Chapter 1: The Context of Mental Health Social Work Practice in Canada

Textbook

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​

• The attainment and preservation of conditions of fundamental equality​

Mental health is defined as a state of well-being in which every individual​:

• Realizes his or her own potential​

• Can cope with the normal stresses of life​

• Can work productively and fruitfully​

• Is able to make a contribution to her or his community​

How many people in Canada experience a mental health problem or illness in any given year?

1 in 5 Canadians.

What is the second leading cause of death among youth and young adults (ages 15–34) in Canada?

Suicide

In 2019, what percentage of Canadian postsecondary students felt so depressed they could not function?

52%.

What percentage reported overwhelming anxiety?

69%.

What proportion of Canadians aged 80–84 have dementia?

More than ¼.

What proportion of Canadians over age 85 have dementia?

Over half.

What was the economic burden of mental illness in Canada in 2011?

$50 billion.

What percentage of health care funding in Canada was spent on mental health care in 2015?

7.2%.

In 1952, Mort Teicher identified two categories of a social worker’s job:​

1. Intake​

• Helping patient and family express feelings​

• Assessing ability and willingness to engage in treatment​

2. Continued service​

• Assisting with use of treatment services​

• Assisting with reintegration into the community ​

CASW (2019) identified three broad areas of social work practice in mental health:​

• Prevention

• Treatment

• Rehabilitation

Rehabilitation

• Reducing the aftereffects of mental illness to support maximizing abilities, including rehabilitation counselling, provision of resources, and advocacy to develop community resources or reduce barriers​

Treatment

• Reducing the impact of mental illness through early assessment, intervention, and treatment, including addressing trauma, relationship problems, and stress and managing risk​

Prevention

• Reducing the incidence of mental illness and dysfunction through modifying stressful environments and strengthening individual coping, including preventative education, social action, and advocacy for social justice​

Aspects of social work practice in mental health:​

• Direct services​

• Case management​

• Community development​

• Supervision and consultation​

• Program management/administration​

• Teaching​

• Program, policy, and resource development​

• Research and evaluation​

• Social action​

The CASW Code of Ethics (2005) outlines six core areas of social work values: ​

• Respect for the inherent dignity and worth of persons ​

• Pursuit of social justice ​

• Service to humanity ​

• Integrity in professional practice ​

• Confidentiality ​

• Competence in professional practice ​

In 2014, the Mental Health Commission of Canada signed onto a recovery declaration based on three core principles: ​

• Hope: believing individuals possess strengths and capabilities to lead satisfying and hopeful lives even when living with mental health challenges​

• Dignity: treating people with respect and supporting personal journeys of healing and growth​

• Inclusion: engaging people in their own care and well-being and supporting them to exercise their rights​

What core belief is the recovery model for mental health practice founded on?

That individuals can and do recover from severe mental illness, and that active participation of the individual is essential in the recovery process.

How can recovery be understood within the recovery model?

Recovery can be viewed from multiple perspectives, depending on the individual and their unique experience.

The Mental Health Commission released “Guidelines for Recovery Oriented Practice” in 2015:​

1. Creating a culture and language of hope​

2. Recovery is personal​

3. Recovery occurs in the context of one’s life​

4. Responding to diverse needs​

5. Working with First Nations, Inuit, and Métis​

6. Transforming services and systems​

Fundamental components of the recovery model: ​

• Self-direction and empowerment​

• Individualized and person-centred approaches ​

• Holistic views​

• Non-linearity​

• Strengths-based focus​

• Peer support​

• Respect, responsibility, and hope​

The Culturally-Responsive Model of Recovery: ​

• Individuals exist in a web of relations including family, community, cities, and countries​

• Culture, systems of oppression and privilege, and social determinants of health are central to recovery​

• Recovery is a collection of processes within the relational web, an aspect of which is the mental health system and the professionals within it​

Psychiatric Medications and Social Work Practice​

• Explore with clients and their families the meanings they ascribe to medications ​

• Ensure that clients and families have access to information about medications, including their purpose, effectiveness, and side effects​

• Assist clients in making informed decisions about their own treatment and recovery plan ​

• Assist clients and families to advocate for themselves with respect to questions or concerns around medications ​

Evidence-based practice is consistent with good social work practice in terms of:​

• The obligation to provide our clients with services that are most likely to assist them and least likely to cause harm​

• The obligation to provide clients with the best available information for them to make informed decisions about their own care​

Three main assertions of evidence-based practice:​

• Intervention decisions should be based on empirical research​

• Critical assessment of empirically supported interventions must be conducted to determine their fit to and appropriateness for the practice situation at hand​

• Interventions should be subject to regular monitoring and the course of treatment revised based on outcome evaluation​

Criteria in considering evidence: ​

• For evidence to be relevant, there must be an explanatory link between the intervention and the outcome, not just a correlation​

• Best available evidence must include all evidence, not a selected subset​

• Evidence must be evaluated on the basis of relevance, credibility, and strength​

Evidence-based decision-making involves a series of steps:​

1. Evaluate the problem to be addressed and formulate answerable questions​

2. Gather and critically evaluate the evidence available​

3. Make a decision about which intervention strategy is the best approach​

• Consider client wishes, practitioner expertise, agency mandate and constraints, and the ecological context​

4. Monitor and evaluate the outcome of the intervention​

Multiple Levels of Influence​

• Assist other members of interprofessional teams to understand the social and community context ​

• Assist families to support affected individuals and creatively manage change​

• Assist individuals to evaluate challenges and opportunities, make choices, deal with adversity, and recover from illness​

• Participate in the modification and development of programs, service systems, and policies ​

Positive impacts of Mental Health Practice on Social Workers​

• Commitment and compassion towards their clients​

• Rewards of working with those overcoming challenges ​

• Resilience, a positive social orientation, optimism, social intelligence, an openness to new experiences, and a keen desire to continue to learn and grow ​

• Increased sensitivity, compassion, and insight​

• Increased appreciation for the resilience of the human spirit ​

Negative impacts of Mental Health Practice on Social Workers

• Acute stress, posttraumatic stress, and secondary traumatic stress​

• Burnout and vicarious trauma​

Addressing stress and trauma experienced by social workers is a shared responsibility between…

social workers themselves, the schools that educate them, and the organizations that employ them​