Mental Health Social Work Research Articles

Truly Listening to Accounts of Mental Health Act Assessments: Reflections on my Practice

Abstract This article draws upon the experience of the author whilst undertaking a qualitative research study exploring service user experiences of being assessed for detention to a mental health hospital. Doing research as a social work practitioner is a growing area and a common motivation is to improve practice. This article brings a different way of reporting research, which is embedded in the reflective tradition of social work. It explores practitioner research and insider/outsider perspectives. Through reflection, the author examines in depth two participants’ narratives, how this impacted her as a mental health social worker and the changes in her practice. These assessments are complex pieces of social work with involuntary service users in a pressured setting and are a challenging area for practitioners to improve service user experiences.

Implementing motivational interviewing in adult mental health social work practice: an analysis of postgraduate student assessed placement reports

ABSTRACT Motivational interviewing is commonly taught on social work qualifying programmes as it is a core skill which practitioners can use in a variety of practice settings. However, the extent to which students can apply it in their practice learning placements is rarely evaluated. This paper reports a content analysis of a random selection of postgraduate social work students’ practice learning placement reports (n = 16) to assess the extent to which they were able to apply it in their practice. The findings revealed many examples of students’ adherence to motivational interviewing principles and practice, facilitated by their self-reported knowledge and confidence in using the approach. However, the analysis also found some students who struggled to utilize it because of a poor understanding or a practice context that mitigated against its use. Therefore, although it is possible to train social work students to use motivational interviewing in their practice learning, further evaluations are required to assess their use of it in their post-qualifying practice and the outcomes of this for service users.

Exploring the Evidence for the Paradigms of Recovery and Social Work Converging in Mental Health Service Delivery Worldwide: Reflections from an Irish Case Study.

Recovery within mental health service delivery is no longer a new consideration in the Western world. However, it is well-documented how challenging its implementation and translation to practice and reality have been in contemporary mental health systems. In conjunction with this, mental health social work is continuously being challenged and debated in relation to its role, responsibilities, and identity in service delivery. This is largely the consequence of the continued dominance of the biomedical model in relation to service delivery. Yet, if we critically reflect on the philosophy and ethos of recovery, it becomes very clear that social work should be the key profession to lead the development and improvement of recovery-orientated services across the globe. To illustrate this argument, the authors first draw on empirical research undertaken by the lead author within the Republic of Ireland on how recovery is socially constructed within mental health service delivery. The key stakeholders involved in the Irish study included professionals, service users, family members, and policy influencers, with participants taking part in semi-structured interviews. Secondly, the authors reflect on some of the findings from this Irish study, presenting an argument for not only a more significant role for social work in an Irish mental health context but also making comparisons from an international perspective. This includes exploring the role of critical social work traditions for supporting services to move beyond a philosophy of recovery that has, to date, overlooked the intersectional injustices and inequalities faced by hard-to-reach populations. Finally, the authors conclude by providing some possibilities for how the paradigms of social work and recovery can and should continue to converge towards each other, opening a space for social work to become a more dominant perspective within mental health systems worldwide.

Attitudes of Spanish mental health professionals towards trans people: A cross-sectional study.

WHAT IS KNOWN ABOUT THE SUBJECT?: The trans community perceives barriers to the mental health services in the form of professionals' transphobia, lack of knowledge, and cultural sensitivity in healthcare. The attitudes of health professionals are mediated by their social context, which can determine their behaviour or attitude towards users. WHAT DOES THE ARTICLE ADD TO EXISTING KNOWLEDGE?: The attitudes of mental health professionals towards trans people are related to variables such as the professional's age, gender, political ideology and religious beliefs. Mental health nursing, psychology and social work are the professions that present more favourable attitudes towards trans people. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The inclusion of a professional perspective that understands sexual and gender diversity among mental health professionals is required. It is necessary to train professionals to promote socio-healthcare based on respect and free from prejudice, discrimination and stigma. ABSTRACT: Introduction The trans community perceives barriers to the mental health services in the form of professionals' transphobia, lack of knowledge and cultural sensitivity in healthcare. Aim Evaluation of the attitudes towards trans people of the professionals who work in the different Spanish mental health services. Method A cross-sectional design was used with a sample of professionals from different professional groups working in mental health units, hospitals and outpatient settings throughout Spain. Results Gender differences were found, with higher values in genderism and sexism among males. Negative attitudes and sexism have also been associated with age and religious beliefs. Mental health nursing, psychology and social work presented more favourable attitudes towards trans people than other mental health professionals. Discussion/Implications for Practice The inclusion of a professional perspective that understands sexual and gender diversity and the acquisition of professional attitudes based on evidence and patient-centred model are basic aspects to promote socio-healthcare based on respect and free from prejudices, discrimination and stigma.

A Market of Lived Experience-User Involvement and the Commodification of Personal Experiences of Mental Illness.

Working actively to engage service users in participatory practices is both a policy expectation and a moral imperative for mental health social workers in contemporary Western mental health care. Recent research suggests that such practices of service user involvement are becoming increasingly individualised and driven by market logic. Based on an ethnographic study within a Swedish public psychiatric organisation, this article applies the concept of commodification to examine this trend. By showing how the practice of user involvement takes the form of a market where personal narratives and experiences of mental health problems are bought and sold as commodities, the analysis illuminates how market logic permeates the everyday practice of user involvement. One consequence of this commodification is that user organisations, as well as individual service users, are restricted in their role as independent actors pursuing their own agenda, and instead increasingly act on behalf of the public and as providers of personal experiences. While it is vital that service user perspectives are heard and recognised within mental health services, mental health social workers need to be aware of the risks of commodifying lived experience. When attention is directed to individual experiences and narratives, there is a risk that opportunities to advocate on behalf of the user collective as a whole and speak from a more principled and socio-political standpoint are lost. In addition, the commodification of personal experience tends to rationalise and privilege user narratives that conform to the dominant institutional logic of the mental health organisation, while excluding more uncomfortable and challenging voices, thereby undermining the ability of service users to raise critical issues that do not align with the interests of the mental health organisation.

Responding to mental health crisis at a street level: mental health practitioners as street-level bureaucrats

Street triage practitioners, consisting of mental health social workers and nurses, act as a conduit between service users and emergency services, and have a significant amount of discretion in determining the care and treatment pathways for individuals experiencing mental health crises. However, this is set against a backdrop of neoliberal reforms that have resulted in an increased focus on risk management, accountability, responsibilisation and managing scarce resources. Based on ethnographic research undertaken in a street triage setting in the UK, this article examines the role of street triage practitioners as ‘street-level bureaucrats’ and explores the impact of neoliberal mental health reforms on street-level practice and how these shape and constrain the use of discretion in a street triage context. Revisiting the relevance of Lipsky through a neoliberal lens, the article identifies how street triage practitioners use their discretion to navigate practice dilemmas in a contemporary mental health landscape.

Validation of the Arabic version of the refugee health screener-13 among postpartum Syrian refugees in Lebanon

PurposeRefugee mothers are at a significantly increased risk of suffering from postpartum depression. However, available tools to screen for it often use a Western paradigm of mental health, which may not be culturally appropriate, and may not account for the background stress experienced by refugees. The purpose of this study is to test and validate refugee health screener-13 (RHS-13), which was developed by consultation with refugees from different backgrounds among a group of Syrian refugee mothers living in Beqaa’s valley in Lebanon.Design/methodology/approachThe tool was tested on a sample of 103 women. Internal consistency of the items for each subscale was assessed using Cronbach’s alpha. An interitem correlation was performed to examine the most correlated items on the scale. Pearson correlation coefficient was calculated between each subscale and its diagnostic proxy. To find the best fit cutoff point between sensitivity and 1-specificity, ROC curves were used.FindingsRHS-13 is a reliable and valid tool to detect depression and anxiety among postpartum Syrian mothers (internal consistency 0.803, correlation with patient health questionnaire: 0.63 and correlation with generalized anxiety disorder-7: 0.73). The best fit cutoff points were 12, 15 and 25, indicating the severity of symptoms from mild to severe, respectively.Originality/valueRHS-13 is a valid tool among postpartum refugees in Lebanon and can be used by primary care physicians, mental health providers and social workers working with refugees from the Middle East to screen mothers for depression and anxiety.

Elucidating the Elements of Clinical Case Consultation in Cognitive Processing Therapy

Research shows the value of consultation following training in Cognitive Processing Therapy (CPT), a frontline psychotherapy for posttraumatic stress disorder; however, the elements of successful CPT consultation are not delineated. This study’s aim was to elucidate the elements of successful consultation in CPT. Participants ( N = 41) were mental health clinicians, including psychologists, social workers, nurses, and psychiatrists, and consultants ( N = 4), who provided clinical case consultation. The clinicians participated in group clinical case consultation for 6 months following their workshop participation. Thirty audio recorded consultation calls were analyzed using thematic analysis. Elements were identified and organized according to the following themes: Organization, Knowledge Consolidation, Case Conceptualization, Directive Instruction, Nondirective Instruction, and Provision of Feedback. Important next steps include: (a) developing a model positing how the elements of successful clinical case consultation in CPT fit together and (b) identifying its mechanisms.

Resilience as Part of Recovery: The Views of Those with Experiences of Psychosis, and Learning for British Mental Health Social Work Practice. A Scoping Review

Abstract There is a significant diversity in approach to ‘resilience’ in the context of mental health recovery following experiences of psychosis, varying from clinically measurable outcomes to a personal trait within a recovery ‘journey’. Given the contested nature of resilience within mental health literature, this study aimed to complete a scoping review to synthesise understandings of resilience by individuals with experiences of psychosis. Drawing on the holistic and person-centred principles that underpin social work approaches to mental distress, these perspectives are considered in the statutory, policy and critical contexts of British social work, establishing learning for practice. A meta-synthesis of qualitative studies was completed, drawing on searches of five databases (Social Care Online, APA PsychInfo, Cinahl, Medline and Web of Science), identifying twelve relevant papers. A thematic analysis identified three overarching themes (personal, social and professional factors) and eight associated sub-themes (personal responsibility, use of experience, coping strategies, peer support, social relationships, contribution, relationships with professionals and structured support). The study identifies systemic and life-course approaches as empowering service user engagements with psychosis, recovery and resilience, suggesting that the social work profession is well placed to engage with resilience enhancement in the context of mental health recovery.

Neoliberalism, Control of Trans and Gender Diverse Bodies and Social Work

ABSTRACT Purpose This paper explores how neoliberal ideologies inform both social and political agendas that influence how social workers can provide support to trans and gender diverse people attempting to access gender-affirming healthcare, using an analysis of social workers’ experiences working in mental health in Nova Scotia, Canada. Method Qualitative semi-structured interviews provide a perspective of the experiences of social workers in Nova Scotia and how their ability to provide mental health services to trans and gender diverse people is impacted by neoliberalism. Results Most social workers attributed the structural context of working within a bio-medical system as contributing to social workers being disempowered, undermined, and not able to practice according to the values of their profession thus limiting their ability to provide affirming mental health supports to trans and gender diverse people in ways that align with their social work professional ethics and values. Discussion Through examining how neoliberal ideologies create notions of ideal social citizens by controlling the body, the paper explores how lived experience of neoliberal practices in mental health social work reinforce transnormativity. This paper highlights the necessity for social workers to resist dominant neoliberal and medicalized discourses which serve as mechanisms of power and control. Conclusion The paper concludes with recommendations for social work practice with trans and gender diverse populations.

Online Delivery of the Individualized Reduction of Falls Intervention for Persons With Multiple Sclerosis Who Use a Wheelchair or Scooter Full-time: A Pilot Study.

People with multiple sclerosis (MS) who use a wheelchair or scooter full-time fall frequently; however, fall prevention programming that meets the unique needs of this population is limited. This study examined the preliminary efficacy of a group-based online fall prevention and management intervention designed specifically for people with MS. This pre/post intervention, mixed-methods study included people with MS who used a wheelchair or scooter full-time, experienced at least 1 fall within the past year, and transferred independently or with minimal or moderate assistance. Participants engaged in a 6-week, online, individualized, multicomponent fall prevention and management intervention: Individualized Reduction of Falls-Online (iROLL-O). No statistically significant change in fall incidence occurred after iROLL-O. However, fear of falling significantly decreased (P < .01) and knowledge related to fall management (P = .04) and fall prevention and management (P = .03) significantly improved. Qualitative results indicated that participants valued the opportunity for peer learning and iROLL-O's attention to diverse influences on fall risk. This study is the first to examine the preliminary efficacy of an online fall prevention and management intervention for people with MS who use a wheelchair or scooter full-time. iROLL-O has promise, and participants found it valuable. Further efforts are needed to retain iROLL-O participants with lower confidence and functional mobility, and more research is needed to investigate the impact of the intervention on key outcomes over time.

Stressors and Resilience in Mental Health Social Workers

In their work, social workers in mental health services experience a high level of work-related stressors. The literature considers that resilience helps social workers to cope effectively with pressures, learn from their experiences, and develop personally and professionally. This paper presents the results of a qualitative study involving 16 social workers working with adults with mental and intellectual disabilities in different services in Bihor County. The results of the study highlight the importance of developing resilience as a factor in coping with stress. The development of resilience is based on the relationship between social workers and the work environment. Organizations contribute by creating a suitable working environment, offering support, etc. Personal characteristics such as self-esteem, adaptability, hopefulness, sense of humor, coping based on problem approach and less focus on emotions, initiative, and creativity, but also social skills and the development of supportive relationships and openness to new experiences, are key elements in this context.

Constructing the school paradox in the lives of children living with parental mental illness.

Children living with parental mental illness are referred to as an invisible population because mental health services rarely target them, as the focus is often on the parent who is ill mentally. The same situation occurs even in school where they are unnoticed. This study conducted in Ghana creates awareness about what these children think about their interactions at school in the context of parental mental illness. Data was collected through interviews and diaries with 13 children living with parental mental illness and analysed to attain the essential features through Husserl's transcendental phenomenology. The children find the school as a happy space where they do not have to be worried about the parent's mental illness. Ultimately, though, even at school, most of the children become concerned about the mental wellbeing of the parent due to their loyalty towards them. This results in the school paradox where the children are torn between having their own time at school and being worried about the parent's condition back home, wanting to be there for the parent. The school paradox is an unhealthy cycle that could be addressed with coordinated efforts from mental health professionals, social workers, psychologists and teachers.

“A breath of fresh air”: mindfulness training for early-career mental health social workers in Israel during COVID-19

ABSTRACT The present study examined the effectiveness of participation in a mindfulness group for Israeli early career social workers during the COVID-19 period. Eleven participants conducting fieldwork in a mental health rehabilitation center were interviewed. The participants described a variety of benefits from their mindfulness training, in three main areas: (1) Personal: applying mindfulness in their daily life; (2) Family: improved work-life balance and family relationships; and (3) Professional: applying mindfulness in their work with mental health clients. Mental support and self-care tools provided to early-career social workers were perceived by the participants as helping them overcome uncertainty, fatigue, and overwork.

Deployment of Mental Health Social Workers in Community Mental Health Centers in Taiwan

&lt;p&gt;社區心理衛生照護模式是以病人居家照護為主軸，提供精神病人社區生活支持體系，協助並結合家庭照顧者的精神疾患的服務模式，推動心理衛生照護的可近性、可及性與在地化，預期至2025年，全國將設置71處社區心理衛生中心，針對心理脆弱族群的早期介入，結合社區資源，因應需求，提升全國的心理健康知能、心理適應、韌力與復原能力。心理衛生社工員（師）評估個案與家庭的核心問題，協調跨專業合作，整合心理衛生、保護性、家庭、司法與法律等社會工作領域，透過個別性的服務計畫，提供連續性、支持 性精神病人照護&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;Community mental health care is a medical service model that centers on patient home care, provides psychiatric patients with a community life support system, and involves assistance from family caregivers. This in turn promotes the proximity, accessibility, and localization of mental health care. A total of 71 community mental health centers are expected to be constructed by 2025 to provide early interventions to psychologically vulnerable groups. Accordingly, community resources will be incorporated to fulfill the needs of these groups, improving the mental health literacy, psychological adaptation, and resilience of psychiatric patients across Taiwan. Mental health social workers are tasked with assessing the core problems facing case patients and their families; coordinating interdisciplinary collaborative care; integrating resources from various social work fields, including mental health, protective, family, judicial, and law fields; and providing continual and supportive psychiatric care through individualized service plans. They are also in charge of reinforcing the medical referral system and using multicultural and strength-oriented perspectives in social work to support and assist psychiatric patients in community life.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Research capacity and culture in an Australian metropolitan public mental health service: scoping the skills and experience of social workers and occupational therapists

BackgroundInvestment in a clinical research culture appears to be associated with benefits for consumers, staff, and overall organisational performance. The validated 55-item Research Capacity and Culture (RCC) tool was developed specifically to gauge the research capacity and culture of health professionals and workplace settings within which they work. Results of some individual studies suggest that professional discipline and workplace setting may impact RCC results however it has never been used in a dedicated public mental health setting. Therefore, this study will explore the research capacity and culture of allied mental health clinicians (Part 1). Another aim is to explore potential connections between workplace settings, locations and disciplines based on published RCC-based data to help signpost potential impediments to service improvements (Part 2).MethodsPart 1: An RCC-based online survey canvased Australian Social Workers and Occupational Therapists (n = 59) based in a metropolitan public mental health service. Non-parametric analyses explored links between research-related experience and participant characteristics.Part 2: Comparative analyses explored the potential influence of workplace settings and professional disciplines on published RCC results.ResultsPart 1: Overall, the research capacity and experiences of mental health Social Workers and Occupational Therapists seemed modest. Discipline was statistically associated with level of research-activity experience, weighted towards occupational therapy; demographic characteristics were not. Only two items in the RCC were rated high; many more items were rated low.Part 2: Published studies exploration found no link between RCC ratings and workplace location, setting, or professional discipline. Sampling biases and use of modified, non-validated RCC versions likely impacted the results.ConclusionsAllied mental health clinicians may not be sufficiently experienced, knowledgeable, or confident with a range of research-related activities given the emphasis on workforce research capability in policy and practice nowadays. This may be commonplace across health-based organisations. We recommend the systematic implementation of research training programs in (mental) health services, and a ‘whole-of-service levels’ approach be used i.e., transform policy, culture and leadership as well as provide practical resources with individual training. Potential benefits include a positive impact on organisation functioning, clinicians’ confidence and practice, and improved consumer outcomes.

Evaluating an implementation model of evidence-based therapy for eating disorders in non-specialist regional mental health settings

BackgroundMany people with eating disorders (EDs) either do not access treatment, access it well after symptoms first start, or drop out of treatment. This study evaluated ways to improve early access to evidence-based interventions for those with EDs in a non-specialist community setting.MethodsIn an Australian regional community, links were formed between general medical practitioners and treatment providers (psychologists, mental health social workers and dietitians), who received ongoing training, feedback and support. Service users had access to 20–40 subsidised treatment sessions. Data were collected from 143 patients over 18 months. Our outcomes are reported according to the RE-AIM implementation framework: Reach (we measured uptake and treatment completion); Effectiveness (impact on disordered eating cognitions, body mass index, remission, and moderators of effectiveness including illness duration, previous treatment, presence of comorbidities, presence of a normative level of disordered eating, presence of any ED behaviours, weighing in treatment, multidisciplinary case conferencing, number of dietetic sessions); Adoption (drop-out and predictors); Implementation (barriers encountered); Maintenance (subsequent activity designed to embed new practices).ResultsTreatment was completed by 71%; significant large decreases in eating disorder cognitions were achieved; remission was obtained by 37% (intent-to-treat). Treatment completion was predicted by lower baseline levels of disordered eating, uptake of ≥ 3 dietetic sessions, and ≥ 2 team case conferences. Greater improvement over time was predicted by regular case conferencing and in-session weighing.ConclusionsImplementation of this model in a regional community setting produced completion rates and outcomes comparable to those found in specialist clinical trials of ED treatments. Service providers identified care coordination as the most important factor to connect users to services and help navigate barriers to ongoing treatment.Trial Registration: This research was an invited evaluation of a project implemented by the Australian Department of Health. The project did not introduce any new clinical practice but sought to improve access to evidence-based multidisciplinary treatment for people with EDs by removing four known systemic barriers: securing an accurate diagnosis, availability of multidisciplinary treatment, cost of treatment, and intensity of treatment. As such, the project did not require trial registration. Notwithstanding, this evaluation obtained ethics approval (Bellberry Human Research Ethics Committee, Application No: 2018-09-728-FR-1).

Clinical and Research Applications of the Electronic Medical Record in Multiple Sclerosis: A Narrative Review of Current Uses and Future Applications.

The electronic medical record (EMR) has revolutionized health care workflow and delivery. It has evolved from a clinical adjunct to a multifaceted tool, with uses relevant to patient care and research. A MEDLINE literature review was conducted to identify data regarding the use of EMR for multiple sclerosis (MS) clinical care and research. Of 282 relevant articles identified, 29 were included. A variety of EMR integrated platforms with features specific to MS have been designed, with options for documenting disease course, disability status, and treatment. Research efforts have focused on early diagnosis identification, relapse prediction, and surrogates for disability status. The available platforms and associated research support the utility of harnessing EMR for MS care. The adoption of a core set of discrete EMR elements should be considered to support future research efforts and the ability to harmonize data across institutions.

Impact of strengths model training and supervision on the therapeutic practice of Australian mental health clinicians.

This study explored the impact of Strengths Model training, supervision and mentorship on the practice of a group of multi-disciplinary mental health clinicians that included mental health nurses, social workers, psychologists, and occupational therapists. A qualitative approach that combined critical realism and grounded theory was used. The findings demonstrated how a substantive category, Getting to Know Clients Better, facilitated participants' progression through a basic social psychological process, Becoming a Strengths-Informed Practitioner. This process consisted of a discernible and sustained change towards more person-centred, hopeful, and recovery-oriented practice. The findings also described an underlying generative mechanism for this, the Client Becomes Visible, which accorded with theoretical models of empathy, based on enhanced cognitive processing. The strength-based approach to practice facilitated the establishment of a collaborative relationship and a stronger therapeutic alliance between the client and clinician. The research demonstrated that Strengths Model is an effective vehicle for improving recovery-orientated mental health services.

Telemedicine and Multiple Sclerosis: A Survey of Health Care Providers Before and During the COVID-19 Pandemic.

Telemedicine provides a gateway to specialty care that, otherwise, patients with multiple sclerosis (MS) could have difficulty accessing. Studies have shown that telemedicine provides a valid alternative to in-person visits. There are limited data on the strengths and limitations of telemedicine from the perspective of MS providers. After reviewing the literature and pilot testing questions about telemedicine in provider focus groups, a 34-question survey was created on the Qualtrics web platform. A stratified sample of MS providers throughout the United States was recruited to participate. The survey initiated in November 2019 and closed in November 2020. Survey participants (N = 94) included neurologists (43.0%), advanced practice providers (28.0%), nurses (14.0%), mental health providers (7.0%), social workers (3.0%), rehabilitation providers (4.0%), and pharmacists (1.0%). Clinical video telemedicine (CVT) was the most commonly used platform, and 76.6% of respondents indicated that they used telemedicine to care for patients with MS. As a result of the COVID-19 pandemic, the rate of telemedicine use increased from 44.4% to 84.2%. Most health care providers (93.0%) were "very satisfied" or "somewhat satisfied" with their most recent telemedicine visit, and 94.4% of providers reported a desire to continue using telemedicine, although 84.6% found it difficult to perform a full examination. There was a large uptick in the use of telemedicine when the COVID-19 pandemic forced clinics to cease in-person visits. Providers predominantly used CVT; store-and-forward telemedicine and remote patient monitoring have fewer technical issues than CVT and seem to be underused.