Chapter 4: Social Work Assessment ​ in Mental Health​

Textbook

The International Federation of Social Work (2014)​:

• Promotes social change and development, social cohesion, and the empowerment and liberation of people.​

• Central principles of social justice, human rights, collective responsibility and respect for diversities.​

• Based on theories of social work, social sciences, humanities and indigenous knowledge engages people and structures to address life challenges and enhance wellbeing. ​

Multiple Levels of Influence​

• Individual​: Biological, psychological & interpersonal strengths and challenges

• Family​: Individual Members, family structure, relationships

• Community​: Resources, cohesion, exclusion

• Societal​: Policies and practices that influence choice

Cultural Influences on ​Mental Health

• Prevalence, etiology, and course of illness​

-Shared traumas, availability of resources, dislocation, government policies​

• Expression of distress​

• Diagnosis and assessment​

-Biases, lack of understanding cultural differences, regional influences​

• Help seeking​

-Knowledge of services, acceptability, stigma, trust in professionals​

Sex and Gender in Assessment​

• Gender and sex based differences ​

• Exposure to violence, financial resources/lack thereof​

• Access to education and occupational opportunities​

• Hormonal and neurobiological differences​

Mental Health Across the Life Span​

• Complex interactions between neurodevelopment predisposed by genetics and environmental factors​

• Considerable variability in age of onset although tendency to emerge at certain times across the lifespan​

• Age of onset associated with different course of illness and treatment approaches​

• Early intervention can lead to better outcomes​

Social Work Assessment​

• Identifying data​

• Presenting problem​

• Brief personal history​

• Mental health history​

• Family constellation​

• Cultural/spiritual/social context​

• Current situation​

• Mental status​

• Suicide risk​

• Formulation​

Formulation

• Predisposing factors: why this person?​

-Vulnerabilities/history/stressors​

• Precipitating factors: why now? ​

-Major stresses/critical events​

• Perpetuating factors: what maintains the problem? ​

-Social-environmental factors/health/substance use/personality/systemic barriers​

• Protective factors: what are the strengths?​

-Supports/successes/abilities​

• Plan: where do we go from here? ​

-Client wishes regarding intervention/referral/advocacy​

Mental Status Exam​

• Appearance, attitude, and behaviour​

• Mood and affect​

• Speech and thought form​

• Speech and thought content ​

• Perception​

• Cognition​

• Insight and judgement​

Examples of Disturbances in Speech/Thought Form​

• Neologism: new word created by the person​

• Word salad: incoherent list of words​

• Circumstantial thinking: person reaches the final point after including many irrelevant details​

• Tangential thinking: person never reaches final point and moves from one topic to another​

• Perseveration: person is unable to move away from a particular point or phrase​

• Echolalia: person repeats the words of others in a repetitive persistent manner​

• Loosening of associations: ideas shift from one to another with no obvious link​

Examples of Speech Content/Delusions​

• Somatic delusions: involving the functioning of the body​

• Persecutory delusions: false beliefs that one is being harassed, cheated, or persecuted​

• Delusions of grandeur: exaggerated ideas of one’s importance​

• Ideas of reference: beliefs that events refer to oneself, for instance, that the radio is speaking directly to the person​

• Thought withdrawal: someone or something is stealing the person’s thoughts​

• Thought insertion: someone is putting thoughts in the person’s head​

Examples of Perceptual Disturbances​

• Auditory hallucinations​

• Visual hallucinations​

• Olfactory hallucinations​

• Tactile hallucinations​

• Somatic hallucinations​

• Hysterical anesthesia: loss of feeling in some part of the body with no medical cause​

• Depersonalization: sense that the self is unreal, unfamiliar ​

• Derealization: sense that the environment is strange or unreal​

Insight:

• Awareness by a mentally ill person that their mental experiences are not based in external reality​

• Degree to which the person’s understanding of events fits with that of others​

Judgement: ​

Degree to which the person is able to consider the consequences of their actions or assess a situation​

Advantages of DSM

• Enhancing interprofessional communication​

• Organizing thinking​

• Directing research efforts​

• Linking treatment to specific challenges​

• Enhancing evidence-based practice​

Disadvantages of DSM

• Countering strengths-based perspectives of social work​

• Pathologizing​

• Individualizing, ignoring social contribution such as oppression, poverty​

• Stigmatizing/labelling​

• Socially constructed views of mental illness​

DSM 5 – Cultural Assessment​

• The cultural definition of the problem​

• Cultural perceptions of the cause, context, and support​

• Cultural factors affecting self-coping and past help-seeking​

• Current help-seeking​

• Cultural formulation interview viewed favourably by both clients and clinicians​