Snapshot of Australia in 2020, recovery-oriented practice, principles, values and attitudes underlying recovery, the person-centred approach, practice standards, assessment, social work interventions, Aboriginal mental health, case management, practising mental health social work
Three sections follow:
1. Background Material that provides the context for the topic
2. A suggested Practice Approach
3. A list of Supporting Material / References
A snapshot of the mental illness situation in Australia (Productivity Commission, 2020)
Recovery from Mental Illness – what does it entail?
From the perspective of the individual with mental illness, recovery means gaining and retaining hope, realising one’s abilities and disabilities, engaging in an active life, and establishing personal autonomy, social identity, meaning and purpose in life, and a positive sense of self (National Practice Standards, 2013).
Recovery cannot be done to or for someone. Recovery is lived and experienced by individuals; what recovery-oriented services do is provide supports and interventions to facilitate people in recovering. The highly individual nature of the recovery process means that individuals may find differing approaches helpful along the way. There is no single recipe for recovery-oriented practice. There are, however, principles to guide recovery-oriented practice. Recovery-oriented practice:
Is strengths based
Is community focused
Is person driven
Allows for reciprocity in relationships
Is culturally responsive
Is grounded in the person’s life context
Addresses the socioeconomic context of the person’s life
Is relationally mediated, a social process
Optimises natural supports (Fossey 2012c).
From the point of view of the person, recovery involves:
making your own decisions rather than having them made for you
no coercion or requirement that people participate
people can share their thoughts and feelings openly
confidentiality is respected, and diversity is embraced and respected
friendly atmosphere and cumbersome administrative processes reduced
independence and self-reliance, responsibility, choice
recognition that everyone has rights that should be protected at all times, and all people have skills and strengths to offer (Our Consumer Place—consumerplace.com.au—as cited in Fossey, 2012c).
Principles, values and attitudes underlying a recovery-oriented mental health practice
There are specific principles that underpin social work practice in the mental health area (Bland, Drake & Drayton, 2021; National Practice Standards, 2013; Fossey, Renouf & Meadows, 2012):
Convey empathy, compassion and hope.
Promote an optimal quality of life for and with people with mental illness.
Emphasise personhood: social workers recognise that people are much more than an illness or diagnostic label and that individuals have broad human needs beyond specific treatment needs. Social workers recognise the importance of family and friendship relationships.
Learn about and value the lived experience of individual consumers and family members and carers; tailor mental health treatment, care and support to meet the specific needs of the individual.
Deliver services with the aim of facilitating sustained recovery.
Affirm the importance of partnership and mutuality: Respectful partnerships are marked by efforts to ensure both consumer and carer participate and have choice in decision-making (a collaborative approach) to enable self- determination (empowerment), mutual assessment and effective action planning.
Recognise the role played by carers, as well as their capacity, needs and requirements, separate from those of the person receiving services.
Recognise and support the rights of children and young people affected by a family member with a mental illness to appropriate information, care and protection.
Address powerlessness, marginality, stigma and disadvantage: Social worker practice promotes equity, access and participation, as well as the recognition of all civil and human rights.
Be aware of and implement evidence-informed practices and quality improvement processes.
Participate in professional development activities and reflect what they have learnt in practice.
The following values and attitudes underpin how mental health practitioners apply skills and knowledge when working with people, families, carers and communities (Bland, 2012b; National Practice Standards, 2013):
Respect All people have the right to be heard and treated with dignity and respect, have their privacy protected, and have their documentation treated in a confidential manner.
A focus on client strengths rather than failings—the ‘strengths perspective’.
Advocacy Uphold the human rights of people, families and carers, including full and effective participation and inclusion in society.
Recovery Practise with a focus on recovery; illness is a partial and not complete identity. Clients can assume personal control over choices, hopes, purpose, support from others and personal achievement.
A focus on empowerment through working with individuals but also with groups of clients to confront some of the structural disadvantage that accompanies mental illness.
Working in partnership Mental health practitioners foster positive professional and authentic relationships with people, families, carers, colleagues, peers and wider community networks.
Excellence Mental health practitioners are committed to excellence in service delivery, and also to personal development and learning. This is supported through reflective practice, ongoing professional development and lifelong learning.
In working with people, carers and families, mental health practitioners are expected to be:
• compassionate, caring and empathic
• ethical, professional and responsible
• positive, encouraging and hopeful
• culturally aware
• collaborative (National Practice Standards, 2013).
A person-centred mental health system
Almost half of all Australian adults have met the diagnostic criteria for a mental illness at some point in their lives, and almost one in five Australians have met the criteria in a given year. About three quarters of adults with mental illness first experience mental ill-health before the age of 25 years. Many do not receive the treatment and support they need. As a result, too many people experience preventable physical and mental distress, disruptions in education and employment, relationship breakdown, stigma, and loss of life satisfaction and opportunities (Productivity Commission, 2020).
The vast majority of people manage their health themselves (such as through the support of family and friends, the use of online resources, social interactions and positive adjustments to their diet, exercise or sleep). For those who need help, the consequences of them either getting (or not getting) the help that is right for them, and as early as possible, are substantial. A person-centred mental health system is essential (Productivity Commission, 2020. [The Productivity Commission outlines the features of a person-centred health system, and these are included after the Productivity Commission citation in the references section at the end of these pages.]
AASW Practice Standards
In 2014 the Australian Association of Social Workers (AASW) updated the 2008 standards for social workers supporting people with mental health issues. This publication applied the National Practice Standards for the Mental Health Workforce (2013) to social work. If interested the 2013 National Standards are provided beneath the National Standards citation in the references section at the end of this document. The standards social workers should follow when working with people with mental health issues follow (AASW, 2014).
Social workers demonstrate that the values of social work are integral to their practice, they uphold their ethical responsibilities, and they act appropriately when faced with ethical problems, issues and dilemmas.
1.1 Establishes a professional working relationship with the person who has a mental illness or disorder and their significant others.
1.2 Acts on the social justice issues related to people with a mental illness.
1.3 Integrates the concept of recovery into practice, promoting choice and self- determination within medico-legal requirements and duty of care.
Social workers have adequate understanding and knowledge of cultural diversity in order to work in a culturally responsive and inclusive way.
3.1 Understands the way mental illness and mental health are conceptualised in the person’s culture of origin.
3.2 Understands the way mental illness and mental health are conceptualised in Aboriginal and Torres Strait Islander peoples’ culture of origin.
Social workers have and obtain the knowledge required for effective practice.
4.1 Possesses current knowledge, concepts and evidence-based theories of the individual in society.
4.4 Possesses knowledge of mental health psychopathology.
4.6 Has knowledge of government mental health policy.
Social workers demonstrate the skills required to implement knowledge into practice, while being mindful of the social work commitment to the human rights perspective.
5.1 Completes a comprehensive bio-psychosocial assessment and case formulation addressing the physical, psychological and social aspects of the person and their situation.
5.2 Develops and implements one or more evidence-based therapeutic interventions with the person.
5.3 Advocates with and for the person in relation to rights and resources.
Social workers demonstrate commitment to ongoing learning through continuing professional development and supervision.
8.1 Maintains a critical reflective approach to social work practice in mental health with the aim of improving currency of knowledge and skills.
8.2 Accesses the research literature to be informed of the evidence base for professional mental health practice.
AASW Standard 5.1 relates to assessment. Assessment refers to the process of developing with the client a shared understanding of both the problems and strengths in the individual and her or his social context. Comprehensive assessment is bio-psychosocial. [This topic is covered in detail elsewhere on this website—access via the home/contents.] Social work assessment should be reflective of two major themes:
The focus of mental health social work on the social context and social consequences of mental illness
A focus on relationship in the lives of clients, and on relationship as a central element of the work (Bland, 2012a).
Bland (2012a) suggests that there are a number of specific emphases that social workers bring to assessment:
Person-in-environment A primary goal of social work assessment is to develop an understanding of the individual person within his or her environment. The focus is broad, starting with the individual and her or his developmental, family, medical, educational and employment history, and working outwards to consider relationships, other significant relationships, his or her work and community.
Locating the person within a family A social worker will gather information from the person and his or her family, about the significant relationships that comprise the person’s family—a genogram can be a helpful way to summarise this.
Locating the person within a community Both assessment and intervention require a detailed knowledge of the pattern of relationships experienced by the individual with others in the community—an ecomap can be helpful in depicting these relationships. Some individuals may be socially isolated; others may have a strong social network. Helping people to rebuild networks lost as a result of mental illness may be a goal for social work intervention. Or social workers may try to get supports to work together more effectively for the person.
Social functioning Exploring the person’s ability to perform a range of instrumental and relational social functions required in day-to-day living is important. Instrumental skills include self-care and hygiene, cooking, cleaning, budgeting, and managing transport needs. Relational skills include maintaining relationships with family, friends and neighbours, the ability to secure and maintain employment and the ability to parent children.
Family functioning There are a range of models for family assessment, but areas commonly considered include the roles of family members, communication among family members, the capacity to solve problems, both instrumental and affective, and the expression of feeling within the family. The emotional environment operating in the patient’s family is important. It is important that a focus on the capacity of the family to support the recovering patient also does not obscure the needs of the family members as they struggle to deal with the impact of mental illness on themselves and other family members. Best practice does not blame families but acknowledges that families consistently do the best they can for their ill family member. Key questions to consider here include:
How well does the family understand the patient’s unusual behaviour as part of an illness? What support is available to the key family caregivers?
In what ways are family members adopting caregiver roles for the ill family member?
Are there children in the family who are dependent for their care on the ill family member/
What additional supports are available to family caregivers from friends, extended family and community supports?
What is the impact of the patient’s illness on the health and welfare of other family members? How do family caregivers balance their caregiving responsibilities with other demands, such as work and care for other family members?
What patient behaviours are most difficult for the family, and can these e modified?
What are the grief and loss issues for significant family members?
How can treatment staff support family members on their care-giving activities?
Strengths, stressors and supports Social workers seek to apply a strengths perspective in individual and family assessment. They look for evidence of coping capacities and problem solving. They consider capacity to endure and motivation to change. Stressors are identified as those environmental factors that create acute or chronic stress for the individual and family, e.g. poor housing or low income. Supports are identified as those relationships (from friends, family, work colleagues or professional helpers) likely to moderate stress, promote coping capacities and encourage recovery.
Social inclusion Any comprehensive assessment needs to consider the extent to which the person with a mental illness enjoys the full range of rights and freedoms available to other citizens, e.g. access to health services and income security, housing, leisure activities, and physical health.
In an accompanying article around assessing people who do not speak English, Minas (2012) urges caution when administering assessment instruments, such as the BPSS, to people with low English proficiency or those from non-English cultural backgrounds. The guidelines suggested by Minas are listed under the citation in the reference section. When applied to the BPSS they suggest the social worker (i) assess the person’s proficiency in English and take steps to alter the approach, when necessary, (ii) be aware of cultural factors that can impinge on any assessment, and (iii) if in doubt, seek cultural consultation or refer to an experienced bilingual mental health professional.
Social work interventions
As well as supporting the person with the mental illness, Renouf and Meadows (2012) suggest advocacy and including families in recovery plans are important areas of social work practice.
Advocacy: activities undertaken by social workers with clients to promote and support basic human rights, and rights to access resources, services and information. The emphasis is on client empowerment—to encourage clients to take control of the process in order to meet their own needs.
Educating clients and families: Providing knowledge and skills around understanding illness and treatments, accessing resources and teaching communication and coping skills. Education is a key strategy in developing consumer and family control over client and family lives and circumstances and is a key to empowerment.
Working closely with families to solve problems: Seeking to assist family members to deal with the problems that develop as consequences of the client’s illness, or as consequences of treatment, disability, and family and community response. This may be short- or long-term (see also Bland, 2012b).
Aboriginal and Torres Strait Islander Mental health
Aboriginal and Torres Strait Islander people prefer to take a holistic view of mental health. The holistic view incorporates the physical, social, emotional, and cultural wellbeing of individuals and their communities. This means that mental health, family violence, and substance abuse should be integrated within a comprehensive primary health care service to reflect the fact that these issues are often linked.
The holistic view of health of Aboriginal Australians is evident in their capacity to sustain self and community in the face of historically hostile and imposed culture. Unique protective factors contained within Indigenous cultures and communities have been sources of strength and healing when the effects of colonisation and what many regard as oppressive legislation have resulted in grief, loss and trauma.
It is important to recognise existing frameworks of healing in Indigenous communities and how culture and spirituality in relation to social and emotional wellbeing are ongoing sources of strength (Dudgeon, Milroy & Walker, 2014).
Nine guiding principles emphasise the holistic and whole-of-life view of health held by Aboriginal people (Dudgeon, Milroy & Walker, 2014).
Aboriginal and Torres Strait Islander health is viewed in a holistic context that encompasses mental health and physical, cultural and spiritual health. Land is central to wellbeing. Crucially, it must be understood that while the harmony of these interrelations is disrupted, Aboriginal and Torres Strait Islander ill health will persist.
Self-determination is central to the provision of Aboriginal and Torres Strait Islander health services.
Culturally valid understandings must shape the provision of services and must guide assessment, care and management of Aboriginal and Torres Strait Islander peoples’ health problems generally and mental health problems in particular.
It must be recognised that the experiences of trauma and loss, present since European invasion, are a direct outcome of the disruption to cultural wellbeing. Trauma and loss of this magnitude continue to have intergenerational effects.
The human rights of Aboriginal and Torres Strait Islander peoples must be recognised and respected. Failure to respect these human rights constitutes continuous disruption to mental health (as against mental ill health). Human rights relevant to mental illness must be specifically addressed.
Racism, stigma, environmental adversity and social disadvantage constitute ongoing stressors and have negative impacts on Aboriginal and Torres Strait Islander peoples’ mental health and wellbeing.
The centrality of Aboriginal and Torres Strait Islander family and kinship must be recognised as well as the broader concepts of family and the bonds of reciprocal affection, responsibility and sharing.
There is no single Aboriginal or Torres Strait Islander culture or group, but numerous groupings, languages, kinships and tribes, as well as ways of living. Furthermore, Aboriginal and Torres Strait Islander peoples may currently live in urban, rural or remote settings, in urbanised, traditional or other lifestyles, and frequently move between these ways of living.
It must be recognised that Aboriginal and Torres Strait Islander peoples have great strengths, creativity and endurance and a deep understanding of the relationships between human beings and their environment.
Mental Health Social Work
Bland, Drake and Drayton (2021) recommend an overarching approach for social workers when practising in the mental health area:
Mental health professionals need to learn about and value the lived experience of individuals and carers.
Mental health professionals should recognise and value the healing potential in the relationships between individuals and service providers and carers and service providers.
These themes define mental health in terms of human encounter, rather than as the technical application of skills and knowledge. Relationships are the basis of recovery and hope. They are central to case management or family work. The lived experiences of consumers and families, as defined by consumers and families should be the priority (Bland, Drake & Drayton, 2021).
When discussing case management, Watson and Thorburn (2012) reinforce the above. Case management is about relationship, and the nature of the relationship is a key factor in recovery-oriented practice. It is who the worker is, not what he or she does, that is most often experienced as helpful in the recovery process:
Value the person for who she or he is
Believe in the person’s worth
See and have confidence in her or his skills and abilities
Listen to and heed what she or he says
Believe in the authenticity of the person’s experiences
Accept and actively explore her or his experiences
Tolerate uncertainty about the future
See problems and setbacks as part of the recovery process and as a source of learning.
Renouf and Meadows (2012) suggest allteam members perform a range of overlapping core shared tasks in the case management approach. These include establishing and maintaining a therapeutic relationship, but teams differ in the amount of shared and specialist work performed by individual members. Different professions (individuals) each bring their particular knowledge and skills to shared tasks in teams. Therefore it is important for each worker to have a good appreciation of both what he or she can and cannot do well, so that he or she cand draw on the knowledge and skill of another team member when this is needed. Each team member is accountable for his or her own professional conduct and the care she or he provides. In practice different team members may have varying degrees of responsibility for work with a particular client. Team leaders have responsibility for establishing and maintaining the conditions necessary for team functioning and decision making.
Bland, Drake and Drayton (2021) continue: The purpose of practice is to promote recovery; to restore individual, family and community wellbeing; to enhance development of each individual’s power and control over their lives; and to advance principles of social justice.
Social work is concerned with the way each individual’s social environment shapes their experience of mental illness and mental health problems. Its concerns include issues of individual personality, vulnerability and resilience, family functioning, strengths and stressors, support networks, culture, community, class, ethnicity, gender, economic wellbeing, employment and housing.
Social work is concerned with the impact of mental illness and mental health problems on the individual, the family and personal relationships, as well as on the broader community, including the impact on sense of self; life chances; family wellbeing; and economic security, employment and housing. Social work is concerned with the interface between mental illness and broader health and welfare issues such as child protection and domestic violence.
At the level of ‘social justice’, social work is concerned with issues of stigma and discrimination, political freedoms and civil rights, promoting access to necessary treatment and support services, and promoting consumer and carer rights to participation and choice in mental health services. It is concerned with making all human services more accessible and responsive to the specific needs and wishes of people with mental illness and their family and carers.
Social workers are both similar and different to other allied health professions. Similarities include knowledge base used, values and ethics. On the other hand social workers are more influenced by sociology and social justice with the social context and consequences being the main focus. Tension can arise between the critical approach (a focus of social workers) and the clinical approach (more of a focus for other allied health professionals). Critical refers to practice associated with an understanding of structural causes of mental health issues, a critique of psychiatry, institutional practices and power imbalances and an emphasis on rights. This tension poses a problem for social workers without clinical knowledge, as this deficit can impact on their effectiveness in implementing the critical approach. However, it is important to maintain a strong critical focus in mental health social work. This involves focusing on the lived experience of people’s mental health problems, not just the disorder. The focus should be on the person, not the illness. Treatment should focus on those aspects of the individual’s life where real change is welcome, e.g. confronting loneliness, having a job, and living a life of meaning and purpose. Involuntary treatment should be approached with an awareness of the ethical dilemmas inherent in this work. Working to develop a sense of power and agency is a core goal of critical practice. Ultimately it is important to treat critical and clinical as separate concepts with their own dimensions (Bland, Drake & Drayton, 2021).
Social workers work with individuals, families and communities with the intent of improving the capacity of ‘the neediest’ to connect with society or protect vulnerable children or ‘empower’ people (Our consumer place, 2013). Social work can involve:
Case management, whereby a social worker assesses the needs of a client and arranges, coordinates, monitors, evaluates and advocates for a package of multiple services to meet the specific client’s complex needs. Some are dissatisfied with the term ‘case management’ as it suggests that power and expertise reside with the mental health practitioner, diminishing the consumer as a person with expertise in her or his own right. Alternative terms are sometimes used: key worker, service coordinator, care coordinator, recovery guide, coach.
Seeking out resources to meet the needs of individual clients and families may be involved as social workers have traditionally been the professionals with the mandate on the team to know about and access resources for the individual and family (Bland, 2012b; Fossey, 2012a; Fossey, 2012b).
Leggatt and Cavil (2012) highlight the importance of families and other carers in mental health service delivery.They may be the major, continuing social and emotional support for consumers, even if they are not living under the same roof.Research indicates the following outcomes are enhanced when the family/carers are involved:
Reduction in relapse rates
Decrease in hospital admissions
Better adherence to medication
Improved social functioning
Improved relationships between family members
Increased employment rates.
Studies have also shown that family interventions are effective across different cultures. Families can assume various roles:
Caregiver, where they need to be educated about many aspects of the mental illness, should receive appropriate training in its management together with an understanding of mental health services available and what they can and should provide. Caregivers should be referred to family support organisations and respite services for support.
Provide information as partners with consumers and clinicians, from close observation of symptoms and behaviours.
Provide information on what does and does not work in rehabilitation.
As carer consultants, teaching clinicians how to interact effectively with families and caregivers.
As advisors in policy development for mental health services
Social workers may have to support a person with a mental illness as in individual social worker, as part of an agency, or as part of a case management team. When supporting a person with a mental illness, social workers should base their work on the following key themes outlined in the background material section above.
Mental health social work revolves around relationships. Relationships between individuals, carers and social workers have the potential to heal. It is who the social worker is, not what the social worker does, that is most helpful in the recovery process.
Social workers need to learn about and value the lived experience of individuals and carers: listen and heed what they say, have confidence in their skills, and value the individual, carer and family.
Families and other carers are important in mental health service delivery. Families can be caregivers, provide information to clinicians, provide information on what works, and teach clinicians how to interact effectively in given situations.
Mental health social work is particularly concerned with the individual’s social environment (family functioning, strengths and stressors, support networks, culture, community, class, ethnicity, gender, economic wellbeing, employment and housing).
Mental health social work is also concerned with social justice (stigma and discrimination, promoting access to necessary treatment and support services, and promoting consumer and carer rights to participation and choice in mental health services).
Mental health social work is concerned with making all human services more accessible and responsive to the specific needs and wishes of people with mental illness and their family and carers.
Mental health social work should maintain a critical focus: an understanding of structural causes of mental health issues, a critique of psychiatry, institutional practices and power imbalances and an emphasis on rights.
Mental health social work can involve case management, whereby a social worker assesses the needs of a client and arranges, coordinates, monitors, evaluates and advocates for a package of multiple services to meet the specific client’s complex needs.
Therefore a mental health social worker might:
Commence with a bio-psychosocial-spiritual assessment
View the situation through a critical lens (i.e. power imbalances, institutional practices, structural causes of mental health issues, relevance of alternative approaches)
Build a relationship with the person and, when relevant, with carers, family and other team members
Promote social justice—promote people’s rights to necessary treatment and support, and to have input into decisions that impact on them
Educate the person and family about the illness and treatments; if necessary, provide communication and coping skills to empower the family to make their needs and wishes known.
Ensure the lived experience of the person (and carer, family, and relevant others) is considered when making decisions about treatment.
Emphasise the importance of, and incorporate the person’s social environment into the recovery-oriented treatment plan
Assist family members to deal with the short- and long-term problems that develop as consequences of the person’s illness, or as consequences of treatment, disability, and family and community response
Psychological therapies are common in mental health treatment through:
Providing psychological support, to foster hope for improvement and to contain distress—this role is fundamental in mental health work
Resolving or mitigating distressing and disabling symptoms—the focus of most specific therapies
Reducing risk factors
Fostering understanding and adaptation—personalised understanding of the nature of a mental health problem and assistance to live with this problem
Addressing stigma, self-stigma and low self-esteem—reassessing stigma and its effects to build an empowered self
Preventing deterioration—those with low motivation to live (Farhall, 2012).
The social work graduate website (accessed on this site via the home/contents buttons) has a number of approaches that can be used when supporting people with a mental illness. These are listed below in two ways: by approach and by mental illness issue.
Psychological Theories by Approach
Acceptance and Commitment Therapy: depression, anxiety disorders, substance abuse, chronic pain, PTSD, anorexia, and schizophrenia.
Behavioural activation: depression, cognitive and physical difficulties
Brief intervention: alcohol/smoking/drug use and gambling
Cognitive Behavioural therapy: generalised anxiety disorder, panic disorder, depression, anxiety, panic, phobias, eating disorders, obsessive compulsive disorder, post-traumatic stress disorder, bipolar disorder, psychosis, sleep difficulties, stress, anger, low self-esteem, pain, extreme tiredness, sexual dysfunction, couples’ problems, child behaviour problems, borderline personality disorder, schizophrenia, alcohol misuse.
Mindfulness: stress, depression, eating disorders, burnout, ACT
Motivational interviewing: alcohol, drugs, gambling,
Narrative therapy: trauma-informed practice, adverse childhood experiences, domestic violence, attachment issues, bullying
Positive psychology: incorporate into general counselling situations
Problem solving: incorporate into general counselling situations
Solution-focused therapy: incorporate into general counselling situations
Task-centred approach: incorporate into general counselling sessions
Psychological Theories by illness
Adverse childhood experiences: narrative therapy, attachment therapy, general counselling
Anxiety disorders: ACT, CBT, mindfulness, general counselling
Depression: ACT, mindfulness, general counselling
Eating disorders: family counselling, CBT, mindfulness, general counselling
Gambling: motivational interviewing, brief intervention, general counselling
Phobias: CBT, general counselling
Stress: CBT, mindfulness
Substance abuse: ACT, motivational interviewing, brief intervention, general counselling
Trauma: narrative therapy, general counselling
A note to clinicians
(Source: Our Consumer Place, 2013: an organisation run by people diagnosed with a mental illness)
A diagnosis tell you nothing about the person. It tells you their diagnosis that can help but too often is used as a cage to trap people in. It tells you nothing about the things that make up who we are, things that are more important than the diagnosis.
You may well be seeing us at the very worst time of our lives. Remember that always.
“Nothing about us without us” – include us in our own care as much as possible, using language we can understand and in whatever ways we are best able to communicate.
Don't be afraid of connection, it can be the most healing power of all. Knowing that you also love gardening or cooking or Lego, discussing those things with us, can help us feel much less estranged from the world.
Psych. services can be really scary places full of scary and scared people. Never assume that just because we are one of them that we are comfortable in the situation. Would you be?
We have lives when we are not in your care, stuff outside needs to be taken care of, bills need to be paid, the cat needs to be fed and the kids need their noses wiped. Telling us to not worry about that stuff doesn't make it so. Even if you can't fix anything, letting us talk about the frustration and fear and helping us to work that stuff out can be as healing as any medication regime.
Accept that the file is written by flawed human beings who may have got things wrong. Make sure you write down what we think is important for people to know, even if you don't see the relevance. Knowing we are heard is really important, you don't have to agree with it to record it.
Don’t assume that we automatically want to look and live like what you consider to be ‘normal’. Work with us to find out what ‘well’ looks and feels like for us. That should be our collective aim.
I'm sorry to break the news but no matter how wonderful you are, no matter how politically sound you are, no matter how lofty your intentions ... if you can hold us against our will, medicate us, write things in a file we can't read and make decisions about our lives we will never have an equal partnership, ever. It can't happen. It takes extra effort from you to recognise that you still hold power.
Finally, please look after you – we need good workers. Maximise your leisure time, laugh at the funny stuff, and always remember that we have more in common as human beings than any differences that so-called illnesses create. You can have bad days. Remember we can have bad days too. Good luck
Structural Social Work Practice With Parents Affected by Mental Illness
Structural social work links individual “problems” to broader societal injustices. It views social inequalities, rather than individual deficiencies as the root of people’s problems. The twofold goal of structural social work is to address people’s problems by examining the social order that surrounds them while simultaneously working to transform society through social reforms and fundamental social change. Social workers operating from a structural perspective foster an open, supportive and (where possible) “equal” relationship with people by recognising and honouring the person’s expertise in their personal situation (George & Marlow, 2005).
It is estimated that up to 1 in 5 young people live in families with a parent who has a mental illness. Children living with parental mental illness are more likely to experience trauma, emotional and/or behavioural difficulties; be removed from the family home and taken into care; and develop their own mental health difficulties and/or substance use issues. A retrospective study conducted in 2014, however, highlighted that young people living with parent/s with mental illness also develop significant strengths including resourcefulness, confidence and maturity. It is not uncommon to only realise a parent has a mental illness when child protection concerns are raised.
With a focus on building the strengths of each family member, social workers seek to engage, empower and partner with families by connecting them with comprehensive, culturally relevant, community-based networks of supports and services.
Practice strategies for supporting parents affected by mental illness
Invariably, parents have found ways to manage their mental illness that provide opportunities to develop strong relationships with their children. Taking the time to inquire about parenting histories, stories of success and strategies that work helps to position the parent as capable and caring, rather than a problem that needs to be fixed.
The aim is to bring to the forefront the impact mental health may be having on someone’s life and the lives of those around them at that moment.
Social workers should adopt a position of curiosity to develop a picture of the ways in which the parent’s mental illness might be affecting their children. Curiosity promotes a collaborative approach and encourages and supports a parent’s autonomy and can lead to an open discussion about parenting, their children and family.
Adopt a family-focused approach to gain a full picture of how the family functions. Working solely with the parent as an individual fails to recognise their continuing parenting roles and responsibilities, as well as their own concerns about their children’s needs (Wendt, Rowley, Seymour, Bastian, & Moss, 2023).
References / Supporting Material
(Some available on request)
AASW: Australian Association of Social Workers. (2014). Practice standards for mental health social workers. AASW.
Bland, R. (2012a). Social work assessment. In G. Meadows, J. Farhall., E. Fossey, M. Grigg F. McDermott, & B. Singh (Eds.), Mental health in Australia: Collaborative community practice (3rd ed., pp. 419-421). Oxford University Press.
Bland, R. (2012b). The social worker. In G. Meadows, J. Farhall., E. Fossey, M. Grigg F. McDermott, & B. Singh (Eds.), Mental health in Australia: Collaborative community practice (3rd ed., pp. 290-294). Oxford University Press.
Bland, R., Drake, G., & Drayton, J. (2021). Social work practice in mental health: An introduction (3rd ed.). Routledge.
Columbus Recovery Center. (2023). How to help your teen struggling with mental health issues. https://www.columbusrecoverycenter.com/help-teen-with-mental-health-issues/
Columbus Recovery Center. (2023). Parents guide: How to help your teen cope with mental health issues. https://www.palmerlakerecovery.com/resources/parents-guide/
Dudgeon, P., Milroy, H, & Walker, R. (2014). Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice (2nd ed.). https://www.telethonkids.org.au/our-research/early-environment/developmental-origins-of-child-health/expired-projects/working-together-second-edition/
Farhall, J. (2012). The focus and context of psychological therapies. In G. Meadows, J.
Farhall., E. Fossey, M. Grigg F. McDermott, & B. Singh (Eds.), Mental health in Australia: Collaborative community practice (3rd ed., pp. 469-473). Oxford University Press.
Fossey, E. (2012a). Case management: Its development in mental health service systems. In G. Meadows, J. Farhall., E. Fossey, M. Grigg F. McDermott, & B. Singh (Eds.), Mental health in Australia: Collaborative community practice (3rd ed., pp. 430-432). Oxford University Press.
Fossey, E. (2012b). Case management: Introduction. In G. Meadows, J. Farhall., E. Fossey, M. Grigg F. McDermott, & B. Singh (Eds.), Mental health in Australia: Collaborative community practice (3rd ed., pp. 429-430). Oxford University Press.
Fossey, E. (2012c). Supporting recovery and living well: Introduction. In G. Meadows, J.
Farhall., E. Fossey, M. Grigg F. McDermott, & B. Singh (Eds.), Mental health in Australia: Collaborative community practice (3rd ed., pp. 503-506, 517-524). Oxford University Press.
Fossey, E., Renouf, N., & Meadows, G. (2012). Working collaboratively: Introduction. In G. Meadows, J. Farhall., E. Fossey, M. Grigg F. McDermott, & B. Singh (Eds.), Mental health in Australia: Collaborative community practice (3rd ed., pp. 320-321). Oxford University Press.
George, P., & Marlowe, S. (2005). Structural social work in action. Journal of Progressive Human services, 16(1), 5-24. doi:10.1300/J059v16n01_02
Leggatt, M., & Cavil. M. (2012). Families and other carers. In G. Meadows, J. Farhall., E. Fossey, M. Grigg F. McDermott, & B. Singh (Eds.), Mental health in Australia: Collaborative community practice (3rd ed., pp. 314-317). Oxford University Press.
Minas, H. (2012). Specialist assessment pf people who do not speak English. In G. Meadows, J. Farhall., E. Fossey, M. Grigg F. McDermott, & B. Singh (Eds.), Mental health in Australia: Collaborative community practice (3rd ed., pp. 421-422). Oxford University Press.
The following guidelines provide basic advice on administering assessment instruments with or without an interpreter to consumers with low English proficiency or who come from cultural backgrounds that are different from those in which the instruments were developed.
Assess whether the person is sufficiently proficient in English to communicate effectively about mental health issues and to demonstrate cognitive functioning.
Communication about mental health issues is one of the most challenging tasks in a second language; therefore it is important to assess English proficiency accurately.
Even if English proficiency is satisfactory, cultural factors may significantly influence consumer responses.
Knowledge and skills assessment instruments such as the MMSE and WAIS are heavily reliant on education and experience in and familiarity with the host culture.
Determine what level of education the person has received and in what country the education was received. Note that lack of education does not equate necessarily with lack of capacity. Clinicians should inquire about opportunities for education, particularly with refugees.
Immigrants and refugees from some communities may have had little or no formal education but may demonstrate sound survival skills and daily functioning. Consider alternative forms of assessment of functioning, rather than normal cognitive assessment.
Mental illness manifestations and social functioning are all influenced by culture: consider to what extent culture and the language contribute to and distort score outcomes.
When in doubt, seek cultural consultation or refer to an experienced bilingual mental health professional.
If the person has low English proficiency and the instrument is administered in English, the results may be invalid, and scores may not accurately reflect the person’s functioning.
If the person has low English proficiency, it is preferable to use pre-translated instruments that have been validated and normed for the target group. If a translated version of a test is available, establish whether it has been validated and normed for the local target group. However, in most cases such instruments will be unavailable for the person’s language and cultural group.
If an existing measure is to be formally translated, the translated instrument should be conceptually and psychometrically equivalent to and measure the same domains as the original instrument.
National Practice Standards for the Mental Health Workforce. (2013). Victorian Government Department of Health, Victoria, Safety and Quality Partnership Standing Committee. https://www.health.gov.au/resources/publications/national-practice-standards-for-the-mental-health-workforce-2013
Standard 1: Rights, responsibilities, safety and privacy
Privacy, dignity and confidentiality are maintained, and safety is actively promoted. Mental health practitioners implement legislation, regulations, standards, codes and policies relevant to their role in a way that supports people affected by mental health problems and/or mental illness, as well as their families and carers.
Standard 2: Working with people, families and carers in recovery-focused ways
In working with people and their families and support networks, mental health practitioners support people to become decision-makers in their own care, implementing the principles of recovery-oriented mental health practice.
Standard 3: Meeting diverse needs
The social, cultural, linguistic, spiritual and gender diversity of people, families and carers are actively and respectfully responded to by mental health practitioners, incorporating those differences into their practice.
Standard 4: Working with Aboriginal and Torres Strait Islander people, families and communities
By working with Aboriginal and Torres Strait Islander peoples, families and communities, mental health practitioners actively and respectfully reduce barriers to access, provide culturally secure systems of care, and improve social and emotional wellbeing.
Standard 5: Access
Mental health practitioners facilitate timely access to services and provide a high standard of evidence-based assessment that meets the needs of people and their families or carers.
Standard 6: Individual planning
To meet the needs, goals and aspirations of people and their families and carers, mental health practitioners facilitate access to and plan quality, evidence-based, values-based health and social care interventions.
Standard 7: Treatment and support
To meet the needs, goals and aspirations of people and their families and carers, mental health practitioners deliver quality, evidence-informed health and social interventions.
Standard 8: Transitions in care
On exit from a service or transfer of care, people are actively supported by mental health practitioners through a timely, relevant and structured handover, in order to maximise optimal outcomes and promote wellness.
Standard 9: Integration and partnership
People and their families and carers are recognised by mental health practitioners as being part of a wider community, and mental health services are viewed as one element in a wider service network. Practitioners support the provision of coordinated and integrated care across programs, sites and services.
Standard 10: Quality improvement
In collaboration with people with lived experience, families and team members, mental health practitioners take active steps to improve services and mental health practices using quality improvement frameworks.
Standard 11: Communication and information management
A connection and rapport with people with lived experience and colleagues is established by mental health practitioners to build and support effective therapeutic and professional relationships. Practitioners maintain a high standard of documentation and use information systems and evaluation to ensure data collection meets clinical, service delivery, monitoring and evaluation needs.
Standard 12: Health promotion and prevention
Mental health promotion is an integral part of all mental health work. Mental health practitioners use mental health promotion and primary prevention principles, and seek to build resilience in communities, groups and individuals, and prevent or reduce the impact of mental illness.
Standard 13: Ethical practice and professional development responsibilities
The provision of treatment and care is accountable to people, families and carers, within the boundaries prescribed by national, professional, legal and local codes of conduct and practice. Mental health practitioners recognise the rights of people, carers and families, acknowledging power differentials and minimising them whenever possible. Practitioners take responsibility for maintaining and extending their professional knowledge and skills, including contributing to the learning of others.
Renouf, N., & Meadows, G. (2012). Working collaboratively in teams. In G. Meadows, J. Farhall., E. Fossey, M. Grigg F. McDermott, & B. Singh (Eds.), Mental health in Australia: Collaborative community practice (3rd ed., pp. 325-333). Oxford University Press.
Our Consumer Place. (2013). The company we keep: A user’s guide to mental health clinicians. https://www.ourcommunity.com.au/files/OCP/CompanyWeKeep.pdf
Productivity Commission. (2020). Mental Health. Report no. 95. Canberra. https://www.pc.gov.au/inquiries/completed/mental-health/report
Features of a person-centred mental health system
Information and supports that help people to live well within their communities, managing their own mental health where possible.
A focus on prevention and help early in life and early in illness.
Support for the mental health of new parents – universal screening for all mental ill-health of all new parents.
Make the social and emotional development of school children a national priority.
A program to provide access to timely, effective aftercare for every person who presents to a hospital after a suicide attempt,
GP or community mental health service following a suicide attempt or in suicide distress should be provided.
Empower Indigenous communities to prevent suicide.
Participation of the consumer’s family or carer actively sought to add to the value and effectiveness of the clinical or support service.
Provide mentally healthy workplaces focusing on psychological safety as much as physical safety.
Expand supported online treatment, group therapies and access to mental healthcare via telehealth.
Expand community-based mental healthcare, including hospital outpatient clinics and outreach services.
Provide the right healthcare at the right time for those with mental illness with technology to play a larger role.
Make sure effective services support recovery in the community especially around providing housing and employment services that help people engage with and integrate back into the community. The involvement of families, kinship groups and carers would be expected.
Meet demand for community support services that help people with mental illness recover and live well in the community. Social inclusion is a necessary, but too often neglected, part of a recovery plan.
Commit to no discharge from care into homelessness.
Legal representation for people facing mental health tribunals (Productivity Commission, 2020).
Watson, S., & Thorburn, K. (2012). Consumer-directed recovery and case management. In G. Meadows, J. Farhall., E. Fossey, M. Grigg F. McDermott, & B. Singh (Eds.), Mental health in Australia: Collaborative community practice (3rd ed., pp. 432-434). Oxford University Press.
Wendt, S., Rowley, G., Seymour, K., Bastian., & Moss, D. (2023). Child-focused practice competencies: Structural approaches to complex problems. Emerging Minds Practice Paper. https://emergingminds.com.au/resources/child-focused-practice-competencies-structural-approaches-to-complex-problems/?audience=practitioner