Social Work in Mental Health WEEK 13

Overview Self-assessment of depression Definitions of mental disorders Theoretical understanding of mental disorders SW’s distinctive contribution and skills SW’s roles SW services

Stigma of Mental Disorder What do you think about the persons with schizophrenia? Do you think that you are healthy mentally? Let’s try to test your depression

Self-assessment of Depression See the handout in English: CES-D (20 items) Pls click this link for your test in Korean https://blutouch.net:6001/test/tests2_1.asp

Definitions A mental disorder (also called a mental illness or psychiatric disorder) is a diagnosis of a behavioral or mental pattern that can cause suffering or a poor ability to function in ordinary life. The causes of mental disorders are often unclear. Theories may incorporate findings from a range of fields. Mental disorders are usually defined by a combination of how a person behaves, feels, perceives or thinks. Psychotherapy and psychiatric medication are two major treatment options. Other treatments include social interventions, peer support and self-help. Common mental disorders include depression, which affects about 400 million, dementia which affects about 35 million, and schizophrenia, which affects about 21 million people globally.

Medical (disease) model of mental disorders The medical model emerged from mid-19th century –shifting earlier moral or religious frameworks Psychiatry consolidated itself in 20th century through assimilation with medicine: identification of pathological symptoms; diagnosis of ‘illness’ and prescription of treatment. Mental health diagnosis basically involves accurate naming of an objective disease by DSM-IV Medication plays an important role but it is a myth that formal diagnostic and classification provide clear answers and certainties to practitioners. Diagnosis of mental illness is also influenced by the social cultural and political contexts Critique of the medical model: the emotions and behaviors that psychiatrists call ‘symptom’ should not be considered pathological but meaningful ‘problems of living’.

Social Model Privileges explanations of mental ill- health as: Life event breakdown (e.g. isolation, violence, bereavement, loss) Social forces that link to class (poverty and unemployment) Race and gender Powerlessness and inequality

Social Workers’ Stand Social worker in mental health work alongside members of other professions they need to appreciate various frameworks that inform their decision making. Social Workers will not be extreme – do not reject the medical model. Adopt a pragmatic perspective

From the asylum to community care Institutionalization’ – how the process socializes people into the role of a good patient, someone dull, harmless and inconspicuous. In the west, especially in UK there is a movement to close down asylums and transfer of care to services to community Q: What are the pros and cons of this trend?

Team work and multidisciplinary Typically consist of psychiatrist (or led by psychiatrists), psychologists, community psychiatric nurse, occupational therapists etc Tensions – role ambiguity and conflict Communication difficulties – team members have been educated and socialized within particular frameworks of their profession The difficulty that MSWs manage their roles in a secondary setting, especially in a multidisciplinary team

SW’s distinctive contribution and skills Social work is about change – SW improve the circumstances of people who are vulnerable or face social exclusion by building on their strengths and by changing the social circumstances which contribute to their mental distress SW’s understanding of law, social policy and the arrays of community resources available

SW’s distinctive skills Assessing complex situation – taking account of strengths, aspiration, vulnerability, family relationships, environmental stressors etc. Working alongside clients to promote their social inclusion Working with family and informal carers to support An individual’s journey to recovery Identifying and working with discrimination stigma and abuse Seeking changes in the social environment to promote recovery

Roles of Social Workers in (Mental) Health Areas Values-based practice – strongly grounded in anti-discriminatory and anti-oppressive approaches to practice Empowering service users and promoting autonomy Psychosocial problem-solving: assessment, service planning, education for the patient and his/her family, information referrals Economic support- connect with donors or exterior resources Utilize community resources Social rehabilitation and integration- discharge planning & home visits Case management and evaluation Reporting & administrative duties Continue to professional development

Areas of Medical/Mental Health Social Workers Medical Institutions- Health agency: acute hospitals and clinics, dental clinics, oriental hospitals/ clinics, nursing clinics etc.- medical social workers(1 year experienced) are hired. Mental health agency: psychiatric hospitals and clinics-mental health social workers who has a license (1000 hours practice for 2nd class & 5 years experience for 1t class) are hired. Public Health Institutions Many social workers are hired due to the implementation due to the implementation of national long-term care insurance. Public clinics (보건소) should be more hired for health promotion. Community Mental Health Institutions This area should be more focused within community based systems

Community-Based Agencies for Mental Health Community mental health centers (지역사회 정신보건센터): case management for social integration Community mental health centers for children and youths (아동/청소년 정 신보건센터): (1) focusing on children and youths, (2) Beyond treatment, prevention services are necessary. Social rehabilitation agencies (사회복귀시설): social rehabilitation services for independence and self-reliance of persons with mental disorders Alcohol counselling centers (알코올상담센터): rehabilitation and prevention services for alcohol Psychiatric nursing homes (정신요양센터): nursing and rehabilitation services for persons with chronic mental disorders Addition rehabilitation centers (중독관련센터): rehabilitation services for internet addiction, gambling, horse racing, smoking, etc. Dementia management centers (치매센터): prevention services in public clinics