Iranian Social Workers: The field of mental health provides a unique opportunity for social workers to practice collaboratively with allied professionals and at the same time maintain the integrity of their knowledge and skill base.
This document will define health and mental health; describe the current roles of social workers within the spectrum of mental health services; identify the necessary education and knowledge base; and consider future directions.
The following definitions form the basis for developing and configuring the delivery of health and mental health services in Canada.
1.1 The Definition of Health
Achieving Health For All, a discussion document released by Health and Welfare Canada in 1986, reflects a growing awareness that health must be viewed in terms of our personal and social resources for action. It speaks of health as “a resource which gives people the ability to manage and even to change their surroundings…a basic and dynamic force in our daily lives, influenced by our circumstances, our beliefs, our culture and our social, economic and physical environments.” (Achieving Health For All, p. 3)
This active concept of health accords greater prominence than ever to the mental and social determinants of health. It also requires us to think of health as something experienced not only individually, but also collectively. Most significantly, this new understanding of health dwells less on people’s traits as individuals and more on the nature of their interaction with the wider environment. “Environment” in this context is interpreted in its broadest sense, and includes not only our physical surroundings, both natural and artificial, but also the social, cultural, regulatory and economic conditions and influences that impinge on our everyday lives.
1.2 The Inseparability of Mental Health from Health
In the past few decades there have been significant developments in our understanding of mental health. As a result, current concepts of mental health reflect a number of themes:
psychological and social harmony and integration;
quality of life and general well-being;
self-actualization and growth;
effective personal adaptation; and
the mutual influences of the individual, the group and the environment
We now know that human biology and human experience interact continually in shaping mental life.
Mental life embraces both inner experience and interpersonal group experience. Our interactions with others take place within a framework of societal values; therefore, any definition of mental health must necessarily reflect the kind of people we think we should be, the goals we consider desirable, and the type of society we aspire to live in. Social workers do not isolate ideas about mental health from such wider social values as the desire for equality among people, the free pursuit of legitimate individual and collective goals, and equitable distribution and exercise of power.
1.3 The Definition of Mental Health
It is from this perspective that the following dynamic and interactive definition of mental health has been developed:
Mental health is the capacity of the individual, the group and the environment to interact with one another in ways that promote subjective well-being, the optimal development and use of mental abilities (cognitive, affective and relational), the achievement of individual and collective goals consistent with justice and the attainment and preservation of conditions of fundamental equality.
1.3 The Definition of Mental Health
In this definition, mental health moves into the realm of the relationship between the individual, the group and the environment. Mental health is no longer conceived of as an individual trait, such as physical fitness; rather it is regarded as a resource consisting of the energy, strengths and abilities of the individual interacting effectively with those of the group and with opportunities and influences in the environment.
This conceptualization leads to certain conclusions about the factors that can enhance or weaken mental health. Whatever makes it difficult for the individual, the group and the environment to interact effectively and justly (for example, poverty, prejudice, discrimination, disadvantage, marginality or poor coordination of or access to resources) is a threat or barrier to mental health.
A key feature of this new definition is that it does not define mental health in terms of the presence or absence of mental disorder, nor does it imply that mental health and mental disorder are simply opposite poles on a single continuum.
1.4 The Social Work Code of Ethics and Practice Domain
The social values which underpin this interactive definition of mental health are strongly congruent with the “humanitarian and egalitarian ideals” which form the value base of social work (Social Work Code of Ethics, p. 7). Further, the emphasis on “interaction” between person, group and environment fits closely with social work’s “person-in-environment” practice domain: “The primary focus of social work practice is on the relationship networks between individuals, their natural support resources, the formal structures in their communities, and the societal norms and expectations that shape these relationships. This relationship-centred focus is a distinguishing feature of the profession.” (CASW National Scope of Practice Statement, p. 2) Work in the mental health field requires an ability to work collaboratively and is strengthened by a systems perspective. As these knowledge and skill areas are emphasized in social work education, social workers are well positioned to play a significant role as our society strives to achieve mental health goals in the twenty-first century.
1.4 SOCIAL WORK ROLE DESCRIPTIONS
Although formal mental health services are generally delivered through the public service in Canada, voluntary or private sector agencies as well as private practitioners also play major roles in most provinces. Social workers are involved at the micro, mezzo and macro levels in all sectors. “The social work profession promotes social change, problem solving in human relationships and the empowerment and liberation of people to enhance well-being. Utilizing theories of human behavior and social systems, social work intervenes at the points where people interact with their environments. Principles of human rights and social justice are fundamental to social work.” (Definition of Social Work, adopted by the General Assembly of the International Federation of Social Workers, Montreal, Quebec, Canada, July 2000.)
Many of the roles that social workers perform are common to all mental health disciplines. Specific to the domain of social work are roles of building partnerships among professionals, caregivers and families; collaborating with the community, usually with the goal of creating supportive environments for clients; advocating for adequate service, treatment models and resources; challenging and changing social policy to address issues of poverty, employment, housing and social justice; and supporting the development of preventive programs. Prevention occurs on many levels and includes a focus on early intervention, individual and public education, advocacy and improving access to services, resources and information.
Mental health settings usually include services in three broad levels of health care application: prevention, treatment and rehabilitation. It is recognized that individual social workers may practice exclusively within one setting or cross the boundaries of all three in response to diverse client, family and community needs.
2.1 Prevention: aims to reduce the incidence of disease or dysfunction in a population through modifying stressful environments and strengthening the ability of the individual to cope. Prevention involves the promotion and maintenance of good health through education, attention to adequate standards for basic needs and specific protection against known risks. In mental health settings, preventive activities include public and client education regarding emotional self-care and healthy relationships, building community knowledge and skills (community development), social action, and advocacy for social justice.
2.2 Treatment: aims to reduce the prevalence (number of existing cases) of a disorder or dysfunction and includes early diagnosis, intervention and treatment. In mental health settings, treatment activities are focused on individuals experiencing acute psychiatric symptoms, emotional trauma, relationship problems, stress, distress or crisis and include assessment, risk management, individual, couple, family and group counselling, intervention or therapy and advocacy. Social work uses relationship as the basis of all interventions.
2.3 Rehabilitation: aims at reducing the after effects of disorder or dysfunction, and involves the provision of services for re-training and rehabilitation to ensure maximum use of remaining capacities by the individual. In mental health settings, rehabilitation activities focus on clients who are disabled by mental illness and may include individual, couple, family, and group interventions to build knowledge and skills, provision of specialized residential, vocational and leisure resources, and advocacy to ensure the development of needed services and to change community attitudes.
Specific to their employment setting, social workers in mental health deliver the following professional services:
Direct Services to individuals, couples, families and groups in the form of counselling, crisis intervention, therapy, advocacy, coordination of resources, etc.
Case Management – coordinating inter-disciplinary services to a specified client, group or population.
Community Development – working with communities to facilitate the identification of mental health issues and development of mental health resources from a community needs perspective.
Supervision and Consultation- clinical supervision/consultation, maintaining quality and management audits and reviews of other social workers involved in mental health services.
Program Management/Administration – overseeing a mental health program and/or service delivery system; organizational development
Teaching – University and college level; workshops, conferences and professional in-services
Program, Policy and Resource Development – analysis, planning, establishing standards
Research and Evaluation
Because of the high degree of congruence between the conceptual framework through which mental health services are now provided and the value base and practice domain of social work it is expected that the profession will play a strong leadership role in this field in the decades ahead.
Since its inception, social work has focused on the social contributions to emotional well being and mental health. As health care moves towards a “population health” approach that emphasizes the importance of social and psychological determinants of health, social workers will continue to make a significant contribution to the health care/mental health team.