Transformative Mental Health Social Work Practice: What, When, and with Whom Do We Learn?

The United Nations Special Rapporteur has called for ‘a revolution in mental health care to end decades of neglect, abuse and violence…enabl[ing] a long overdue shift to a rights-based approach’ (United Nations Human Rights Office of the High Commissioner, 2017). Principles underpinning social work practice with people living with mental distress who receive diagnoses such as schizophrenia, personality disorders and bipolar disorder, align with sought after changes. Using Cooperative Inquiry and referring to the Model of Holistic Competence in Social Work, this study investigated mental health social work seeking to foster this shift. Findings confirmed inherent discordance between social work values and mental health care dominated by biomedical and neoliberal views. Upholding social work values in this context involves complex practice, integrating procedural and meta-competencies. By incorporating skills in relational practice and advocacy; knowledge of multiple explanatory frameworks for mental health and mental health systems literacy; self-regulation; fostering tenacity whilst addressing ‘othering’; and judgement informing choices around conformity and confrontation, social work navigates tensions associated with this discordance. This paper highlights the nature of values-based social work practice as aligned with mental health reforms.

The Australian social work course accreditation standards aim to ensure graduates have an understanding of the social, cultural, and political structures that influence psychosocial wellbeing. Unlike the previous standards, the current standards do not require the curricula to address specific knowledge and skills for working with people who live with severe mental distress or mental health conditions that might result in diagnoses such as schizophrenia, personality disorders, and bipolar disorder. Anticipating the revision of curricula resulting from these recent changes to the accreditation standards, four social work academics from across three Australian universities engaged in a peer review of mental health social work curricula. By exploring the purpose, emphasis, and challenges in curriculum design, this stage of the review aimed to identify the positioning of future curricula to prepare graduates who embrace the complex array of opportunities and demands of social work practice in this field. Our investigations confirmed diversity in mental health social work practice, revealing mental health social work curricula must meet multiple and evolving agendas. IMPLICATIONS International calls for transformative approaches to mental health present opportunities for enhanced recognition of the social justice orientation of social work. The absence of an accreditation requirement to address social work practice with people who live with severe mental distress or low prevalence mental health conditions might prove a regrettable gap in Australian Social Work Education Accreditation Standards 2021. Further collegial discussion and debate about the beneficial outcomes of mental health social work curricula are desirable.

This study explored the metacurriculum of an undergraduate mental health social work subject that was developed and delivered collaboratively by lived experience and social work academics in a regional Australian university. Metacurriculum refers to implicit messages about how students learn how to learn that is, the ontological and epistemological positioning of curriculum. In this subject, students were invited to reflect on multiple, diverse, lived-experience narratives of mental distress as they developed their understanding of mental health social work practice. Using cooperative inquiry, we collectively critically reflected on the experience of teaching and learning with this curriculum. Coresearchers included a student who had completed the subject; a mental health social work practitioner/tutor, a social work academic, and a lived-experience academic who coproduced the subject material; and mental health academics acting as critical friends. Findings revealed engaging with lived-experience narratives was experienced as generating compassion for all humanity; challenging stigma by sharing the responsibility of positioning; and enabling critically reflexive dialogue. We concluded that diverse, lived-experience narratives can be incorporated to enact metacurriculum that aligns social work teaching and learning with emerging transformative approaches to mental health. IMPLICATIONS Incorporating diverse narratives of mental distress into curriculum can highlight the operation of intersectionality and privilege. Engaging with multiple narratives of mental distress undermines the binary construction of “them” and “us”. Metacurriculum enacting inclusive, collaborative knowledge development aligns teaching and learning with transformative mental health.

The United Nations Convention on the Rights of Persons with Disabilities (hereafter CRPD) has provided a radical imperative for the reform of mental health and capacity legislation around the world. The interpretation of the CRPD has been controversial, ranging from the complete abolition of detention, forcible treatment, and substitute decision-making to accepting that elements of these measures need to be retained based on non-discriminatory criteria, additional safeguards, and a comprehensive shift towards supported decision-making. While the potential effects of the CRPD on mental health social work and social work generally are considerable given their shared commitment towards social justice, to date there has been no review of research evidence exploring their relationship. In addressing this knowledge gap, this study held a preliminary discussion with practitioners and academics at the European Association of Social Work Mental Health Special Interest Group in Amsterdam 2022, followed by a scoping literature review on the question: What impact, if any, has the CRPD had on social work practice? The review produced four main findings: impact on legislation; positive impact on practice; limited impact on practice; and impact on social work education and research. In sum, while there were some positive indications of social work and mental health social work practice being influenced by the CRPD, these were scant. Barriers to change included tendencies among some social workers to practise substitute decision-making, in part related to resourcing and policy contexts, and understandings of disability aligned to individualised/medical rather than social perspectives. The results indicate that legal reform on its own is insufficient to impact social work practice, and that realising the potential of the CRPD will necessitate good quality training, as well as improving social workers' knowledge of the human rights of people with mental impairment.

When graduates of Australian social work courses embark on a career in mental health, the systems they enter are complex, fragmented and evolving. Emerging practitioners will commonly be confronted by the loneliness, social exclusion, poverty and prejudice experienced by people living with mental distress; however, social work practice may not be focused on these factors. Instead, in accordance with the dominant biomedical perspective, symptom and risk management may predominate. Frustration with the limitations evident in this approach has seen the United Nations call for the transformation of mental health service delivery. Recognising paradigmatic influences on mental health social work may lead to a more considered enactment of person centred, recovery and rights-based approaches. This paper compares and contrasts influences of neo-liberalism, critical theory, human rights and post-structuralism on mental health social work practice. In preparing social work practitioners to recognise the influence of, and work more creatively with, intersecting paradigms, social work educators strive to foster a transformative approach to mental health practice that straddles discourses.

The article reports the findings of a recent survey of 339 social workers whose area of practice is mental health in the Canadian province of Ontario. The survey was developed in response to unprecedented threats to the profession, and a dearth of information on the contribution of social workers to the provision of mental health services in this Canadian context. International literature on the role of social work in mental health provides the context for discussion of these findings. Survey results confirm that mental health social work practice in Ontario is aligned with current international trends. Despite social workers' apparent contribution, significant challenges both internal and external to the profession keep social work practice in the shadows of other mental health professionals.

The use of Quality of Life (QOL) indicators has become increasingly common in health and social services. This article proposes a framework to strengthen mental health social work practice by outlining subjective wellbeing, a component of the QOL construct. Following a discussion on the current policy influences on mental health service provision in Aotearoa New Zealand the QOL construct is outlined. The application of a QOL framework to mental health social work practice draws parallels between QOL principles and the current mental health philosophies of recovery, social inclusion and community care. The authors maintain that a focus on applying QOL in mental health social work will see its contribution to the mental health sector enhanced and its role and function more clearly described.

ABSTRACTBetter 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.IMPLICATIONSSocial 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.

The social work profession in the United Kingdom is criticized for its reluctance to engage with spirituality. Its absence in Northern Ireland is particularly significant given the role of religion in its political conflict. Drawing upon qualitative research with mental health service users and social workers about religion, spirituality, and mental distress, this article explores the ambivalence that exists around this subject in mental health social work practice. It appears that the political conflict continues to impact social work provision. Support is needed for practitioners and service users to give voice to this aspect of mental well-being. This study comprised one-to-one interviews with 12 mental health social workers and 12 mental health service users. Half of the participants from each group were invited to take part in a telephone interview. All of the participants were invited to bring an object which signified what religion and/or spirituality meant to them, to the interview.

This article is based upon a qualitative doctoral study about the role, if any, of spirituality in the lives of mental health service users, and how the subject is engaged with mental health social workers in Northern Ireland (NI). One-to-one interviews with twelve mental health service users and twelve mental health social workers were conducted with participants invited to bring an object. The object was used to assist dialogue with participants regarding their experience of spirituality, and its application in practice. International research proposes that spirituality plays a supportive role for some people experiencing mental health problems. The acknowledgement of spirituality in mental health social work practice in NI is, however, challenging due to various factors. Of particular significance is NI’s history of violent political conflict, shaped in part by the contested role of religion in the creation of the NI state. This article considers how the selection, presence and absence of the object were used to support participants in exploring a subject that can be challenging to communicate. This article proposes the use of objects within mental health social work practice and research as useful aides to explore culturally sensitive and personal topics.

Introduction Overview of the Historical and Contemporary Discourses Influencing Social Work with Lesbians and Gay Men The Legal and Policy Framework for Practice Social Work Values and Ethical Practice: Moving beyond Anti-Discriminatory or Anti-Oppressive Practice Family and Kinship and Their Relationship to Social Work Practice Homosexuality, Religion and Social Work Practice Social Work Practice with Lesbians and Gay Men: Working with Older Adults, Adults with Learning Disabilities and Adults with Physical Disabilities Social Work Practice with Lesbians and Gay Men: Mental Health Social Work Practice with Lesbians and Gay Men: Working with Children and Families Conclusion References

SUMMARY This article considers aspects of the possible impact of social exclusion upon psychosis and the implications of this for mental health social work practice. Against a background of calls for evidence based practice, and increasing recognition of the significance of theories and understandings as the foundations of practice, the article will first explore current and historical ways of viewing and intervening with the relationship between social adversity and mental health. Then, alternative understandings of this relationship, supported by recent research regarding the impact of trauma and extreme social adversity upon physiological and physical processes implicated in mental ill-health, will be discussed. These approaches have major implications for social work practice with psychosis, suggesting that experiences of trauma and disadvantage, and interventions seeking to alleviate the inner and outer effects of these experiences-tasks central to the social work remit-can make a significant difference to mental health outcomes. However, this is not to advocate a simple (albeit under-resourced) 'social solution'! On the contrary, the understandings underpinning these approaches recognise biological processes play a role in mental and physical ill-health: importantly, however, they can be shown to question the stigma traditionally attached to the concept of biological disorder in mental health, thus pointing to the value of a truly biopsychosocial approach with psychosis, involving fully holistic interventions that differ from those currently dominant, and which carry implications for more egalitarian worker-user relationships.

Many mental health social workers employed in NHS mental health trusts in England undertake generic care co-ordination roles. Their identity as social workers is often overlooked, diminishing their potential to lead the implementation of social interventions to improve social outcomes for people with mental health problems. This study explores the extent to which mental health social work students were able to implement an evidence-informed social intervention—Connecting People—during a mental health practice learning placement. A thematic analysis of sixteen placement reports was conducted and evidence was found of high fidelity to the practice model alongside areas for improvement. Additionally, barriers and facilitators to the implementation of Connecting People in practice were noted. The findings demonstrated that it was possible to implement the model in mental health services, though the support of supervisors, teams and employers was required. The use of social approaches in mental health services may provide a leadership opportunity for mental health social workers which is distinct from their statutory functions, potentially assisting their retention in the profession.

The Recovery Approach has been adopted by mental health services worldwide and peer support constitutes one of the main elements of recovery-based services. This article discusses the relevancy of recovery and peer support to mental health social work practice through an exploration of social work ethics and values. Furthermore, it provides an exploration of how peer support can be maximized in groupwork to assist the social work clinician to promote recovery and well-being. More specifically, this article discusses how the narrative therapy concepts of “retelling” and “witnessing” can be used in the context of peer support to promote recovery, and also how social constructionist, dialogical, and systemic therapy approaches can assist the social work practitioner to enhance peer support in recovery oriented groupwork.

Purpose – Over the last 12 years there have been substantial developments in UK law and policy relevant to mental health social work practice. The previous legal frameworks across the jurisdictions were very similar but the new laws have developed in different ways and provide greater opportunities for comparison. Across all the jurisdictions policy developments, especially in the areas of recovery and risk assessment, have influenced the way that mental health social workers practice. Design/methodology/approach – This exploratory study used case study vignettes with 28 respondents to examine how these major legal and policy developments impact on social work practice. Findings – There were variations in how levels of risk are defined and often a lack of clarity about how this informs decisions. There was a consensus that recovery is important but difficulties in understanding how this might apply in crises. Predictably, differences in legal and policy contexts meant that there were a variety of perspectives on how mental health social workers applied the laws in their jurisdictions. Research limitations/implications – The limited focus on research informed practice and the lack of transparency in decision making across areas of risk assessment and intervention, use of recovery approaches and the use of mental health laws suggest the need for a more evidence-based approach to training, education and practice. Originality/value – There is very limited previous research on practitioner experiences of the complexities involved in implementing mental health law. This paper provides some insights into the issues involved and for the need for more detailed examination of the decision-making processes involved.