Social Work: Critical Analysis of the of Chris - Case Study Example

 This paper presents a comprehensive and critical analysis of the case of Chris, who is a 46 year old, unemployed individual currently residing in Hulme, Manchester. An evaluation of Chris’s mental and psychological history reveals that over an extensive and significant period of time, the individual has battled with alcohol misuse, depression and self-harm. Accordingly, a fundamental observation with regards to the present condition of Chris is associated with his admission to the NHS psychiatric unit following a suicide attempt. In the light of the individual’s long-history with mental health problems, he has been granted access to the social work mental health services, the immediate provision of which succeeded his discharge from the NHS mental health unit. The primary objective of this paper is to identify, explore, discuss and evaluate the ways, methods and frameworks which can be undertaken or implemented to assist the optimization of Chris’s well-being and life chances by working with the individual’s family network and friends in association with his community networks. The development of the critical study of this case is characterized by the adoption of a research based and research informed approach which has been structured in a systematic manner. This aspect essentially ensures that the validity and reliability of the findings of the research are not compromised or rendered limited due to the incorporation of such perspectives which fail to take into account the significance of assessing the psychological, mental, social and emotional development of Chris from his childhood and throughout his adulthood for the purposes of this case analysis. Therefore, the foundations of this research based and research informed approach are based on the exploration of four critical factors which address 1) the dynamic concept of resilience 2) the ecological approach to the practice 3) the attachment theory and 4) the concepts of identity and identity development. The notion of resilience has attracted extensive research which has been conducted by psychopathologists to effectively understand the underlying principles of this concept in a bid to associate the findings with those determinants of the external environment which play a fundamental role in defining people’s reactions to the identified determinants. According to Davydov et al. (2010, p. 2). Resilience can be viewed as a defence mechanism, which enables people to thrive in the face of adversity and improving resilience may be an important target for treatment and prophylaxis. Rutter (2012) defines the paradigm of resilience by drawing from evidence and empirical data that are suggestive of the fact that certain individuals deliver a comparatively enhanced outcome when facing a level of hardship while, others may display reactions or responses that are essentially negative and even harmful to their life prospects. Rutter (2012) understands that the variation and differentiation in these responses governs an individual’s response to negative experiences that may occur in the future. This view implies that when faced with a depressing or stressing condition in a future scenario a person is likely to exhibit a reaction which is either “…a sensitizing effect or strengthening “steeling” effect” (Rutter 2012, p. 335). When applying the concept of resilience in Chris’s case, it is important to highlight the foundations of his childhood that have potentially dictated the present conditions and life decisions that have been taken by Chris. This observation stems from the assessment of Davydov et al. (2010) who claim that resilience, as a concept, shares a correlation with those aspects of individual development that are determined by the environment, these elements include social characteristics and various features of the ethnic group to which an individual belongs. The socioeconomic context of Chris’s case can be assessed within the spectrum of both his childhood and adulthood. At the age of 11, Chris had to experience the separation of his sister Gemma who he identifies as a constant figure in his life. Gemma had to move out of the family home to avoid the escalating burden of her family’s economic status. Marmot (2005) understands that inequality and poverty are two primary causes which constitute of the social determinants that impact the physical and mental health of an individual. Accordingly, resilience can also be examined as a function of genetic factors and the dynamics of gene-environment interaction (Davydov et al. 2010; Rutter 2012). While, assessing the case of Chris the immediate observation that can be reported is that elements of the ethnic group do not potentially determine his resilience to self-harm, suicidal tendencies, alcohol misuse and depression. This is because the case does not report or highlight a potential role which the individual’s membership or affiliation with an ethic or minority may have played in dictating his responses to the mental health issues that have been identified. This observation guides the development of the research based approach towards understanding the fundamental influence of genetic factors on Chris’s life. Rutter (2012) claims that genetic factors are associated with determining individual reactions to a range of external environments, thus their influence cannot be limited to a single dimension. Chris’s description of his childhood documents the tumultuous relationship he shared with his alcoholic father, whose acts of domestic violence forced Chris’s mother to leave the family home and her children when he was aged nine. Chris reports that after departing from the family, his mother made infrequent contact with her children and this aspect can be associated with feelings of loss, deprivation, abandonment and rejection that Chris may have felt as a child. Rutter (2012) states that the basis of psychopathology is threatened by an extensive range of factors and the aspect of parental negativity can be mediated by genetics to a moderate extent. Consequently, if a parent experiences mental health issues then the onset of these disorders has the potential to impact the mental development of children by portraying environmentally mediated effects (Rutter 2012). The preceding discussion has the most critical impact on Chris’s struggle with depression which can be traced back to his childhood in the midst of his parent’s separation. However, it is important to highlight that the risk of developing depression is rooted in poor parenting and negative parental behavior or attitude that is most likely to be result as a consequence of the family breakup (Rutter 2012). For example, Chris’s claims that throughout his childhood he had to “fend for himself” along with his older siblings due to his father’s misuse of alcohol points towards the negativity of the external environment in which he lived as a child. At this point in the discussion, it is important to incorporate a life course perspective in assessing the case of Chris. This exploration is pivotal to the formulation of recommendations and ways through which the individual’s family network and community networks can be utilized to enhance his well-being and life chances. Rutter (2012) states that even though a key focus of studies on resilience intends to discuss the childhood circumstances of a person in determining his/her response to stressors and hardships, adulthood experiences may also dictate the extent of resilience in an individual as a defence mechanism. This part of the discussion can be dedicated to the analysis of Chris’s long-term relationship with Janet, at the age of 38 which was termed as volatile due his partner’s disapproval of his alcohol misuse and bouts of depression. A critical element of this relationship which separates it from Chris’s prior relationships is the involvement of his two children with Janet, who were aged three and five upon the breakup of the relationship. Even thought, Chris’s relationship with Janet was never legalized as a marriage its long-term presence in his life holds monumental significance. This observation asserts that the dimension of this relationship can be viewed in terms of the stable attachment that is provided to Chris in addition with a new kinship group. Rutter (2012) claims that positive experiences hold the ability of eliminating the negative experiences of that are faced in early life. However, the volatility of Chris’s relationship with Janet did not allow him to benefit from the union as he did from a previous relationship when he was 17, describing it as a “period of happiness for six years”. Furthermore, Janet’s relocation to Scotland along with her children has escalated Chris’s mental health state for he is unable to gain access to them because of modifications in legal aid entitlement. As noted by Mamot (2005) social determinants such as poverty and inequality are critical factors which have led to the emergence of health inequalities and discrepancies in the provision of physical and mental services across the globe. Chris’s case is marked by the constant progression of economic disparity from his childhood to adulthood and this characteristic has significantly impacted his ability to optimize his standard of living and also his life chances to allow him to function as a responsible and productive member of society. As a child, economic hardships led Chris to part with his older Gemma who he views as an influential figure in his life. Presently, Chris resides in a one-bedroom flat and his employment patterns in the past do not indicate of a job that may have acted as a stable source of income for a significant period of time. In fact, Chris has only been able to acquire temporary positions in the past 5 years which is a testament of his unsatisfactory economic condition. Wilkinson and Pickett (2011) assert that the consequences of current political practices and policies that are put into practice within a nation have widespread implications which affect the social institutions of a country including families. The authors have put forward the concept of encouraging the spread of equality for all, which is believed to be an action that would benefit each and every member of society tremendously. Wilkinson and Pickett (2011) therefore, suggest a large-scale reformation of the system which is characterized by a modification of governmental policies that have proven to be ineffective. An example of these strategies has been highlighted by Featherstone, Broadhurst and Holt (2012) who believe that the advancement of the practices of excessive standardization has led to the development of unsupportive policies which have severely limited the ability of social workers to foster the establishment of strong associations with parents and children. Wilkinson and Pickett (2011, p. 226) postulate that the inefficiency of the present scenario can be restricted or even eliminated if present policies and regulations are “…coupled with egalitarian policies which steer us to new and more fundamental ways of improving the quality of our lives”. Certainly, an acceptance of these observations is critical to the positive development of current standards which encompass the provision of social work services to individuals such as Chris. Jack and Gill (2013) recommend that addressing the needs of families who are living in poverty is substantially different from dealing with the concerns of individuals who have improved economic circumstances. Chris’s socioeconomic conditions have remained unstable since his early years however; his present economic conditions are a source of grave concern because his mental state does not allow him to maintain stable employment to enhance his life chances and well-being. Moreover, alcohol misuse is an issue that is bound to aggravate the impact of Chris’s worsening financial conditions if it is not addressed effectively and on an immediate basis. As is the case with the concept of resilience within the context of Chris’s case, the life course perspective is also applicable with regards to the present socioeconomic conditions of the individual. As stated by Ferraro and Shippee (2009) the theory of cumulative inequality states that factors such as genes, childhood circumstances and experiences and family lineage can be associated with the economic inequalities which are faced by individuals as adults. Consequently, these observations can also be associated with the notion of accumulated stress which implies that the present mental health issues being faced by Chris are an outcome of the amalgamation of a range of stressors that Chris was exposed to as a child. These stressors include the presence of an alcoholic parent and the departure of his mother due to domestic abuse. The role of childhood economic circumstances, poverty and inequality shares a correlation with a range of negative outcomes that are experienced in adulthood or during childhood. A longitudinal study conducted over a period of 30 years by Gibb, Fergusson and Horwood (2012) found that children belonging to low-income backgrounds reported higher rates of the onset of mental health problems as adults. These problems included the tendency of having suicidal thoughts, self-harm, depression and a range of disorders prompted by a disadvantaged childhood. In another study Rojas and Stenberg (2010) applied the theories of Durkheim and Merton to develop appropriate and applicable variables to establish a correlation between environmental variables and suicide. The findings of the study found a positive correlation between childhood poverty and the increased risk of suicide in adulthood (Rojas and Stenberg 2010). The social ecology of Chris encompasses an evaluation of his present life including an identification of his living environment, the exploration of possible stressors in the wider system of the macro or external environment, an assessment of Chris’s intimate relationships and his association with the members of his immediate and extended family. This section of the research would assist the development of a framework to build the protective factors and influences which are present in relation to the risks that are being faced by Chris. Chris’s relationship with Janet has been a source of grave concern for his well-being, because he has not been able to gain access to his children since Janet’s relocation to Scotland with her new partner Dave. Moreover, Chris’s relationship with Gemma who has been the most influential and supportive figure in his life since the early years has become strained during the past three years due to his worsening mental state and struggle with alcohol abuse. Previously, Chris had also enjoyed a positive relationship with Gemma’s children however; he has not been able to maintain this bond due to the onset of his problems. According to Jack (1997), the implementation of community social work strategies has been identified as a positive development in the field of social work to address the concerns of families. This notion is rooted in the formulation of social support networks that can assist an individual to develop protective factors and mitigate risk factors. Rutter (2012) claims that protective factors must be assessed in the light of their nature and not the implications that these factors pose. The identification of stressors in the external environment must be conducted to individually address the implications of each of these factors by limiting their significance in Chris’s life. Chris’s separation from his children has worsened his mental health situation for it has caused his stress levels to rise as he is currently unable to challenge Janet’s position and her custody of the children who are presently residing with her and her partner Dave in Scotland. Jack (2000) notes that high stress levels are responsible for a deterioration in the mental health of parents. According to Munn-Gidings and Winter (2013), a study conducted on sample size of 400 users of mental health and social work services found that participants valued the implementation of therapies which largely comprised of ‘talk-based’ sessions thereby, leading to the conclusion that individuals favored ‘holistic’ procedures in comparison with treatments that were based on offering medical services. With regards to the recommendations of this research Chris’s contact with social work mental health services can be viewed as a positive sign following his discharge from the NHS psychiatric unit. The first course of action that should be executed should therefore, be entirely based on a framework that allows Chris to communicate his problems, issues and uncertainties in addition with the concerns that are enhancing his anxieties the most. The second component of this procedure highlights the importance of engaging the individual by allowing him/her to share valuable information by the means of narrating a story so that a social worker can gain first-hand experience on the case and bear witness to the experiences of a person (Munn-Giddings and Winter 2013) who has faced numerous adversities. Thoits (2011) recommends the formulation, establishment and execution of mechanisms which utilize an individual’s social relationships to develop an effective system of social support that has the capability to promote the mental and psychological well-being of a person. Thoits (2011) claims that these mechanisms have the potential to directly address the problems of an individual or act as reducers of stress to eliminate mental health issues that are rooted in depression, anxiety and stress. The first suggested mechanism is that of social influence or social comparison, which can allow Chris to assess his own behaviors, actions and attitudes in terms of their consequential effects. For example, Chris must be made aware of the fact that his tendency for self-harm and alcohol misuse have been the root causes that have contributed towards the breakup of his relationship with Janet, the loss of his children and the deterioration of his ties with Gemma and her children. Thoit (2011) claims that this mechanism permits a person to view his behavior in the light of his/her reference group and encourages him/her to adopt the attitudes that have been modeled by the members of the reference group. It is suggested that the execution of this mechanism should comprise of Gemma and her children who shared a positive relationship with Chris up until three years ago when his problems started to escalate. Once the goals and objectives of this mechanism have been achieved, Chris’s community and family networks should be engaged simultaneously to encourage the development of a behavior guidance framework which highlights the significance of role-identities and Chris’s roles as a father, partner and brother to ultimately encourage him to adopt the role of a functional, productive and responsible citizen of the community and member of society. References Davydov, D. M., Stewart, R., Ritchie, K., & Chaudieu, I. (2010). Resilience and mental health. Clinical Psychology Review, 30(5), 479-495. Featherstone, B., Broadhurst, K., & Holt, K. (2012). Thinking systemically—thinking politically: Building strong partnerships with children and families in the context of rising inequality. British journal of social work, 42(4), 618-633. Ferraro, K. F., & Shippee, T. P. (2009). Aging and cumulative inequality: How does inequality get under the skin?. The Gerontologist, 49(3), 333-343. Gibb, S. J., Fergusson, D. M., & Horwood, L. J. (2012). Childhood family income and life outcomes in adulthood: Findings from a 30-year longitudinal study in New Zealand. Social Science & Medicine, 74(12), 1979-1986. Jack, G. (1997). An ecological approach to social work with children and families. Child & Family Social Work, 2(2), 109-120. Jack, G. (2000). Ecological influences on parenting and child development.British Journal of Social Work, 30(6), 703-720. Jack, G., & Gill, O. (2013). Developing cultural competence for social work with families living in poverty. European Journal of Social Work, 16(2), 220-234. Marmot, M. (2005). Social determinants of health inequalities. The Lancet,365(9464), 1099-1104. Munn-Giddings, C., & Winter, R. (2013). A handbook for action research in health and social care. Routledge. Rojas, Y., & Stenberg, S. Å. (2010). Early life circumstances and male suicide–A 30-year follow-up of a Stockholm cohort born in 1953. Social Science & Medicine, 70(3), 420-427. Rutter, M. (2012). Resilience as a dynamic concept. Development and psychopathology, 24(2), 335. Thoits, P. A. (2011). Mechanisms linking social ties and support to physical and mental health. Journal of Health and Social Behavior, 52(2), 145-161. Wilkinson, R. G., & Pickett, K. (2011). The spirit level. Bloomsbury Press. Read More