Social Work and Psychiatry in Mental Health - Essay Example

? Social Work and Psychiatry in Mental Health Social work is all about improving vulnerable peoples’ and communities’ circumstances through building on their personal strengths and the situations that have led to their mental distress. The main setbacks for such an effort have been mental health practices, in terms of both services and structure. This paper will review how social work affects mental health practices and how such practices impact social services. This will be achieved through the perspectives of different psychiatrists and psychologists, a review of The Mental Capacity Act 2005 and historical events, which support the position taken in this paper. By doing so, the paper will create a clear understanding of the policies and structures behind the effect of psychiatry on social practice in mental institutions (Boyle, 2010, p.67). Concepts, Theories, Policy and Legislation Relevant To Social Work Practice Social workers are experts when it comes to identifying social and environmental factors that led to mental disturbance, like stigma and abuse of personal development, through questions, reflections and challenges within the multidisciplinary context. The individual’s strength, aspirations and vulnerabilities in the cultural context, and social and family relationships are analysed critically from the start (Foster, 2007.p. 120). By mobilising a range of community resources, network and voluntary services, the social worker works with service users to encourage them to feel socially included. In their duty of offering protection to those who may be at risk from harm, the social workers must balance the legal and human rights issues of risk and safety to achieve the least restrictive alternative within their statutory roles and responsibilities. They also work together with family care to seek change in the social and environmental context hence supporting the recovery of an individual (Routledge, 2005, p. 89). Concepts, Theory and Research Related To Relevant Practice Issues Odegaard (Bennewith, O., Amos, T., Lewis G., Katsakou, C, Wykes T., Morris R and Priebe, 2003, p. 78)highlighted reports that indicated a higher incidence of mental illness among immigrants could be explained by the genetically predisposed of some migrants to develop mental illness. Castle Der and Murray (1991) indicate that the intensity of mental disturbance due to migration differs with races and ethnic groups migrating to the same destination. In the UK, migrants from India, Pakistan and Afro-Caribbean origin showed higher rates of schizophrenia when compared with native, white British people (Boyle, 2010, p. 142). In mental health practice, the challenge of posttraumatic stress disorder (PTSD) is evident (Penguin and Peck, 2004). Measuring for PTSD was introduced after the Vietnam war. PTSD is highly contested; some claim that normal expressions of grief and distress which arise from abnormal experiences should not be turned into a medical problem. Psychiatry tends to underestimate the impact of PTSD, which can result from delays in the asylum application process, detention, obstacles to employment, societal attitude, loneliness, racial discrimination and boredom, all of which contribute to mental health problems (Penguin and Peck, 2004, p. 152). Pat Bracken, a consultant psychiatrist who was seeing refugees with mental health problems affirmed that formulating the suffering of asylum seekers in terms of PTSD had an effect when it came to locating their problems in their home country (Bracken, 2002, p.100) According to Bracken and Thomas (2001) post migration stress added to previous trauma creating an additional mental health risk. Athwart notes that asylum seekers who were not detained dispersed across the country as they waited for a decision on their application. The uncertainty and anxiety associated with the delay was a mental health risk for the asylum seekers. Those whose applications were terminated experienced stress as they were unable to work and support from NASA was withdrawn (Bracken and Thomas, 2001, p. 81). In practice, social workers experience various challenges, including language barriers. As psychiatry relies heavily on subjective description of symptoms, it is difficult for them to properly identify the cause of mental distress. Translators can misinterpret the patient's ideas so are not completely reliable. In addition, accessing competent and professional interpreters is not easy in the UK (Laurence, 2003, p. 62). The medical model problem solving approach proposed by psychiatrists for mental health practice, locates the issues within the service user rather than considering the wider context in which the service user is located. Focus is on the behaviour and emotions of the mental health service user (Brewer, 2000, p. 82). Impact Of Own Values, Beliefs And Assumptions On A Range Of Practice Situations According to Bental (2003), mental health is a state of wellbeing where an individual is conscious of his own abilities, can handle the normal stresses of life, work effectively and fruitfully and contribute to the society. In contrast, the Mental Health Act 2007 defines mental disorder as a disability of the mind. Laurence (2003) points out that cultures are shaped by the way humans understand and behave. He notes that health and social care professionals are also influenced by prejudicial ideas, attitudes and behaviours. Mental disorders can manifest in diverse, extraordinary and complex ways, which might be frightening to those experiencing them. Expression of sympathy and despite can cause stigma for patients. A survey by the Department of Health in 2007 found an increase in prejudice towards the mentally ill. This was indicated by a variety of factors: not wanting to live next door to people diagnosed with mental distress, not believing that they have the same right to a job and belief that they are prone to violence (Bentall, 2003, p. 162). Foster (2007) points out that mentally distressed people are likely to experience abuse and violent attacks. Stigma has meant people are unwilling to ask for help for mental distress. Surprisingly, a Mental Health survey in 2000 found that 32% of UK service users had experienced discrimination from health care professionals and two thirds identified the professionals’ attitudes, behaviours and oppressive treatment as stigmatising (Foster, 2007, p.71). Approaches To Practice Situations Within Legal And Ethical Frameworks To Empower And Promote The Rights Of Service Users The Mental Capacity Act 2005 suggests that circumstances about one who lacks capacity must be clear before decisions are made on his behalf. The introduction of the Mental Capacity Act promoted broad awareness of the rights of people lacking capacity (Boyles 2010, p. 45). In response, national and international campaigns and programmes were developed to reduce the stigmatisation effect. These include the mental health media, MIND, Rethink and the Institute of Psychiatry Campaign. One programme for asylum seekers is the Harvard Programme in Refugee Trauma, aimed to build a clinical rapprochement between Western and indigenous understandings and treatments of psychological problems (Barber, Brown and Martin 2009, p. 45). To ensure mental health service users are treated well, the approaches used in diagnosis need to be revised. Routledge (2005) outlines various approaches for diagnosing mental distress and its treatment. One is the Medical Model approach, which relies on scientific interpretation of human emotions and behaviour. The approach is criticised for being influenced by subjective attitudes and beliefs as the experience of learning to diagnose mental distress is often influenced by the cultural and political contexts in which the psychiatric training takes place. Routledge(2005) points out that sociologists and dissident clinicians have their own approach because they felt that using emotions and behaviours to diagnose mental distress was insufficient. Instead they focused on independent life events that trigger distress, such as isolation, violence, bereavement and loss. They also considered other factors like poverty, unemployment, racism, gender, sexuality, age and disabilities that precipitate mental distress. The is called the social model and gives a deeper analysis of the causes of mental distress so a better and appropriate remedy for recovery can be achieved (Routledge, 2005, p 75). The Mental Health Act of 1983 (amended by the Mental Health Act 2007) gives the mental health practitioner the powers and responsibility to assess a person if compulsory admission to hospital might be required (Routledge, 2005, p 75). Health service practitioners in mental distress have a statutory right to an assessment of their needs alongside the mental health service user assessment, a provision in the Cares Recognition and Services Act of 1995 (Byrne, 2001). Looking at other factors that contribute to mental distress can help the recovery of the mental health service user. Byrne (2001) notes that ‘khat’, a leaf which is legal in Somalia and the UK, contributes to mental distress when smoked. He identifies residential mobility between parts of London as another risk factor. For Byrne, racism and ethnic differences also contributed to mental distress because individuals face prejudice and institutional discriminatory processes. Since culture influences mental health in many ways, Warf suggests that cultural diversity should be part of the diagnosis. Universal policies have helped the least able to access the mental health services because they experience little benefit from innovations which are not targeted at them, but yet attractive to them (Byrne, 2001, p. 83). Similarly, to help patients to recover from mental distress, stigmatisation must be addressed (Byrne, 2001, p. 56) in regard to the National Service Framework for mental health. All health and social service departments ought to combat discrimination against people with mental health problem and promote social inclusion. To achieve stigma-free environments, professional and governmental organisations set up programmes like the World Psychiatric Association’s (WPA) ‘open the doors’, the UK Royal College of Psychiatrists’ ‘Changing Minds’ and the New Zealand government’s ‘Like Minds, Like Mine’ (Brown and Lloyd, 2001, p. 23). These actions were promoted in schools, workplaces and media with poor public mental health awareness. They advocated changes in multiple settings of the environment and improvement in psychiatric service delivery and treatment. Furthermore, the programmes helped improve self-esteem as patient disliked decisions being made for them without prior consultation (Brown and Lloyd, 2001, p. 72). Capponi (2003) points out three changes in the mental health system. One is a decrease in divisions between service providers and service users. The service users are now permitted to participate in their support instead of passively receiving the service provider’s instruction. Secondly, funding changes have increased community mental health services and decreased institutional health services. Thirdly, there is change in the philosophy of mental health services, with an increased focus on recovery (Capponi, 2003, p. 76). Impersonality and bureaucracy, supported by a pathological understanding of mental distress, has strong affect on contemporary social workers training in mental health organisation and social attitudes. Capponi (2003) suggests that employing mental health service users brings about a significant change that enhances recovery. In the traditional structure, the relationship between presumes and non-presumes was not convincing as the latter was viewed as inferior. Capponi (2003) notes that collaboration between presumes and non-presumes has increased, encouraging exchange of ideas about the emerging structure. Schools have begun teaching and emphasising the understanding of recovery philosophy. Social work professionals, including presumes, offer motivational speeches that prepare students for a broader understanding of social work. Consumer survivor initiatives and self-help organisations have also been established which provide a vital resource where consumer survivors are willing to educate social work students (Capponi, 2003, p.84). To develop a strategic approach for developing capacity in social research, priorities for future research funding and bottlenecks which obstruct potential and actual researchers from enlarging their activities must be identified. Growth needs to be focused to make a positive difference in people’s lives and the services they receive (Brewer, 2000, p. 93). Social research ought to improve processes such as social assessment, measurement of the impact of social care and social interventions so service users are not rotated through increasingly medical experiences of hospital care and community treatment (Capponi, 2003, p. 100). Personal Learning And Areas For Further Professional Development Although demographic characteristics had little impact, significant differences emerged in disciplinary affiliation. In the run up to the proposed reform of the Mental Health Act, the lack of evidence based on the impact of compulsion emerged as a much greater concern for social work and social care professionals than for health professionals. This indicates a more critical appreciation of some of the drawbacks of compulsion within the professional discourses of social work and social care. A similar and anticipated difference of emphasis emerged in research on the integration of social care and health services; this seems to represent a much bigger area of concern for those involved in social care, as evidenced by earlier studies (Banks, 2004, p. 83) In various respects, the difficulties of social research are mirrored in other areas that are also perceived as marginalised by clinical hegemony, such as public health. In an analysis of public health capacity building, Banks (2004) identified two areas of difficulty. Firstly, there is epistemology: evidence-based medicine has established a hierarchical approach to the determination of what counts as robust evidence, which may not be salient for a range of socially defined areas such as understanding behaviour patterns, evaluations of complex services or social epidemiology (Banks, 2004, p. 82). There are also temporal factors: politicians and policy makers, no doubt with notable exceptions, have a narrow, pragmatic agenda focused on short-term gains. Thus, the political agenda for mental health is driven by satisfying public anxiety about danger and the alleged failure of community care. It is difficult to promote a research agenda concerned with broader considerations of population health and maintenance of well-being (Brown and Lloyd, 2001, p. 86). Surveys have highlighted a variety of issues to be tackled and innovations that are required to enhance social research capacity in mental health and contribute to practitioner confidence and role clarity in integrated services. This includes: building on the existing achievements of service user researchers in initiating and leading research collaborations, focusing efforts to build research-mindedness among social work and social care practitioners through qualifying and post-qualifying education, mentoring practitioner researchers, creating senior social research positions in service organisations, building partnerships between universities and providers, and creating fellowships to foster the recruitment and training of career researchers. In addition, an important phase of capacity building is identifying priorities for future research so that there is shared acknowledgement about stakeholders regard as necessary issues; this survey could be a first contribution towards this (Bateman, 2001, p. 71). The social worker’s distinct role in hospital detention was established by the Mental Health Act 1959 and the Mental Health (Scotland) Act 1960, and confirmed in the respective mental health statutes of the 1980s, through the creation of Approved Social Workers (ASW) in England, Northern Ireland and Wales, and Approved Mental Health Officers (MHO) in Scotland (Banks 2004, p.67). The traditional role of social work, supporting and networking with wider agencies, could be brokered from the independent sector or carried out by other professions. These developments have led some to state ‘mental health social work’ is a rarely used term today (Barber, Brown and Martin, 2009, p. 104). The statement of principles within any statute is intended as an implementation guide for professionals. The principles are listed at the beginning of the MHSA03, whereas the MHA07 leaves the principles to the respective national Codes of Practice (Foster 2007, p. 182). The result is that the values which underpin the context in England and Wales will be a statement of principles, which should inform decisions under this Act (Foster, 2007, p. 182). This leaves the principles more open to interpretation and review, without recourse to the elected chambers of Westminster where changes in law have to be considered. He indicates that Northern Ireland benefits from being the last to modernise their mental health law. It has consulted the Bam ford Review of Mental Health and Learning Disability. As a result, the legal framework in England is least supportive of citizenship rights for people defined as having a mental disorder (Lane, 2008, p. 47). Boyles (2010) notes that formal assessment for the court from social services has rapidly become the prioritising system. This has been a tremendous problem in the past. The new system also highlighted concerns about the quality of some expert witness reports previously requested from external sources. Under the new system, social work teams were requested to make early contact with the prioritising panel in situations where an expert report might be required. This has enabled consultation and discussion about the process of assessment and early warnings about the need for complex and expert assessments. Panel members are also supposed to liaise with the local legal services department and guardians ad-litem panel about the prioritising system. In many cases, consultation on the assessment process from panel members either clarified that specific mental health assessment would not be needed in Court, or indicated the precise nature of the assessment needed, thus enabling clear instructions to be issued. In other cases, early warning enabled appropriate experts to be identified, and assessment sessions timetabled to facilitate the smooth running of proceedings (Boyle, 2010, p. 107). The centralisation of referrals has highlighted the need for therapeutic services. A close working relationship facilitated dialogue about the possibility of therapeutic resources. The process of appointing a therapeutic service coordinator should be aided by the provision of a unified base in a one-stop centre. Currently, there are eleven full-time equivalent social work posts in the therapeutic social work team (Carpenter, Schneider, Brandon and Woof, 2003, p. 91). Most of these posts are also attached to multidisciplinary child mental health teams. One is attached to a multiagency probation initiative working with sex offenders and those who commit domestic violence. Concurrently, a consultant psychology post should be appointed to manage and provide more specialist child protection services from within the health service. The work of the prioritising team has continued and expanded. In addition to reviewing prioritised cases and running workshops for principal social workers about the types of the cases that are best referred, this team also assesses the interface between health and social services. The system receives many informal enquiries at an early stage of social work involvement, enabling a more proactive approach. Area social workers cannot hold a citywide overview of therapeutic resources, but are able to discuss case needs with the therapeutic social work team coordinator and match these needs to appropriate resources. The multidisciplinary nature of the panel has increased the inclusion of research about the planning process for placement children, as recommended by Carpenter, Schneider, Brandon and Woof (2003, p. 91). Advocate Effectively With A Range Of Different Agencies And Professionals On Behalf Of Service Users Discussions about ethical social work practice before and after referrals have led to recommendations about practice and facilitated sharing of exemplary practice within the city. Concerns about the overuse of experts in child protection cases have led to links being established with the local judiciary and the local panel of guardian’s ad-litem. Closer working relationships have been cemented between the health service and social services. The LEED model is not a solution to health and social service problems. It does however provide one model for working more closely together for children with emotional and behavioural problems, and who are part of child protection investigations and concerns. Social services have had to accept that not all cases can be referred, and health services have had to accept social services’ view of priority and ensure that all identified cases are seen quickly. Four years ago, many children were being referred, often inappropriately, and sitting on waiting lists. Currently, all referred children are reviewed centrally and, if deemed a genuine priority, seen extremely quickly (Carpenter, Schneider, Brandon and Woof, 2003, p. 91). Regular consultation and training is provided to social services to help support those working with these families. Increased therapeutic resources have been identified and provided as a result of close and positive working relationships. Greater consensus concerning the need for referral and assessments is being reached, particularly identifying and recognising the particular skills of social workers in assessment and therapeutic management. Clarifying reasonable expectations of social worker assessments have been a vital part in deciding when referral to a mental health professional needs to be made. The service model helps us undertake responsibility in keeping with conceptualisation, decision making regarding treatment, and evaluation of outcomes. Under the umbrella of evidence-based practice however, more attention is focused on treatment than assessment (Carpenter, Schneider, Brandon, and Woof, 2003, p. 103). One factor that can influence diagnostic accuracy is the method of assessment used. Considerable evidence shows that structured and semi structured clinical interviews are more widely used than traditional unstructured approaches to diagnostic assessment. In a study of adult inpatients at a university affiliated psychiatric hospital, Griffiths, and Brown (2001) found primary diagnoses from the Structured Clinical Interview for DSM-IV and the Computer-Assisted Diagnostic Interview were more frequently in agreement with consensus diagnoses than those derived from traditional, unstructured diagnostic assessments. \ Discrepancies between the Diagnostic Interview Schedule for Children and the usual diagnostic practice of clinicians in community mental health clinics for children and families have also been reported (Barber, Brown and Martin, 2009, p. 130). Didactics and clinical supervision in structured diagnostic assessment using DSM-IV criteria are offered by the majority of social worker, psychiatry residences, and clinical psychology programmes. Yet only a minority of programmes required the gold standard of both didactic and clinical supervision. Percentages were lowest for MSW and PsyD programmes, where a requirement for didactic training was likely, but clinical supervision in structured diagnostic assessment was not (Capponi, 2003, p. 142). These findings indicate that social workers constitute the majority of professionals providing services to persons with psychiatric disorders in the United States (Banks, 2004, p. 91) and determining a patient’s psychiatric diagnosis is a critical component of evidence-based practice. Offering a particular topic on an elective basis does not guarantee that all students will take the course. Moreover, inadequate training in empirically supported diagnostic instruments could result in patients receiving a less complete and accurate assessment following referral to mental health services. This may influence the treatments they are offered and subsequently receive. Looking at accreditation criteria, as we did in relation to training in empirically support psychotherapy (Barber, Brown and Martin, 2009, p. 94) In conclusion, psychiatry plays a significant role in shaping the practices of mental health structure and services. The diagnosis of mentally distressed people is of foremost concern because misinterpretation of the experiences can lead to more harm to the patient. The spirit of inclusion and understanding of people diagnosed with mental distress is recommended for their recovery. New structure and policies which guard the privacy, needs and requirements of the mentally distressed have helped faster recoveries and liberation from previous oppressive medical experiences. With improved research and study in mental health practices, the mental health service user recovery, psychiatry foremost concern will be good. Bibliography Adams, R., 1990. Self-Help, Social Work And Empowerment, Macmillan Education, London Amnesty International., 2005. 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