Social Work Practice in Mental Health

An Introduction

Robert Bland, Gabrielle Drake, John Drayton

• Publisher: Routledge
• Year: 2021
• ISBN:
  9781000352665
• Edition: 3
• Topic: Medicine
• Subtopic: Health Care Delivery

This new edition of Social Work Practice in Mental Health builds on the underpinning principles of the previous editions whilst reflecting how the context for practice has steadily evolved.

Organised into two parts and 11 chapters, the book focuses on recovery theory, the importance of relationship and examining the social context and the consequences of illness. It explores the perspectives of consumers and family carers in shaping practice together with a focus on skills including assessment and risk assessment, working in a multidisciplinary team, working with trauma, working within a legal framework and spirituality in practice. The book also maintains the key themes from previous editions of valuing lived experience and the importance of relationships.

This book will be essential reading for social work students and an invaluable resource for practitioners in social work and mental health.

Part I

The context for practice

1 A starting point

Understanding social work in mental health

DOI: 10.4324/9781003148913-2

Knowledge about mental health and the skills to work effectively with people who have mental health problems are basic to contemporary social work practice. Social workers have been employed in mental health settings for many years now, and mental health has been a traditional field of specialist social work practice. Learning about mental illness and treatment approaches, and critiquing the various medical and social models to explain mental illness and its impacts, have traditionally been core elements of the social work curriculum. Social work’s interest in family, community, social welfare and social justice has contributed significantly to the broad knowledge base for policy and practice in mental health. However, beyond the hospital and community mental health treatment settings are a range of recovery-based support services that also employ social workers. As well as working in adult mental health, social workers are employed in areas of child and adolescent mental health, forensic mental health, specialised aged-care settings and with specific population groups such as Indigenous Australians and culturally and linguistically diverse communities.

Understanding the challenge

Despite this long and positive connection between social work and mental health, significant challenges continue to confront the profession in responding to the rapidly changing work environment. In later chapters of this book, we will look at changes to the knowledge base for mental health practice, changes to mental health policy, workforce issues and the challenges to practice arising from the emergence of the consumer and family movements in mental health. Analysis of the highly complex context for contemporary social work practice suggests a number of major challenges for social work. These include:

• the highly contested workplace – in multidisciplinary teams, social workers face unrelenting competition for authority and expertise from other disciplines;
• the need for a workable paradigm for practice – social workers need to be able to define clearly the distinctive domain for social work practice;
• connecting social work practice to a theory or knowledge base;
• working collaboratively with consumers and family carers;
• the education and training of social workers – what knowledge, skills and values do social workers need for practice, and how might they best acquire these?

Developments in policy, services and education offer opportunities for social work to contribute to the reform process as a vital and relevant discipline. The profession needs to be able to assert with confidence that the core concerns of social work – human rights, self-determination, family relationships and welfare, employment, housing, community, life chances – are central to mental health. We need to continue to argue for a broader agenda in mental health, beyond narrow clinical concepts of illness and treatment. At the same time, we need to demonstrate the range of core knowledge and skills that underpin generic mental health competencies. In the current context of valorising the evidence base for practice and the specificity of interventions, we are challenged to be clear about what we do, and to be able to demonstrate the effectiveness of our actions.

In this book, we take up the challenge to find some directions for the profession. We believe that these directions will be relevant internationally, but we begin by setting out the Australian situation, as this is the specific context from which we are writing.

Social work in the Australian mental health workforce

There are more than 13 000 social workers in Australia. One in six members of the Australian Association of Social Workers (AASW) identifies with the mental health field because of their employment and/or expertise. Others work in human services such as child and family welfare, child protection, acute health, rehabilitation, income security, corrections and juvenile justice, and aged care, which are all fields that require knowledge and skills in supporting people with mental health problems (AASW, 2007). Social workers comprise nearly 10 per cent of the Australian mental health workforce but are active participants in hospital and community mental health services, non-government agencies and private practice. Most social workers are employed in direct service positions, but a significant number work as team leaders and program managers and in policy and program development. Allied health professionals are the fastest growing professional group in state and territory mental health services, and social workers have become the largest single allied health profession (Department of Health and Ageing, 2013).

The Australian National Mental Health Strategy from 1990 to the present day has been based on a multidisciplinary workforce, and social work is identified as one of the five key mental health disciplines (Australian Health Ministers, 1992b). The various policy and workforce initiatives developed through the strategy have included social workers (for example, Deakin Human Services Australia, 1999; National Mental Health Commission, 2013; Victorian Government Department of Health, 2013) and detail the standards of knowledge, skills and values that all mental health professionals – social workers included – should meet. Social work was a contributor to the Mental Health Council of Australia (now known as Mental Health Australia) from its inception in 1996 and as such has had the opportunity to participate in the development and review of national mental health policy.

A project of major significance for the profession was the Commonwealth-funded Development of Competency Standards for Mental Health Social Workers (AASW, 1999). This project was funded as part of the education and training agenda in the National Mental Health Strategy. The AASW tendered the project to a team of social workers, educators and consumers who conducted an extensive national consultation with social workers, consumers and families to develop a comprehensive description of social work practice in mental health. The final product has proven useful as a guide to the accreditation of specialist mental health social workers in Australia and as a basis for educators to develop a curriculum for social work education and training. It has also served as a guide for the accreditation of social workers as approved mental health workers under the recent Commonwealth arrangements to provide some limited Medicare funding for specific mental health interventions provided by social workers in private practice. This document has more recently been revised and republished (AASW, 2008b).

We will discuss many of the policy and practice issues that arise from the strategy in later chapters of this book. At this stage it is important to understand the central place that social work has enjoyed in the history of policy and service developments in Australian mental health.

The ubiquity of mental illness

Recent revisions to the education standards that govern the curriculum in Australian schools of social work (Australian Association of Social Workers, 2020) include psychosocial health and wellbeing across the lifespan as a core component of social work curricula. The argument is that ‘mental illness is ubiquitous’. Put simply, this means that no matter where social workers choose to practise they will invariably work with people who have mental health problems.

For example, many people who receive Centrelink benefits will have mental health problems, and those problems will impact on the life experiences of those clients. Clients may be confused and isolated or fearful and angry because of their mental illness. The Centrelink social worker needs to understand how mental illness impacts on the way the client presents and uses services and must work to ensure that the client’s entitlements to income support are maintained. The worker needs to be able to engage positively and respectfully with the client, whom other agency staff may perceive as different or even dangerous.

There are a number of such areas of interface between mental health and other social problems, and it is in these areas that much of the creative practice of social workers can be found. Child protection and family welfare is clearly such an area. Mental illness in a parent might impact upon their capacity to provide the necessary care for dependent children. There is a strong need for child protection workers to have a basic understanding of the nature of mental illness and to be able to work effectively with mental health services to benefit children and families. Other areas of interface include mental illness and family violence, disability, health and illness, housing, and schools. We will address some of these specific areas in detail in Chapter 8, and we hope that this book as a whole can be useful for social workers in all settings.

Key themes

Two key themes emerging from the developments in mental health in recent years are central to the way we have conceptualised social work practice in this book. These themes are the importance of the lived experience of mental illness and the importance of relationships as a basis for change. These ideas emerged most strongly in the Deakin Human Services Project (Deakin Human Services Australia, 1999), a highly creative and radical approach to changing the education and training agenda for the professions in mental health. The project was committed to a process of decision-making through partnership among professionals, consumers, family and carers. It brought together eight representatives from each of the five major mental health disciplines (psychiatry, psychology, nursing, occupational therapy and social work) with an equal number of consumers and carers for a series of weekend workshops in Canberra. Each of the disciplines worked on its own agenda to guide professional development (Harries, 1999). Whole-group discussions generated a consensus about an agenda for reform of education and training, which included a commitment of all parties to two central principles identified by the consumers and family carers:

• Mental health professionals need to learn about and value the lived experience of consumers and carers.
• Mental health professionals should recognise and value the healing potential in the relationships between consumers and service providers and carers and service providers.

These simple but radical principles emphasise a set of values that define practice in mental health in terms of human encounter, rather than as the technical application of skills and knowledge. As we will argue later in the book, relationships are the basis of recovery and hope. They are central to specific interventions such as case management or family work. By giving priority to the lived experience of consumers and families, as defined by consumers and families, we ensure that our work will be guided by principles of partnership, mutuality and empowerment.

Towards a definition of social work in mental health

We have found in our practice across various settings and over many years that the capacity to articulate the social work role in the agency is a necessary condition for effective practice. This is particularly the case in the multidisciplinary workplace, where there is an emphasis on teamwork and the need for each of the disciplines to define their area of competence. There is an irony in this challenge of needing to be clear about the skills, knowledge and values shared by all members of the team (what we have in common) while being able to articulate what is special about social work. Each of the disciplines faces this challenge, but the generic nature of social work education has meant that many social work graduates are not well prepared for practice in mental health.

Review of the teaching of mental health content in schools of social work (AASW Project Team, 2003) showed that, while some schools offer students a solid basis for mental health practice, many offer very little course content on mental health. The review found that students were often exposed to a critique of psychiatry as part of a critical theory approach but were given very little positive direction about the scope and nature of mental health practice. Not surprisingly, these studen...