording practices, social workers were able to meet the challenge of improving social work recording in medical records, returning it to its proper place as a vital component of clinical and ethical practice rather than an administrative task submerged beneath competing priorities. It was anticipated that the social work documentation proforma that resulted from the ethics audit process would have applicability in other health care settings.     

Service User Involvement in Social Work Education: A Case Example

The financial resources provided by the General Social Care Council (GSCC) which supports the education and registration of social workers, has allowed for an increase in user involvement in social work programmes in England and Wales. This article discusses the sources of knowledge appropriate for social workers and social care workers including the significance of the service user knowledge base for social work theory and practice. A project is described which involved students in a consultation process with service users whose role it was to contribute to the students' learning in a particular area, specifically understanding their experience of social workers and the issues of discrimination which they faced and the processes which were helpful in resisting oppression.     

The mental health dimension in the new social work degree: starting a debate

The Mental Health in Higher Education Project (mhhe) aims to increase networking and debate about the learning and teaching of mental health, both within and across the disciplines and professions in higher education. Despite the recent prominence that has been given to mental health in terms of policy development and new practice models, there has so far been little discussion as to what should constitute the mental health component of the new social work degree that is currently being introduced in England. This paper sets the context for the debate and reports on the outcome of an mhhe workshop on this theme held at the 2003 Social Work Education Conference in Warwick.     

Imagining Social Work: A Qualitative Study of Students' Perspectives on Social Work in China

Social work education in China has expanded rapidly since it was reintroduced in 1988. This has led to a growing body of English language literature on the development of social work education in China. However, thus far, this literature lacks an empirical foundation and little research on students' perspectives has been done. To fill this gap, this paper reports on a qualitative study of a group of graduating social work students (n = 32) from four social work programmes in Jinan, the provincial capital of the Shandong Province. Three major findings are reported. Firstly, the students liken their social work learning experience to a roller coaster ride with many ups and downs. Secondly, the cultural compatibility of western social work in China has not yet been conclusively established, while an ‘indigenized’ social work needs to be compatible with Chinese family values, referred to as ‘familism’ in direct Chinese to English translation, and with the dominant socialist political ideology. Thirdly, the future of social work is bright given increasing government support for its development.     

Localising Social Work: Lessons Learnt from a Community Based Intervention amongst the Bedouin in Jordan

This paper presents an example of local social work practice in Jordan in the health field. It draws on a research study on Bedouin health in the North Eastern Badia. The project developed, implemented and evaluated a training intervention developed in partnership with a range of providers for improving local social work practice. Evaluation methods used included a pre and post test, focus group discussions and students' field notes. Findings revealed the significance of promoting culturally competent practice to respond to local health and social needs. Students and practice assessors agreed that the training interventions were an effective way to implement theory into local practice in relation to Bedouin society. This training intervention is an example of developing local social work practice as a way of responding critically to social inequalities.